The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis

Protective Role of Regular Physical Activity on Mental Health During the COVID-19 Pandemic

Understanding the impacts of lifestyle on mental health has become crucial. This study analyzed whether regular physical activity influences mental health indicators related to major depressive disorder, generalized anxiety, and COVID-19-related anxiety and obsession among Brazilian adults during the pandemic. Additionally, social adjustment and health and disability were assessed to measure broader impacts of physical activity on daily functioning and quality of life during the COVID-19 pandemic, an anxiogenic period. Participants completed sociodemographic, physical activity, and clinical surveys, along with standardized mental health scales: the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the Brazilian version of the Coronavirus Anxiety Scale (CAS-BR), the COVID-19 Obsession Scale (PB-OCS), the Work and Social Adjustment Scale (WSAS), and the WHO Disability Assessment Schedule (WHODAS 2.0). Descriptive analysis characterized the sample, while univariate, bivariate, and multivariate analyses of variance were conducted to explore the influence of physical activity and sex on mental health outcomes. The results indicated that women exhibited poorer mental health outcomes than men across most measures. Engaging in regular physical activity significantly reduced the risk of major depressive disorder in both women and men. Additionally, physically active women-but not men-had a lower likelihood of generalized anxiety and social adjustment impairments. Furthermore, individuals with longer engagement in physical activity (> 5 years) experienced greater mental health benefits compared to those with shorter engagement (< 5 years), particularly for depressive symptoms and generalized anxiety. This study highlights the protective effects of regular physical activity on mental health, with sex-specific differences in its impact. Long-term engagement in physical activity provides greater mental health benefits, reinforcing the importance of promoting sustained participation rather than short-term engagement.

Association of mental health, quality of life, and SARS-CoV-2 infection in individuals in need of care: Results from a multicentre registry study

OBJECTIVE

Investigating the association between mental health, quality of life, and SARS-CoV-2 infection in individuals in need of care compared to independent living individuals. Individuals in need of care include both care home residents and those receiving care either through an outpatient care service or from family members.

METHODS

This cross-sectional study assessed symptoms of depression (PHQ-9 > 9) and anxiety (GAD-7 > 9), quality of life (EQ-5D-5L, EQ-VAS), dementia (SIS), SARS-CoV-2 infection and socio-demographic variables in the total sample (N = 978, 64.4% female, mean age: 77.5 ± 13.8 years) and subgroups (study group, STG, n = 532, individuals in need of care, SARS-CoV-2 positive; control group 1, CG1, n = 213, individuals in need of care, SARS-CoV-2 negative; control group 2, CG2, n = 233, independent living individuals, SARS-CoV-2 positive). Multivariate logistic regressions were performed.

RESULTS

Depressive symptoms (PHQ-9 > 9) were significantly associated with lower quality of life in the total sample (EQ-VAS: OR 0.96, 95% CI 0.95-0.97, p < 0.001; EQ-5D-5L: OR 0.14, 95% CI 0.07-0.29, p < 0.001) and across all subgroups. Anxiety (GAD-7 > 9) was significantly associated with lower quality of life in the total sample (EQ-VAS: OR 0.97, 95% CI 0.95-0.98, p < 0.001; EQ-5D-5L: OR 0.19, 95% CI 0.08-0.50, p < 0.001) and all subgroups except CG1. In individuals in need of care with COVID-19, depressive symptoms were additionally associated with symptomatic infection (OR 3.47, 95% CI 1.45-8.28, p = 0.005).

CONCLUSION

Depression and anxiety were significantly associated with reduced quality of life, irrespective of living environment or SARS-CoV-2 infection status, underscoring the need for targeted mental health interventions in older adults. While our model explained a considerable portion of the variability in depression and anxiety, further research is needed to account for the remaining proportion.

Investigating the Impact of the Family Interaction Model on the Anxiety and Mental Well-Being of Patients During Visit Restrictions in Intensive Care Units: A Mixed-Methods Study

BACKGROUND

Patients hospitalised in the intensive care unit (ICU) often experience feelings of isolation and a sense of profound loneliness. These individuals frequently report symptoms of anxiety, depression and other psychiatric disorders.

AIM

The aim of this study was to examine the impact of the family interaction model on the anxiety and mental well-being of patients during the visit restrictions in the ICUs. Additionally, the experiences of intensive care patients and their relatives regarding this process were investigated.

STUDY DESIGN

This research utilised a parallel design mixed-methods approach, incorporating both quantitative and qualitative designs. A qualitative research design was employed in the quasi-experimental framework to examine post-intervention experiences. The research sample consisted of 47 patients in the intervention group.

RESULTS

The intervention group, that received videos and messages from their relatives, exhibited a decrease in anxiety over time. In contrast, the control group demonstrated an increase in anxiety over time. The results indicated that 77% of these changes were due to the group variable (CI: -38.627 to -30.902; p < 0.05). Mental well-being scores demonstrated an increase over time in the intervention group, while a decrease was observed in the control group. The analysis revealed that 83.4% of this change could be attributed to the group variable (CI: 29.178-35.048; p < 0.05). In the interviews, three themes were obtained from both patients and the relatives of the patients in the intervention group. In the control group, four themes were found. In the qualitative interviews conducted with the patients in the intervention group, the subthemes regarding their feelings about the disease process and intensive care experience included fear, uncertainty and anxiety, and hopelessness and longing, while after the patients were shown the video, themes that overlapped with positive feelings were found. These subthemes were determined as happiness, excitement and hope. In the control group, the subthemes regarding their experiences of the disease process were determined as death anxiety, hopelessness and helplessness, uncertainty, agitation and physical discomfort (pain and fatigue).

CONCLUSIONS

The results of this study demonstrated that using remote communication methods to facilitate interaction between patients and their families was linked to reduced anxiety in patients, improved mental well-being and increased satisfaction among their relatives.

RELEVANCE TO CLINICAL PRACTICE

The primary strength of the study is its pioneering role in facilitating communication between intensive care patients and their relatives at the public hospital level during the pandemic period. Additionally, it has shed light on the emotional outcomes associated with this communication. Moreover, the project facilitated the transmission of the patient's final statements to their relatives, effectively serving as a verbal testament to the bond between the patient and their family. Primarily, communicating the final statements of deceased patients is of paramount humanitarian importance. The results of this study prove that intensive care nurses have an important role in enabling patients to connect with their loved ones in their final stages. Thus, nurses can support recovery, increase communication and ensure farewells.

A nationwide study exploring the factors associated with psychological resilience during the COVID-19 pandemic in Singapore

Background

The COVID-19 pandemic is a global adverse event that affected many individuals' well-being. Resilience is an essential component that allows one to cope during stressful events such as the pandemic. Not many studies have longitudinally explored changes in resilience across time during the pandemic in the Southeast Asia region. The current article investigates resilience and the sociodemographic and psychological factors associated with resilience across two waves of survey of a Singapore adult population.

Methods

The study was conducted across two timepoints from May 2020 to June 2021 (T1) and October 2021 to September 2022 (T2). 1129 participants partook during T1 (response rate = 54.8%) and 858 participants partook during T2 (response rate = 76.0%). The questionnaire included sociodemographic information and measures such as the Brief Resilience Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, the stress component of the Depression, Anxiety and Stress Scale, and four COVID-19-related stressors. Generalized estimating equations (GEE) were utilized to investigate the relationships adjusting for timepoints.

Results

Most participants had normal levels of resilience (M = 3.61, SD = 0.62), and resilience scores did not differ much over time (p = 0.852). Males, younger adults, university-educated, employed individuals, and individuals living in private housing had higher levels of resilience. Higher levels of anxiety symptoms, depressive symptoms, stress, and one specific COVID-19-related stressor (i.e., employment concerns) were associated with lower levels of resilience. Individuals who reported having moderate to severe depression and anxiety symptoms were more likely to have low resilience.

Discussion

The findings suggest that resilience levels remained within the normal range and unchanged over time, reflective of the population's ability to cope with the pandemic. However, there is still a need for more targeted interventions for individuals who are more vulnerable to lower resilience. Continued research is also needed to understand the long-term psychological effects of the pandemic.

How Did Personality Traits Shape Reactions to Uncertainty During the Outbreak of the COVID-19 Pandemic?

This study examined how three broad uncertainty-related dispositions-Affective Discomfort with Uncertainty, Cognitive Rigidity and Closure, and Need for Predictability versus Complexity-relate to individual responses to the unprecedented global uncertainty triggered by the COVID-19 pandemic. We collected data from 446 participants (61% female, ages 18-62) during Italy's government-mandated lockdown in April 2020. Participants completed validated scales for uncertainty-related traits and a specially designed survey assessing pandemic responses, including Pandemic Anxiety and Routine Disruption-capturing fear of infection, distress from lifestyle changes, and difficulty processing conflicting information-and Proactive Compliance and Normative Trust, which reflects engagement in protective behaviors and endorsement of official guidelines. Structural equation modeling revealed that Cognitive Rigidity and Closure was the strongest predictor of Pandemic Anxiety and Routine Disruption, as well as Proactive Compliance and Normative Trust (PCNT), overshadowing the influence of Affective Discomfort with Uncertainty. Need for Predictability versus Complexity positively predicted Proactive Compliance and Normative Trust but was unrelated to Pandemic Anxiety and Routine Disruption. These findings highlight the twofold role of cognitive rigidity in amplifying emotional distress and fostering compliance during crises. The study emphasized the interplay between emotional and cognitive uncertainty-related traits in predicting pandemic-related distress and adherence to public health measures.

Healthcare professionals' perceptions of system preparedness during public health emergencies: a path analysis of mental health impacts

Background

The easing of COVID-19 policies in China appears to have been inadequately prepared, leading to a profound shift in the mental wellbeing of healthcare professionals following the lifting of these measures. Our study aims to investigate the pathways underlying negative emotions experienced by healthcare professionals due to perceived inadequate system preparedness, aiming to enhance their mental health protection and facilitate more effective responses during future large-scale public health crises.

Methods

A total of 826 healthcare professionals were enrolled. Depression symptoms, anxiety symptoms, perceived stress, resilience, perceived inadequate system preparedness were measured in our research.

Results

The prevalence of depression and anxiety symptoms among healthcare professionals were 32.1 and 16.2%, respectively, during the concentrated outbreak of COVID-19 in China after easing policy. The chain mediation analysis reveals that perceived inadequate system preparedness significantly directly predicts depression or anxiety symptoms among healthcare professionals, indirectly through the mediating role of stress, as well as via the chain mediation of stress and resilience. However, it does not predict these symptoms through the mediator of resilience alone. Furthermore, contracting COVID-19 directly predicts depression symptoms.

Conclusions

Perceived inadequate system preparedness can have a detrimental impact on negative emotions through various channels. When facing the potential outbreak of a large-scale public health event in the future, it is crucial to implement measures such as providing psychological counseling, increasing risk allowances, and ensuring an adequate supply of personal protective equipment to be better prepared. Additionally, psychosocial interventions should be implemented to enhance the resilience of healthcare professionals and safeguard the mental wellbeing of those infected with COVID-19, etc.

Analysis of sub-health status and related factors in medical students in the Chinese Mainland from the perspective of health ecology

BACKGROUND

Sub-health status (SHS) refers to the physical condition in which a person falls between being healthy and having a disease. The sub-health status of medical students is related to many factors. The aim of this study is to explore the current situation and related factors of sub-health of medical students from the perspective of health ecology, to provide a basis for the formulation of intervention measures and improve the health level of medical students.

METHODS

The data for this study came from a nationwide cross-sectional survey conducted in June-August 2022, covering 32 provinces and autonomous regions in mainland China. Multi-stage random sampling was used to recruit. 30,505 valid questionnaires were finally collected. According to the purpose of this study, the subjects were medical students. A total of 1878 subjects were included in the study. Binary stepwise logistic regression and back propagation neural network (BPNN) were used to explore the influencing factors of sub-health.

RESULTS

The prevalence of sub-health among medical students in mainland China is 57.5%. Results revealed that negative life events (odds ratio [OR] = 1.64; 95%CI = 1.31-2.04), anxiety (OR = 1.97; 95%CI = 1.27-3.10), depression (OR = 1.80; 95%CI = 1.30-2.51), second-hand smoke exposure (OR = 1.32; 95%CI = 1.06-1.64), problematic Internet use (OR = 1.15; 95%CI = 1.12-1.17), and perceived stress (OR = 1.16; 95%CI = 1.10-1.22) were identified as risk factors for sub-health among medical students, and the level of health literacy was found to be a protective factor for sub-health (OR = 0.96 (95%CI = 0.94-0.98). Sub-health risk increased with increasing smartphone use 1-2 h (OR = 1.34; 95%CI = 1.03-1.73) and ≥ 2 h (OR = 1.44; 95%CI = 1.05-1.98). Four important variables were determined according to the BPNN results: perceived stress, problematic Internet use, depression, and health literacy.

CONCLUSIONS

Medical students in mainland China have a high rate of SHS, indicating it's a pressing public health issue for them. Factors like mental health, internet use problems, and health literacy are linked to SHS occurrence in this group. This study provides a scientific basis for early identification of high-risk groups, and provides a reference for developing personalized intervention measures based on the perspective of health ecology.

The influence of epidemic risk perception on impulse buying behavior and its internal mechanism

This study investigates the impact of risk perception on impulse buying behavior during the epidemic, the mediating role of anxiety, and the moderating role of source credibility in order to reveal the internal mechanism under the relationship between risk perception and impulse buying behavior. Experiment 1 explored the cross-sectional relationship between risk perception and impulse buying behavior during the epidemic, as well as anxiety and sensation seeking. The results found that anxiety played a mediation role between risk perception and impulse buying behavior, and sensation seeking played a moderating role. Through manipulating the degree of risk perception and source credibility, Experiment 2 examined how risk perception and anxiety influence buying behavior, as well as the role of source credibility in this relationship. The results demonstrated that the main effect of impulse buying was substantial, and the interaction effect of risk perception and source credibility was significant. It further revealed that anxiety partially mediated the relationship between risk perception and impulse buying behavior. Overall, our study found that risk perception of the epidemic predicted impulse buying behavior. Anxiety mediates the effect of risk perception on impulse buying behavior. Sensation seeking and source credibility play a moderating role in the effect of risk perception on impulse buying behavior.

A Distillation Approach to Transformer-Based Medical Image Classification with Limited Data

Background/Objectives: Although transformer-based deep learning architectures are preferred in many hybrid architectures due to their flexibility, they generally perform poorly on image classification tasks with small datasets. An important improvement in performance when transformer architectures work with limited data is the use of distillation techniques. The impact of distillation techniques on classification accuracy in transformer-based models has not yet been extensively investigated. Methods: This study investigates the impact of distillation techniques on the classification performance of transformer-based deep learning architectures trained on limited data. We use transformer-based models ViTx32 and ViTx16 without distillation and DeiT and BeiT with distillation. A four-class dataset of brain MRI images is used for training and testing. Results: Our experiments show that the DeiT and BeiT architectures with distillation achieve performance gains of 2.2% and 1%, respectively, compared to ViTx16. A more detailed analysis shows that the distillation techniques improve the detection of non-patient individuals by about 4%. Our study also includes a detailed analysis of the training times for each architecture. Conclusions: The results of the experiments show that using distillation techniques in transformer-based deep learning models can significantly improve classification accuracy when working with limited data. Based on these findings, we recommend the use of transformer-based models with distillation, especially in medical applications and other areas where flexible models are developed with limited data.

Investigating the attitude of psychiatrists towards the presence of stigma about COVID-19

Introduction

The COVID-19 pandemic has led to significant global disruption, resulting in increased stigma and discrimination towards certain communities and populations affected by the virus. Given that psychiatrists play a crucial role in both preventing and treating the complications associated with disease-related stigma, this study aims to examine their attitude towards the stigma associated with COVID-19.

Methods

This research utilized a cross-sectional survey design to evaluate psychiatrists' attitudes towards COVID-19 stigma. We used a 15-item researcher-made questionnaire with scores ranging from 15 to 75. The questionnaire was distributed to 131 psychiatrists in Tehran (capital city of Iran) from April 9, 2023 to May 26, 2023, with responses collected voluntarily. Data were analyzed with descriptive statistics, independent t-tests, and one-way ANOVA to evaluate stigma attitudes across demographic variables using SPSS software (version 25).

Results

The Cronbach's alpha for the COVID-19 Stigma Attitude Scale for Psychiatrists (CSASP) was determined to be 0.861, indicating strong reliability. Moreover, all questions achieved acceptable corrected item-total correlation values above 0.2. It was revealed that the highest and lowest recorded scores were 68 and 25, respectively (average 51.16 ± 8.83). Also 19 individuals (14.5%) exhibited a weak attitude, 41 individuals (31.3%) displayed a rather weak attitude, 54 individuals (41.2%) showed a rather strong attitude, and 17 individuals (13%) demonstrated a strong attitude toward the presence of COVID-19 stigma. Furthermore, 96 individuals (73.3%) recognized stigma surrounding COVID-19 at the onset of the pandemic; of these, 11 (11.5%) disagreed with the idea of current stigma, while 18 (18.7%) had no opinion. Thus, 67 participants (69.8%) still believe such a stigma exists. Finally, 83 respondents (63.3%) acknowledged stigma related to AIDS and leprosy, with 53 (63.8%) of them also believing in the stigma surrounding COVID-19.

Conclusion

The findings highlighted various attitudes towards the ongoing stigma associated with COVID-19, with most psychiatrists recognizing its persistence throughout the pandemic. The research also points to the interconnectedness of stigma across different diseases, emphasizing common societal factors like fear, misinformation, and cultural biases. This underscores the crucial role psychiatrists play in addressing stigma and its effects on society.

The effectiveness of online therapy in promoting wellbeing and reducing burnout among psychotherapists

Introduction

The COVID-19 pandemic has worsened global mental health, thereby burdening mental health services and raising burnout risk among professionals. Online therapy may be an optimal solution to reduce burnout risk, ensuring flexibility for psychotherapists and the continuity of care for patients. This study investigates the link between burnout and online therapy, focusing on environmental sensitivity and exploring tailored solutions to reduce burnout while maintaining healthcare performance.

Method

Participants were 95 French psychotherapists (89% females), aged from 24 to 59 years (M = 37.13, SD = 7.75). Participants were administered the Maslach Burnout Inventory, the Highly Sensitive Person Scale, and a questionnaire assessing their professional activity.

Results

Digital psychotherapists reported lower levels of burnout compared to traditional psychotherapists who did not use online therapy. Specifically, they had lower depersonalization scores (mean difference of 0.37 points, p = 0.038) and tent to have lower scores in emotional exhaustion (mean difference of 0.44 points, p = 0.07). This association was more pronounced for those with high environmental sensitivity.

Discussion

Online therapy ensures greater workplace flexibility, serving as a protective factor in reducing psychotherapists' burnout. Integrating digital health into public mental health services can enhance care delivery and support the wellbeing of professionals, especially those with high environmental sensitivity. Essential guidelines for online therapy use are needed to maximize benefits and ensure its effective implementation.

Assessment of Psychosocial Risk and Resource Factors Perceived by Military and Civilian Personnel at an Armed Forces Medical Center

The aim of this study is to identify the factors contributing to psychosocial risks (PSR) and the specific resources available within an Army Medical Center (AMC), with a view to developing a questionnaire adapted to this unique context. A qualitative study was carried out with 56 military and civilian employees, using semi-directive interviews. The results highlight similarities with PSR and resource factors already identified in the literature, such as workload, emotion management and salary recognition. They also reveal PSR factors specific to the activity of AMC staff, such as the need for availability and mobility, discipline and rigor, task shifting and impeded quality, as well as resource factors such as sports practice and cohesion. The results were used to develop a questionnaire, currently being validated, tailored to the context of army medical centers, with the aim of improving strategies for preventing Psychosocial Risks (PSRs).

Survey and Analysis of Mental Health among Otolaryngology Nurses Following the Conclusion of COVID-19 Prevention and Control Measures

Aims/Background The coronavirus disease 2019 (COVID-19) pandemic placed unique pressures on healthcare workers, especially nurses. This study examines the factors influencing mental health, stress perception, and burnout among otolaryngology nurses after the cessation of COVID-19 prevention and control. Methods A cross-sectional study was conducted among 220 otolaryngology nurses in Sichuan province from 20 January to 28 January, 2023. Data were collected using a general information questionnaire, the Nurse Workplace Mental Health Questionnaire, the Chinese Perceived Stress Scale (CPSS-14), and the Maslach Burnout Inventory-General Survey (MBI-GS). Statistical analyses included the Kruskal-Wallis test, Spearman correlation analysis, and multiple linear regression to identify significant factors and relationships within the dataset. Results Of the 220 questionnaires distributed, 218 were valid, yielding a recovery rate of 99.09%. The cohort included 3 males (mean age: 34.67 ± 12.39) and 215 females (mean age: 35.63 ± 9.27). The average mental health score was 128.10 ± 21.29, indicating a moderate level of psychological well-being. The CPSS-14 average score was 37.42 ± 7.27, reflecting moderate stress, while MBI-GS scores highlighted varying levels of burnout, especially in emotional exhaustion (median = 10.00). The Kruskal-Wallis test identified significant factors affecting mental health, stress, and burnout, including family support, COVID-19 testing status, staffing adequacy, frequency of caring for critically ill patients, teamwork satisfaction, job satisfaction, and resignation plans (p < 0.05). Spearman correlation analysis revealed significant negative associations between mental health and stress (r = -0.525) and total burnout scores (r = -0.646; p < 0.01). Multiple linear regression identified emotional exhaustion (β = -0.922), low personal accomplishment (β = -0.623), and inadequate staffing (β = -2.769) as significant negative predictors of mental health, while teamwork satisfaction (β = 5.516) and job satisfaction (β = 5.032) were positively associated with improved mental health (p < 0.01). Conclusion Otolaryngology nurses experience notable mental health challenges in the post-pandemic era, driven by stress and burnout. Addressing staffing shortages, fostering teamwork, and enhancing job satisfaction are critical strategies to improve their psychological well-being.

Prospective associations between psychosocial work stress, work-privacy conflict, and relationship satisfaction of young parents during the COVID-19 pandemic: The mediating role of symptoms of depression and anger/hostility

The COVID-19 pandemic changed employment conditions and childcare availability worldwide. This contributed to higher work-related stress among working parents, which in turn may have led to lower relationship satisfaction. This study examined the prospective associations between psychosocial work stress or work-privacy conflict (WPC) and relationship satisfaction among parents of young children during the first year of the COVID-19 pandemic. Further, this study aimed to investigate a potential mediating role of psychological symptoms, i.e., symptoms of depression and anger/hostility, and to determine whether this applies equally to mothers and fathers. Longitudinal data were derived from the German, prospective cohort study DREAMCORONA. Working and cohabiting mothers (n =  138) and fathers (n =  187) completed questionnaires on psychosocial work stress, WPC, and psychological symptoms from May-June 2020 (T1) and on relationship satisfaction from October-December 2020 (T2). Mediation analyses were conducted separately for mothers and fathers, controlling for working from home and number of children. Mediation effects were found only for fathers. Higher levels of psychosocial work stress were associated with higher levels of symptoms of depression, which in turn predicted lower relationship satisfaction. The prospective association between higher paternal WPC and lower relationship satisfaction was mediated by higher symptoms of both depression and anger/hostility. No mediation effects were found for mothers. However, also in mothers, psychosocial work stress was associated with symptoms of depression, whereas WPC was associated with symptoms of both depression and anger/hostility. This study highlights the importance of identifying protective mechanisms for working parents to maintain mental health and satisfying romantic relationships in times of crisis and beyond. To develop targeted prevention approaches, it appears advantageous to continue examining sex differences. Additionally, it is essential to educate working parents about the potential risks associated with work-related stress and to ensure the availability of stable counselling services.

Prevalence and Associated Factors of Mental Health Outcomes in Peruvian Healthcare Workers During the COVID-19 Pandemic: The FRONTLINE Study

Background: The COVID-19 pandemic impacted global health, particularly the mental health of healthcare workers in low-resource countries like Peru. Aim: To determine the prevalence of depressive, anxiety, and post-traumatic stress symptoms among health workers in Peru throughout the COVID-19 pandemic between December 2021 and August 2022. Methodology: Cross-sectional study on health workers (physicians, nurses, midwives, medical technologists, and healthcare technicians) from Peru selected by non-probabilistic sampling adjusted by post-stratification weights and the Raking method. We evaluate depressive, anxiety, and post-traumatic stress symptoms with Patient Health Questionnaire 9, General Anxiety Disorder 7, and Post-traumatic Stress Disorder Checklist for DSM-5. Results: We evaluated 2,122 participants, of which 72% were women, and the average age was 38 years. The prevalence of depressive symptoms was 18.6% (95%CI 16.6%-20.8%), anxious symptoms were 12.2% (95%CI 10.6%-13.9%), and post-traumatic stress symptoms were 9.3% (95%CI 7.9%-10.9%). Age, sex, and type of health facility were associated with anxiety and depression symptoms, and for post-traumatic stress symptoms, age, and marital status. Conclusion: Our study provides more updated evidence on the mental health situation of healthcare workers. It reveals a significant proportion of workers with evidence of depressive, anxious, or post-traumatic stress problems.

Workers' Psychological Distress During the Early Months of the COVID-19 Pandemic in Brazil: A Cross-Sectional Study

The COVID-19 pandemic significantly impacted the mental health of workers. This study aimed to assess the prevalence of psychological distress among Brazilian workers during the early months of the pandemic and explore its associated factors. A cross-sectional study was conducted using an online questionnaire administered to 2903 Brazilian workers, including 1752 non-healthcare workers (NHCWs) and 1151 healthcare workers (HCWs), between April and May 2020. Snowball sampling was employed for participant recruitment, and the research questionnaire was adapted for use with the Brazilian population through a process of translation and cultural adaptation, based on an instrument initially created and validated for use in Spain. Differences between NHCWs and HCWs were tested using the chi-square or Fisher's Exact test and Mann-Whitney test followed by effect size measurement. Multiple linear regression models were used to analyze the association between psychological distress and the predictor variables. Psychological distress was observed in 72.6% (95% CI 70.1-74.2%) of the participants, with no significant difference observed between NHCWs and HCWs. Although 32 variables showed statistically significant differences between NHCWs and HCWs, only 7 demonstrated clinical-epidemiological relevance, primarily related to occupational factors. Work-related stress was positively associated with psychological distress, but this relationship diminished in the absence of family members infected with COVID-19. Conversely, a higher sense of coherence was protective against psychological distress, although this effect weakened in the absence of family members infected with COVID-19. The study highlights the high prevalence of psychological distress among Brazilian workers during the pandemic's early months. Work stress played a significant role, while sense of coherence appeared to mitigate mental health challenges. These findings highlight the need for targeted mental health interventions, particularly for workers facing both professional and family-related stressors during crises.

Incidence and prevalence of dysthymia among young adults in China, 1990-2021, with forecasts to 2046: an age-period-cohort analysis of the Global Burden of Disease Study 2021

BACKGROUND

Dysthymia, a chronic depressive disorder, poses a significant public health challenge due to its prolonged course and substantial impact on quality of life, particularly among high-risk populations such as young adults. This study aims to investigate trends in dysthymia incidence and prevalence among young adults in China from 1990 to 2021 and to project future patterns through 2026.

METHODS

Using data from the Global Burden of Disease (GBD) 2021 Study, we conducted an Age-Period-Cohort (APC) analysis to assess the relative risks (RRs) of dysthymia incidence and prevalence among Chinese young adults aged 20-44 years from 1990 to 2021. Bayesian and Nordpred APC models were applied to forecast age-standardized incidence rates (ASIR) and prevalence rates (ASPR) for the next 25 years (2022-2046).

RESULTS

Between 1990 and 2019, both ASIR and ASPR of dysthymia exhibited a declining trend. Among females, ASIR decreased from 363.099 (95% uncertainty interval [UI]: 339.146, 387.051) per 100,000 population to 318.100 (95% UI: 296.812, 339.388), while among males, it declined from 232.757 (95% UI: 216.022, 249.492) to 208.467 (95% UI: 193.617, 223.317). Similarly, ASPR decreased from 2,072.562 (95% UI: 1,813.254, 2,331.870) to 1,795.234 (95% UI: 1,582.628, 2,007.841) for females and from 1,278.432 (95% UI: 1,116.869, 1,439.994) to 1,131.620 (95% UI: 994.059, 1,269.180) for males. However, a marked increase was observed from 2020, with 2021 rates approaching 1990 levels for both sexes. APC analysis showed that RRs for dysthymia incidence and prevalence increased with age, particularly beyond 35-39 years. More recent cohorts demonstrated lower RRs compared to earlier cohorts, whereas period effects remained relatively stable. Projections indicate a continuous rise in ASIR and ASPR from 2022 to 2046 for both sexes. Throughout the study period, dysthymia prevalence rates consistently exceeded incidence rates, with females exhibiting higher rates than males.

CONCLUSION

Enhancing early diagnostic capabilities in primary care, advancing standardized treatment strategies, improving mental health literacy through health education and social media, and implementing targeted interventions for high-risk groups-particularly young women and individuals in early adulthood-are essential for alleviating the burden of dysthymia in China and other countries with similar demographic and epidemiological characteristics.

Asynchronous Distance Learning Performance and Knowledge Retention of the National Institutes of Health Stroke Scale Among Health Care Professionals Using Video or e-Learning: Web-based Randomized Controlled Trial

BACKGROUND

Stroke treatment has significantly improved over the last decades, but the complexity of stroke cases requires specialized care through dedicated teams with specific knowledge and training. The National Institutes of Health Stroke Scale (NIHSS), widely used to assess neurological deficits and make treatment decisions, is reliable but requires specific training and certification. The traditional didactic training method, based on a video, may not adequately address certain NIHSS intricacies nor engage health care professionals (HCPs) in continuous learning, leading to suboptimal proficiency. In the context of time-constrained clinical settings, highly interactive e-learning could be a promising alternative for NIHSS knowledge acquisition and retention.

OBJECTIVE

This study aimed to assess the efficacy of a highly interactive e-learning module compared with a traditional didactic video in improving NIHSS knowledge among previously trained HCPs. Furthermore, its impact on knowledge retention was also assessed.

METHODS

A prospective, multicentric, triple-blind, and web-based randomized controlled trial was conducted in 3 Swiss university hospitals, involving HCPs previously trained in NIHSS. Invitations were sent through email, and participants were randomized to either the e-learning or traditional didactic video group through a fully automated process upon self-registration on the website. A 50-question quiz was administered before and after exposure to the training method, and scores were compared to assess knowledge acquisition. The quiz was repeated after 1 month to evaluate retention. Subjective assessments of learning methods that is, user satisfaction, probability of recommendation, perceived difficulty, and perception of duration, were also collected through a Likert-scale questionnaire. A sample size of 72 participants were deemed necessary to have an 80% chance of detecting a difference of 2 points in the postcourse quiz between groups at the 5% significance level.

RESULTS

Invitations to participate were sent through email to an estimated 325 HCPs. 174 HCPs enrolled in the study, of which 97 completed the study course. Both learning methods significantly improved NIHSS knowledge, with an improvement of 3.2 (range 2.0-4.3) points in the e-learning group and of 2.1 (1.2-3.1) points in the video group. However, the e-learning group performed better, with higher scores in knowledge acquisition (median score 39.0, IQR 36.0-41.0 vs 37, IQR 34.0-39.0; P=.03) and in knowledge retention (mean score 38.2, 95% CI 36.7-39.7 vs 35.8, 95% CI 34.8-36.8; P=.007). Participants in the e-learning group were more likely to recommend the learning method (77% vs 49%, P=.02), while no significant difference was found for satisfaction (P=.17), perceived duration (P=.17), and difficulty (P=.32).

CONCLUSIONS

A highly interactive e-learning module was found to be an effective asynchronous method for NIHSS knowledge acquisition and retention in previously NIHSS-trained HCPs, and may now be considered for inclusion in NIHSS training programs for HCPs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3390/healthcare9111460.

Depression and anxiety among nurses during the COVID-19 pandemic: Longitudinal results over 2 years from the multicentre VOICE-EgePan study

AIMS

To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population.

BACKGROUND

The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain.

DESIGN

A multicentre prospective longitudinal study.

METHODS

Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April-July 2020, T2: November 2020-January 2021, T3: May-July 2021, T4: February-May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined.

RESULTS

Throughout the study (T1-T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4).

CONCLUSION

During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health.

RELEVANCE TO CLINICAL PRACTICE

The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals.

IMPLICATIONS FOR THE PROFESSION

Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems.

REPORTING METHOD

The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method.

PATIENT CONTRIBUTION

Five hundred and seven nurses completed the questionnaire and provided data for analysis.

TRIAL AND PROTOCOL REGISTRATION

The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.

Association Between Occupational Stress and Mental Health in Healthcare Workers During the Coronavirus Pandemic in 2019

Background During the coronavirus pandemic in 2019, deterioration of mental health was reported among healthcare workers. However, few studies have examined the relationship between healthcare workers' mental health and occupational stress in healthcare settings during the spread of coronavirus disease 2019 (COVID-19). This study aimed to identify job stressors associated with mental health issues among healthcare workers. Methods The study was conducted from May 2020 to January 2021. We analyzed the impact of job stressors on mental health issues using the nine-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder, Impact of Event Scale-Revised, and the Brief Job Stress Questionnaire in 204 healthcare workers working at a hospital treating patients with COVID-19. Results The results indicate that job stressors affecting depression, anxiety, and post-traumatic stress differed. High total Interpersonal Conflicts and Job Fitness stress scores were significantly associated with depressive symptoms (Interpersonal Conflicts OR:1.77; 95% CI:1.15-2.70; p = 0.001, Job Fitness OR:1.84; 95% CI:1.05-3.23; p = 0.04). High total Job Overload and Interpersonal Conflicts stress scores were significantly associated with anxiety symptoms (Job Overload OR:1.76; 95% CI:1.06-2.93; p = 0.003, Interpersonal Conflicts OR1.90; 95% CI:1.09-3.31; p = 0.002). High total Job Overload and Job Control stress scores were significantly associated with post-traumatic stress (Job Overload OR1.37; 95% CI:1.01-1.85; p = 0.04, Job Control OR1.69; 95%CI:1.17-2.43; p < 0.001). Conclusions These findings suggest that strategies addressing job stressors to maintain or improve mental health during an infectious disease epidemic should be tailored to individual stress responses. Additionally, the results indicate that maintaining positive interpersonal relationships in the workplace and reducing workload are particularly important for supporting mental health among healthcare workers.

A Longitudinal RCT on the Effectiveness of a Psychological Intervention for Hospital Healthcare Workers During the COVID-19 Pandemic: What We Learned to Date

The COVID-19 pandemic has led to significant psychological distress among frontline healthcare workers (HCWs), with a particular increase in trauma-related symptoms. This study investigated the longitudinal course of trauma-associated symptoms and behaviors in HCWs and the effectiveness of a brief dialectical behavior therapy (DBT)-informed intervention in mitigating these symptoms over 12 months. The trial included 225 HCWs randomly assigned to one of three groups: no intervention (control), in-person DBT-informed intervention, or online DBT-informed intervention. Over time, a natural decrease in PTSD symptoms was observed in all groups. Contrary to expectations, no difference was found between the control and intervention groups. However, for participants with severe PTSD symptoms, the intervention significantly mitigated their distress. No differences emerged between in-person and online interventions, suggesting equal effectiveness. Females reported higher trauma-related symptoms, while no differences emerged among different professional roles. These findings underscore the importance of targeted interventions for HCWs experiencing severe symptoms and highlight the potential of online modalities. Further research is needed to optimize the deployment of mental health resources within the healthcare setting, particularly during crises.

Anxiety and depression in cancer patients and survivors in the context of restrictions in contact and oncological care during the COVID-19 pandemic

Treatment modifications and contact restrictions were common during the COVID-19 pandemic and can be stressors for mental health. There is a lack of studies assessing pandemic-related risk factors for anxiety and depression of cancer patients and survivors systematically in multifactorial models. A total of 2391 participants, mean age 65.5 years, ≤5 years post-diagnosis of either lung, prostate, breast, colorectal cancer, or leukemia/lymphoma, were recruited in 2021 via the Baden-Württemberg Cancer Registry, Germany. Sociodemographic information, pandemic-related treatment modifications, contact restrictions, and anxiety/depression (Hospital Anxiety and Depression Scale, HADS) were assessed via self-administered questionnaire. Clinical information (diagnosis, stage, and treatment information) was obtained from the cancer registry. Overall, 22% of participants reported oncological care modifications due to COVID-19, mostly in follow-up care and rehabilitation. Modifications of active cancer treatment were reported by 5.8%. Among those, 50.5% had subclinical anxiety and 55.4% subclinical depression (vs. 37.4% and 45.4%, respectively, for unchanged active treatment). Age <60 years, female sex, lung cancer, low income, and contact restrictions to peer support groups or physicians were identified as independent risk factors for anxiety. Risk factors for depression were lung cancer (both sexes), leukemia/lymphoma (females), recurrence or palliative treatment, living alone, low income, and contact restrictions to relatives, physicians, or caregivers. The study demonstrates that changes in active cancer treatment and contact restrictions are associated with impaired mental well-being. The psychological consequences of treatment changes and the importance for cancer patients to maintain regular contact with their physicians should be considered in future responses to threats to public health.

Evolution of burnout syndrome in Spanish healthcare professionals during and after the COVID-19 pandemic: psychosocial variables involved

Introduction

Evidence shows that throughout the COVID-19 pandemic, healthcare workers have experienced high levels of burnout. The preceding literature also points to the need to consider the three elements of burnout independently, as they appear to have different evolutionary trends and possibly different buffering and amplifying variables, although these aspects have hardly been explored.

Methods

The aim of the present investigation is precisely to shed light on these latter issues. It is a prospective study, carried out in 256 healthcare workers in Spain during three time points in relation to the COVID-19 pandemic: (1) (T1) between 5 May and 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March), (2) (T2) 6 months after the end of the state of alarm (January-April 2021), and (3) (T3) 1 year after this second evaluation (April-July 2022). The different components of burnout syndrome (emotional exhaustion, depersonalization and self-fulfillment) were assessed at the second and third time points. Together with sociodemographic and occupational data (age, gender, professional category, years of experience, hours of work), anxiety, depression, stress, family support, friends' support, and self-efficacy were assessed at the first time point. At the second time point, cognitive fusion and resilience were assessed. At the third time point, optimism and hopelessness were assessed.

Results

The results show significant decreases in burnout syndrome (p < 0.001). However, when observing the evolution of each of the dimensions, it can be seen that emotional exhaustion has significantly decreased (p < 0.001), while an increase in depersonalization (p < 0.001) and a decrease in self-fulfillment (all p < 0.001) are observed. The results of the repeated measures General Linear Models, after controlling for the effect of the covariates show that the evolution of emotional exhaustion is associated with the levels of depression at T1 (p = 0.031), of cognitive fusion at T2 (p < 0.001) and of resilience at T2 (p = 0.039). The evolution of depersonalization is associated with levels of hopelessness at T2 (p = 0.042). Finally, the evolution of self- fulfillment is associated with levels of optimism at T3 (p = 0.043) and hopelessness at T3 (p = 0.019).

Discussion

The results highlight the need to attend to the three components of burnout in a differentiated manner. Our results indicate that, during the COVID-19 pandemic, although overall burnout levels tend to decrease, it is actually emotional exhaustion that decreases, but levels of depersonalization increase and self- fulfillment decreases. In addition, the data point to the different personality factors involved in each of the dimensions. While the evolution of emotional exhaustion seems to be more affected by the levels of symptomatology (i.e., depression) at the onset of the pandemic, and of the inability to handle intrusive thoughts (i.e., cognitive fusion), the evolution of depersonalization and self- fulfillment are more related to long-term cognitive-emotional personality variables such as optimism and hopelessness.

Practical implications

The results found have important practical implications for the prevention of each of the implicated components of the syndrome. Although further research is needed, emotional exhaustion is shown to be one of the dimensions affected in the short term and intervention programs aimed at reducing anxiety and depression at times of acute stress (onset of the COVID-19 pandemic), including thought management, seem fundamental. Depersonalization and decreased self-fulfillment do not seem to respond to the same pattern. They are shown as results of a chronification of a poor management of emotional exhaustion, and in the case of their appearance, given the variables associated with their evolution (i.e., optimism and hopelessness), therapies more focused on the meaning of existence, such as Acceptance and Commitment Therapy, could be useful.

Home office is associated with weight gain during the COVID-19 pandemic: Brazilian population-based studies

The COVID-19 pandemic caused changes in life, affecting habits and behaviors, and one of its consequences is an increase in weight. We aimed to evaluate the association between remote work and weight gain during the COVID-19 pandemic in two cities in southern Brazil. A population-based cross-sectional study carried out in the southern region of Brazil. Data were collected face-to-face, in households selected by census sampling. The outcome was weight gain, and the exposure was remote working. To verify this association, Poisson Regression was used to calculate the crude and adjusted prevalence ratio and its 95% confidence intervals, using 5% significance level. In total, 2,152 individuals were interviewed. The prevalence of weight gain during the pandemic was 38.4% (95%CI 36.1-40.7), being significantly higher in those who worked remotely (47.0% vs 37.7, p=0.02). Those individuals who worked remotely were 23% more likely to gain weight during the pandemic compared to those who did not work remotely (PR: 1.23; 95%CI 1.02-1.49). Health and education services may be encouraged to implement educational actions at the collective level, aimed at enlightening the population and preventing weight gain in periods of confinement.

Revisiting Alcohol Consumption Among Nurses After the COVID-19 Pandemic: A Qualitative Descriptive Study

The COVID-19 pandemic continues to cause nurses stress and trauma, with alcohol potentially being used to manage this stress. Prior studies of nurses' alcohol consumption during the COVID-19 pandemic have shown increases in alcohol consumption to manage stress associated with the pandemic. The aim of this paper is to explore perceptions of alcohol consumption and stress among nurses, particularly since the declared end of the COVID-19 pandemic. We used semi-structured interviews with Australian nurses (n = 55), using a qualitative-descriptive study design, conducted between October 2023 and January 2024. Data were analysed using structural coding and reported in accordance with CORE-Q guidelines. Four key themes emerged from the data: (1) Alcohol consumption in response to ongoing role stress, (2) Alcohol consumption in response to incidents, (3) The lasting impact of the COVID-19 pandemic and (4) Do nurses feel comfortable seeking help for alcohol use? High-risk alcohol consumption has persisted beyond the end of the COVID-19 pandemic to manage the stress associated with clinical environments. Alcohol was also used in response to incidents, and the ongoing trauma and impact of the pandemic was described as a significant source of stress and anxiety. Not all nurses in our study felt comfortable seeking help for alcohol use, with participants describing concern for their nursing registration if they self-reported their alcohol consumption. Participants reported stronger links between stressful working environments and increased alcohol consumption. Nurses in our study do not feel safe seeking help or self-reporting alcohol consumption for fear of the regulatory body instituting sanctions that lead to loss or suspension of their registration. These factors require urgent attention to ensure workforce wellbeing and sustainability.

Knowledge of COVID-19 and associated factors among kidney transplant recipients and donors in Singapore

BACKGROUND

Effective interventions during the coronavirus disease 2019 (COVID-19) pandemic require an understanding of patients' knowledge and perceptions that influence their behaviour. Our study assessed knowledge of COVID-19 among kidney transplant recipients and donors, hitherto unevaluated.

METHODS

We conducted a cross-sectional survey among 325 kidney transplant recipients and 172 donors between 1 May 2020 and 30 June 2020. The survey questionnaire assessed knowledge levels of COVID-19, sociodemographic data, health status, psychosocial impact of COVID-19 and precautionary behaviours during the pandemic.

RESULTS

The mean COVID-19 knowledge score of the study population was 7.5 (standard deviation: 2.2) out of 10. The mean score was significantly higher among kidney recipients compared to kidney donors (7.9 [1.9] vs. 6.7 [2.6]; P <0.001). Younger age (21-49 vs. ≥50 years) and higher education (diploma and higher vs. secondary and lower) were associated with significantly higher knowledge scores in donors, but not among recipients ( P -interactions ≤0.01). In both kidney recipients and donors, financial concerns and/or social isolation were associated with lower knowledge levels.

CONCLUSIONS

Concerted efforts are needed to improve COVID-19 knowledge in kidney transplant recipients and donors, particularly older donors, donors with lower education and patients with financial concerns or feelings of social isolation. Intensive patient education may mitigate the impact of education levels on COVID-19 knowledge levels.

Understanding resident wellness: A path analysis of the clinical learning environment at three institutions

PURPOSE

The clinical learning environment (CLE) affects resident physician well-being. This study assessed how aspects of the learning environment affected the level of resident job stress and burnout.

MATERIALS AND METHODS

Three institutions surveyed residents assessing aspects of the CLE and well-being via anonymous survey in fall of 2020 during COVID. Psychological safety (PS) and perceived organizational support (POS) were used to capture the CLE, and the Mini-Z Scale was used to assess resident job stress and burnout. A total of 2,196 residents received a survey link; 889 responded (40% response rate). Path analysis explored both direct and indirect relationships between PS, POS, resident stress, and resident burnout.

RESULTS

Both POS and PS had significant negative relationships with experiencing a great deal of job stress; the relationship between PS and stress was noticeably stronger than POS and stress (POS: B= -0.12, p=.025; PS: B= -0.37, p<.001). The relationship between stress and residents' level of burnout was also significant (B = 0.38, p<.001). The overall model explained 25% of the variance in resident burnout.

CONCLUSIONS

Organizational support and psychological safety of the learning environment is associated with resident burnout. It is important for educational leaders to recognize and mitigate these factors.

Cognitive Emotion-Regulation and Depressive Symptoms in a Group of Healthcare Workers During the COVID-19 Pandemic: A Person-Based Approach

This study aimed to identify profiles of cognitive emotion regulation strategies and to examine the association between emotion regulation profiles and depressive symptoms using a sample of healthcare workers under the impact of COVID-19. A total of 3477 Chinese healthcare workers participated in the online survey. Latent profile analysis was used to identify cognitive regulation patterns using nine strategies. Depressive symptoms were compared among cognitive regulation patterns. The results yielded three cognitive emotion regulation patterns: regulators with low controllability of emotions and events (RLCEE, 65.5%), regulators with high controllability of emotions and events (RHCEE, 33.0%) and high regulators (HR, 5.4%). The HRs reported the highest level of depression symptoms, followed by the RHCEEs and RLCEEs. The results illustrated a significant association between depressive symptoms and emotion regulation profiles in healthcare workers under the impact of the COVID-19 pandemic.

Impact of the COVID-19 pandemic on utilization of mental health services among children and adolescents using an interrupted time series analysis

This study aimed to examine the impact of both the initial state of emergency (SOE) imposed from April to May 2020 in response to the COVID-19 pandemic and the COVID-19 outbreak itself on the utilization of mental health services among children and adolescents in Japan during the recent pandemic. We conducted an interrupted time series analysis of the number of mental health visits and average incurred medical expenses, stratified by sex and age group, using monthly medical claims data on 3,029,048 patients for the period from January 2016 to December 2020. It was demonstrated that the SOE resulted in a reduced number of visits for mental health services. After the second outbreak of COVID-19 in Japan, which occurred after the SOE, the number of initial visits and the average incurred medical expenses for mental health services increased notably among girls and adolescent females. The findings of this study suggest that: (1) the provision of mental health services for potential patients with mental disorders was insufficient during the pandemic, and (2) the mental health of girls and adolescent females deteriorated during the pandemic. Early screening and treatment of potentially vulnerable patients with mental disorders should be enhanced during a pandemic.

Impact of pediatric COVID-19 isolation on children's well-being and caregiver mental health

BACKGROUND

The Korean government implemented mandatory hospital isolation in the early phase of the COVID-19 pandemic. This study investigated the mental health of children and caregivers who underwent mandatory hospital isolation due to COVID-19.

METHODS

This prospective study examined the physical condition and mental health of children under 7 years of age with COVID-19 and the mental health of their caregivers who underwent isolation in negative pressure rooms at two hospitals in Korea from April to September 2021. Caregivers received a self-report questionnaire via text message. Their responses were analyzed to compare the physical condition and mental health of children with COVID-19 and the mental health of their caregivers during and after isolation and identify factors influencing caregivers' mental health.

RESULTS

Sixty caregivers participated in the study. More than half of the caregivers perceived their children's disease severity as mild. During hospital isolation, 36.4% of the children experienced decreased oral intake, which improved significantly post-isolation (8.7%, P = 0.014). During isolation, approximately 22.2% of the children frequently awoke from sleep, 20.0% displayed irritability, and 70.8% had symptoms of depression. Approximately 36.7% of caregivers showed at least moderate levels of depression during isolation, which significantly decreased to 14.3% three months after discharge (P = 0.032). Factors associated with caregivers' mental health included child-related issues, such as difficulty concentrating, frequent awakenings, and irritability.

CONCLUSION

Mandatory hospital isolation has a significantly negative psychological impact on children and caregivers during pandemics. Isolation decisions must be carefully considered during pandemics, especially those concerning young children. Heightened vigilance is warranted for the early detection and intervention of mental health issues in children and their caregivers.

Psychological distress and the COVID-19 pandemic: the role of personality and coping strategies

Personality traits and coping strategies significantly predict predisposition to psychopathology. This study aimed to examine the predictive role of coping strategies in psychological distress during the COVID-19 pandemic in a sample of Portuguese individuals, considering personality and sociodemographic variables. Data were collected using Google Forms from 2402 individuals (86.8% women; mean age ± SD = 36.80 ± 11.80) between March and June 2020, found primarily through Facebook. The evaluation instruments included the Brief Symptom Inventory (BSI), NEO Five-Factor Inventory, and Brief-COPE. Younger adults, females, single individuals, and those with lower education experienced higher distress. Neuroticism was strongly associated with all dimensions of psychological distress and the overall BSI. Maladaptive coping strategies (self-distraction, denial, self-blame, behavioral disengagement) were positively correlated with distress, whereas agreeableness and positive reframing were negatively correlated. Regression analysis showed that gender, age, education, and psychiatric diagnosis predicted 12% of distress; adding neuroticism increased prediction to 34% and coping strategies to 37%, with self-blame among coping strategies being the strongest predictor. Personality traits and coping strategies were significant predictors of psychological distress during the COVID-19 pandemic. These findings emphasize the need for interventions that target neuroticism and maladaptive coping strategies to improve mental health outcomes during public crises.

Measuring Self-Reported Well-Being of Physicians Using the Well-Being Thermometer: Cohort Study

Background

Advancements in medical science have focused largely on patient care, often overlooking the well-being of health care professionals (HCPs). This oversight has consequences; not only are HCPs prone to mental and physical health challenges, but the quality of patient care may also endure as a result. Such concerns are also exacerbated by unprecedented crises like the COVID-19 pandemic. Compared to other sectors, HCPs report high incidence of stress, depression, and suicide, among other challenging factors that have a significant negative impact on their well-being.

Objective

Given these substantial concerns, the development of a tool specifically designed to be used in clinical settings to measure the well-being of HCPs is essential.

Methods

A United Kingdom-based cross-sectional pilot study was carried out to measure self-reported well-being in a cohort of 148 physicians, using the newly developed well-being thermometer. The aim of the tool is to allow respondents to develop an individual sense of "well-being intelligence" thus supporting HCPs to have better insight and control over their well-being and allow insights into how to manage it. The tool consists of 5 well-being domains-health, thoughts, emotions, spiritual, and social. Each domain can be measured individually or combined to produce an overall well-being score.

Results

The tool demonstrated good internal consistency; the Cronbach α in this study was 0.84 for the total scale.

Conclusions

Results from this cohort demonstrated that the well-being thermometer can be used to gather intelligence of staff well-being. This is a promising new tool that will assist HCPs to recognize their own well-being needs and allow health care organizations to facilitate change in policies and practices to reflect a better understanding of staff well-being.

The impact of inflammatory response on psychological status of medical staff during COVID-19 pandemic

BACKGROUND

Limited research has been conducted on the relationship between inflammatory markers and psychological status in medical staff fighting COVID-19.

OBJECTIVE

This article examines the psychological and inflammatory conditions of medical personnel working on the front lines of the battle against COVID-19.

METHODS

A total of 102 clinical staff members were included in this study. All subjects received the Symptom Checklist-90 questionnaire (SCL-90) and Posttraumatic Stress Disorder Checklist-Civilian questionnaires for assessing different mental symptoms. The levels of various inflammatory markers, including IL-1β, IL-2, IL-6, IL-8, TNF-a, and IFN-γ, along with GDNF, were evaluated.

RESULTS

Spearman correlation analysis showed that the levels of IL-6 were positively associated with the anxiety score (Spearman's rho = .230, p = .021), obsessive-compulsive symptoms (Spearman's rho = .201, p = .042). The levels of IL-8 were negatively associated with the anxiety score (Spearman's rho = -.223, p = .028), obsessive-compulsive symptoms (Spearman's rho = -.252, p = .012), hyperarousal (Spearman's rho = -.221, p = .028). The levels of TNF-α were positively associated with the anxiety score (Spearman's rho = .201, p = .045), obsessive-compulsive symptoms (Spearman's rho = .222, p = .035).

CONCLUSION

Generally, our results suggested that IL-6, IL-8 and TNF-α might play a role in the development of psychological symptoms among medical staff.

Latent profile analysis of burnout, depression, and anxiety symptoms among Chinese medical staff with frontline anti-epidemic experience in the post-COVID-19 pandemic era

Background

Frontline medical staff's psychological symptoms deserve persistent attention after 3 years of high-pressure and high-intensity work during the pandemic. In addition, the meaning of burnout and its relationship with depression and anxiety have long been debated. This study aimed to identify profiles of these symptoms among Chinese medical staff with frontline anti-epidemic experience, along with their distinguishing characteristics.

Methods

Psychological symptoms of burnout (exhaustion, cynicism, and inefficacy), depression, and anxiety from 989 doctors and 1,105 nurses were explored with latent profile analysis. The R3step method was conducted to analyze the predictive factors of those medical staff's symptoms.

Results

Three symptom profiles were identified for medical staff, with high-level (62.1%), moderate-level (28.9%), and low-level symptoms (9.0%). In the low-level and moderate-level profiles, symptom variables considered had a consistent trend. However, within the high-level profile, the inefficacy of burnout remained at a lower level, and anxiety performed as the most prominent symptom. Variables of gender, age, salary satisfaction, work hours, and work intensity predicted medical staff profiles (p < 0.05).

Conclusion

In the post-COVID-19 era, former frontline Chinese medical staff's psychological symptoms were divided into three latent profiles. Symptoms of burnout, depression, and anxiety did not move in lock-step, indicating that they are different and robust constructs. Targeted intervention strategies should be developed for different subgroups.

Anxiety and Depression-Related Factors in Hospitalized Patients Diagnosed With Coronavirus Disease 2019: A Detailed Cross-Sectional Analysis From a Tertiary Center

Aim During pandemic periods, psychogenic assessment and precautions are critical for patients requiring hospitalization. This study investigates the factors influencing anxiety levels in patients hospitalized for coronavirus disease 2019 (COVID-19) and analyzes the impact of demographic, social, and medical variables on anxiety and depression levels. Methods The research involved 150 female and 180 male patients hospitalized and treated in the adult pandemic service of a tertiary referral center in Istanbul from November 5, 2020, to February 5, 2021. Data were collected from patients on the third day of hospitalization by face-to-face or room-phone interviews. The study employed a hospital anxiety and depression scale together with sociodemographic information forms. Results Statistically significant positive associations were observed between anxiety and depression scores and age, as well as the severity of shortness of breath. Conversely, negative associations were identified with educational status. Female patients exhibited significantly higher scores in both categories compared to men. Illiterate individuals exhibited significantly higher anxiety scores than those who graduated from middle and high school. Non-working individuals exhibited significantly higher anxiety and depression scores compared to their working counterparts. Patients with chronic kidney disease, malignancy, and chest pain exhibited significantly elevated anxiety and depression scores relative to those without these conditions. Regarding room type, anxiety and depression scores were significantly higher in single rooms compared to double rooms and in the presence of a companion compared to being alone. In the logistic regression model, the primary anxiety risk factors identified include non-working status, a negative perception of the effectiveness of protective equipment, occupancy of single rooms, and fear of death. The main risk factors for depression identified were fear of death, a heightened risk among individuals with insufficient knowledge compared to those with adequate knowledge, absence of companionship, and a lack of educational information. Conclusions In patients who were illiterate, unemployed, lacked sufficient knowledge, held negative perceptions about protective equipment, experienced fear of death, resided in a single room, and were without an accompanying individual, both infection management and mental health must be addressed with sensitivity, and programs for psychological support should be formulated. The study's findings could potentially guide future pandemics.

Evolution of Well-Being and Associated Factors during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic was a global public health crisis with an unparalleled impact worldwide, presenting a significant challenge for both physical and mental health. The main objective of this study was to analyze the risk of depression during the COVID-19 pandemic and how this was affected by sociodemographic factors, pandemic fatigue, risk perception, trust in institutions, and perceived self-efficacy.

METHODS

A cross-sectional study was conducted in the Region of Murcia through two online surveys completed by 1000 people in June 2021 (Round 1) and March 2022 (Round 2). Risk of depression was measured using the 5-item World Health Organization Well-Being Index (WHO-5) questionnaire, and descriptive, bivariate, and multivariate regression analyses were performed to identify factors associated with the risk of depression.

RESULTS

In Round 1, 35.2% of the sample presented a risk of depression, which increased to 39.1% in Round 2. Those at greater risk were women, individuals with lower socioeconomic status, those with less family support, lower trust in institutions, higher perceived risk of contracting the disease, and higher levels of pandemic fatigue.

CONCLUSIONS

Identifying vulnerable populations facing mental health issues can help the authorities and institutions that are responsible for managing public health crises to develop and implement inclusive strategies and interventions tailored to the population's needs.

Impact of the COVID-19 Pandemic on Subjective Well-Being and Quality of Life: A Comprehensive Bibliometric and Thematic Analysis

This study employs bibliometric and thematic analysis to evaluate the growing body of research on subjective well-being and quality of life during the COVID-19 pandemic. The findings underscore the pandemic's profound impacts on global health, evidenced by a notable increase in studies addressing mental health and quality of life, fostered by international scientific collaboration. Keyword analysis reveals critical themes, including the pandemic's influence on mental health, physical activity, and social support systems. This research provides valuable insights into the long-term consequences of the pandemic and highlights adaptive strategies for managing future crises. By identifying key trends and research gaps, the study serves as an essential resource for academics, policymakers, and public health practitioners, offering a roadmap for future investigations.

An umbrella review of the prevalence of depression during the COVID-19 pandemic: Call to action for post-COVID-19 at the global level

BACKGROUND

Pandemics can lead to mental health problems such as depression. This meta-analysis of meta-analyses aimed to estimate the precise prevalence of depression during the COVID-19 pandemic.

METHODS

Web of Science, PubMed, Scopus, and Embase were searched for published meta-analyses using relevant keywords, such as depression, prevalence, COVID-19, and meta-analysis up to March 18, 2024 according to the PRISMA guidelines. Relevant journals as well as the search engine Google Scholar were manually searched to discover more articles. The AMSTAR tool was used for quality assessment. A random-effects model was used for the analysis. All analyses were conducted using the STATA 17 software.

RESULTS

Of 535 records, 82 meta-analyses were included. The results showed that the overall prevalence of depression was 30% [95% CI: 29-32] with a high heterogeneity (I2: 90.98%). The highest prevalence of depression according to population group was found in medical students (40% [30-49]), specific groups (40% [3-78]), and patients (36% [27-45]). The results of meta-regression based on the different times between the start of COVID-19 and the last date of search in the articles (week) and the prevalence of depression, showed that each past week of Covid-19 increases the prevalence of depression by almost 0.00021% [95% CI: -0.00025, 0.00068], P-value: 0.36, but "time" is not a significant predictor of an increase in depression.

CONCLUSIONS

The results showed that the prevalence of depression was high during the COVID-19 pandemic, particularly among medical students. Policy makers should pay more attention to these groups and those who are at greater risk. Primary mental health interventions and policies are necessary to support the mental health of these individuals during the pandemic.

The voices of youths in COVID-19 times: exploring young people's emotional representations

Since the spread of the COVID-19 virus worldwide, the pandemic had psychological consequences for the entire population for various reasons including restrictions, isolation, and socioeconomic changes. Young people were particularly affected by these psychological consequences, which formed the focus of the mental health concerns voiced by the World Health Organization. This research aimed to analyze, first-hand, the primary emotions that COVID-19 evoked in young Spanish people after two years of the pandemic. Participants were recruited through a snowball sampling procedure using emails, virtual platforms of the schools, and social networks, and a google forms questionnaire was administered for data collection. A total of 479 Spanish young people (18-36 years) participated in this study. The questionnaire consisted of a free-association exercise based on the Grid Elaboration Method (GEM) to analyze the participants' emotional representations of COVID-19. In addition, lexical analysis was used to analyze the text corpus. As a result, it could be observed that sadness was the core emotion experienced among young people, followed by fear. Specifically, emotional breakdown, fear, fatigue, and anger figured centrally in their emotional representations. Moreover, the findings revealed new patterns of self- and onward blaming towards youths. It was concluded that results of this research provide important clues for managing the mental health of young people, particularly during future pandemics.

Depression and anxiety between nurses and nursing assistants working in long-term care facilities during the COVID-19 pandemic

AIM

This study investigated the levels of depression and anxiety in nurses and nursing assistants working in long-term care facilities during the COVID-19 pandemic. We also explored the potential causes of depression and anxiety in nurses and nursing assistants working in long-term care facilities during the pandemic.

BACKGROUND

The COVID-19 pandemic has had a considerable impact on long-term care facilities. The high infection and mortality rates for COVID-19 have resulted in an increased workload for caregivers.

INTRODUCTION

The COVID-19 pandemic exposed caregivers working in long-term care facilities to higher risks of anxiety and depression. Additionally, the high risk of infection in the work environment and concerns about spreading COVID-19 to family members and long-term care facility residents led to various forms of stress among caregivers.

METHODS

The present study was a cross-sectional study. Questionnaires were used to investigate depression and anxiety among regarding nurses and nursing assistants working in long-term care facilities during the pandemic.

RESULTS

The depression and anxiety levels of the nurses were higher than nursing assistants, but had no statistically significant difference (p = 0.551). The factors influencing levels of depression and anxiety in nurses contained facility affiliation and experience working. In terms of nursing assistants, age, marital status, and facility affiliation were correlated with the levels of depression and anxiety.

DISCUSSION

The pandemic has severely impacted caregivers. In the process of implementing pandemic prevention measures and providing care for COVID-19 patients, safeguarding the psychological health of caregivers is also essential.

CONCLUSION

The levels of depression and anxiety in nurses were higher than in nursing assistants working in long-term care facilities during the pandemic.

IMPLICATION FOR NURSING AND HEALTH POLICY

Long-term care facilities managers are recommended to enhance the education and training process for caregivers. Managers are also recommended to ensure provision of sufficient amounts of pandemic prevention equipment and resources.

Influences of sex and gender on the associations between risk and protective factors, brain, and behavior

Risk and protective factors for psychiatric illnesses are linked to distinct structural and functional changes in the brain. Further, the prevalence of these factors varies across sexes and genders, yet the distinct and joint effects of sex and gender in this context have not been extensively characterized. This suggests that risk and protective factors may map onto the brain and uniquely influence individuals across sexes and genders. Here, we review how specific risk (childhood maltreatment, the COVID-19 pandemic, experiences of racism), and protective factors (social support and psychological resilience) distinctly influence the brain across sexes and genders. We also discuss the role of sex and gender in the compounding effects of risk factors and in the interdependent influences of risk and protective factors. As such, we call on researchers to consider sex and gender when researching risk and protective factors for psychiatric illnesses, and we provide concrete recommendations on how to account for them in future research. Considering protective factors alongside risk factors in research and acknowledging sex and gender differences will enable us to establish sex- and gender-specific brain-behavior relationships. This will subsequently inform the development of targeted prevention and intervention strategies for psychiatric illnesses, which have been lacking. To achieve sex and gender equality in mental health, acknowledging and researching potential differences will lead to a better understanding of men and women, males and females, and the factors that make them more vulnerable or resilient to psychopathology.

Consumo de alcohol, tabaco y cannabis en profesionales sanitarios en España durante la fase pandémica aguda de COVID-19

INTRODUCCIÓN

la pandemia de la COVID-19 expuso a los profesionales sanitarios a circunstancias que incrementaron su estrés, recurriendo al consumo de sustancias como estrategia de afrontamiento.

OBJETIVOS

conocer el patrón de consumo de alcohol, tabaco y cannabis en profesionales sanitarios españoles en el periodo prepandemia y durante la fase pandémica aguda (FPA), diferenciando en función de la profesión y estableciendo si hubo diferencias entre ambos periodos.

MÉTODOS

estudio descriptivo no probabilístico con muestreo por conveniencia. Participaron 630 profesionales sanitarios. Se utilizó una encuesta en línea con categorización de la profesión sanitaria, AUDIT-C para consumo de alcohol, preguntas ad hoc para tabaco, y CAST para cannabis. Se realizó análisis de frecuencia y diferencia de medias (t de Student, Z Wilcoxon), reportando el tamaño del efecto y Phi.

RESULTADOS

el 57.1 % de los profesionales sanitarios mostró consumo de la riesgo de la alcohol antes de la FPA; disminuyendo al 42.4 % en la FPA. Entre los consumidores, la proporción de consumidores de riesgo previa a la FPA fue del 95 % en todas las profesiones sanitarias y superior al 65 % durante la FPA. Entre ambos periodos, únicamente hubo un descenso significativo en médicos/as (χ2 MN = 8.108; p < 0.004). Respecto al tabaco, el 14.1 % afirmó consumirlo, observándose un incremento significativo del consumo medio de cigarrillos entre ambos periodos (t(80) = -3.994; p < 0,001), explicado por el incremento entre psicólogos/as (t(42) = -3.245; p < 0.002). Respecto al cannabis, el 2.7 % afirmó haberlo consumido, presentando el 14.3 % adicción moderada y el 7.1 % dependencia.

CONCLUSIONES

durante la crisis sanitaria se produjo una reducción del consumo de alcohol, tabaco y cannabis entre profesionales sanitarios, siendo desigual por categoría profesional. Sin embargo, se detectaron incrementos del consumo y consumos de riesgo en algunos colectivos, señalándose las implicaciones para su salud y labor sanitaria. Se propone impulsar medidas de promoción de la salud mental en los centros sanitarios que incorporen estrategias de abordaje de sustancias.

Management Of Psychiatric Emergencies and Associated Comfort Among EMS Physicians in Lombardy, Italy: A Cross-Sectional Study

OBJECTIVES

The aims of this study were to explore the knowledge of EMS physicians (EMSPs) on the legal aspects related to the management of prehospital psychiatric emergencies, assess their degree of comfort, and measure their perceived communication skills.

METHODS

A survey was distributed to the 376 EMSPs working in the prehospital setting in Lombardy, Italy. Knowledge of medico-legal aspects was measured through multiple-choice questions; the Comfort Score (CS) and perceived Communication Skills Score (CSS) were calculated using Likert Scale questions. CS ranged from 11 points (lowest) to 44 (highest); CSS ranged from 8 points (lowest) to 32 (highest).

RESULTS

A total of 272 EMSPs answered the survey (RR= 72.3%); 45.2% were women. Mean age was 45.76 years (SD 8.8). Mean percentage of correct knowledge test answers was 52.4 (SD 12.3); 81.3% believed to have little knowledge of the Italian legislation regarding this topic. Mean CS was 29.3 (SD 5.5); mean CSS was 19.1 (SD 3.9). A higher percentage of correct answers in the knowledge test was associated with lower CS (P = 0.019). Higher self-appraised knowledge of the Italian legislation was associated with higher CS (P < 0.001) and higher CSS (P < 0.001).

CONCLUSIONS

These findings should prompt policy makers to ensure proper training and support for EMSPs in the matter of prehospital psychiatric emergency management.

Effectiveness of a Saffron and Withania Supplement on Mood in Women With Mild-to-Moderate Anxiety During the COVID-19 Lockdown

Background: A nutritional supplement based on medicinal plants (saffron and ashwagandha), tryptophan, and vitamin B6 could contribute to alleviating/improving mood and associated disorders. The aim of this study was to evaluate the potential benefits of this combination supplement. During the study period, participants underwent a period of forced home confinement due to the COVID-19 pandemic, which represented an unexpected impact factor. Methods: This open-label prospective trial enrolled a cohort of female employees who reported mild to moderate anxiety. The primary objective was to evaluate changes in the level of anxiety using the adapted Hamilton Anxiety Rating Scale (HARS) after 12 weeks of regular supplementation with Safromotive (two tablets daily, for 12 weeks). The secondary objectives were to evaluate health-related quality of life (HRQoL) and tolerability. Results: In total, 46 women with a mean age of 45.0 (6.5) years were included. A statistically significant improvement in HARS was observed, with a 7.5-unit decrease from baseline to 12 weeks (p  < 0.0001) and from 4 to 12 weeks of supplement intake (p=0.0058). However, no significant changes were found during the lockdown period (between weeks 8 and 12 of the study). No relationship was found between women's sociodemographic characteristics and the HARS total score. A significant reduction in the HRQoL questionnaire score of 1.2 units was observed between baselines and 12 weeks of treatment (p=0.0273). At the end of the study, 78.6% of the women reported consistency the supplement intake during the study course. Conclusion: This nutritional supplement composed of saffron, ashwagandha, tryptophan, and vitamin B6 appears to improve anxiety and HRQoL, but confinement could have impacted the evolution of the outcome.

Will Public Health Emergencies Affect Compensatory Consumption Behavior? Evidence from Emotional Eating Perspective

This research examines the correlation between the COVID-19 pandemic and the desire to engage in compensatory consuming behaviors, specifically emphasizing emotional eating as a psychological coping strategy, particularly with respect to snacks and sweets. Conducting sentiment analysis by using a Natural Language Processing (NLP) method on posts from Sina Weibo, a leading Chinese social media platform, the research identifies three distinct phases of consumer behavior during the pandemic: anxiety, escapism, and compensatory periods. These stages are marked by varying degrees of emotional eating tendencies, illustrating a psychological trajectory from initial shock to seeking comfort through food as a means of regaining a sense of normalcy and control. The analysis reveals a notable increase in posts expressing a desire for compensatory consumption of snacks and sweets in 2020 compared to 2019, indicating a significant shift towards emotional eating amid the pandemic. This shift reflects the broader psychological impacts of the crisis, offering insights into consumer behavior and the role of digital platforms in capturing public sentiment during global crises. The findings have implications for policymakers, health professionals, and the food industry, suggesting the need for strategies to address the psychological and behavioral effects of natural disasters.

Trends and determinants of nurses' mental health following the COVID-19 pandemic in China: a longitudinal, comparative study over a two-year period

Introduction

The COVID-19 pandemic has placed nurses at the forefront of healthcare, exposing them to various mental health challenges such as depression, anxiety, and post-traumatic stress disorder (PTSD). However the long-term effects and risk factors of the COVID-19 pandemic on nurses' mental health are unknown. The objective of our study is to investigate the enduring impact of the COVID-19 pandemic on the psychological distress and PTSD of nurses, while also identifying the factors that influence these outcomes.

Methods

To investigate this question, we conducted a self-reported questionnaire survey of 8785 registered nurses recruited using snowball sampling methodology from 22 provinces in China, at five time points (T0-T4). At all times, we took measures of general health, while at the last four times we also measured PTSD. And we used logistic regression analysis to explore their impacts.

Results

The incidence of whole levels psychological distress among nurses was 27.7% at T0, peaking at 57.6% at T4. For severe psychological distress, it began at 5.5% at T0 and rose to 9.5% at T4. PTSD rates among nurses were recorded at 7.8% in T1, reaching a maximum of 14.7% in T4. They all got progressively worse in the volatility. In all times, coping strategies are independent factors for various levels of psychological distress and PTSD, while social support is a key factor for severe psychological distress and PTSD.

Conclusions

Our findings indicated a gradual deterioration in the mental health of nurses following the COVID-19 outbreak. In all instances, coping strategies exhibit an independent correlation with all grades of psychological distress and post-traumatic stress disorder (PTSD), whereas social support emerges as an independent protective factor mitigating the risk of severe psychological distress and PTSD.

Retaining Healing Hands: A Transnational Study on Job Retention Interventions for the Healthcare Workforce

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce's intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution.

Generalized Anxiety Disorder Among Physicians: A Cross-Sectional Study

BACKGROUND

Generalized anxiety disorder (GAD) is defined as excessive worry that occurs on most days for at least six months, causes significant distress or impairment, and is associated with increased use of health services.

METHODOLOGY

A cross‑sectional study was carried out among physicians working in Saudi Arabia through an online questionnaire. The questionnaire consisted of a sociodemographic part and the validated Arabic version of the Generalized Anxiety Disorder‑7 (GAD‑7) questionnaire.

RESULTS

The study included 110 physicians, 63 (57.3%) of whom were women with a mean age of 36.9 ± 10.0 years. Men represented 47 (42.7%) of the participants. The majority of the participants were non-Saudi (80, 72.7%). According to their scores on the GAD-7, 40 (36.4%) participants had no anxiety, 35 (31.8%) had mild anxiety, 25 (22.7%) had moderate anxiety, and 10 (9.1%) had severe anxiety. A score of 10 on the GAD-7 represented a reasonable cutoff point for identifying cases of anxiety. Accordingly, we found that 35 (31.8%) of the participating physicians had anxiety.

CONCLUSION

Physicians working in Saudi Arabia showed a significant rate of general anxiety disorder. Early detection, health education, and treatment are recommended.

Impact of the COVID-19 Pandemic on Physical Therapy Clinical Practice in Egypt: A Cross-Sectional Study

Background The coronavirus disease 2019 (COVID-19) was an expanding pandemic caused by a new strain of the coronavirus family known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). No previous studies have examined the impact of COVID-19 pandemic on physical therapy practice in Egypt. Objectives This study aimed to assess the impact of COVID-19 pandemic on physical therapy clinical practice in Egypt five months after the pandemic declaration. The study investigated how Egyptian physical therapists interacted during the pandemic and the effect of the pandemic on precautionary measures. Additionally, this study assessed the knowledge of physical therapists about COVID-19. Methods A cross-sectional study with a convenient sample was conducted in Egypt through an online structured questionnaire. Data were collected between August 28, 2020, and October 10, 2020. Results A total of 409 physical therapists from 23 Egyptian governorates completed the survey. At some point during the COVID-19 pandemic, 249 (60.9%) physical therapists left their work. Only 131 (32%) visited patients' homes. The majority of respondents, 330 (80.7%), reported that they were afraid to catch any infection from patients during assessment and treatment. Moreover, 330 (80.7%) reported feeling anxious about the COVID-19 pandemic, and 220 (53.8%) reported that their mental health and well-being were not okay. The majority of the participants committed to precautionary measures of physical therapists during the COVID-19 pandemic. The mean knowledge score was 18.29±1.99 out of 23. Conclusions The COVID-19 pandemic affected physical therapy clinical practice in Egypt. It had a psychological impact on Egyptian physical therapists. Egyptian physical therapists committed to precautionary measures against COVID-19 and demonstrated a very good knowledge about COVID-19. Physical therapists should be aware of precautionary measures against infectious diseases, which help can prevent the spread of disease if any new pandemic occurs.

Rehabilitation Specialty Hospital Conversion to Support a COVID-19 Pandemic Surge: Nurses' Perceptions

PURPOSE

The purpose of this study was to understand the novel experience of a rehabilitation specialty hospital conversion to acute medical/COVID-19 patient care from the perspective of rehabilitation nurses.

DESIGN

A descriptive qualitative study was conducted.

METHODS

Thirty-six nurses employed by the rehabilitation specialty hospital were invited to participate. Narrative data were collected via an online survey and were analyzed using a conventional content analysis approach.

RESULTS

Fifteen (42%) of those eligible participated. The overarching descriptor of the rehabilitation nurses' experiences was "we did what we had to do." Three primary descriptors emerged: challenged, conflicted, and compromised. Communication from leadership prominently informed the conversion experience.

CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING

Expecting rehabilitation specialty nurses to care for a different patient population is an important consideration and requires leadership to understand the distinctive characteristics of the specialty and its approach to care.

CONCLUSIONS

Addressing the impact on nursing staff in any disaster requires listening and communicating to provide needed support. Recognizing the characteristics of nursing specialties, the need for self-care among nursing staff and the salience of effective communication are essential during specialty hospital conversions.