COVID-19 and staff mental health: is there an evidence? An Italian field study

Psychosocial outcomes of COVID-19 pandemic on healthcare workers in maternity services

AIM

We investigated the effects of the COVID-19 outbreak on social support and anxiety levels in healthcare professionals working in maternity services situated in Trabzon, Turkey.

MATERIALS AND METHODS

Our study was designed retrospectively and observationally. Social support to the participants was measured using a scale called the multidimensional scale of perceived social support (MSPSS). State anxiety scale (STAI TX-1) and trait anxiety scale (STAI TX-2) were used to determine the level of anxiety. All scales were measured before and during the pandemic. Independent t-test and one-way ANOVA were used to analyze the data where p < 0.05 was considered significant.

RESULTS

The participants' demographic data (n = 96) included the mean age of doctors (n = 30), midwives (n = 34), and nurses (n = 32) which were 41.38 ± 4.16/38.58 ± 1.79/37.34 ± 2.19, respectively. Mean gravida was 1.69 ± 2.87/2.23 ± 0.12/2.31 ± 0.14, respectively. Mean BMI was 24.69 ± 2.87/26.04 ± 0.8/25.69 ± 1.98 in the same order (p > 0.05). The total mean values of the MSPSS, STAI TX-1, STAI TX-2 scales before and during the pandemic were found as 66.55 ± 6.63 - 55.25 ± 4.76, 36.71 ± 10.04 - 50.08 ± 11.65, 37.33 ± 8.09 - 53.32 ± 9.94, respectively. A significant difference was found for the mean of all scales amongst the groups (p < 0.05).

CONCLUSION

During the COVID-19 pandemic, a significant number of healthcare workers were deprived of social support and their anxiety levels increased.

Health-Promoting Quality of Life at Work during the COVID-19 Pandemic: A 12-Month Longitudinal Study on the Work-Related Sense of Coherence in Acute Care Healthcare Professionals

(1) Background: During a pandemic, the wellbeing of healthcare professionals is crucial. We investigated the long-term association of the Work-related Sense of Coherence (Work-SoC) and the evolution of psychological health symptoms of acute care healthcare professionals during the first year of the COVID-19 pandemic. (2) Methods: This longitudinal observational study enrolled 520 multinational healthcare professionals, who completed an online survey every three months from April 2020 to April 2021. Mixed linear models examined the associations between Work-SOC and COVID-19-related anxiety, perceived vulnerability, depressiveness, and psychological trauma symptomatology. (3) Results: Healthcare professionals with a higher Work-SoC reported lower levels of COVID-19-related anxiety, perceived vulnerability, depressiveness, and psychological trauma symptomatology in April 2020 than healthcare professionals with an average or lower Work-SoC, but the levels increased to higher values in April 2021. Healthcare professionals with a lower Work-SoC reported higher levels of depressiveness and psychological trauma symptomatology in April 2020 but lower levels in April 2021. (4) Conclusions: Healthcare professionals with higher levels of Work-related Sense of Coherence might be protected against variations in psychological symptoms for about three months, but this protection seems to decrease as the pandemic continues, resulting in mental health deterioration. In contrast, healthcare professionals with a lower Work-SoC might be protected at later stages of the pandemic.

Online Public Rumor Engagement Model and Intervention Strategy in Major Public Health Emergencies: From the Perspective of Social Psychological Stress

During major public health emergencies, a series of coupling problems of rumors getting out of control and public psychological imbalance always emerge in social media, which bring great interference for crisis disposal. From the perspective of social psychological stress, it is important to depict the interactive infection law among distinct types of rumor engagers (i.e., advocates, supporters, and amplifiers) under different social psychological stress states, and explore the effectiveness of rumor intervention strategies (i.e., hindering and persuasion) from multiple dimensions, to scientifically predict the situation of public opinion field and guide the public to restore psychological stability. Therefore, this paper constructs an interactive infection model of multiple rumor engagers under different intervention situations based on a unique user-aggregated dataset collected from a Chinese leading online microblogging platform (“Sina Weibo”) during the COVID-19 in 2020. The simulation result shows that (1) in the period of social psychological alarm reaction, the strong level of hindering intervention on the rumor engagers leads to more serious negative consequences; (2) in the period of social psychological resistance, the persuasion and hindering strategies can both produce good outcomes, which can effectively reduce the overall scale of rumor supporters and amplifiers and shorten their survival time in social media; (3) in the period of social psychological exhaustion, rumor intervention strategies are not able to have a significant impact; (4) the greater the intensity of intervention, the more obvious the outcome. Experimental findings provide a solid research basis for enhancing social psychological stress outcomes and offer decision-making references to formulate the rumor combating scheme.

Determinants of the mental health condition of healthcare workers during the initial phase of the COVID-19 pandemic in Turkey

Aim

Current study aimed to determine the stressors experienced by healthcare workers during the initial phase of the COVID-19 pandemic in Turkey.

Subject and msethods

A cross-sectional design was utilized, and an online survey was conducted in early April 2020 among 2506 healthcare workers, using snowball sampling. A questionnaire highlighting the elements pertinent to the COVID-19 outbreak and General Health Questionnaire were used to collect data. Multiple linear regression analysis was performed to assess the impact of the early stages of the outbreak on the mental health condition of healthcare workers.

Results

The mean of the General Health Questionnaire-12 was 6.03 (min = .00, max = 12.00). Participants reported high frequency of some variables, such as favorable relationships with their teammates (90.7%, n = 2274), striving to create a more hygienic home (84.6%, n = 2121), anger and hopelessness due to the community's neglect of precautions (84.2%, n = 2109) and fear of exposure to violence against healthcare workers (72.8%, n = 1825). The final regression model contained seven variables (gender, individual preparedness, perceived level of training related to COVID-19, meeting basic needs during the pandemic, fear of being infected, fear of infecting loved ones, and family relationships).

Conclusion

Our study indicates that the management of the COVID-19 pandemic has to be planned and sustained by relevant measures maintaining the psychological wellbeing of healthcare workers. Psychological support should be provided for individuals and the teams; healthcare workers’ families should also be involved in and benefit from sustained and intermittent psychological support.

Understanding the Mediating Role of Anxiety and Depression on the Relationship Between Perceived Stress and Sleep Quality Among Health Care Workers in the COVID-19 Response

OBJECTIVE

There is an increasing amount of evidence exploring the adverse effects of perceived stress or anxiety and depression independently on sleep quality during the COVID-19 outbreak, although the underlying mechanisms are unclear. The aim of the current study was to explore the role of anxiety and depression as a potential mediator between perceived stress and sleep quality among health care workers.

METHODS

Data were collected through an online survey using the snowball sampling method and comprised 588 current health care workers in Zhejiang and Hubei provinces, China, from February to March 2020. We administered the Sleep Quality Questionnaire (SQQ), the Perceived Stress Scale (PSS-10), the Patient Health Questionnaire (PHQ-4) and the sociodemographic characteristics and COVID-19-related characteristics questionnaire. Structural equation modelling (SEM) was used to examine the direct and indirect relationships between perceived stress, anxiety and depression, and sleep quality.

RESULTS

The average scores for sleep quality and perceived stress were 16.01 (95% CI [15.40, 16.57]) and 15.46 (95% CI [15.05, 15.87]), respectively. The positive rates of anxiety and depression symptom tests were 9.86% and 10.37%, respectively. The SEM results indicated that the original relationship between perceived stress and sleep quality was beta = 0.52 (P < 0.001) and reduced to beta = 0.25 (P = 0.045) while introducing anxiety and depression as mediating variables. Perceived stress was positively associated with anxiety and depression (beta = 0.78, P = 0.014), and anxiety and depression were positively associated with sleep quality (beta = 0.42, P < 0.001).

CONCLUSION

Poor sleep quality and high perceived stress were common during the COVID-19 crisis. Reducing perceived stress could help reduce anxiety and depression symptoms, thereby improving sleep quality among health care workers. In an attempt to promote psychological resources, we should perhaps take multiple measures, including personal tailored intervention and organizational humanistic concern.

Predictors of Change in Mental Health during the COVID-19 Pandemic

BACKGROUND

Cross-sectional data suggest that depression, anxiety, and stress have increased during the COVID-19 pandemic. However, longitudinal research is needed to test changes in mental health and determine factors that contribute to change. The purpose of this study was to compare anxiety, depression, and stress pre-pandemic to during the pandemic within the same sample and identify predictors of change (i.e., disease threat, changes to daily life, social isolation, financial worries).

METHOD

Three national samples of U.S. adults were recruited through an online platform (Amazon's Mechanical Turk). Participants completed online surveys pre-pandemic (September - December 2019) and during the pandemic(April - June 2020).

RESULTS

Across the three samples, mini-meta analyses revealed significant increases in anxiety and stress (Cohen's ds = 0.17, 0.16, respectively; ps < 0.01). Financial concern and effects of COVID-19 on daily life predicted higher levels of depression, anxiety, and stress during the pandemic across all three samples (ds = 0.24, 0.40, and 0.40, respectively; ps < 0.001).

LIMITATIONS

Response rates for follow-up surveys were relatively low, with some noted differences between those who did and did not complete both surveys.

CONCLUSIONS

Significant increases in anxiety and stress were observed across three samples of U.S. adults from before to during the COVID-19 pandemic. Financial concern and effects of the pandemic on daily life emerged as the most consistent predictors of psychological distress across these samples.

Prolonged Stress Causes Depression in Frontline Workers Facing the COVID-19 Pandemic-A Repeated Cross-Sectional Study in a COVID-19 Hub-Hospital in Central Italy

The COVID-19 pandemic has severely tested the mental health of frontline health care workers. A repeated cross-sectional study can provide information on how their mental health evolved during the various phases of the pandemic. The intensivists of a COVID-19 hub hospital in Rome were investigated with a baseline survey during the first wave of the pandemic in April 2020, and they were contacted again in December 2020, during the second wave. Of the 205 eligible workers, 152 responded to an online questionnaire designed to measure procedural justice, occupational stress (effort/reward imbalance), sleep quality, anxiety, depression, burnout, job satisfaction, happiness, and turnover intention. Workers reported a further increase in workload and compassion fatigue, which had already risen during the first wave, and a marked reduction in the time devoted to meditation and mental activities. A low level of confidence in the adequacy of safety procedures and the need to work in isolation, together with an increased workload and lack of time for meditation, were the most significant predictors of occupational stress in a stepwise linear regression model. Occupational stress was, in turn, a significant predictor of insomnia, anxiety, low job satisfaction, burnout, and intention to leave the hospital. The number of workers manifesting symptoms of depression increased significantly to exceed 60%. Action to prevent occupational risks and enhance individual resilience cannot be postponed.

SARS/MERS/SARS-CoV-2 Outbreaks and Burnout Syndrome among Healthcare Workers. An Umbrella Systematic Review

The coronavirus-19 (COVID-19) pandemic is putting a severe strain on all healthcare systems. Several occupational risk factors are challenging healthcare workers (HCWs) who are at high risk of mental health outcomes, including Burnout Syndrome (BOS). BOS is a psychological syndrome characterized by emotional exhaustion, depersonalization, and low personal accomplishment. An umbrella review of systematic reviews and meta-analyses concerning BOS and coronavirus (SARS/MERS/SARS-CoV-2) outbreaks was carried out on PubMed Central/Medline, Cochrane Library, PROSPERO, and Epistemonikos databases. Data relating to COVID-19 is insufficient, but in previous SARS and MERS outbreaks about one-third of HCWs manifested BOS. This prevalence rate is similar to the figure recorded in some categories of HCWs exposed to chronic occupational stress and poor work organization during non-epidemic periods. Inadequate organization and worsening working conditions during an epidemic appear to be the most likely causes of BOS. Preventive care and workplace health promotion programs could be useful for protecting healthcare workers during pandemics, as well as during regular health activities.

Defining Post-COVID Symptoms (Post-Acute COVID, Long COVID, Persistent Post-COVID): An Integrative Classification

The pandemic of the coronavirus disease 2019 (COVID-19) has provoked a second pandemic, the "long-haulers", i.e., individuals presenting with post-COVID symptoms. We propose that to determine the presence of post-COVID symptoms, symptoms should appear after the diagnosis of SARS-CoV-2 infection; however, this situation has some problems due to the fact that not all people infected by SARS-CoV-2 receive such diagnosis. Based on relapsing/remitting nature of post-COVID symptoms, the following integrative classification is proposed: potentially infection related-symptoms (up to 4-5 weeks), acute post-COVID symptoms (from week 5 to week 12), long post-COVID symptoms (from week 12 to week 24), and persistent post-COVID symptoms (lasting more than 24 weeks). The most important topic is to establish the time reference points. The classification also integrates predisposing intrinsic and extrinsic factors and hospitalization data which could promote post-COVID symptoms. The plethora of symptoms affecting multiple systems exhibited by "long-haulers" suggests the presence of different underlying mechanisms.

Psychological Impact of Exposure to the COVID-19 Sanitary Crisis on French Healthcare Workers: Risk Factors and Coping Strategies

Background: COVID-19 sanitary crisis is associated with emotional difficulties such as depression, anxiety and reactional post-traumatic symptoms among healthcare workers. Indeed, healthcare workers were particularly exposed to COVID-19 sanitary crisis. This study aimed to investigate the effects of exposure to COVID-19 sanitary crisis on affective symptoms (anxiety, post-traumatic stress, burnout) among French healthcare workers and the mediating role of cognitive emotion regulation strategies (positive re-evaluation and set in perspective) and coping strategies (active coping, planning, instrumental support, emotional support, emotional expression, positive reappraisal, acceptance, denial, blame, humor, religion, distraction, substance use, behavioral disengagement). Method: This cross-sectional survey-based study collected demographic data and mental health measurements from 1,010 volunteers (838 women) who consented online to participate, from March 24 to June 28, 2020, in France. Participants filled out online questionnaires and visual analogic scales that evaluate affective symptoms related to the COVID-19 sanitary crisis, namely symptoms of post-traumatic stress, burnout, emotion regulation abilities, and coping abilities. Results: The majority (57.8%) of the participants presented post-traumatic symptoms. Depending on the sub-dimensions evaluated, a proportion of participants reported moderate (25.9-31.2%) to severe (17.2-40.7%) burnout symptoms. We found a significant effect of the level of exposure to COVID-19 on affective symptoms. Being a woman, having a lower job position and having less experience were associated with higher level of affective symptoms. Moreover, coping strategies had a mediating effect on the relation between stress and burnout, supporting the coping reserve model. Conclusion: Post-traumatic and burnout symptoms were highly prevalent among French healthcare workers at the beginning of the COVID-19 crisis. Exposure to COVID-19 is a determining factor. We can thus promote both coping training and a good environment to limit the emotional consequences of exposure to COVID-19.

Occupational Stress and Mental Health among Anesthetists during the COVID-19 Pandemic

Anesthetist-intensivists who treat patients with coronavirus disease 19 (COVID-19) are exposed to significant biological and psychosocial risks. Our study investigated the occupational and health conditions of anesthesiologists in a COVID-19 hub hospital in Latium, Italy. Ninety out of a total of 155 eligible workers (59%; male 48%) participated in the cross-sectional survey. Occupational stress was assessed with the Effort Reward Imbalance (ERI) questionnaire, organizational justice with the Colquitt Scale, insomnia with the Sleep Condition Indicator (SCI), and mental health with the Goldberg Anxiety and Depression Scale (GADS). A considerable percentage of workers (71.1%) reported high work-related stress, with an imbalance between high effort and low rewards. The level of perceived organizational justice was modest. Physical activity and meditation—the behaviors most commonly adopted to increase resilience—decreased. Workers also reported insomnia (36.7%), anxiety (27.8%), and depression (51.1%). The effort made for work was significantly correlated with the presence of depressive symptoms (r = 0.396). Anesthetists need to be in good health in order to ensure optimal care for COVID-19 patients. Their state of health can be improved by providing an increase in individual resources with interventions for better work organization.