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Tang LK, Yobas P, Wong DNX, Pikkarainen M, Zhang R, Ho D, He HG. Personal and work-related factors associated with post-traumatic growth in nurses: A mixed studies systematic review. J Nurs Scholarsh 2024. [PMID: 38703352 DOI: 10.1111/jnu.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses. DESIGN Mixed studies systematic review. METHODS Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design. RESULTS A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation. CONCLUSION The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors. CLINICAL RELEVANCE Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.
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Affiliation(s)
- Lian Kwang Tang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Raffles Hospital, Singapore, Singapore
| | - Piyanee Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Dionne Ning Xuan Wong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Minna Pikkarainen
- Oslomet, Oslo Metropolitan University, Oslo, Norway
- University of Oulu, Oulu, Finland
| | - Renwen Zhang
- Department of Communications and New Media, National University of Singapore, Singapore, Singapore
| | - Dean Ho
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
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Hulett JM, Spotts RA, Narkthong N, Scott SD. Massage therapy for hospital-based nurses: A proof-of-concept study. Complement Ther Clin Pract 2024; 55:101846. [PMID: 38484434 DOI: 10.1016/j.ctcp.2024.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Jennifer M Hulett
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA; Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA.
| | - Ruth Anne Spotts
- Ellis Fischel Cancer Center, University of Missouri, Columbia, MO, USA
| | - Natsayakarn Narkthong
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA; Prince of Songkla University, Songkhla, Thailand
| | - Susan D Scott
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA; University of Missouri Health Care, Columbia, MO, USA
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Newman C, Roche M, Elliott D. Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross-sectional survey. J Adv Nurs 2024; 80:1201-1211. [PMID: 37771198 DOI: 10.1111/jan.15885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023]
Abstract
AIMS The aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences. DESIGN Cross-sectional survey conducted January to April 2020. METHODS All 205 nurses working in an Australian high-security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF-36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored. RESULTS Sixty-eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self-harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non-acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self-harming behaviour was associated with poorer physical health. CONCLUSIONS Nurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well-being. Nurses who are victim of, or witness, physical violence are most likely to take time off work. IMPACT This study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses. No patient or public contribution.
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Affiliation(s)
- Claire Newman
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Michael Roche
- University of Technology Sydney, Ultimo, New South Wales, Australia
- University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Doug Elliott
- University of Technology Sydney, Ultimo, New South Wales, Australia
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Zhang J, Yang X, Zhang X, Liu Y, Liu M, Fang Y, Liu M, Wu M. Mediating effects of social support and presenteeism on turnover intention and post-traumatic stress disorder among Chinese nurses in the post-pandemic era: a cross-sectional study. Front Public Health 2024; 12:1323126. [PMID: 38420027 PMCID: PMC10899410 DOI: 10.3389/fpubh.2024.1323126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Background The shift in national policies for epidemic prevention and control in the post-pandemic era is undoubtedly a challenge for health care professionals. Nurses, as an important part of the health care professional population, have an even greater impact on their mental health and occupational safety. This may expose nurses to post-traumatic stress disorder (PTSD) and presenteeism, and ultimately lead to their turnover. Objective This study aimed to investigate the relationship between turnover intention and post-traumatic stress disorder among Chinese nurses during post-pandemic era, and the mediating role of social support and presenteeism. Methods In this study, a multicentre cross-sectional survey was conducted in April 2023 among nursing staff in several tertiary general hospitals in northern China, with online data collection using the Turnover intention Scale (PTSD), the Impact of Events Scale (IES), the Social Support Scale (SSS), and the Stanford presenteeism Scale (STAS) and the relationship between variables was analyzed using hierarchical multivariate regression, and Structural Equation Modeling (SEM) was used to analyze the relationship between post-traumatic stress disorder and the Turnover intention from the pathway between. Results Data were collected from 2,513 nurses who met the inclusion criteria, in which general information such as age, department, specific department, Professional title, history of alcohol consumption, form of employment, Years of working, and Average working hours per day were statistically significant with the difference in the turnover intention. The results of the study showed a 32% high turnover intention among nurses in the post-pandemic era, which was lower than the turnover intention during the pandemic. The results of hierarchical multiple regression analysis showed that post-traumatic stress disorder, social support, and presenteeism were significant predictors of turnover intention. The total effect of post-traumatic stress disorder on turnover intention to work was 0.472 [bias modified 95% confidence interval (0.415-0.483), p < 0.001]. Social support and attendance played a partially intermediate role in post-traumatic stress disorder and propensity to leave (an indirect effect of 26% of the total effect). Conclusion Turnover intention and post-traumatic stress disorder levels are high and social support plays an important role in the tendency to leave the job and post-traumatic stress disorder, healthcare institution can be achieved by strengthening social support for nurses in the post-epidemic era and preventing the occurrence of presenteeism.
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Affiliation(s)
- Jingshuo Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xin Yang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiaoman Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yuping Liu
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Mengshi Liu
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yu Fang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Mengjie Liu
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Min Wu
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Merriweather C, Cafasso M. Identifying concerns and solutions: Efforts to improve nurse retention. J Pediatr Nurs 2023; 71:143-144. [PMID: 37407151 DOI: 10.1016/j.pedn.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
| | - Mandi Cafasso
- University of Cincinnati, College of Nursing, Cincinnati, Ohio, USA
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Casimiro-Andújar AJ, Checa JC, Lirola MJ, Artés-Rodríguez E. Promoting Physical Activity and Health in the Workplace: A Qualitative Study among University Workers, Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2350. [PMID: 36767715 PMCID: PMC9915219 DOI: 10.3390/ijerph20032350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
The social changes we have been experiencing in recent years are generating anxiety that, together with sedentary lifestyles and poor health habits, are leading to premature ageing of society, in addition to the high rates of obesity and associated morbidity. In order to improve the lifestyles of the university community, the objective of this research project was the implementation of the UAL Activa programme based on physical activity. The beneficiaries were UAL staff from different sections, a total of 68 participants aged between 28 and 61 years (Mage = 49.36). Additionally, a total of 12 final year students of the degree in physical activity and sport sciences were responsible for designing and developing the exercise tasks. In-depth interviews were held with the participants of this project about the different benefits that their participation had brought them. The results obtained from the analysis with Nvivo v.10. showed five thematic blocks on the perceived improvements in physical fitness, physical condition, mood and emotional state, assessment of the new lifestyle, and social relations. In conclusion, the benefits of physical activity and the need to continue implementing action and intervention plans to encourage and promote its practice in all sectors of the population were highlighted.
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Affiliation(s)
- Antonio Jesús Casimiro-Andújar
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - Juan Carlos Checa
- Department of Geography, History and Humanities, Faculty of Humanities, University of Almería, 04120 Almería, Spain
| | - María-Jesús Lirola
- Department of Psychology, Faculty of Psychology, University of Almería, 04120 Almería, Spain
| | - Eva Artés-Rodríguez
- Area of Statistics and Operative Research, Department of Mathematics, Faculty of Sciences, University of Almería, 04120 Almería, Spain
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Ham E, Seto MC, Rodrigues NC, Hilton NZ. Workplace stressors and PTSD among psychiatric workers: The mediating role of burnout. Int J Ment Health Nurs 2022; 31:1151-1163. [PMID: 35574982 DOI: 10.1111/inm.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
Critical workplace events (e.g., assaults), chronic stressors, burnout, and work conditions all affect nurse well-being. The present study investigated associations among these sources of stress and posttraumatic stress disorder (PTSD) symptoms in psychiatric nurses, hypothesizing that burnout would mediate the paths between workplace stressors and PTSD. Surveys were completed by 611 psychiatric nurses or allied health staff working on inpatient units in three psychiatric hospitals. Participants reported on critical events and chronic stressors specific to providing psychiatric care and completed the Maslach Burnout Inventory (MBI), Areas of Worklife Survey (AWS) (work conditions), and PTSD Checklist for DSM-5. Data were analysed using structural equation modelling. Burnout had a direct relation to PTSD symptoms and partially mediated the effect of exposure to critical events, but not chronic stressors, on PTSD symptoms. Chronic stressors related to patients' disturbing behaviour (e.g., flooding room, eating non-food items) had a direct effect on PTSD symptoms, but those related to resisting care (e.g., screaming constantly, physically resisting care) had no significant association. Worklife conditions had a negative direct effect on Burnout and indirect effect on PTSD, whereby participants reporting poorer alignment of work conditions with their expectations had higher Burnout and PTSD symptom scores. Different sources of workplace stress have different relations to PTSD symptoms, and Burnout has both direct and mediation effects. Interventions aimed at reducing patients' aggressive and disturbing acts and improving healthcare providers' burnout and worklife factors in hospitals may all be needed to reduce PTSD among psychiatric staff.
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Affiliation(s)
- Elke Ham
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Michael C Seto
- University of Ottawa's Institute of Mental Health Research, Ottawa, Canada
| | | | - N Zoe Hilton
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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Wang J, Zeng Q, Wang Y, Liao X, Xie C, Wang G, Zeng Y. Workplace violence and the risk of post-traumatic stress disorder and burnout among nurses: a systematic review and meta-analysis. J Nurs Manag 2022; 30:2854-2868. [PMID: 36122417 DOI: 10.1111/jonm.13809] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/03/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
AIM This review examined the association between workplace violence and the risk of post-traumatic stress disorder (PTSD) and burnout among nurses. BACKGROUND The extent to which workplace violence is associated with an increased risk of PTSD and burnout in nurses remains unclear. EVALUATION We searched nine electronic databases (PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Chinese Biomedical, China National Knowledge Internet, and WANFANG). KEY ISSUES Overall, 114 full-text studies were identified; 43 met the inclusion criteria, of which 10 were included in the meta-analysis. Compared to their counterparts with non-exposure to workplace violence, nurses experiencing it had 2.13 and 2.25 times higher odds of reporting PTSD and burnout after adjusting the confounding factors. Additionally, the moderator and mediator factors might help reduce the risk of both in this population. CONCLUSION This study indicated that workplace violence increases the risk of PTSD and burnout. IMPLICATIONS FOR NURSING MANAGEMENT Our review identified the magnitude of the association between exposure to workplace violence and the reported symptoms of PTSD and burnout in nurses. Furthermore, multi-targeted efforts directed at the identified social/organisational, task-related, and individual resources might help mitigate their harmful impact in the aforementioned population.
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Affiliation(s)
- Jinfeng Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qinglin Zeng
- School of Clinical Medicine, Sichuan College of Traditional Chinese Medicine, Mianyang, China
| | - Yuqiang Wang
- School of Stomatology, Shanxi Medical University, Taiyuan, China
| | - Xinqi Liao
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Caixia Xie
- Nursing research center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Guofu Wang
- Chengdu Fifth People's Hospital, Chengdu, China
| | - Yanli Zeng
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Braquehais MD, Mozo X, Gausachs E, Santiago R, Llavayol E, González-Irizar O, Nieva G, Valero S, Ramos-Quiroga JA, Bruguera E. Nurse admissions at a specialized mental health programme: A pre-Covid-19 retrospective review (2000-2019). J Adv Nurs 2022; 78:2807-2814. [PMID: 35174899 DOI: 10.1111/jan.15189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/23/2021] [Accepted: 01/29/2022] [Indexed: 11/29/2022]
Abstract
AIMS Nursing is a stressful and emotionally demanding profession. To date, few mental health treatment interventions have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer specialized mental health programme in Europe from 2000 to 2019. DESIGN A retrospective observational study of 1297 medical e-records of nurses with mental health disorders admitted to the Galatea Care Programme in Barcelona was conducted. METHODS Three periods were analysed: 2000-2006, 2007-2012 and 2013-2019. Socio-demographic and clinical variables were compared. Diagnoses followed Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria. RESULTS Gender and age at referral did not change over time. Self-referrals grew from 85.1% in the first period to 95.3% in the last period; inpatient admissions decreased from 24.1% to 18.2%, although this was not significant; nurses were less frequently on sick leave on admission over time (59.1% vs. 45.7%); they were more likely to have a temporary contract in the second period (9.5% vs. 4.8% and 4%) and prevalence of main diagnosis changed with a considerable decrease in affective and substance use disorders after 2006 and a progressive increase in adjustment disorders during the whole period. CONCLUSION Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings. WHAT PROBLEM DID THE STUDY ADDRESS?: Nursing is a stressful and emotionally demanding profession. To date, few specialized mental health services have been developed for them worldwide. This study aims to explore referral trends in nurses with mental disorders admitted to a pioneer programme in Europe, the Galatea Care Programme in Barcelona, from 2000 to 2019. WHAT WERE THE MAIN FINDINGS?: The number of referrals to the programme grew especially after the first 7-year period. Admissions were more likely to be voluntary during the last period. Prevalence of substance use disorders at admission dropped steadily while prevalence of adjustment disorders progressively increased over the two decades. Nurses were also less likely to be on sick leave at admission. WHERE AND ON WHOM WILL THE RESEARCH HAVE IMPACT?: Free, voluntary, highly confidential programmes for nurses with mental disorders may enhance voluntary and earlier help seeking. These findings can be considered when implementing specialized interventions for them in other settings.
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Affiliation(s)
- M Dolores Braquehais
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain.,Department of Psychiatry, Mental Health and Addiction Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Xulián Mozo
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain
| | - Eva Gausachs
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain
| | - Regina Santiago
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain
| | - Enric Llavayol
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain
| | - Olga González-Irizar
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain
| | - Gemma Nieva
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain.,Department of Psychiatry, Mental Health and Addiction Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sergi Valero
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain.,ACE Alzheimer Center BarcelonaResearch Center and Memory Clinic, Fundació ACE, Barcelona Alzheimer Treatment and Research Centre, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - José A Ramos-Quiroga
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain.,Department of Psychiatry, Mental Health and Addiction Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Avenida de Monforte de Lemos 3-5, Madrid, Spain.,Departmen of Psychiatry, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eugeni Bruguera
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Galatea Foundation, Barcelona, Spain.,Department of Psychiatry, Mental Health and Addiction Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Psychiatry, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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