Thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic: qualitative analysis of open-ended survey responses

Self-Reported Advantages and Disadvantages of Online Networking About Opioid Misuse Among Those Who Have or Are Currently Misusing Opioids

INTRODUCTION

The opioid crisis is a significant public health concern. Online social networking platforms allow individuals with Opioid Use Disorder (OUD) to connect with others with shared experiences, which may combat treatment barriers. This study explored the self-reported advantages and disadvantages of engaging with social media content related to opioid misuse.

METHODS

Participants who reported ever misusing opioids (n = 248) were recruited from opioid-related forums on Reddit. Qualitative analysis identified themes in open-ended survey responses regarding perceived advantages, disadvantages, and impacts of online networking about opioid misuse. Bivariate analyses were conducted to compare qualitative themes mentioned by participants with their quantitative survey responses regarding treatment interest, perceived social support, and OUD symptom severity.

RESULTS

Advantages to socially networking about opioid misuse reported included connecting with others (69.5%), seeking advice (31.7%), and reduced fears of stigma/judgment (11.8%). Disadvantages reported included fear of being monitored (31.5%), receiving judgment/negative comments (28.6%), and viewing triggering content (12.9%). Mixed method analyses indicated that those who mentioned privacy of online communities as an advantage were less likely to report interest in treatment (p = 0.02). Those who reported having a non-judgmental community/outlet as an advantage were more likely to report higher levels of opioid dependence in the past 30 days (p = 0.03).

DISCUSSION

Online networking about opioid misuse has both advantages and disadvantages, and these perceived impacts vary by an individual's readiness for recovery and/or treatment. The findings of this study have implications for research and practice involving development of non-stigmatizing forms of assessment and support including harm reduction strategies.

Prevalence and influencing factors of suicidal ideation among doctors and nurses during the surge period of the COVID-19 pandemic in China: a multicenter cross-sectional study

BACKGROUND

From November 2022 to February 2023, China has experienced a surge period of COVID-19 pandemic and doctors and nurses working in hospitals have suffered from serious psychological crisis because of the medical crowding, which may result in the occurrence of suicidal ideation (SI). This study aims to explore the prevalence and influencing factors of SI during this surge phase.

METHODS

A multicenter cross-sectional study was conducted in China from 5 January 2023 to 9 February 2023. Data were collected by online questionnaires, with SI measured by a single item. Ordinal logistic regression analysis and stratified analyses were preformed to identify influencing factors.

RESULTS

A total of 5696 doctors and nurses were retained for further analysis, with 25.28% reporting SI during the COVID-19 surge phase. Participants experiencing anxiety symptoms or supporting other departments treating COVID-19 patients were more likely to report SI. Additionally, higher levels of resilience, mindfulness, and perceived social support were protective factors against SI.

CONCLUSION

During the COVID-19 surge phase, over a quarter of doctors and nurses in China suffered from SI, which should be of great concern. Tailored interventions should be implemented to alleviate SI among doctors and nurses when new infectious diseases outbreak in the future.

Unexpected effects of pandemic-related changes on mental health: Evidence from a nationwide survey in South Korea

BACKGROUND

Substantial evidence indicates that the COVID-19 pandemic has adversely affected population mental health globally. However, most studies assumed a linear relationship where only negative pandemic-induced changes led to worse mental health outcomes, overlooking the complex relationship between COVID-19-related changes and mental health. This study examined how various types and magnitudes of pandemic-related changes relate to depression and suicidal thoughts in a large, nationwide adult population sample.

METHODS

We analyzed data from the 2021 Korean Community Health Survey, a cross-sectional survey of 229,213 adults. The study examined the association between mental health outcomes and three types of pandemic-related changes: daily life impact (scored 0-100), economic activities (employment and income changes), and health behaviors (physical activity, instant food consumption, alcohol consumption, and smoking). Complex sample multiple logistic regression analysis was used to assess these associations, adjusting for sociodemographic factors.

RESULTS

The relationship between pandemic-related changes and mental health showed non-linear patterns. Compared to those reporting moderate changes, individuals reporting either no change (depression: aOR 1.253, 95% CI 1.135-1.384; suicidal thoughts: aOR 1.355, 95% CI 1.236-1.486) or complete disruption (depression: aOR 1.895, 95% CI 1.667-2.155; suicidal thoughts: aOR 1.788, 95% CI 1.558-2.052) in daily life showed higher risks of poor mental health. Unexpectedly, positive changes such as improved working conditions (suicidal thoughts: aOR 1.419, 95% CI 1.200-1.677) and increased income (depression: aOR 1.304, 95% CI 1.139-1.493; suicidal thoughts: aOR 1.244, 95% CI 1.079-1.435) were also associated with adverse mental health outcomes.

CONCLUSIONS

This study reveals that both minimal and substantial changes in daily life, as well as both positive and negative changes in economic conditions and health behaviors, were associated with poor mental health outcomes during the pandemic. These findings suggest the need for comprehensive mental health interventions that consider various types and magnitudes of life changes during crisis situations.

Global Overview of Suicidal Behavior and Risk Factors among General Population during the COVID-19 Pandemic: A Systematic Review and a Meta-Regression

The COVID-19 pandemic has significantly impacted mental health worldwide, leading to increased rates of suicidal behavior. This systematic review and meta-regression aim to investigate the global prevalence and risk factors associated with suicidal behaviors in the general population during the pandemic. The study included 202 articles from January 1, 2019, to October 31, 2023, sourced from databases such as Embase, MEDLINE, CINAHL, Web of Science, and Cochrane Library. The meta-analysis revealed a prevalence of 13.5% for suicidal ideation, 10.4% for suicide attempts, and a death rate of 0.5%, translating to 4.52 per 100,000 person-years. Significant risk factors identified include being transgender, young adults (18-44 years), unmarried status, low education, retirement, living alone, low social support, a history of suicide attempts, substance use, depression, anxiety, PTSD, sleep problems, poor perceived physical health, loneliness, quarantine, and residing in the Americas or multiple regions. The findings underscore the urgent need for targeted mental health interventions during pandemics, focusing on high-risk groups such as young adults, transgender individuals, those with low social support, and people with mental health issues. This comprehensive analysis provides valuable insights for policymakers and healthcare providers to develop effective strategies to mitigate the heightened risk of suicide during global health crises.

One-Hour Suicide Prevention Training Makes a Difference!

ABSTRACT

Nurses and other healthcare workers in the United States are at increased risk of suicide compared to non-healthcare workers. College students also experience high suicide risk. To impact suicide prevention in these populations, a Question, Persuade, Refer (QPR) 1-hour gatekeeper suicide prevention training program was implemented at the University of Detroit Mercy for faculty, staff, and administrators in the College of Health Professions (N = 43). Knowledge in seven areas of suicide significantly increased after the training (p < .001). Sixteen attitudes about suicide improved; however, only two showed a statistically significant change. Results support that 1-hour QPR training can be effectively implemented in a large organization.

Psychiatry as a vocation: Moral injury, COVID-19, and the phenomenology of clinical practice

In this article, we focus on a particular kind of emotional impact of the pandemic, namely the phenomenology of the experience of moral injury in healthcare professionals. Drawing on Weber's reflections in his lecture Politics as a Vocation and data from the Experiences of Social Distancing during the COVID-19 Pandemic Survey, we analyse responses from healthcare professionals which show the experiences of burnout, sense of frustration and impotence, and how these affect clinicians' emotional state. We argue that this may relate to the ethical conflicts they experience when they are forced to make clinical decisions where there are no optimal outcomes, and how in turn that impacts on their own emotional state. We then further examine the notion of 'burnout' and the phenomenology of 'moral injury'. Our argument is that these experiences of moral injury across a range of clinicians during the pandemic may be more prevalent and long-standing in psychiatry and mental health than in other areas of healthcare, where ethically difficult decisions and resource constraints are common outside times of crisis. Hence, in these clinical arenas, moral injury and the phenomenology of emotional changes may be independent of the pandemic. The insights gained during the pandemic may provide wider insights into the challenges of developing services and training the workforce to provide appropriate mental health care.

Culture, conditions and care support mental health of healthcare workers during crises

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has presented immense challenges to health systems worldwide and significantly impacted the mental health of frontline healthcare workers.

AIMS

This study drew on the experiences of frontline healthcare workers to examine organizational strategies needed to support the mental health and well-being of healthcare workers during times of crisis.

METHODS

Semi-structured focus groups or individual interviews were conducted with healthcare workers to examine their perspectives on organizational strategies for enhancing staff mental health and well-being during crises. Data were analysed thematically. Following this, evidence for the identified strategies was reviewed to assess alignment with participant views and recommendations.

RESULTS

Thirty-two healthcare workers from diverse disciplines (10 allied health, 11 nursing, 11 medical) participated in the study. Data analysis identified three broad themes contributing to supporting mental health and well-being. These themes can be encapsulated as the 'Three Cs'-culture (building an organizational culture that prioritizes mental health); conditions (implementing proactive organizational strategies during crises) and care (ensuring fit-for-purpose strategies to support mental health and well-being).

CONCLUSIONS

Study findings underscore the necessity of an integrated and systemic organizational approach to address mental health and well-being in the healthcare workplace. This approach must be long term with the components of the 'Three Cs', particularly cultural change and conditions, viewed as a part of a suite of strategies to ensure crisis preparedness. It is imperative that organizations collaborate with their staff, providing support and fostering a safe and inclusive work environment that ultimately benefits patients, their care and staff well-being.

Stress, anxiety, depression and sleep disturbance among healthcare professional during the COVID-19 pandemic: An umbrella review of 72 meta-analyses

The outbreak of SARS-CoV-2, which causes COVID-19, has significantly impacted the psychological and physical health of a wide range of individuals, including healthcare professionals (HCPs). This umbrella review aims provide a quantitative summary of meta-analyses that have investigated the prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic. An umbrella review of systematic reviews and meta-analyses reviews was conducted. The search was performed using the EMBASE, PubMed, CINAHL, MEDLINE, PsycINFO, and Google Scholar databases from 01st January 2020 to 15th January 2024. A random-effects model was then used to estimate prevalence with a 95% confidence interval. Subgroup analysis and sensitivity analyses were then conducted to explore the heterogeneity of the sample. Seventy-two meta-analyses involved 2,308 primary studies were included after a full-text review. The umbrella review revealed that the pooled prevalence of stress, anxiety, depression, and sleep disturbance among HCPs during the COVID-19 pandemic was 37% (95% CI 32.87-41.22), 31.8% (95% CI 29.2-34.61) 29.4% (95% CI 27.13-31.84) 36.9% (95% CI 33.78-40.05) respectively. In subgroup analyses the prevalence of anxiety and depression was higher among nurses than among physicians. Evidence from this umbrella review suggested that a significant proportion of HCPs experienced stress, anxiety, depression, and sleep disturbance during the COVID-19 pandemic. This information will support authorities when implementing specific interventions that address mental health problems among HCPs during future pandemics or any other health crises. Such interventions may include the provision of mental health support services, such as counseling and peer support programs, as well as the implementation of organizational strategies to reduce workplace stressors.

Moral injury and mental health among health-care workers during the COVID-19 pandemic: meta-analysis

Background: During the COVID-19 pandemic, health-care workers (HCWs) may have been confronted with situations that may culminate in moral injury (MI). MI is the psychological distress that may result from perpetrating or witnessing actions that violate one's moral codes. Literature suggests that MI can be associated with mental health problems.Objective: We aimed to meta-analytically review the literature to investigate whether MI is associated with symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, burnout, and suicidal ideation among active HCWs during the COVID-19 pandemic.Method: We searched eight databases for studies conducted after the onset of the COVID-19 pandemic up to 18 July 2023, and performed random-effects meta-analyses to examine the relationship between MI and various mental health outcomes.Results: We retrieved 33 studies from 13 countries, representing 31,849 individuals, and pooled 79 effect sizes. We found a positive association between MI and all investigated mental health problems (rs = .30-.41, all ps < .0001). Between-studies heterogeneity was significant. A higher percentage of nurses in the samples was associated with a stronger relationship between MI and depressive and anxiety symptoms. Samples with a higher percentage of HCWs providing direct care to patients with COVID-19 exhibited a smaller effect between MI and depressive and anxiety symptoms. We observed a stronger effect between MI and PTSD symptoms in US samples compared to non-US samples.Conclusion: We found that higher MI is moderately associated with symptoms of PTSD, anxiety, depression, burnout, and suicidal ideation among HCWs during the COVID-19 pandemic. Our findings carry limitations due to the array of MI scales employed, several of which were not specifically designed for HCWs, but underscore the need to mitigate the effect of potentially morally injurious events on the mental health of HCWs.

Loneliness in the workplace: a mixed-method systematic review and meta-analysis

BACKGROUND

Loneliness is a risk factor for a range of mental and physical health problems and has gained increasing interest from policy-makers and researchers in recent years. However, little attention has been paid to loneliness at work and its implications for workers and employers.

AIMS

Identify workplace, health and personal factors associated with workplace loneliness.

METHODS

We searched five databases (PubMed, MEDLINE, EMBASE, PsycINFO and EBSCO Business Source Complete) for relevant articles published from 1 January 2000 to 23 February 2023. Quantitative data were synthesized using narrative synthesis and random-effects meta-analysis of correlation coefficients. Qualitative data were synthesized using thematic synthesis. Evidence quality was appraised using the Mixed-Methods Appraisal Tool.

RESULTS

We identified 49 articles meeting the inclusion criteria. Pooled results indicate that workplace loneliness was associated with lower job performance (r = -0.35, 95% CI -0.49, -0.21), reduced job satisfaction (r = -0.34, 95% CI -0.44, -0.24), worse worker-manager relationship (r = -0.31, 95% CI -0.38, -0.24) and elevated burnout (r = 0.39, 95% CI 0.25, 0.51). Qualitative results suggest links between loneliness and inadequate workplace social interactions and mental health problems. As most studies used cross-sectional data and few adjusted for potential confounders, the direction and robustness of the associations remain untested.

CONCLUSIONS

Our results indicate that loneliness is associated with poor occupational functioning and well-being among workers. Results also show that loneliness is associated with modifiable aspects of the work environment, suggesting that the workplace may offer a fruitful avenue for interventions targeting loneliness.

Working conditions, psychological distress and suicidal ideation: cross-sectional survey study of UK junior doctors

BACKGROUND

Evidence attests a link between junior doctors' working conditions and psychological distress. Despite increasing concerns around suicidality among junior doctors, little is known about its relationship to their working conditions.

AIMS

To (a) establish the prevalence of suicidal ideation among junior doctors in the National Health Service; (b) examine the relationships between perceived working conditions and suicidal ideation; and (c) explore whether psychological distress (e.g. symptoms of depression and anxiety) mediates these relationships.

METHOD

Junior doctors were recruited between March 2020 and January 2021, for a cross-sectional online survey. We used the Health and Safety Executive's Management Standards Tool; Depression, Anxiety and Stress Scale 21; and Paykel Suicidality Scale to assess working conditions, psychological distress and suicidality, respectively.

RESULTS

Of the 424 participants, 50.2% reported suicidal ideation, including 6.1% who had made an attempt on their own life. Participants who identified as LGBTQ+ (odds ratio 2.18, 95% CI 1.15-4.12) or reported depression symptoms (odds ratio 1.10, 95% CI 1.07-1.14) were more likely to report suicidal ideation. No direct relationships were reported between working conditions (i.e. control, support, role clarity, strained relationships, demand and change) and suicidal ideation. However, depression symptoms mediated all six relationships.

CONCLUSIONS

This sample of junior doctors reported alarming levels of suicidal ideation. There may be an indirect relationship between working conditions and suicidal ideation via depressive symptoms. Clearer research exploring the experience of suicidality in junior doctors is needed, including those who identify as LGBTQ+. Systematic interventions addressing working environment are needed to support junior doctors' mental health.

Suicide risk and associated factors in healthcare workers seeking psychological support during COVID-19: a cross-sectional study

Healthcare workers have been one of the groups most severely affected by the COVID-19 pandemic, leaving them with serious psychological effects. Some of these effects have not been treated promptly, leading to further psychological symptoms. The objective of this study was to evaluate suicide risk in healthcare workers seeking psychological help during the COVID-19 pandemic, and factors associated with this risk on participants that were searching for treatment during the COVID-19 pandemic. This is a cross-sectional study analyzing data from 626 Mexican healthcare workers seeking psychological help due to the COVID-19 pandemic through the www.personalcovid.com platform. Before they entered treatment, the Plutchik Suicide Risk Scale, the Depression Scale of the Center for Epidemiologic Studies, the Pittsburgh Sleep Quality Index, and the Professional Quality of Life Measure, were administered. Results: 49.4% (n = 308) presented suicide risk. The most severely affected groups were nurses (62%, n = 98) and physicians (52.7%, n = 96). Predictors of suicide risk in healthcare workers were secondary traumatic stress, high depressive affect, low positive affect, emotional insecurity and interpersonal problems, and medication use. Conclusions: The suicidal risk detected was high, found mostly in nurses and doctors. This study suggests the presence of psychological effects on healthcare workers, despite the time that has elapsed since the onset of the pandemic.

Effectiveness of teen Mental Health First Aid in Improving Teen-to-Teen Support Among American Adolescents

BACKGROUND

teen Mental Health First Aid (tMHFA) is an Australian school-based universal program for grade 10 to 12 students. tMHFA teaches teens how to recognize and respond to a peer in crisis or experiencing mental health concerns.

METHODS

Schools implementing tMHFA in 2019 and 2020 were propensity score matched, yielding a sample of instructors (n = 130) and students (n = 1915) in 44 high schools in 24 American states. Effectiveness and acceptability were assessed with student surveys at baseline and after implementation.

RESULTS

There were significant findings for primary outcomes, including improved helpful first aid intentions (Cohen ds = 0.57 to 0.58), confidence supporting a peer (ds = 0.19 to 0.31); the number of adults rated as helpful (ds = 0.37 to 0.44); and reductions in stigmatizing beliefs (ds = 0.21 to 0.40) and "harmful first aid intentions" (ds = 0.11 to 0.42). Instructors and students rated the program favorably with students sharing improvements on their recognition and responses to mental health problems and crises.

CONCLUSION

tMHFA is an effective, feasible, and scalable training program for increasing mental health literacy and decreasing mental health stigma in adolescents in the short term, consistent with trials of tMHFA in Australian adolescents.

The impact of adolescent suicide on clinicians: a mixed-methods study

BACKGROUND

Clinician reactions to client suicide may include shock, grief, guilt, self-doubt, shame, anger, and fears of blame and medico-legal consequences. Clinicians will often differ in their reactions to the suicide and the type of supports required. Adolescent suicide-specific literature is limited.

AIMS

We sought to explore clinician reactions and perceptions of support following child and adolescent suicide.

METHODS

One hundred and fifteen staff working for a Child and Adolescent Mental Health Service were invited to complete an online survey with quantitative and qualitative components, and an in-depth semi-structured interview. Results were presented to teams for reflection and further feedback.

RESULTS

Eight clinicians participated in the semi-structured interview, and 33 in the online survey. Thirteen were the primary clinician, and 21 were part of a multi-disciplinary team when a client suicided. Respondents were predominantly female, from a range of disciplines. Fifty per cent of primary clinicians found the support good to very good. The rest were neutral. However, 26% of team members found support poor to very poor. Clinicians reported questioning their clinical effectiveness and chosen vocation. Some reported a need to disconnect or withdraw to preserve motivation and empathy for the work. They received significant support from their team, and teams were very anxious for the well-being of primary clinicians.

CONCLUSIONS

Health services must find ways of helping staff feel that their sense of vocation is valued and nurtured. These strategies will likely include fostering team cohesiveness and mutual support and allowing opportunities to temporarily step back and recover after challenging experiences.

Comparison of depressive symptoms among healthcare workers in high-risk versus low-risk areas during the first month of the COVID-19 pandemic in China

INTRODUCTION

The psychological health of healthcare workers (HCWs) has become a significant concern, particularly during the initial stage of a pandemic. This study compared the depressive symptoms among HCWs in high-risk areas (HRAs) and low-risk areas (LRAs) with matching demographics.

METHODS

A cross-sectional study was employed to compare the depressive symptoms (Patient Health Questionnaire score ≥ 10), workplace environment characteristics, the Health Belief Model (HBM) and socio-demographics of the HCWs working in HRAs and LRAs in several accessible regions (mainly Hubei Province and Guangdong-Hong Kong-Macao Greater-Bay-Area) in China. Eight hundred eighty-five HCWs were recruited for unmatched analysis between March 6 and April 2, 2020. After matching with occupation and years of service using a 1:2 ratio, 146 HCWs in HRAs and 290 HCWs in LRAs were selected for matched analysis. Subgroup analyzes were performed using two individual logistic regressions to delineate the associated factors in LRAs and HRAs, respectively.

RESULTS

HCWs in LRAs (Prevalence = 23.7%) had 1.96 times higher odds of depressive symptoms than those in HRAs (Prevalence = 15.1%) after adjusting for occupation and years of service (p < 0.001). Significant differences in workplace environment characteristics (p < 0.001) and the 5-dimension of the HBM of HCWs (p < 0.001 to p = 0.025) were found between HRAs and LRAs.Logistic regression showed that workers with years of service between 10 and 20  years (OR:6.27), ever had contact with COVID-19 patients (OR:14.33) and had higher scores of "perceived barrier" of HBM (OR:4.48) predicted depressive symptoms in HRAs while working in pneumology departments and infectious disease units (OR:0.06), and high "self-efficacy" in the HBM (OR:0.13) was a protective factor against depressive symptoms.Contrarily, in LRAs, those HCWs who worked in ICUs (OR:2.59), had higher scores of "perceived susceptibility toward the COVID-19 outbreak" (OR:1.41), "perceived severity of the pandemic" (OR:1.25), and "perceived barriers of wearing masks" (OR:1.43) in the HBM predicted depressive symptoms. High "cues to action" (OR:0.79), and better "knowledge" (OR:0.79) in the HBM were protective factors against depressive symptoms.

CONCLUSION

The risk of depressive symptoms of HCWS was double in LRAs than in HRAs in the first month of the COVID-19 pandemic. Furthermore, salient predictors for depressive symptoms among HCWs in HRAs and LRAs were very different.

Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: lessons learned

BACKGROUND

The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care Unit staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support.

METHODS

A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement.

RESULTS

All 178 respondents (response rate: 25-32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to 'team cooperation', 'team solidarity' and 'work ethic'. Lessons learned were mostly related to 'quality of care' and 'professional qualities'.

CONCLUSIONS

Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals' dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience.

TRIAL REGISTRATION

The trial was registered on The Netherlands Trial Register, number NL9177.

Impact of Unexpected In-House Major COVID-19 Outbreaks on Depressive Symptoms among Healthcare Workers: A Retrospective Multi-Institutional Study

The coronavirus disease 2019 (COVID-19) has significantly affected the mental health of healthcare workers (HCWs). The authors have provided psychosocial support to HCWs working in typical hospitals and nursing homes in Fukushima Prefecture, Japan, where major COVID-19 outbreaks have occurred since December 2020. This study retrospectively examines depressive symptoms before psychosocial interventions among HCWs working at typical hospitals and nursing homes experiencing in-house major COVID-19 outbreaks. We have offered psychosocial support in eight hospitals and nursing homes, obtaining data on the mental health status of 558 HCWs using the Patient Health Questionnaire-9. The study's results indicate that 29.4% of HCWs have exhibited moderate or higher depressive symptoms, and 10.2% had suicidal ideation. Multiple logistic regression analysis showed that being a nurse was associated with higher depressive symptoms and suicidal ideation compared to other HCWs. In addition, multiple logistic regression analysis of Polymerase Chain Reaction-positive HCWs showed that being a nurse and the number of COVID-19-related symptoms was associated with high depressive symptoms. These results suggest that HCWs in typical hospitals and nursing homes experiencing major COVID-19 outbreaks are more likely to exhibit severe depressive symptoms, which may worsen if infected with COVID-19. This study's findings expand the current understanding of HCWs' depressive symptoms and the importance of psychosocial support during unexpected major outbreaks in healthcare facilities.

Formal and informal help-seeking intentions/behaviors among students and workers during the COVID-19 pandemic: a scoping review

BACKGROUND

Students and workers have been subjected to increased levels of psychological distress due to the quarantine policy and containment measures during the COVID-19 pandemic. This scoping review aimed to present an overview of published evidence regarding formal and informal help-seeking intentions/behaviors for non-mental health-related issues as well as mental health-related issues among students and workers during the pandemic.

METHODS

In June 2022, we searched MEDLINE, APA PsycNet, and CINAHL for articles reporting the state of help-seeking intentions/behaviors among students and workers during the pandemic. Peer-reviewed original articles published in English were selected.

RESULTS

In total, 150 articles were identified, and 12 articles were selected for final analysis after removing articles that met the exclusion criteria. Three studies targeted university students, and nine targeted healthcare workers. Study settings were restricted to Western countries and China. Of the 12 studies, 11 were observational and predominantly cross-sectional studies. Two longitudinal studies using student samples suggested that university students became more reluctant to seek help from both formal and informal sources during the COVID-19 pandemic compared to before, despite the increased need for support during the pandemic. Among healthcare workers, the proportions of those who sought help from formal sources in person were low (7-26%), even among those with mental health issues, despite the increase in the need for mental health services. One randomized controlled study reported that a brief video-based intervention increased treatment-seeking intentions among healthcare workers in the intervention group compared with the non-intervention group.

CONCLUSIONS

The present review revealed that, although most studies included in the final analysis were cross-sectional, intentions/behaviors to seek help from both formal and informal sources decreased among university students, even those with mental health issues. Among healthcare workers, while the frequency of help-seeking from formal sources in person was low, a brief online intervention was suggested to be useful for promoting help-seeking from formal sources. During public health crises such as the COVID-19 pandemic, system and infrastructure development of online help-seeking services could potentially promote formal and informal help-seeking intentions/behaviors for diverse issues, including non-mental health-related issues, among university students and healthcare workers/providers.

Policy Changes as a Context for Moral Injury Development in the Wake of Dobbs v Jackson Women's Health Organization

The U.S. Supreme Court's 2022 ruling in Dobbs v Jackson Women's Health Organization held that the U.S. Constitution does not confer the right to an abortion, which set into motion an overhaul of reproductive health care services in certain states. Health care professionals are now operating within a rapidly changing landscape of clinical practice in which they may experience conflict between personal and professional morals (eg, bodily autonomy, patient advocacy), uncertainty regarding allowable practices, and fear of prosecution (eg, loss of medical license) related to reproductive health care services. The ethical dilemmas stemming from Dobbs create a context for exposure to potentially morally injurious events, moral distress, and moral injury (ie, functional impairment stemming from exposure to moral violations) among health care professionals. Considerations related to clinical intervention and approaches to policy are reviewed. Early identification of health care professionals' potentially morally injurious event exposure related to restricted reproductive services is critical for preventing and intervening on moral injury, with implications for improving functioning and retention within the medical field.

Suicidal ideation and suicide attempts in healthcare professionals during the COVID-19 pandemic: A systematic review

Background

COVID-19 has caused a series of economic, social, personal, and occupational consequences that may affect the mental health of healthcare workers (HCWs), with the consequent risk of developing suicidal ideation and behaviors.

Objectives

The aim of this study was to identify the main risk factors that may predispose HCWs to suicidal ideation and suicide attempts during the COVID-19 pandemic.

Methods

A systematic review of studies published between January 2020 and August 2022 was conducted following the PRISMA guidelines in the following electronic databases: Pubmed, Scopus, Web of Science, CINAHL, and PsycINFO. Methodological quality was assessed using the critical appraisal tools for non-randomized studies of the Joanna Briggs Institute (JBI). The followed protocol is listed in the International Prospective Register of Systematic Reviews (PROSPERO) with code CRD42022340732.

Results

A total of 34 studies were included in this review. There are a number of underlying factors such as higher rates of depression, anxiety, pre-pandemic lifetime mental disorders or previous lifetime suicide attempt, living alone, having problems with alcohol and/or other drugs, etc. that favor the emergence of suicidal tendencies and ideation in times of COVID-19. Similarly, the pandemic may have precipitated a series of factors such as economic concerns, assessing one's working conditions as poor, having family members or friends infected, changes in services or functions, and feeling discriminated against or stigmatized by society. Other factors such as age, sex, or type of healthcare worker show differences between studies.

Conclusion

Organizations should ensure the adoption of strategies and programmes for early detection of suicides as well as increased attention to the mental health of professions with a high workload.

Systematic review registration

PROSPERO, identifier CRD42022340732.

Lack of Interventional Studies on Suicide Prevention among Healthcare Workers: Research Gap Revealed in a Systematic Review

Addressing the mental health needs of healthcare workers (HCWs), who are at high risk of suicide, is an important public health issue. Therefore, this systematic review investigated the effect of psychosocial intervention targeting suicidal behavior (i.e., suicidal ideation, attempt, or fulfillment) of HCWs. Five electronic databases were searched for interventional studies reporting HCWs' suicidal behavior outcomes. Only two interventional studies were included in this review, and no consistent conclusion was drawn from the existing literature regarding the psychosocial prevention strategies focusing on the suicide risk of HCWs. The results indicate that compared with numerous observational studies reporting poor mental health and/or severity of suicidal risk among HCWs, intervention studies using psychosocial strategies to reduce the risk of suicide are relatively scarce. Although the insufficient number and heterogeneity of the included studies leave the results inconclusive, our findings emphasize the need to fill the research gap in this field. The causes of the gap are further explored, and suggestions for future research are provided.