Optimal Well-being, Depression, and Caregiving: An Explorative Investigation

Positive mental health, depression and burnout in healthcare workers during the second wave of COVID-19 pandemic

WHAT IS KNOWN ON THE SUBJECT?: In the past 2 years, the COVID-19 pandemic had a robust negative impact on the mental health of healthcare providers, with increasing rates of depression, anxiety, acute stress and burnout. Healthcare workers experiencing poor mental health are reluctant to seek help and treatment because they are afraid of being stigmatized and excluded by their colleagues and employers. During the pandemic positive emotions, resilience and psychological well-being buffered distress and burnout in healthcare workers. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes positive mental health, depression, anxiety and burnout in healthcare workers during the second wave of the pandemic. Forty-eight per cent of healthcare workers were flourishing (high levels of positive emotions and well-being), 10% languishing (absence of well-being and positivity). Flourishing individuals reported lower levels of depression, anxiety and burnout. These findings documented a relevant number of resilient healthcare workers, who restored/maintained their well-being also under stressful conditions. Vulnerable healthcare workers were less than 20%, and they reported severe anxiety, depression and burnout. No differences emerged between languishing and moderate mental health groups in their levels of anxiety, depression and burnout. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The condition of flourishing is the only one that provides protection from depression and anxiety and burnout, while moderate mental health does not differ substantially from the languishing state. The study confirms the importance of maintaining and/or promoting the well-being of healthcare workers. Interventions for promoting positive mental health of vulnerable workers are needed. Mental health nurses can have the skills and expertise for evaluating early symptoms of psychological distress and for implementing interventions for promoting and restoring well-being. These interventions may include informational campaign (i.e. preparing and distributing pamphlets and guidelines) and emotional support programmes (psychoeducation and training, mental health support team, peer support and counselling) that can be delivered also via digital platforms.

ABSTRACT

INTRODUCTION: Few studies focused on healthcare workers' positive mental health (i.e. high levels of psychological well-being) and its association with anxiety, depression and burnout in the second wave of the pandemic.

AIMS

To evaluate the protective role of well-being in buffering burnout and psychological distress.

METHODS

We evaluated 173 Italian healthcare workers with indicators of psychological distress (Depression Anxiety Stress Scales [DASS]-21), burnout (Copenhagen Burnout Inventory [CBI]) and positive mental health (Mental Health Continuum) and we cross-classified them according to their levels of mental health (flourishing, languishing and moderate mental health) and their levels of anxiety, depression and burnout.

RESULTS

Forty-eight per cent of health workers were classified as flourishing, 10% as languishing and 42% as moderate mental health. Flourishing individuals presented lower scores on DASS and CBI scales, whereas no differences emerged between languishing and moderate mental health groups. More than 80% of health workers with clinically significant symptoms of anxiety, depression and risk of burnout were classified as not flourishing.

DISCUSSION

This investigation documented the presence of flourishing mental health in almost half of the sample of Italian healthcare workers. However, those with moderate or languishing mental health manifested higher levels of anxiety, depression and higher risks of burnout.

IMPLICATION FOR PRACTICE

The study confirms the importance of maintaining and/or promoting the well-being of this population, with a crucial role of mental health nurses who can easily approach other healthcare workers and provide them informational (training, guidelines) and emotional support programmes (psychoeducation, mental health support team, peer support and counselling) when facing adverse working conditions.

Multicentre narrative research on major depression to integrate the experiences of patients, their caregivers and healthcare providers in Italy

OBJECTIVE

This research aimed to investigate the experience of major depression by integrating the perspectives of patients, caregivers and healthcare providers through narrative-based medicine (NBM) to provide new insights to improve care relationships.

DESIGN AND SETTING

The research was conducted in 2019 and involved five Italian psychiatric centres and targeted adult patients, their caregivers and healthcare providers to address data source triangulation. A sociodemographic survey and a narrative plot, based on Natural Semantic Metalanguage were collected. Narratives were analysed through NBM classifications, NVivo software and interpretative coding.

PARTICIPANTS

Thirty-six patients with a diagnosis of major depression, 27 caregivers and 33 healthcare providers participated in the research.

RESULTS

Among the 96 collected narratives, 'lonely' was the word patients used most frequently, while 'sad' and 'lifeless' were used most respectively by caregivers and healthcare providers. A positive care relationship was crucial for 84% of patients in relation to their care pathway, and nature (36%) and the arts (28%) were the most frequent resources. Caregivers expressed feelings of powerlessness and inadequacy, and 21% of them reported a declining social life while providing care to a loved one with depression. Thirty-one percent of mental health professionals experienced difficulties in their first encounter with patients; however, their emotions progressively moved towards trust and satisfaction. Furthermore, 89% of patients and healthcare providers and 58% of caregivers evaluated writing the narrative to be a positive experience.

CONCLUSION

Findings suggested the possible role for language in understanding major depression, thereby improving care relationships between patients and physicians. Care pathways might also be more attentive to caregivers, to reduce their risk of burnout. Finally, narrative medicine could be integrated with the care pathway as an additional space of expression, dialogue, reflection and development of empathy.