Psychological impact of repeated epidemic exposure on healthcare workers: findings from an online survey of a healthcare workforce exposed to both SARS (severe acute respiratory syndrome) and COVID-19

Psychological status of medical security teams in Winter Olympic Games and Paralympics under COVID-19

Background

Medical security work for the 2022 Beijing Winter Olympic and Paralympics faced enormous challenges under COVID-19. This study aimed to investigate the mental status of those medical team members to provide a reference for scientifically implementing medical security services for large-scale events.

Methods

In this prospective cohort study, the Patient Health Questionnaire-9, Self-rating Anxiety Scale, General Self-Efficacy Scale, and Psychological Questionnaire for Emergent Events of Public Health (PQEEPH) were administered to 145 members of the medical team. A generalized mixed linear model was used to analyze the impact of work duration, position, on/off rotation, and gender on psychological status.

Results

Work duration significantly impacted depression, anxiety, self-efficacy, and all dimensions of PQEEPH. Women scored higher than men in the PQEEPH dimensions of depression, neurasthenia, fear, and total score. Working status affected the dimensions of depression, neurasthenia, and total score. Deterioration in emotional state became apparent in the fourth week and recovered 1 week after the task concluded, while self-efficacy decreased from beginning to end.

Conclusion

All the medical team members experienced emotional deterioration and decreased self-efficacy in medical security tasks. To maintain a medical team's psychological wellbeing during large-scale activities, rotation times should be set reasonably, and adequate mental health services should be provided.

Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

The SARS-CoV-2 (COVID-19) pandemic has increased healthcare worker (HCW) susceptibility to mental illness. We conducted a meta-analysis to investigate the prevalence and possible factors associated with post-traumatic stress disorder (PTSD) symptoms among HCW during the COVID-19 pandemic. We searched PubMed, SCOPUS and EMBASE databases up to May 4th, 2022. We performed random effects meta-analysis and moderator analyses for the prevalence of PTSD-relevant symptoms and severe PTSD symptoms. We identified 1276 studies, reviewed 209 full-text articles, and included 119 studies (117,143 participants) with a total of 121 data points in our final analysis. 34 studies (24,541 participants) reported prevalence of severe PTSD symptoms. Approximately 25.2% of participants were physicians, 42.8% nurses, 12.4% allied health professionals, 8.9% auxiliary health professionals, and 10.8% "other". The pooled prevalence of PTSD symptoms among HCWs was 34% (95% CI, 0.30-0.39, I² >90%), and 14% for severe PTSD (95% CI, 0.11 - 0.17, I² >90%). The introduction of COVID vaccines was associated with a sharp decline in the prevalence of PTSD, and new virus variants were associated with small increases in PTSD rates. It is important that policies work towards allocating adequate resources towards protecting the well-being of healthcare workers to minimize adverse consequences of PTSD.

"The emotions were like a roller-coaster": a qualitative analysis of e-diary data on healthcare worker resilience and adaptation during the COVID-19 outbreak in Singapore

BACKGROUND

Uncertainties related to COVID-19 have strained the mental health of healthcare workers (HCWs) worldwide. Gaining the ability to adapt and thrive under pressure will be key to addressing this. We explore what characterises risk, vulnerability and resilient responses of HCWs during the early stages of the outbreak in Singapore.

METHODS

We undertook qualitative theory-guided thematic analysis of e-diary entries from HCWs who navigated the outbreak from June-August 2020. Data were extracted from a subset of an online survey of n = 3616 participants collected across 9 institutions, including restructured hospitals, hospices and affiliated primary care partners.

RESULTS

N = 663 or 18% submitted qualitative journal entries included for analyses. All professional cadres, local as well as foreign HCWs participated. Themes are reported according to the Loads-Levers-Lifts model of resilience and highlighted in italics. The model assumes that resilience is a dynamic process. Key factors threatening mental health (loading) risk included a notable rise in anxiety, the effects of being separated from loved ones, and experiencing heightened emotions and emotional overload. Bad situations were made worse, prompting vulnerable outcomes when HCWs experienced stigma in the community and effects of "public paranoia"; or under conditions where HCWs ended up feeling like a prisoner with little control or choice when either confined to staff accommodation or placed on quarantine/Stay Home Notices. Those with strife in their place of residence also described already difficult situations at work being aggravated by home life. Protection (lifts) came from being able to muster a sense of optimism about the future or feeling grateful for the pace of life slowing down and having the space to reprioritise. In contrast, when risk factors were present, balancing these in the direction of resilient outcomes was achieved by choosing to re-direct stress into positive narratives, drawing on inner agency, uptake of therapeutic activities, social support as well as faith and prayer and drawing comfort from religious community among other factors.

CONCLUSION

The Loads-Levers-Lifts model is used to guide analysis to inform intervention designs. Levers promoting resilience through targeting therapies, workplace policies and awareness campaigns accounting for identified loads are proposed.

"Well, I Signed Up to Be a Soldier; I Have Been Trained and Equipped Well": Exploring Healthcare Workers' Experiences during COVID-19 Organizational Changes in Singapore, from the First Wave to the Path towards Endemicity

(1) Background: As COVID-19 transmission continues despite vaccination programs, healthcare workers (HCWs) face an ongoing pandemic response. We explore the effects of this on (1) Heartware, by which we refer to morale and commitment of HCWs; and identify how to improve (2) Hardware, or ways of enabling operational safety and functioning. (2) Methods: Qualitative e-diary entries were shared by HCWs during the early phases of the outbreak in Singapore from June to August 2020. Data were collected via an online survey of n = 3616 HCWs of all cadres. Nine institutions—restructured hospitals (n = 5), affiliated primary partners (n = 2) and hospices (n = 2)—participated. Applied thematic analysis was undertaken and organized according to Heartware and Hardware. Major themes are in italics (3) Results: n = 663 (18%) HCWs submitted a qualitative entry. Dominant themes undermining (1) Heartware consisted of burnout from being overworked and emotional exhaustion and at times feeling a lack of appreciation or support at work. The most common themes overriding morale breakers were a stoic acceptance to fight, adjust and hold the line, coupled with motivation from engaging leadership and supportive colleagues. The biggest barrier in (2) Hardware analysis related to sub-optimal segregation strategies within wards and designing better protocols for case detection, triage, and admissions criteria. Overall, the most cited enabler was the timely and well-planned provision of Personal Protective Equipment (PPE) for front-liners, though scope for scale-up was called for by those not considered frontline. Analysis maps internal organizational functioning to wider external public and policy-related narratives. (4) Conclusions: COVID-19 surges are becoming endemic rather than exceptional events. System elasticity needs to build on known pillars coupling improving safety and care delivery with improving HCW morale. Accordingly, a model capturing such facets of Adaptive Pandemic Response derived from our data analyses is described. HCW burnout must be urgently addressed, and health systems moved away from reactive “wartime” response configurations.