Sleep disorders and mental health in hospital workers during the COVID-19 pandemic: a cross-sectional multicenter study in Northern Italy

The effect of disaster resilience and trauma exposure on PTSD, depression, and sleep disorder among healthcare workers involved in the Kahramanmaraş Earthquakes (2023): a structural equation model

Healthcare workers (HCWs) serve as the cornerstone of health services, which are among the primary needs during disasters. The chaotic environment caused by disasters can lead to mental health disorders in HCWs, similar to those experienced by disaster victims. Experiencing mental health disorders can hinder HCW's professional approach to intervention. HCWs should not be overlooked for the possibility of experiencing mental health disorders while providing healthcare services during disasters. Therefore, this study aims to examine the impact of psychological resilience and trauma exposure on PTSD, depression, and sleep disorders among HCWs involved in the Kahramanmaraş Earthquakes, which were Turkey's most devastating earthquakes. In this quantitative research, a survey technique was employed, reaching 642 hCWs involved in the Kahramanmaraş Earthquakes. Structural Equation Modeling (SEM) was used to test the impact of variables on each other. According to the SEM results, trauma exposure in the HCWs had a significant and positive effect on PTSD (β=+0.899, p = 0.000), depression (β=+0.685, p = 0.000), and sleep disorders (β=+0.603, p = 0.000). Psychological resilience had a significant and negative effect on PTSD (β=-0.278, p = 0.004) and depression (β=-0.322, p = 0.008). Surprisingly, psychological resilience had a significant and positive effect on sleep disorders (β=+0.692, p = 0.000). In conclusion, while trauma exposure led to PTSD, depression, and sleep disorders in the HCWs, psychological resilience mitigated PTSD and depression. Unexpectedly, psychological resilience increased sleep disorders. For this reason, it is recommended that future studies investigate in detail the reasons why HCWs experience sleep disorders and examine them in depth.

Impact of COVID-19 on Sleep, Anxiety, and Depression Among Medical Call Center Staff: Insights from a January 2021 Study

BACKGROUND The COVID-19 outbreak emerged as a dual threat, effecting both the physical and mental well-being of healthcare staff. This study aimed to evaluate sleep quality using the Pittsburgh Sleep Quality Index (PSQI), levels of anxiety and depression using the Hospital Anxiety Depression Scale (HADS), and the significant influencing factors during COVID-19 pandemic in 284 workers in a medical call center in January 2021. MATERIAL AND METHODS Out of 443 pre-hospital care providers, 284 consented to participate. Data collection was done using an introductory information form, the PSQI for sleep quality, and the HADS for anxiety (HADS-A) and depression (HADS-D). Surveys were hosted on an online survey website and distributed via WhatsApp, with completed forms retrieved from the website. RESULTS Male sex (P=0.0001) and extended working hours in current workplace (P=0.017) were associated with higher HADS-A scores. Health problems, increased need for mental support, and poor job satisfaction correlated with lower HADS-D scores (P=0.025, P=0.005, P=0.0001, respectively) and higher PSQI scores (P=0.008, P=0.009, P=0.008, respectively). A moderately significant positive correlation was found between overall sleep quality and HADS-A (P=0.001, r=0.538) and HADS-D scores (P=0.001, r=0.493). CONCLUSIONS The pandemic significantly impacted the mental health and sleep quality of frontline healthcare personnel, necessitating the identification and mitigation of adverse psychosocial factors. Implementing and evaluating psychoeducational programs and establishing multidisciplinary mental health teams can provide for essential support and counseling, promoting the well-being of healthcare staff and ensuring effective emergency care.

Sleep quality and job satisfaction in Spanish nurses: the consequences of COVID-19

Introduction

Sleep is fundamental to the quality of life and can affect individuals' well-being and mental health.

Objective

This study analyzed sleep quality and job satisfaction among Spanish nurses following the COVID-19 pandemic.

Materials and Methods

A cross-sectional study was conducted using the Pittsburgh Sleep Quality Index (PSQI), Font Roja Job Satisfaction Questionnaire, and sociodemographic and work- related variables. A "snowball" sampling method was employed through social media dissemination.

Results

The mean PSQI score was 9.75 ± 4.36 points. The poorest sleep quality was identified in participants without dependents (p=0.031; p=3.329; 95% CI=0.035-6.354) and those with dependents other than children (p=0.022; p=4.121; 95% CI=0.575- 7.667). However, having a Ph.D degree (p=0.001; p=-3.406; 95% CI=-5.503- 1.309) or specialist degree (p=0.021; p=-1.639; 95% CI=-3.031- -0.247) was associated with better sleep quality. Higher job satisfaction was found among women (p=0.034; p=0.104; 95% CI=0.007-0.201) who did not work with COVID-19 patients (p=0.049; p=-0.085; 95% CI=-0.174- -0.003).

Discussion

Improving working conditions, such as the nurse-to-patient ratio and distribution of work shifts, is crucial to enhancing nurses' sleep quality.

Conclusions

Spanish nurses reported poor sleep quality. Not having dependents or having dependents other than children were risk factors for poor sleep quality. Job satisfaction was higher among women who did not work with COVID-19 patients. No relationship was found between job satisfaction and sleep quality.

Progressive muscle relaxation alleviates anxiety and improves sleep quality among healthcare practitioners in a mobile cabin hospital: a pre-post comparative study in China

OBJECTIVE

To investigate the anxiety levels, sleep quality and potential risk factors of healthcare practitioners involved in the management of COVID-19 patients in a mobile cabin hospital, and further to assess the impact of progressive muscle relaxation (PMR) on their anxiety levels and sleep quality.

METHODS

We conducted a pre-post self-controlled trial. Healthcare practitioners meeting the inclusion criteria underwent daily 30-min PMR sessions for seven consecutive days. The Pittsburgh Sleep Quality Index (PSQI) and Hamilton Anxiety Scale (HAMA) were used to assess the anxiety and sleep quality of subjects pre- and post-intervention. Statistical analysis was performed using the Wilcoxon test, Mann-Whitney U test, Kruskal-Wallis H test, and Spearman rank correlation.

RESULTS

A total of 94 participants completed the study. No statistically significant differences in HAMA or PSQI total scores were observed between groups categorized based on demographic variables such as age, sex, and years of education (p > 0.05). The PSQI total score and its components (excluding sleep medication usage) exhibited a positive correlation with the HAMA total score and its psychological anxiety component (p < 0.05), and a correlation was observed between somatic anxiety manifestations and several components of the PSQI. The PSQI total scores before and after intervention were 10.0 (8.0, 13.0) and 8.0 (6.0, 9.0) respectively (p < 0.001); the HAMA total scores were 8.0 (5.0, 13.0) and 6.0 (4.0, 9.5) respectively (p < 0.001). The detection rates of poor sleep and anxiety states, along with their severity, significantly decreased post-intervention (p < 0.001).

CONCLUSION

Healthcare practitioners experience prominent anxiety and sleep issues in the mobile cabin hospital. PMR can be an effective intervention for improving the anxiety and sleep quality of healthcare professionals during support periods in the mobile cabin hospital. However, trials with larger samples are necessitated to further affirm these preliminary findings.

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems.

METHODS

Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale.

RESULTS

A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder.

CONCLUSIONS

The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

Association of adverse childhood experiences and depression among medical students: the role of family functioning and insomnia

Background

Few studies have explored the mechanisms linking adverse childhood experiences (ACEs) to depression in medical students. This study aimed to investigate the relationship between ACEs and depression through the serial mediation effect of family functioning and insomnia.

Methods

A cross-sectional survey was conducted with 368 medical students from university in Chengdu in 2021. The participants were asked to complete four self-report questionnaires, including ACEs scale, the family APGAR index, the ISI and PHQ-9. Singe and serial mediation analyses were conducted using structural equation modeling by Mplus 8.3.

Results

ACEs had a significant direct effect on depression (β = 0.438, p < 0.001) and through three significantly indirect pathways: (1) through family functioning (β = 0.026, 95% CI: 0.007-0.060), accounting for 5.9% of the total effect; (2) through insomnia (β = 0.103, 95% CI: 0.011-0.187), accounting for 23.5% of the total effect; and (3) through the serial mediators involving in family functioning and insomnia (β = 0.038, 95% CI: 0.015-0.078), accounting for 8.7% of the total effect. The total indirect effect was 38.1%.

Limitations

This cross-sectional study prevented us from establishing causality.

Conclusion

This study highlights the role of family functioning and insomnia as serial mediators of the relationship between ACEs and depression. Findings help to elucidate the mechanism that underlines the pathway between ACEs and depression in medical students. These findings may indicate developing measures to strengthen family functioning and improve insomnia aiming to reduce depression in medical students with ACEs.

Efeitos da pandemia e fatores associados à saúde mental de profissionais de saúde

Objetivo: identificar,na literatura científica, os efeitos da pandemia e fatores associados àsaúde mental de profissionais de saúde que atuam no enfrentamento da COVID-19. Método: revisão integrativa da literatura, através das bases de dados Web of Science, LILACS, Medline e CINAHL, realizada em novembro de 2020.A busca se deu de forma ampla, criteriosa e independente por dois pesquisadores; em casos de divergência, houve a participação de um terceiro pesquisador. Resultados: 12 artigos compuseram a amostra. Ansiedade, depressão e distúrbios do sono foram os efeitos na saúde mental mais prevalentes em profissionais de saúde durante a pandemia de COVID-19. O setor de trabalho, a falta de Equipamentos de Proteção Individual (EPIs) e o aumento da carga horária de trabalho foram os principais fatores desencadeantes desses efeitos. Considerações Finais: faz-se necessária a implantação de estratégias e intervenções eficazes que garantam um suporte psicológico a curto, médio e longo prazo para os profissionais de saúde.

Psychological Health in Intensive Care Unit Health Care Workers after the COVID-19 Pandemic

BACKGROUND

Although the COVID-19 pandemic had an impact on the general population, health care workers (HCWs) constituted one of the groups that were most adversely affected by the associated risks, owing to the significant consequences on their mental health. This study examined these psychological effects on HCWs who cared for COVID-19 patients who were admitted to the intensive care unit in an Italian hospital.

METHODS

Subjects were administered several self-reported questionnaires: Kessler 10 Psychological Distress Scale (K10), Perceived Stress Scale-10 (PSS), Impact of Event Scale Revised (IES-R), and Post-traumatic Growth Inventory (PTGI), as well as two open-ended questions oriented toward understanding their positive and negative emotional experience and differentiating between two phases of the emergency.

RESULTS

Overall, 45% of HCWs showed medium-to-high anxiety/depressive symptoms, whereas 60% presented with medium-to-high levels of perceived stress. In addition, 37% of subjects developed symptoms of PTSD and 50% showed post-traumatic growth in the "appreciation of life" and "new possibilities" dimensions. With regard to the open-ended questions, three themes were identified: quality of workplace relationships, sense of emotional-relational competence, and sense of clinical-technical competence. In addition, two macrocategories of responses were identified in the answers: growth and block.

CONCLUSIONS

The mental health of HCWs who are involved in the front line of COVID-19 was significantly impacted by this experience, showing high levels of post-traumatic stress and anxiety and depressive symptoms more than 1 year after the emergency began. A qualitative analysis of staff experiences can be a useful guide for structuring interventions and prevention.

Poor Health Conditions among Brazilian Healthcare Workers: The Study Design and Baseline Characteristics of the HEROES Cohort

This study was conducted to describe the health conditions (the psychosocial aspects, sleep quality, and musculoskeletal symptoms) among Brazilian healthcare workers in the context of the pandemic. Workers answered an online questionnaire, including the short version of the Copenhagen Psychosocial Questionnaire (COPSOQ II), the Pittsburgh Sleep Quality Index (PSQI), the Nordic Musculoskeletal Questionnaire (NMQ), and the Beck Depression Inventory (BDI). The most unfavourable psychosocial factors were work pace (61%; 95% CI: 52–69%), emotional work demands (75%; 95% CI: 67–82%), predictability (47%; 95% CI: 39–56%), work-family conflict (55%; 95% CI: 46–64%), burnout (86%; 95% CI: 78–91%), and stress (81%; 95% CI: 73–87%). Most workers (74%; 95% CI: 66–81%) were classified as poor sleepers. Musculoskeletal symptoms were frequent in the neck (64%; 95% CI: 55–72%), shoulders (62%; 95% CI: 54–70%), upper back (58%; 95% CI: 50–67%), and lower back (61%; 95% CI: 52–69%). Depressive symptoms were also highly prevalent (mild: 22%; 95% CI: 15–30%, moderate: 16%; 95% CI: 11–23%, severe: 8%; 95% CI: 4–14%). Most healthcare workers experience unfavourable psychosocial factors, poor sleep quality, as well as musculoskeletal and depressive symptoms. These findings underscore the urgent need to acknowledge and address psychological and physical distress to improve the personal and professional well-being of this population.

"It's All COVID's Fault!": Symptoms of Distress among Workers in an Italian General Hospital during the Pandemic

BACKGROUND

Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have been faced with specific stressors endangering their physical and mental health and their functioning. This study aimed to assess the short-term psychological health of a sample of Italian HCWs and the related influencing factors. In particular, the study focused on the differences related to HCWs' gender and to having been directly in charge of COVID-19 patients or not.

METHODS

An online survey was administered to the whole staff of the Modena General University Hospital three months after the onset of the pandemic, in 2020. Demographic data and changes in working and living conditions related to COVID-19 were collected; mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R).

RESULTS

1172 out of 4788 members returned the survey (response rate = 24.5%), the male/female ratio was 30/70%. Clinically significant symptoms assessed according to the DASS-21 emerged among 21.0% of the respondents for depression, 22.5% for anxiety and 27.0% for stress. Symptoms suggestive of a traumatic reaction were reported by 19.0% of the sample. Symptoms of psychological distress were statistically associated with female gender, job role, ward, changes in lifestyle, whereas first-line work with COVID-19 patients was statistically associated with more stress symptoms. HCWs reported a significant level of psychological distress that could reach severe clinical significance and impact dramatically their quality of life and functioning.

CONCLUSIONS

Considering the persistence of the international emergency, effective strategies to anticipate, recognize and address distress in HCWs are essential, also because they may impact the organization and effectiveness of healthcare systems.