The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus

Diagnostic radiographers' lived experiences of trauma imaging

INTRODUCTION

Gauteng in South Africa experiences a high volume of trauma cases that necessitate hospital admissions and medical interventions. As part of the healthcare team, radiographers are responsible for imaging patients with trauma injuries. Treating patients with trauma injuries has a significant impact on the psychological functioning of healthcare workers. Therefore, it was essential to understand diagnostic radiographers' experiences during trauma imaging.

METHODS

A qualitative approach with a phenomenological research design was used. Individual interviews were conducted with qualified diagnostic radiographers experienced in trauma imaging who were purposively sampled from private and public trauma healthcare settings in the Gauteng province. The interview data were thematically analysed.

RESULTS

Three themes and related subthemes were generated: 1) Adverse effects of trauma imaging with the subthemes, professional emotional saturation, desensitisation and vicarious traumatisation; 2) Managing the effects of trauma imaging with the subthemes, preparedness and coping strategies; 3) Developing from trauma imaging experiences with the subthemes post-traumatic growth and professional dedication.

CONCLUSION

Diagnostic radiographers shared that trauma imaging negatively affected them emotionally, compounded by inadequate support and resources. Those with prior exposure to trauma imaging or personal trauma experiences coped better. Despite these challenges, radiographers valued their roles and the chance to improve their skills, expressing a strong passion for their profession and a commitment to their patients' well-being. Diagnostic radiographers would benefit from counselling services and opportunities to debrief.

IMPLICATIONS FOR PRACTICE

This study provides valuable insights into the experiences of diagnostic radiographers working in trauma imaging. These findings can be instrumental for medical imaging departments as they develop targeted strategies to support radiographers imaging trauma patients. Additionally, radiography educators can use the study findings to prepare students for trauma imaging.

Fear of Death, Emotional Intelligence and Resilience Among Healthcare Staff During COVID-19: A Correlative Study

The suffering, pain and fear of death experienced by patients during the pandemic have evoked a wide range of feelings and emotions in healthcare professionals. Managing these emotions is influenced by factors such as emotional intelligence and resilience. Recognising and addressing these emotions can enhance the quality of care and help prevent mental health issues. This study analyses the relationship among fear of death, emotional intelligence and resilience, as along with the sociodemographic variables of healthcare professionals during the COVID-19 pandemic. A descriptive, comparative and correlational study was conducted. Participants included professionals from the Neurosurgery, Pneumology, Emergency Service and Floating Staff units in a tertiary-level hospital in Spain. Data were collected through an anonymous and voluntary online survey, which included sociodemographic data, Collett-Lester fear of death, emotional intelligence and resilience scale. Participation was anonymous and voluntary. A total of 121 professionals participated, predominantly women (85.12%), with a mean age of 41.89 years (SD ± 9.6). Nurses compromised 64% of the sample. Fear of others' death (37.2%) and the dying process of others (33.1%) increased. Emotional intelligence levels were generally adequate across all work areas, with women scoring higher in attention and clarity. However, significant differences in emotional regulation were observed between groups. Resilience scores were high across all participants (> 78.77). Positive correlations were found among age, fear of the dying process of others (p=0.003) and resilience (p=0.002). An inverse correlation was observed between fear of others' death and resilience (p=0.018) and emotional regulation (p=0.020). Linear regression analysis identified attention to emotions, acceptance and bioethics training as predictors of fear of death.

Large-scale validation of the Kessler-10 Scale's psychometric properties among healthcare professionals in China

OBJECTIVES

The Kessler Psychological Distress Scale (K10) is a 10-item questionnaire designed to measure psychological distress. The present study aimed to validate the factor structure of the K10 and its reliability and validity using a large sample from healthcare professionals in China mainland.

METHODS

K10 data were collected in September 19 to October 20, 2023 via anonymous online survey (total sample, N = 8602). The internal consistency reliability of the K10 was examined. Exploratory factor analysis (N = 4301) and confirmatory factor analysis(N = 4301) were conducted to validate the structural validity.

RESULTS

Exploratory factor analysis revealed two factors, depression (DEP) and anxiety (ANX), which together accounted for 75.91 % of the total variance. Confirmatory factor analysis further supported the two-factor oblique model as the best fit, outperforming the one-factor model. The internal consistency of the K10 was α = 0.952, while the internal consistency coefficients for ANX and DEP were 0.883 and 0.940, respectively.

CONCLUSIONS

K10 is a validated and concise tool that serves a dual purpose of screening psychological distress and assessing depressive and anxiety symptoms among healthcare professionals in China.

Crisis Management and Problem-Solving Skill Levels of Nurses Caring for Patients With COVID-19 and Affecting Factors: A Cross-Sectional Survey

This study aims to assess the crisis management and problem-solving skills of nurses caring for patients with COVID-19. The participants of this descriptive cross-sectional were 132 nurses who cared for patients with COVID-19 in a public hospital. The crisis management scale (CMS), problem-solving inventory (PSI), and Nurse Introduction Form were used to collect data. In this study, the nurses' CMS total score average was 3.75 ± 0.442, the average PSI total score was 86.32 ± 24.420, and it was determined that their crisis management ability was at a good level and their problem-solving skills were at a medium level. A significant difference was found between the nurses' descriptive characteristics of having children (P = .029), being informed about crisis management (P = .035), and their total average score on the CMS (P < .05). A statistically significant negative relationship was found between the nurses' total CMS and PSI scores (P < .05).This study showed that the problem-solving skill levels of nurses caring for patients with COVID-19 affected their crisis management skills.

Psychometric properties and validity of inventory of symptoms of professional traumatic grief among nursing professionals

BACKGROUND

Traumatic grief can exert a considerable influence on the mental and physical well-being of nurses, potentially altering their ability to provide high quality care. This impact is most pronounced in specific contexts such as health emergencies, palliative care and paediatric intensive care units. In the context of the Covid-19 pandemic, health professionals have faced an unprecedented increase in loss and trauma, and this situation is seen as an exacerbating factor in complicated bereavement. Despite the availability of instruments for the assessment of prolonged or pathological grief, there is a pressing need for additional studies that allow for a more accurate understanding and measurement of this phenomenon, filling certain existing methodological gaps. The main purpose of this research is to evaluate the psychometric properties of the Inventory of Symptoms of Professional Traumatic Grief (ISDUTYP), with a view to improving assessment tools in this field.

METHOD

Construct validity, reliability, criterion validity, convergent validity and discriminant validity were assessed. The scale's psychometric properties were tested with 930 nursing professionals. The data were collected between September 2022 and January 2023.

RESULTS

A total of 930 people took part in the study. The factorial analysis of ISDUTYP showed that, according to eigenvalues and the scree plot, the optimal number of factors was 2. These factors consisted of 13 and 12 items, respectively, and had clinical significance. Factor 1 could be termed "Behavioural Symptoms," while Factor 2 could be termed "Emotional Symptoms." Cronbach's alpha values demonstrated excellent reliability for all scores. In particular, Cronbach's alpha was 0.964 for the overall score, 0.950 for the behavioural symptoms subscale, and 0.950 for the emotional symptoms subscale. Regarding criterion validity, all expected correlations were statistically significant. Finally, almost all hypotheses defined of convergent and discriminant validity were fulfilled.

CONCLUSIONS

The high reliability and validity of the scale supports its use in research and clinical practice to assess the impact of professional traumatic grief and enhance its treatment. The validated scale for measuring nurses' grief has significant implications in clinical practice, allowing for the identification and management of nurses' grief, fostering a healthy work environment, and improving patient care quality.

Direct and Indirect Effects of Risk Perception and Risk Information on PTSD in Frontline Healthcare Workers

Background

The COVID-19 Delta variant caused an outbreak in Guangdong in mid-May 2021. The risk information and risk perception of COVID-19 have been considered factors associated with mental health statuses, especially posttraumatic stress disorder (PTSD), in frontline healthcare workers.

Objective

The aim of this study is to investigate the interactive relationship in risk information and risk perception of COVID-19 and PTSD in healthcare personnel from the emergency department.

Design

We conducted a survey one month after the outbreak. A cross-sectional survey design is adopted, and 3078 participants are enrolled. The PTSD checklist for DSM-5 (PCL-5), risk information questionnaire, and risk perception questionnaire are utilized to collect data.

Methods

Bivariate correlation analysis and structural equation modelling are performed to analyze the mediating role of risk perception in the relationship between risk information and PTSD.

Results

The estimated prevalence of PTSD among frontline healthcare workers is 28.2%. The risk information for COVID-19, risk perception, and PTSD symptoms are mutually correlated. The specific paths from risk perception to PTSD show significant effects, in which two had negative effects and one had a positive effect. The risk perception feature in 2020 differed from that in 2019, which is largely due to the risk perception of the virus.

Conclusion

The estimated prevalence of PTSD among frontline healthcare workers remains high. Risk information for COVID-19 has dual effects on PTSD through the mediation of risk perceptions. Unfamiliarity with the SAR-COVID-2 Delta variant increased the risk perception of COVID-19. Effective risk communication regarding COVID-19 can have a positive effect on the mental health of frontline healthcare workers.

Anxiety or reflection? exploring profiles of death awareness among chinese nurses: a latent profile analysis

BACKGROUND

Nurses frequently encounter death due to their professional roles, impacting their perceptions of mortality. Previous research has largely focused on the negative aspect of death awareness, known as death anxiety, while the other aspect, death reflection, has been less explored. This study aims to investigate the profiles of death awareness among Chinese nurses and identify factors influencing these profiles, such as socio-demographic characteristics, work-related characteristics, death education, and resilience.

METHOD

A cross-sectional study was conducted using a convenience sample of 2882 nurses across China. Data were collected through an online survey from September to November 2023. Latent Profile Analysis was utilized to identify distinct profiles of death anxiety and death reflection among nurses. Multinomial logistic regression was used to analyze the predictive factors for different death awareness profiles.

RESULTS

Three distinct profiles were identified: Calm Reflectors (low death anxiety, high death reflection), The Anxious (high death anxiety, low death reflection), and Anxious Reflectors (high levels of both death anxiety and death reflection). Factors such as resilience, years of service, parental status, education level, and read death education-related information significantly predicted the classification into these profiles. Specifically, higher resilience and engagement in death education were associated with the Calm Reflectors profile.

CONCLUSIONS

Our study suggests that nurses' death awareness can be categorized into three distinct profiles: Calm Reflectors, The Anxious, and Anxious Reflectors. Key predictors of these profiles include resilience, educational level, years of service, parental status, and read death education-related information. The findings suggest that enhancing resilience and targeted educational interventions are crucial for supporting nurses in managing death-related emotional and cognitive responses effectively.

Barriers and facilitators to seeking psychological support among healthcare professionals: a qualitative study using the Theoretical Domains Framework

BACKGROUND

Despite facing significant mental health risks, healthcare professionals often demonstrate a low frequency of seeking psychological support. This study aimed to explore the factors influencing healthcare professionals' psychological help-seeking behaviours in order to enhance the mental health of this critical population.

METHODS

Semi-structured interviews were conducted with registered clinical doctors, nurses, and hospital managers aged 21-55 years, recruited from comprehensive public hospitals in China. Participants were selected through purposive and snowball sampling to ensure diversity in roles, specialities, and work experiences. The interview guide was developed using the Theoretical Domains Framework (TDF) to explore the reasons for seeking psychological support. Data were analyzed using framework analysis and relevant domains were identified according to the frequency of participants' belief statements. The facilitators and barriers in each domain were summarized using the coded reference points.

RESULTS

A total of 34 participants were interviewed (12 nurses, 8 physicians, 14 hospital managers). We identified seven relevant domains in influencing the behaviour of seeking psychological support: knowledge, beliefs about capabilities, environmental context and resources, social/professional role and identity, emotion, social influences, and behavioural regulation. The most common facilitators of psychological help-seeking include accessible resources, positive interpersonal relationships, increased awareness, effective behavioural strategies, and emotional acknowledgement, while barriers include privacy concerns, stigma, time constraints, doubts about the effectiveness of psychological services, limited knowledge, and perceived professional role conflicts.

CONCLUSION

The behaviour of healthcare professionals seeking psychological support is complex and influenced by the interaction of multiple factors. The findings highlight the need for targeted interventions that enhance mental health literacy, address stigma, provide accessible psychological support resources, and cultivate a supportive organisational culture to improve their well-being.

Comparative bibliometric study of mental health research trends during COVID-19, Mpox, dengue, and Ebola outbreaks infectious diseases

As the prevalence of mental health issues continues to rise, the impact of widespread diseases on mental health has garnered increasing attention. This study employs bibliometric analysis to evaluate the state of research on mental health concerns associated with four infectious diseases: COVID-19, mpox, dengue fever, and Ebola. Utilizing Citespace, we conducted an in-depth analysis encompassing publication trends, author networks, institutional affiliations, and international collaborations, alongside themes in references and keywords. Our findings reveal that each of these diseases has significantly affected mental health over the last two decades. Notably, the volume of mental health literature related to COVID-19 far surpasses that of the other diseases, with 34 833 documents compared to 36 for mpox, 62 for dengue, and 279 for Ebola. The United States emerges as the most influential country in this field. International cooperation during infectious diseases was not strong, and the contribution of low-middle income countries was lower than that of high income countries. Our research underscores the growing societal relevance of mental health, influenced by factors including social distancing and mortality due to these diseases. Looking ahead, there is a crucial need for enhanced international cooperation and a focused attention on the mental health of vulnerable populations during pandemics.

Post-pandemic depression, anxiety, and stress: A look at the mental health of medical and administrative staff

INTRODUCTION

Research has shown how mental health among hospital staff worldwide was affected during the COVID-19 pandemic. However, evidence of the physiological status of healthcare and administrative workers at the first level of medical care post-pandemic is scant. Therefore, it is necessary to identify mental health problems among hospital staff following the COVID-19 pandemic.

OBJECTIVE

To determine the prevalence of symptoms and severity of depression, anxiety, and stress among health personnel in the primary care post-pandemic of the Institute of Social Security and Services for State Workers in Puebla.

MATERIALS AND METHODS

A cross-sectional observational study was conducted on medical and administrative staff, comprising 190 participants who worked during the pandemic. A data collection instrument and the 21 item Depression, Anxiety, and Stress Scale were used to determine the prevalence of symptoms and severity of these three mental health issues.

RESULTS

The prevalence of symptoms of depression was 20.5 %, with a moderate predominant severity index (38.5 %), anxiety was 33.2 %, with an extremely severe predominant index (36.5 %), and stress was 30.0 %, with a moderate predominant severity index (36.8 %), respectively. The nursing subgroup, within the medical area staff, exhibited a prevalence of anxiety symptoms of 44.7 %, which was statistically significant (p = 0.008).

CONCLUSION

Despite the post-pandemic period during which this study was conducted, the nursing staff was the most affected group in terms of the prevalence of symptoms of anxiety and depression. Another relevant finding was that administrative workers showed an extremely severe intensity of symptoms of depression, anxiety, and stress.

Understanding the impact of the pandemic on university students: Changes in sleep, eating patterns, and psychological well-being

BACKGROUND

Covid-19 is one of the world's major pandemics. It has affected millions of people in various ways.

OBJECTIVE

This study investigates the influence of pandemic-induced shifts in eating and sleeping behaviors on the psychological well-being of university students.

METHODS

The study adopted a cross-sectional research design. A total of 604 students participated in the study. The Personal Form, the Psychological Well-Being Index, and the Pittsburgh Sleep Quality Index were used to collect data. The research was conducted between October 2021 and December 2022.

RESULTS

The participants reported a mean psychological well-being score of 40.76 ± 9.38, alongside a Pittsburgh Sleep Quality Index score of 7.46 ± 3.30. Analysis revealed a significant negative correlation between the mean psychological well-being scores and the Pittsburgh Sleep Quality Index scores (p < 0.01). Throughout the pandemic, the participants experienced a decline in physical activity, an increase in their body weight, and a change in their eating habits. While psychological well-being remained relatively high, sleep quality was notably poor. Notably, improvements in psychological well-being corresponded with enhancements in sleep quality, suggesting a reciprocal relationship between the two variables.

CONCLUSIONS

The pandemic negatively impacted the physical activity and body weight of young adults. This study highlights the importance of promoting physical activity among university students during pandemics and similar crises to reduce adverse effects on body weight. It also highlights the importance of educating students about the importance of healthy sleep and how to maintain good sleep hygiene.

The mental health impact of repeated COVID-19 enforced lockdowns in England: evidence from the UK Household Longitudinal Study

BACKGROUND

Research shows initial COVID-19 lockdowns increased population mental distress. Yet, the mental health impact of repeated lockdowns in England remains unknown.

AIMS

To: (a) explore changes in population mental health symptoms over the COVID-19 pandemic period (March 2020 to March 2021) in England, comparing this with trends from a decade before (2009-2019) as well as after (2021-2023); (b) compare the mental health impact of each of the three lockdowns in England with periods of eased restrictions, determining who was most affected; (c) examine the impact of demographics and distinct time periods on the prevalence of mental health symptoms.

METHOD

A secondary analysis of a national longitudinal cohort study, utilising data from Waves 1-13 of the UK Household Longitudinal Study and from Waves 1-9 of the COVID-19 Survey. Mental health was assessed using the 12-item General Health Questionnaire. Student t-tests and logistical regressions were conducted.

RESULTS

There was a significant increase in the prevalence of self-reported symptoms of mental health during England's pandemic period, encompassing three lockdowns, compared with the average of rates from 10 years before. Rates of reported mental health symptoms were not significantly different across each lockdown, but were significantly higher than pre-pandemic rates, declining with eased restrictions. Rates from the end of lockdown to May 2023 revealed elevated mental health symptoms compared with pre-pandemic. Elevated symptoms were observed for women, people homeworking, those with health conditions, individuals aged 30-45 years and those experiencing loneliness.

CONCLUSION

Repeated lockdowns in England had a substantial impact on mental health, indicating requirements for ongoing mental health support.

Impact of the COVID-19 pandemic on health emergency and disaster risk management systems: a scoping review of mental health support provided to health care workers

OBJECTIVES

This systematic scoping review examined the strategies used by different countries and institutions to support the mental health of health care workers (HCWs) during the COVID-19 pandemic, to identify effective practices and the lessons learned in dealing with the associated challenges.

METHODS

Of 1330 retrieved articles from PubMed, Scopus, and the Web of Science, 34 articles were ultimately included in the final analysis.

RESULTS

The analysis revealed that mental health consultation services, especially telephone support lines, online interventions, and apps, played a critical role in addressing the psychological burden experienced by HCWs. Group activities and peer support strategies offered personalized support, and educational programs offered crucial information regarding stress management. Improvements in the work environment, such as the addition of dedicated rest areas, enhanced the well-being of HCWs. However, many interventions suffered from low participation and a lack of tailored content, despite their apparent effectiveness.

CONCLUSIONS

Many interventions have focused on psychological support and resilience-building for HCWs, but they often overlook systemic issues. Comprehensive mental health support must address these systemic factors, such as adequate staffing, training, and resource allocation. Future strategies should emphasize leadership commitment to tackling root causes and actively involve HCWs in program design to ensure relevance and effectiveness. Educational resources and wellness interventions, although reported as effective, need to be tailored and adapted to specific emergencies. Additionally, research gaps, especially in low-resource settings, highlight the need for further studies to enhance preparedness for future crises.

Unraveling the interconnectedness between physician burnout and symptoms of depression, anxiety, and stress: a network analysis among Chinese psychiatrists

Background

The COVID-19 pandemic significantly increased the levels of burnout and symptoms of depression, anxiety, and stress among healthcare professionals. However, research on the interrelations between burnout and psychological symptoms is scarce, particularly among psychiatrists. This study addresses this gap in a national sample.

Method

Data was collected via an online survey conducted in Mainland China from January to March 2021 with a sample size of 3,783 participants. Psychological symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21), and physician burnout was assessed using the Maslach Burnout Inventory-Human Service Survey (MBIHSS). Network analysis was used to examine the interconnection between physician burnout and psychological symptoms, with further analysis conducted on multiple levels, including individual symptoms in central positions or acting as bridges between clusters, and identifying core symptom combinations with significant correlations.

Results

Stress emerged as the highest Expected Influence (EI) index, with emotional exhaustion in the burnout cluster being the singular bridge symptom. Furthermore, depressive symptoms such as hopelessness and anhedonia showed a strong and the most straightforward association with emotional exhaustion, while stress-related overreaction was closely associated with depersonalization.

Conclusion

Network analysis between burnout and psychological symptoms identified critical symptoms like stress and emotional exhaustion in Chinese psychiatrists. Close monitoring of these symptoms may be crucial for mitigating the risk of common psychological disturbances and preventing their exacerbation in this population.

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.

Comparing E-Cigarettes and Traditional Cigarettes in Relation to Myocardial Infarction, Arrhythmias, and Sudden Cardiac Death: A Systematic Review and Meta-Analysis

BACKGROUND

The use of electronic cigarettes (e-cigarettes) as a perceived safer alternative to traditional cigarettes has grown rapidly. However, the cardiovascular risks associated with e-cigarettes compared to regular cigarettes remain unclear.

OBJECTIVE

To systematically review and compare the cardiovascular outcomes of e-cigarette use versus traditional cigarette use, focusing on the risks of myocardial infarction, arrhythmias, and sudden death.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Peer-reviewed studies published in English were included if they reported cardiovascular outcomes related to e-cigarette or traditional cigarette use. A total of 20 studies were included, covering observational and interventional studies focusing on heart rate variability, myocardial infarction, arrhythmias, and sudden cardiac events. The quality of the evidence was assessed using the GRADE criteria, and data were extracted and analyzed based on the PICOS (Population, Interventions, Comparisons, Outcomes, and Study designs) framework.

RESULTS

The systematic review found that both e-cigarettes and traditional cigarettes pose significant cardiovascular risks, with traditional cigarettes linked to a higher incidence of myocardial infarction, arrhythmias, and sudden cardiac death. E-cigarette users also face increased risks of arrhythmias and myocardial infarction compared to non-smokers, primarily due to the constituents of aerosolized e-liquid, including nicotine and flavorings, which contribute to adverse cardiac effects. Regular e-cigarette use, particularly in combination with traditional cigarette use, was associated with a heightened risk of myocardial infarction. Studies also reported heart function abnormalities, such as systolic and diastolic dysfunction, and reduced ejection fractions. Additionally, changes in heart rate variability, heart rate, and blood pressure were observed, indicating both acute and chronic effects of e-cigarettes on cardiovascular autonomic regulation.

CONCLUSIONS

While e-cigarettes may present a lower cardiovascular risk compared to traditional cigarettes, they are not without harm. Both products are linked to increased risks of myocardial infarction and arrhythmias, though traditional cigarettes pose a higher overall threat. Given the limitations in the current evidence base, particularly concerning the long-term effects of e-cigarette use, further research is needed to clarify these cardiovascular risks and inform public health guidelines.

Nurses' Experiences at the Intensive Care Unit for COVID-19 in Indonesia: A Study of Hermeneutic Phenomenology

Background

Nurses working in Intensive Care Unit (ICU) for COVID-19 are more at risk as they interact more with infected patients. Therefore, this study aimed to explore the experience of Indonesian nurses who work in ICU for COVID-19 patients.

Materials and Methods

A qualitative hermeneutic phenomenological approach was used. A total of 20 nurses working in the respective ICUs of eight COVID-19 referral tertiary hospitals in Indonesia were recruited using purposive sampling. Semistructured individual video call interviews were conducted in June-September 2021; then, Diekelmann's hermeneutic phenomenological approach was used to analyze and interpret the data.

Results

Thirteen subthemes describing the following four themes, namely, the pleasing and bad feelings, new challenges of working, nursing professional growth, and nurse resource management for COVID-19.

Conclusions

This study describes nurses' experiences working in ICUs during the COVID-19 crisis, such as their feelings, perceived challenges, and received support. Nurse leaders play a significant role in providing adequate Personal Protective Equipment (PPE), flexible work shifts, and a caring and healing work environment. However, being aware of the limit of pressure that an individual can manage and providing adequate allowance as rewards for work in risky areas are essential to avoid burnout.

Impact of COVID-19 Pandemic on the Prevalence of Metabolic Syndrome in Health Care Workers: A Cohort Study at a Designated COVID-19 Hospital in Taiwan

OBJECTIVES

This cohort study aimed to determine the effect of the COVID-19 pandemic on the prevalence of metabolic syndrome (MetS) among health care workers at a dedicated COVID-19 hospital in Taiwan.

METHODS

This study recruited 397 health care workers who completed health checkups before and during the COVID-19 pandemic. The differences of MetS and its components prevalence before and during the COVID-19 pandemic were compared using the paired samples t tests for normally distributed variables, and Wilcoxon signed-rank tests for nonnormally distributed variables.

RESULTS

The prevalence of MetS among health care workers significantly increased from 20.9% to 28.7% during the pandemic ( P < 0.001). Central obesity and hypertension were the primary contributors to the development of MetS.

CONCLUSIONS

COVID-19 pandemic was associated with an increasing prevalence of MetS in health care workers, necessitating health-promoting measures to mitigate this risk.

The impact of the COVID-19 pandemic on the quality of sleep of medical residents in a tertiary care hospital

STUDY OBJECTIVES

The COVID-19 pandemic has created unprecedented levels of stress and anxiety, which has a profound effect on sleep quality. However, limited data are available on the sleep quality of medical residents who work directly with patients infected with SARS-CoV-2. As sleep is a crucial brain state, our goal is to know the sleep quality of these medical residents.

METHODS

This study evaluated sleep quality among medical residents caring for patients with COVID-19 at Hospital São Paulo, São Paulo, Brazil. It used a validated questionnaire and assessed sleep habits and sociodemographic variables. The study focused on sleep latency, bedtime changes, early awakening, and discouragement.

RESULTS

A total of 150 resident physicians participated, 93 females and 57 males. We observed poor sleep quality in 72.7%, discouragement complaints in 91.33%, what was moderate or intense in 52.0%. Discouragement was associated with sleep fragmentation and awakening early in the morning; sleeping pill users had a greater sleep latency (P < .00001). Poor sleep quality was linked to changes in bedtime and use of sleeping medications during social isolation in 2020 (P = .037 and P < .001, respectively).

CONCLUSIONS

During the COVID-19 pandemic, more than two-thirds of resident physicians experienced poor sleep quality. They changed their bedtime, increased sleep latency, the use of hypnotics, feelings of discouragement, fragmented sleep, and early awakening in the morning. These findings should serve as a wake-up call for everyone, especially those in administrative roles. They are a matter of concern for medical residents, chief residents, supervising physicians, medical directors, and faculties. Maximās grātiās vōbīs agimus.

CITATION

dos Santos FTAR, Bizari Fernandes do Prado L, Bizari Coin de Carvalho L, do Prado GF. The impact of the COVID-19 pandemic on the quality of sleep of medical residents in a tertiary care hospital. J Clin Sleep Med. 2025;21(1):17-22.

Predictors of Generalized Anxiety Disorder (GAD) among health care providers during the COVID-19 pandemic at a regional teaching and referral hospital in Western Kenya

Corona Virus Disease of 2019 (COVID-19) is an unprecedented challenge to health care systems globally and locally. The study aimed to assess generalized anxiety disorder and associated factors among health care providers (HCP) during COVID-19 pandemic. A total of 202 health care providers participated in the study. This was a hospital-based cross-sectional study. The survey questionnaire consisted of six components: demographic factors, occupational factors, psychological factors, socioeconomic factors, and the multi-dimensional scale of perceived social support (MSPSS). The symptoms of anxiety were measured by a standardized questionnaire, a 7-item Generalized Anxiety Disorder scale (GAD-7). Chi-Square statistic was used as a selection criterion for the predictors of generalized anxiety disorder to be included in the final binary regression analysis model at α<0.05. Among 202 health care providers interviewed, the overall prevalence of anxiety symptoms was 59.9%. Some of the aspects that reduced the risk of GAD were; being a younger HCP (OR 0.11, P = 0.004), fewer years of experience (OR 0.09, P = 0.008), availability of workplace precautionary measures (OR 0.06, P = 0.004), lower income level (OR = 0.04, P = 0.014), living alone (OR = 0.02, P = 0.008) and permanent employment terms (OR = 0.0001, P< 0.0001). On the other hand, insufficient state of personal protective equipment (PPEs) (OR = 10.64, P = 0.033), having a family member as a COVID-19 contact (OR = 11.24, P = 0.023) and facing COVID-19 related stigma (OR = 8.06, P = 0.001) significantly increased the odds of GAD. The study result is a call to prioritize the health care providers' psychological well-being by putting in place measures to preserve and enhance their resilience in order to ensure they work optimally and sustain service delivery during a pandemic.

Enhancing hospital protection measures reduces frontline medical workers' stress during the pandemic

Frontline medical workers (FMWs) faced high stress levels in frontline clinics during the COVID-19 pandemic. This study aims to alleviate FMWs' psychological stress by enhancing protection measures, which includes refining the selection process, improving protective measures for their work in frontline clinics, and determining the appropriate time for evacuation. A Chinese-language-version stress questionnaire, covering stress-related issues and sociodemographic characteristics, was administered to FMWs in Shanghai during the COVID-19 pandemic in 2022, yielding 107 valid responses. The questionnaire's reliability and validity were subsequently confirmed. Exploratory factor analysis (EFA) was applied to the stress-related questions, with the KMO and Bartlett's test values of 0.886, 877.8522 (df = 120, p < 0.0001), respectively. Structure equation modeling (SEM) was used to confirm the factors and measure the relationships among the stress-related questions, factors and sociodemographic characteristics. The parameters of SEM named SOFAIDC were significant with SRMSR, RMSEA, AGFI, NFI, and PNFI being 0.0422, 0.0507, 0.9946, 0.9958, and 0.7615, respectively. Paired sample t-tests revealed the significant decrease in FMWs' stress score of the current week and the previous week, with all t-values being negative and significant (p < 0.01). A latent growth model (LGM) named LGM30 verified the overall decreasing stress trend over the weeks, with high R-squares (> 0.80), significant positive linear and negative quadratic time parameters. Based on the trajectory analysis, a stress scorecard with an AUC of 0.856 was developed. This study found that there are four factors for FMWs' psychological stress (anxiety about infection, exhaustion, lack of cognition for infection, and hesitant feeling), and improving targeted hospital protection could alleviate FMWs' psychological stress through SOFAIDC, as all the total effect of factors or items from the feeling of being protected by hospital were negative. Meanwhile, although overall FMWs' stress trend has decreased, 22.43% of FMWs have maintained or experienced a high stress trend, and the stress might increase over weeks in frontline clinics. To perfect hospital protection to alleviate FMWs' psychological stress, the scorecard could be used to select FMWs with low-stress trends, LGM30 could be used to determine the withdrawal time (such as week 8), and targeted hospital protections could be designed based on the relationships between feeling of being protected by the hospital and factors in SOFAIDC, such as providing adequate protective equipment, improving the rationality of FMWs' work schedules, recruiting personnel with higher education levels, and paying adequate monetary compensation.

Psychological problems and related factors among primary healthcare staff in major cities in China during the COVID-19 pandemic

This study aimed to explore psychological problems and related factors among frontline primary healthcare workers who belongs to community health service centers and directly provides medical security services to community residents during the COVID-19 in Shanghai. We used a cross-sectional data analysis design to investigate the anxiety and depression levels of 929 frontline healthcare staff (primary healthcare providers, nurses, village doctors, and public health workers) during the Shanghai epidemic.The prevalence of depression among frontline primary healthcare workers was 39.7% (369 cases) and that of anxiety was 30%(279 cases). There was a significant correlation between the depression symptoms and anxiety symptoms. And factors associated with depression were being female, advanced education, expecting psychological interventions, expecting vacations as a reward, and expecting financial rewards. Factors strongly associated with anxiety were being female, expecting psychological interventions, and expecting vacations as a reward. Psychological problems among frontline primary healthcare workers merit more attention during the COVID-19 outbreak, especially those who are vulnerable (e.g., females and those with an advanced education).

Work stress and professional quality of life among Chinese nurses during the COVID-19 pandemic: the chain mediating role of self-compassion and benefit finding

BACKGROUND

Since the outbreak of the Coronavirus Disease 2019 (COVID-19), front-line nurses have faced not only daily work stress but also a high risk of infection and excessive workload, leading to unsatisfactory professional quality of life (ProQOL). This study aimed to explore whether self-compassion (SC) and benefit finding (BF) play a chain mediating role between work stress and ProQOL among Chinese nurses during the COVID-19 pandemic.

METHODS

From March to April 2022, a sample of 13,936 Chinese nurses was recruited through snowball sampling. Demographic information, work stress, SC, BF, and ProQOL were assessed. The SPSS 25.0 software and Amos 24.0 software were used for statistical analysis. The bootstrap method was employed to construct and examine the chain mediating structural equation model.

RESULTS

The ProQOL level of Chinese nurses during the COVID-19 pandemic was moderate. The overall fit indices for the compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) models were satisfactory (χ²/df = 2.486, 3.256, 2.553, RMSEA = 0.011, 0.014, 0.011, the GFI, AGFI, NFI, and CFI values were all above 0.90). Work stress had direct effects on CS, BO, and STS (β=-0.171, 0.334, 0.222, P < 0.001), and also indirectly affected these outcomes through SC (point estimate=-0.010, 0.021, 0.024, P < 0.001), BF (point estimate=-0.033, 0.015, - 0.011, P < 0.001), as well as their chain mediating effect (point estimate=-0.015, 0.006, - 0.005, P < 0.001).

CONCLUSIONS

Our study suggests that SC and BF partially mediated the association between work stress and ProQOL in Chinese nurses during the COVID-19 pandemic. Training on SC and BF may be crucial components of interventions aimed at improving ProQOL.

Factors contributing to nurses' intent to leave during COVID-19

To examine the association between demographic characteristics (i.e., gender, race, age, and years of experience), burnout, and nurses' intent to leave their jobs during the first wave of COVID-19 in New Jersey. COVID-19 has exacerbated burnout and intent to leave among acute care nurses. Nonetheless, little is known about demographic factors contributing to nurses' desire to leave their jobs. A cross-sectional survey of actively licensed registered nurses who provided direct patient care in an acute care hospital in New Jersey during COVID-19. Among 2760 nurses, those who reported burnout were 4.78 times more likely to report intent to leave their job within 1 year as compared to nurses who did not report burnout. Black RNs were 2.06 times more likely to report intent to leave as compared to White RNs. Older nurses (aged 40-49) were 36% less likely to report intent to leave as compared to younger nurses (aged 21-29). RNs with 30 years of experience or more were 58% less likely to report intent to leave as compared to RNs with less than 5 years of experience. In addition, Black RNs with 6-12 years of experience were 2.07 times more likely to report intent to leave as compared to White RNs with less than 5 years of experience. Nurses' intent to leave during the first wave of the pandemic was influenced by burnout, race, age, and years of experience. Based on the results of the current study, Black nurses were more likely to report intent to leave their job within 1 year as compared to White RNs. Nurses' intention to leave is one of the most important global issues facing the healthcare system. Findings of the current study demonstrate that burnout, race, age, and years of experience are significant predictors of nurses' intent to leave their jobs. Therefore, organizations should prioritize strategies to reduce burnout and create diverse and inclusive work environments.

Predictors of Poor Mental Health Outcomes in Healthcare Workers during COVID-19: A Two Waves Study

Objective: This cross-sectional study aimed to identify potential predictors of poor mental health outcomes among healthcare workers in two different waves of the COVID-19 emergency in Italy. Methods: An online survey collected data from N = 557 healthcare workers (21-77 years). The study predictors were sociodemographic characteristics, occupational status, factors related to the work environment, COVID-19-related adverse events, and lifetime traumatic events. The poor mental health outcomes that were considered were depersonalization/derealization, anxiety, depression, and somatization symptoms. Results: The main predictors of poor mental health outcomes were sleeping less than six hours per night, inadequate protective equipment measures, female gender, personal and familiar infection, living alone, working as a nurse, and working in a COVID-19 ward. Healthcare workers in 2021 reported experiencing more serious accidents and stressful events than those of the first wave. Depressive symptoms and COVID-19-related adverse events were higher in the second pandemic outbreak than in the first. Conclusions: Preventive strategies against poor mental health outcomes should be particularly focused on female nurses who live alone, work in areas with high infection rates, and have experienced the COVID-19 infection personally or who are close to people that have experienced the infection.

Immediate shock and residual stress: Unmasking the dual dynamics of covid-19 on the mental health of health professionals in China

Background

The pandemic of 2019 has created large scale disruption around the globe. It has posed extraordinary hurdles for Chinese health workers, affecting their mental health with respect to situations in the present as well as the future. Recognising the dynamic features of these mental health issues among health professionals is critical for developing effective support systems.

Objectives

This study aims to explore the dual impact of COVID-19 on the mental health of health professionals in China, both during and after the pandemic; to explore the probable underlying factors causing these mental health issues; to identify both adaptive and maladaptive coping behaviours employed by the health personnel; and to assess the organisational and social support to mitigate the effect of the pandemic on the mental health of the Chinese health professionals.

Method

To address these objectives an explorative qualitative research design has been adopted involving analysis of previous researches in the relevant field.

Results

The study confirms anxiety, depression, sleep disorders, PTSD, and burnout among medical personnel as immediate shock and residual stress, along with its demographic variations. Few maladaptive coping behaviours have been identified that can lead to delayed psychological effects even after a pandemic.

Conclusion

The key findings underscore the complicated interaction of immediate and delayed mental health challenges among health professionals, advocating for the deployment of tailored treatments and policy modifications to address the ever changing needs of this vital workforce.

Psychological distress and attitudes toward seeking professional psychological help among Omani nurses: Strategies for nursing practice

BACKGROUND

This study investigated the psychological distress and attitudes toward seeking professional psychological help among Oman's nurses, highlighting the importance of changing negative attitudes toward mental health among healthcare professionals. Nurses face difficult circumstances and serve as role models. Creating supportive environments can improve treatment quality and public awareness and reduce social stigma, ultimately contributing to better care and quality of life.

MATERIALS AND METHODS

This study used a cross-sectional design with a convenience sampling approach. A sample of 205 nurses working in Oman completed the study questionnaires, including a sociodemographic questionnaire, the attitude toward seeking professional psychological distress scale, and the Kessler Psychological Distress Scale. The survey was distributed between May and June 2023.

RESULT

The study found that most participants had moderate psychological distress (43.22%, n = 67) and a low attitude toward seeking professional psychological help (66.67%, n = 48). There were significant differences in distress based on gender (P < 0.001), marital status (P < 0.001), and working department (F = 3.140, P = 0.004), while attitude had significant differences based on gender (P < 0.001) and marital status (P < 0.001). The study also found no significant correlation between psychological distress and attitudes toward seeking help among Oman's nurses (T (1, 204) = 0.019, P = 0.985), with a r2 of 0.005.

CONCLUSION

Nurses must be trained to handle stress and job strain from terminally ill patients, complex cases, and difficult situations. They should prioritize psychological assistance as a sign of strength and self-awareness as it demonstrates stability and self-awareness in nursing. This can be promoted by obtaining education, enhancing healthcare accessibility, and providing a support system.

Recent advances in COVID-19-induced liver injury: causes, diagnosis, and management

Since the start of the pandemic, considerable advancements have been made in our understanding of the effects of SARS-CoV-2 infection and the associated COVID-19 on the hepatic system. There is a broad range of clinical symptoms for COVID-19. It affects multiple systems and has a dominant lung illness depending on complications. The progression of COVID-19 in people with pre-existing chronic liver disease (CLD) has also been studied in large multinational groups. Notably, SARS-CoV-2 infection is associated with a higher risk of hepatic decompensation and death in patients with cirrhosis. In this review, the source, composition, mechanisms, transmission characteristics, clinical characteristics, therapy, and prevention of SARS-CoV-2 were clarified and discussed, as well as the evolution and variations of the virus. This review briefly discusses the causes and effects of SARS-CoV-2 infection in patients with CLD. As part of COVID-19, In addition, we assess the potential of liver biochemistry as a diagnostic tool examine the data on direct viral infection of liver cells, and investigate potential pathways driving SARS-CoV-2-related liver damage. Finally, we explore how the pandemic has had a significant impact on patient behaviors and hepatology services, which may increase the prevalence and severity of liver disease in the future. The topics encompassed in this review encompass the intricate relationships between SARS-CoV-2, liver health, and broader health management strategies, providing valuable insights for both current clinical practice and future research directions.

A visualized and bibliometric analysis of nursing research during the COVID-19 pandemic

BACKGROUND

The global spread of Coronavirus disease 2019 (COVID-19) has been increasing since December 2019. A total of 8460 publications were obtained from the Web of Science Core Collection from 2019 to 2023, providing insights into the progress of nursing research throughout the COVID-19 pandemic.

METHODS

Bibliometric analysis was conducted on these articles using CiteSpace. The analysis focused on examining the distribution of these publications in terms of space and time, distribution of authors, subject categories, distribution of topics, and cited references.

RESULTS

These results may be explained from 3 perspectives. Initially, the number of yearly publications on nursing research consistently increased during the COVID-19 pandemic. Furthermore, a co-occurrence analysis of the countries and the authors revealed that certain countries, including the United States, China, and England, have successfully implemented organized and standardized nursing models. These countries also have well-developed and established nursing research systems. Notably, academic communities in specific regions, such as the team led by MD Stefan Gravenstein, Mor Vincent, and White Elizabeth at Brown University in the United States, have emerged as leaders in this field. Furthermore, examining the papers' subject categories and topic distribution indicate that nursing during the COVID-19 pandemic has been predominantly interdisciplinary, encompassing various disciplines such as clinical medicine, essential medicine, psychology, public health management, and even telematics science.

CONCLUSION SUBSECTIONGS

Our study provided valuable insights into acquiring knowledge on nursing research during the COVID-19 pandemic, pinpointed possible partners for researchers interested in nursing, and uncovered prevalent research patterns and popular subjects.

Anxiety in Nursing Students during the COVID-19 Pandemic: Systematic Review and Meta-Analysis

OBJECTIVES

To analyse the influence of the COVID-19 pandemic on the development of anxiety in nursing students and the factors involved.

DESIGN

A systematic review and meta-analysis.

DATA SOURCE

PubMed, CINAHL, Scopus and Web of Science.

BACKGROUND

Nursing students are at an increased risk of developing mental overload, due to the presence of many sources of stress during their academic training. Therefore, the COVID-19 pandemic has had an impact on the mental health of the general population, especially on healthcare workers and consequently on students undertaking placements in healthcare settings.

METHODS

A systematic review was conducted using PubMed, CINAHL, Scopus and Web of Science databases. A total of 24 articles were included in the review, and 20 articles were selected for the meta-analysis.

RESULTS

We found that the anxiety scores of nursing students during the COVID-19 pandemic were slightly higher (50%) than before the pandemic. The most influential risk factors for developing anxiety were academics, age, gender, having children, living in urban areas or with family, having an addiction to social networks, and having a fear of becoming infected with COVID-19. Resilience, spiritual support and feelings of happiness protected students against the risk of developing high levels of anxiety.

CONCLUSIONS

The COVID-19 pandemic has led to increased levels of anxiety in nursing students. Thirty-five percent of the meta-analytically analysed sample had elevated levels of anxiety.

Physical, psychological, and social experiences of women recovered from COVID-19 in Iran: A qualitative study

BACKGROUND

This paper aims to examine the impact of COVID-19 on various health aspects of women recovered from this disease in Ardabil province, Iran.

MATERIALS AND METHODS

This qualitative study using a content analysis approach was carried out through in-depth individual and focus group discussion using semi-structured interviews schedule in 26 women during June and August 2021. Interviews were recorded, transcribed, and MAXQDA six-stage analysis framework.

RESULTS

Negative consequences of COVID-19 were generally categorized into five main themes (including increased self-conscious excitement, perceived social stigma, depression, changes in behavioral patterns, and reduced level of quality of life) and 13 subthemes. The positive consequences were the following five themes (including the development of the spiritual attitude, increasing the importance of personal health, the rise of perceived support, increased sense of altruism, and increased financial management) and four subthemes.

CONCLUSION

Based on the findings, it is concluded that effective support by the government, society, and the medical staff could help to relieve people's psychological and social stress through providing financial aid, the right information, and training.

Investigation of the psychiatric factors that determine the fear of COVID-19 in healthcare workers and hospital staff in a university hospital in Turkey

To examine the association of health and hospital workers' fears of coronavirus disease 2019 (COVID-19) with anxiety, anxiety sensitivity, depression, and sociodemographic variables during the COVID-19 pandemic. A total of 527 participants (237 men/289 women) were included, 222 of the participants were doctors, 99 nurses, 22 assistant health personnel, and 182 hospital personnel without health education. Participants filled in the sociodemographic data form, Beck Depression Inventory, Beck Anxiety Inventory, Anxiety Sensitivity Index-3, and Fear of COVID-19 Inventory. In linear regression analysis, independent predictors of the fear of COVID-19 were determined as Beck Anxiety Inventory (p < 0.001), Beck Depression Inventory (p = 0.001), and Anxiety Sensitivity Index-3 Physical subscale (p = 0.001). The fear of COVID-19 is associated with the physical subscale of anxiety, depression, and anxiety sensitivity.

Consequences of the COVID-19 pandemic on the mental health of nurses in the Spanish out-of-hospital Emergency Service

OBJECTIVE

To analyse the impact of the COVID-19 pandemic on the mental health of nurses in Spanish out-of-hospital Emergency Services, identifying predictor factors of greater severity.

METHOD

A multicentre cross-sectional descriptive study was designed, including all nurses working in any Spanish out-of-hospital Emergency Services between 01/02/2021 and 30/04/2021. The main outcomes were the level of depression, anxiety and stress assessed through the DASS-21 scale. Sociodemographic, clinical, and occupational information was also collected. Univariate and multivariate analyses were conducted to determine possible associations between variables.

RESULTS

The sample included 474 nurses. 32.91%, 32.70% and 26.33% of the participants had severe or extremely severe levels of depression, anxiety and stress, respectively. Professionals with fewer competencies to handle stressful situations, those who had used psychotropic drugs and/or psychotherapy on some occasion before the pandemic onset, or those who had changed their working conditions presented more likelihood of developing more severe levels of depression, anxiety and/or stress.

CONCLUSION

Nurses in Spanish out-of-hospital Emergency Services have presented medium levels of depression, anxiety and stress during the pandemic. Clinical and occupational factors have been associated with a higher degree of psychological distress. It is necessary to adopt strategies that promote professionals' self-efficacy and mitigate the triggers of negative emotional states.

The effect of COVID-19 phobia on employee performance and job satisfaction: a cross-sectional study

Background

The mass fear of COVID-19, which is called "coronaphobia", causes many negative effects such as increasing unemployment rates, decreased performance in working life and organisational problems in the business world. The study is conducted to examine how COVID-19 is reflected in job performance and job satisfaction in terms of the sustainability of occupational health and safety of workers especially white-collar workers, in enterprises due to the pandemic.

Methods

The study was conducted as a descriptive, cross-sectional type. Data were collected from the employees in the designated factories by creating an online form using the "COVID-19 Phobia Scale", "Employee Performance Scale", and "Job Satisfaction Scale".

Results

The findings obtained in the study showed a significant positive relationship between employee performance and job satisfaction. It was determined that job satisfaction and employee performance had a significant but weak relationship with COVID-19 phobia.

Conclusions

The findings expand previous studies by filling the lack of knowledge on how job performance and job satisfaction have effected at workplace during a pandemic. The study data show that job performance and job satisfaction in workplace employees affect each other and that both are affected by unexpected or extraordinary situations such as pandemics.

Anxiety, Depression, Social Support, Needs, and Concerns of Frontline Nurses during COVID-19 Peak Infection Period: A Cross-Sectional Multicenter Study

Background

The worldwide pandemic of COVID-19 had put enormous pressure on frontline healthcare workers. In December 2022, China released its "10 new measures," signaling the end of the "dynamic zero COVID-19 strategy." This triggered a period of peak infection, which shocked China's healthcare system and affected the mental health of nurses.

Objective

To explore the anxiety, depression, and social support levels of frontline nurses during the peak period of COVID-19 infection and to identify the main needs and concerns of nurses during this period.

Design

A multicenter cross-sectional study. Settings. 18 hospitals of different grades in three cities in Hunan Province from December 21, 2022, to January 10, 2023, the peak period of COVID-19 infection. Participants. A total of 4,160 nurses completed the survey.

Methods

The questionnaire included general information, symptoms, the preparation for nurses, GAD-7, PHQ-9, PSSS, and two open-ended questions investigating nurses' needs and concerns. General linear models were used to analyze the factors influencing anxiety. Hospital preparation for nurses, nurses' needs, and nurses' concerns were categorized and subjected to frequency counts.

Results

The median (P25, P75) scores for anxiety and depression among nurses were 7.00 (3, 12) and 8 (3, 12), respectively. Type of hospital, professional title, family structure, isolation staff lounge preparation, ibuprofen preparation, health status of parents, fever, chest distress, dyspnea, cough, insufficient protective equipment, number of children, and PSSS others were the influencing factors of GAD grades. The top 3 needs were free drugs and treatments (78.71%), shift breaks and paid leave (77.66%), and understanding and supports from hospitals and families (75.99%). The first three concerns were the fear of spreading the disease to family members (83.89%), the after-effects of infection (65.67%), and cross-infection with colleagues and patients (61.70%).

Conclusions

Nurses' anxiety was more severe during peak infection period. Overloaded work schedules and insufficient sleep became a common situation. Worries about family members became the main concern of nurses. Managers should make contingency plans for public health emergencies and provide frontline nurses with protective equipment, stress-relieving measures, and a rotation system. More importantly, they should pay attention to the needs of nurses' family members and provide medical and care support. The media should also explain how hospitals operate and carry out their duties during these extraordinary times in order for the public to comprehend the condition of frontline epidemic fighters.

Differentiating the relationships between traditional and new media use and sleep quality during the COVID-19 pandemic: roles of psychological distress and age

Background

Numerous studies have consistently demonstrated a decline in sleep quality during the COVID-19 pandemic. The primary objective of this study is to explore the impact of engaging with pertinent epidemic information through the media amid the COVID-19 crisis on individuals' sleep quality and the underlying mechanisms through which this influence operates.

Methods

An online cross-sectional study design was employed. A total of 1,063 British adults (36.2% males; M age = 38.85, SD age = 13.36, ranging from 18 to 77 years old) participated in the study and completed our questionnaires, which included media usage frequency during the pandemic, the 10-item Kessler Psychological Distress Scale (K10), the Insomnia Severity Index (ISI), and the Ten-item Personality Inventory (TIPI).

Results

Pearson's correlation analyses indicated that there was no significant correlation between COVID-19-related traditional media use (television, radio, newspaper) and psychological distress or sleep quality. However, exposure to information related to COVID-19 through new media use (Facebook, Tik Tok, Twitter) was correlated with greater psychological distress and poorer sleep quality. A moderated mediation analysis showed that psychological distress fully mediated the relationship between new media use and poor sleep, which was moderated by age, with the association between psychological distress and poor sleep quality being stronger among older adults.

Conclusion

Exposure to information of COVID-19 via new (but not traditional) media use deteriorated sleep quality through greater psychological distress, and this relationship was stronger among older adults.

Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

As future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.

METHODS

We systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg's and Egger's tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.

RESULTS

We identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%-49%) and 48% (95% CI, 43%-52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%-32%) and 30% (95% CI, 26%-35%), respectively. There was high heterogeneity between studies, with I2 ranging from 99.58%-99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.

CONCLUSIONS

We demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

Death Anxiety and WellBeing in Doctors During COVID-19: The Explanatory and Boosting Roles of Sleep Quality and Work Locality

The COVID-19 pandemic, a global public health crisis, has triggered anxiety and fear of death in general public and particularly among health professionals. This study aimed to assess the direct and mediated associations between death anxiety, sleep quality, and subjective wellbeing in doctors working during the pandemic. A secondary aim was tested to analyze the interactive role of workplace locality in these associations. An indirect-effect model was tested on a sample of 244 doctors working during the pandemic. Findings revealed that the association between death anxiety and subjective wellbeing was mediated through sleep quality. Furthermore, death anxiety significantly and negatively predicted subjective wellbeing in doctors working in rural setups compared to those working in urban setups. The theoretical and practical implications of the findings are discussed.

Mental health problems of front-line medical staff in the early stage of public health emergencies

In the face of the unprecedented public health crisis caused by the novel coronavirus pneumonia epidemic, front-line health workers are under enormous mental pressure. This paper aims to explore the mental health challenges faced by front-line health workers in the early stages of a public health emergency, such as stress, anxiety, and depression. At the same time, the factors that increase their mental stress are analyzed, and practical measures are put forward to prevent and manage mental health problems, aiming at improving the quality of medical treatment during public health emergencies. This paper has some reference value for people engaged in mental health prevention.

Prevalence and correlates of mental health problems among different occupations of medical workers during COVID-19 outbreak in China

BACKGROUND

Health workers involved in the fight to prevent the COVID-19 outbreak were exposed to hazards. Detailed information on mental health problems in different medical occupations is crucial. To examined the prevalence of mental health issues in three medical occupations as well as the relationships between mental health problems and correlates in each occupation.

METHODS

This study utilizing the Questionnaire Star program was conducted among medical workers working at medical institutions in China from February 17 to 24, 2020. The Self-Reporting Questionnaire (SRQ-20), the Zung Self-rating Anxiety Scale (SAS), and the Zung Self-rating Depression Scale (SDS) were used to assess mental health problems.

RESULTS

The prevalence of any mental health problems in the three occupations was 43.6, 34.6, and 32.9% for nurses, paramedical workers (PMWs), and doctors, respectively. Three occupations shared some correlates, such as being overworked, not having enough time to rest, support from colleagues, and previous mental health status. There were specific factors for each occupation. For doctors, age, educational level, living status, support from family, and previous physical status were related factors in mental health problems. Working in a designated hospital for treating COVID-19, having COVID-19 event exposures, and receiving support from family were associated with the mental health problems of the nurses. PMWs' mental health problems was linked to educational level and care from supervisors or heads of department.

CONCLUSION

Different medical occupations have distinct impacts on mental health issues. Policy makers and mental health professionals working to prepare for potential disease outbreaks should be aware of multiple factors in different occupations.

Caring for patients in the Covid era: Are the quality of life the same for doctors and nursing staff?

BACKGROUND

The Covid-19 pandemic has represented one of the most stressful events of recent times and has placed enormous psychological pressure on doctors and nurses.

AIMS

The objective of this work is to evaluate the psychological impact of the Covid-19 outbreak on Spanish nurses and doctors, and to identify factors related to their mental health.

METHODS

The study is a descriptive study and examined 812 doctors and 768 nurses. The dependent variables were health-related quality of life, anxiety, depression, perceived stress and insomnia. Participants completed the Health-related Quality of Life-Questionnaire, the Generalized Anxiety Disorder 7-item-Scale, the Patient Health Questionnaire-9, the Impact Event Scale-Revised, and the Insomnia Severity Index. Sociodemographic and Covid-related data were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were used.

RESULTS

A greater proportion of nurses than doctors suffered clinical anxiety, depression and insomnia (56.84 % vs 45.81 p-value<0.0001, 64.67 % vs 53.39 p-value<0.0001, and 23.04 % vs 18.02 p-value 0.01, respectively). Although in our study nurses were more likely to suffer clinical anxiety, stress and insomnia than doctors, our results nevertheless showed that there were no differences in terms of quality of life. Different factors related to mental health were identified for doctors and nurses. Nurses working in care homes or geriatric services (OR = 4.13, IC95% 1.71-9.99, p-value 0.002), and in services with greatest contact with Covid-19 patients (OR = 1.71,IC95% 1.10-2.68, p-value 0.02) were more likely to suffer depression.

CONCLUSIONS

Our study confirms that doctors and nurses are at high risk of clinical anxiety, depression, stress or insomnia during the Covid-19 pandemic.

Protective strategies against occupational stress among health professionals during the COVID-19 pandemic

The purpose of this study was to investigate which protective strategies against occupational stress were developed for health professionals during the COVID-19 pandemic. This was an integrative literature review conducted in 2021. The Medical Literature Analysis and Retrieval System Online and the Latin American and Caribbean Literature in Health Sciences databases were searched using the Boolean operator AND and the controlled vocabularies "health professionals" AND "occupational stress" AND "COVID-19", both in English and Portuguese. After applying the inclusion criteria and reading the selected articles, a final sample of 24 articles was obtained. Protective strategies against occupational stress developed by institutions included psychological support, support from managers and team leaders, provision of personal protective equipment, appropriate schedules and workload, and training. As for the strategies developed by health professionals themselves, these included resilience, peer support, and self-care. Several protective strategies during the pandemic were observed, but institutions still need to develop and/or improve practices to offer better psychological conditions to health professionals in general.

Effect of COVID-19 Risk Perception and COVID-19 Self-Care of Korean Correctional Nurses on Occupational Burnout: Mediating Effect of Stress and Anxiety About Viral Epidemics

ABSTRACT

The purpose of this study was to investigate whether stress and anxiety about viral epidemics have effects as parameters in the relationship among COVID-19 risk perception, COVID-19 self-care, and occupational burnout for Korean correctional nurses. The subjects of this study were 107 correctional nurses working at 52 correctional facilities in Korea that are conducting COVID-19 management and prevention activities. Data were collected from March 12 to 30, 2022. Results suggest that correctional nurses during the COVID-19 pandemic may experience occupational burnout because of increased stress and anxiety about viral epidemics as their COVID-19 risk perception increased. In addition, stress and anxiety about being infected with the COVID-19 virus itself will cause burnout. This study contributes to promotion of the mental health of Korean correctional nurses and provides basic data for developing an intervention program to prevent occupational burnout.

International students' perceived discrimination and psychological distress during the COVID-19 pandemic

OBJECTIVE

This study examined the relationship between perceived discrimination and psychological distress among international students during the COVID-19 pandemic.

METHODS

A total of 188 international students from two large U.S. universities participated in the study. Perceived discrimination, psychological distress, and demographic information were assessed using self-reported questionnaires.

RESULTS

COVID-related variables and perceived discrimination were significantly associated with international students' psychological distress. Their COVID-related anxiety mediated the relationship between perceived discrimination and psychological distress.

CONCLUSION

Initiatives to mitigate the perceived discrimination experienced by international students may improve their mental health.

Prevalence and characters of post-acute COVID-19 syndrome in healthcare workers in Kashan/Iran 2023: a cross-sectional study

BACKGROUND

Post-acute COVID-19 syndrome that is called long COVID-19 consists of the symptoms that last more than 12 weeks with no other explanation. The present study aimed to determine the prevalence, frequency of symptoms, and risk factors of long COVID-19 in the healthcare workers (HCWs) of a selected hospital in Kashan/Iran in 2023.

METHODS

A total of 350 HCWs with a history of COVID-19 infection were randomly recruited to the study from February to May 2023. Participants completed a questionnaire including demographic characteristics, information related to COVID-19 infection, underlying diseases, and a checklist of long COVID-19 symptoms. Mann‒Whitney U test, chi-square test, T‒tests, and binary logistic regression were used for data analysis by SPSS 16.

RESULTS

The results showed that 75.7% of HCWs experienced symptoms of long COVID-19. The most common symptoms were fatigue (53.1%), cough (43.1%) and muscle weakness (37.1%). In bivariate analysis job title, body mass index (BMI), frequency and number of symptoms of COVID-19 infection, preexisting disease, tobacco use, age, and years of experience showed a significant statistical association with long COVID-19. In binary logistic regression the number of symptoms during COVID-19 infection, nursing occupation, use of corticosteroids, and symptoms of dyspnea and loss of taste could explain the occurrence of long COVID-19.

CONCLUSION

The long COVID-19 is a prevalent condition among HCWs especially nurses. Symptoms of long COVID-19 such as fatigue and cough can persists over time. This chronic condition has significant associations with different clinical risk factors.

The association of fear of COVID-19 on occupational stress in pediatric nurses: Examining the mediating role of psychological well-being

PURPOSE

This study investigated the associations of fear of COVID-19 with occupational stress and the mediating role of psychological well-being in pediatric nurses.

METHODS

This cross-sectional study was conducted between December 2021 and February 2022. The sample consisted of 464 pediatric nurses from public or university hospitals in Türkiye. Data were collected using a sociodemographic characteristics questionnaire, the Fear of COVID-19 Scale, the Occupational Stress Scale, and the Psychological Well-Being Scale. The data were analyzed using Pearson's correlation and regression analysis.

RESULTS

Participants' fear of COVID-19 was positively associated with their occupational stress (F = 17.263; p < 0.001) but negatively associated with their psychological well-being (F = 10.575; p = 0.001). Their psychological well-being was negatively associated with their occupational stress (F = 22.084; p < 0.001). Nurses fear of COVID-19 explained three and 2 % of their occupational stress and psychological well-being, respectively. Nurses' psychological well-being explained 4 % of their occupational stress. The results showed that participants' psychological well-being did not mediate between their fear of COVID-19 and occupational stress.

CONCLUSION

Pediatric nurses fear COVID-19 but have an above-mean level of occupational stress and psychological well-being. In conclusion, psychological well-being does not mediate between pediatric nurses' fear of COVID-19 and occupational stress.

PRACTICE IMPLICATIONS

The pandemic was a traumatic experience for pediatric nurses. Hospital administrators and nurse managers must monitor the psychosocial health of pediatric nurses and support them in times of crisis.

The impact of the COVID-19 pandemic on the well-being, work conditions, and education of early career psychiatrists in the WHO Eastern Mediterranean Region: study protocol

Background

The COVID-19 pandemic placed great strain on healthcare professionals, leading to a substantial impact and a redistribution of the workforce. Despite the active involvement of the Eastern Mediterranean Region Office (EMRO) and the World Health Organization in managing mental health crises, there is a knowledge gap concerning the working conditions and training opportunities available for early career psychiatrists (ECPs) during the pandemic period.

Objectives

This study aims to investigate the impact of the COVID-19 pandemic on ECPs and how it affected their well-being, employment, and educational opportunities.

Methods

A mixed methods study has been conducted in Iran, Egypt, and Tunisia, three EMRO member countries. It includes a cross-sectional survey with self-reported questions, and a qualitative study with individual in-depth interviews.

Discussion

The findings of this study will raise awareness to the working conditions of ECPs within the EMRO region and its member societies, both during the COVID-19 pandemic and beyond. The results will serve as a basis for encouraging supervisors and policymakers to mitigate the pandemic's impact on psychiatric training, strengthen healthcare systems' preparedness, and equip early career psychiatrists with the necessary skills to deal with the mental health consequences of the COVID-19 pandemic.

mHealth Gratitude Exercise Mindfulness App for Resiliency Among Neonatal Intensive Care Unit Staff: Three-Arm Pretest-Posttest Interventional Study

BACKGROUND

Health care is highly complex and can be both emotionally and physically challenging. This can lead health care workers to develop compassion fatigue and burnout (BO), which can negatively affect their well-being and patient care. Higher levels of resilience can potentially prevent compassion fatigue and BO. Strategies that enhance resilience include gratitude, exercise, and mindfulness.

OBJECTIVE

The purpose of this study was to determine if a 3-week daily resiliency practice, prompted via a gratitude, exercise, and mindfulness smartphone app, impacted the professional quality of life, physical activity, and happiness level of health care workers in a newborn intensive care unit setting.

METHODS

In total, 65 participants from a level III newborn intensive care unit at a regional hospital in the western United States completed this study. The Professional Quality of Life Scale, Physical Activity Vital Sign, and Subjective Happiness Score instruments were used to evaluate the effects of the mobile health (mHealth) intervention. Further, 2-tailed dependent paired t tests were used to evaluate participant pre- and postintervention instrument scores. Multiple imputation was used to predict scores of participants who practiced an intervention but did not complete the 3 instruments post intervention.

RESULTS

Dependent t tests using the original data showed that participants, as a whole, significantly improved in BO (t35=2.30, P=.03), secondary trauma stress (STS; t35=2.11, P=.04), and happiness (t35=-3.72, P<.001) scores. Compassion satisfaction (CS; t35=-1.94, P=.06) and exercise (t35=-1.71, P=.10) were trending toward, but did not reach, significance. Using the original data, only the gratitude intervention group experienced significant improvements (CS, BO, and happiness), likely due to the higher number of participants in this group. Analysis using imputed data showed that participants, as a whole, had significant improvements in all areas: CS (t64=-4.08, P<.001), BO (t64=3.39, P=.001), STS (t64=4.08, P<.001), exercise (t64=-3.19, P=.002), and happiness (t64=-3.99, P<.001). Looking at the intervention groups separately using imputed data, the gratitude group had significant improvements in CS, BO, STS, and happiness; the exercise group had significant improvements in STS and exercise; and the mindfulness group had significant improvements in CS and happiness.

CONCLUSIONS

Phone app delivery of resilience-enhancing interventions is a potentially effective intervention model for health care workers. Potential barriers to mHealth strategies are the technical issues that can occur with this type of intervention. Additional longitudinal and experimental studies with larger sample sizes need to be completed to better evaluate this modality.

From Anxiety to Hardiness: The Role of Self-Efficacy in Spanish CCU Nurses in the COVID-19 Pandemic

Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within "positive psychology" have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed to test a model regarding the mediating role of self-efficacy between anxiety experienced at the beginning of the COVID-19 pandemic and hardiness assessed six months later among nurses in critical care units (CCU) in Spain. Materials and Methods: An observational, descriptive, prospective longitudinal study with two data collection periods: (1) from the 1 to the 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March) in which socio-demographic and occupational variables, anxiety (Depression, Anxiety and Stress Scale, DASS-21), self-efficacy (General Self-Efficacy Scale, GSES) and basal resilience (Resilience Scale-14, RS-14) were assessed, and (2) a follow-up 6 months later (January-March 2021) in which hardiness (Occupational Hardiness Questionnaire, OHQ) was evaluated. To analyze the data, multivariate regressions were performed using the PROCESS macro (simple mediation, model 4). Results: A total of 131 Spanish nurses from CCUs, with a mean age of 40.54 years (88.5% women) participated in the study. Moderate and severe levels of anxiety were observed in 19.1% of the sample. Significant and positive correlations were observed between self-efficacy, hardiness and resilience (all p < 0.001). Significant negative correlations were observed between anxiety and self-efficacy (p < 0.001), hardiness (p = 0.027) and resilience (p = 0.005). The indirect effect of anxiety on hardiness through self-efficacy was significant (Effect (SE) = -0.275 (0.100); LLCI = -0.487, ULCI = -0.097), contributing to 28% of the variance, including resilience (p = 0.015), age (p = 0.784), gender (p = 0.294) and years of experience (p = 0.652) as covariates. A total mediation was observed (non-significant anxiety-hardiness direct effect; Effect (SE) = -0.053 (0.215), t = 0.248, p = 0.804, LLCI = -0.372, ULCI = 0.479). Conclusions: The results suggest that in Spanish CCU nurses, anxiety experienced at the beginning of the COVID-19 pandemic may contribute to the development of hardiness through positive resources such as self-efficacy.