Depression, Anxiety, and Stress Among Healthcare Workers During the COVID-19 Outbreak and Relationships With Expressive Flexibility and Context Sensitivity

The relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era

BACKGROUND

Following pandemics, anxiety often remains prevalent within families, particularly among mothers, even after the acute phase. Mothers typically engage in increased emotional self-disclosure and interactions with family members, which can promote improved mental health and strengthen family dynamics through the shared expression and management of psychological concerns. This study aimed to determine the relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era.

METHODS

In this cross-sectional correlation study, 305 mothers of elementary school children in Borujerd, Lorestan, Iran, in 2022 were included using a multi-stage sampling method. Data collection tools comprised demographic questionnaires, the Emotional Self-Disclosure Scale, and the Spence Children's Anxiety Scale-Parent Report, all of which were completed by mothers as self-reports. Independent t-tests, one-way analysis of variance, Pearson's correlation test, and multivariate regression were employed to analyze the data.

RESULTS

There was a negative and significant correlation between mothers' emotional self-disclosure and children's anxiety (r = -0.890, P < 0.001) which remained significant after controlling for confounding variables (B = -0.667, P < 0.001). There was a statistically significant difference in mothers' mean emotional self-disclosure scores based on their place of residence, education, occupation, and their spouse's age, education, and occupation, as well as the child's sex, educational level, and age (P < 0.001). However, the results were insignificant concerning the mother's age (P > 0.05).

CONCLUSIONS

There was an inverse and relatively strong relationship between maternal emotional self-disclosure and child anxiety. This indicates that an increase in maternal emotional self-disclosure was associated with a reduction in child anxiety. Therefore, in similar crises, managing and promoting emotional self-disclosure among mothers may help in reducing children's anxiety, particularly in mothers who are well-educated, employed, reside in urban areas; have younger, well-educated, and employed spouses; and have female children with younger age and lower educational levels.

General Practitioners' Mental Well-Being During Crises: Results of the PRICOV-19 Study Pilot in Serbia

BACKGROUND/AIMS

This study was conducted with the aim of assessing the mental well-being of general practitioners (GPs) amidst the COVID-19 pandemic in Serbia. These findings are intended to provide valuable insights to primary care stakeholders about the potential need for support interventions.

MATERIALS AND METHODS

In the context of the international cross-sectional survey on primary health care during the COVID-19 pandemic (PRICOV-19), our initial focus was on evaluating the appropriateness of employing the Mayo Clinic Well-Being Index (MWBI) for Serbian GPs. The Spearman test validated the correlation between the GPs' scores of the MWBI and Depression Anxiety Stress Scales-21 (DASS21) in the Serbian context. The univariate and multivariate linear regressions modeled the personal and job-related potential predictors of higher MWBI scores (p < 0.05).

RESULTS

A strong, positive, and significant correlation was found between the MWBI score; the total DASS21 score; and the scores for depression, anxiety, and stress (p < 0.001). In this pilot study, 71.3% of the GP respondents had poor mental well-being indicated with MWBI scores ≥ 2 (the mean was 3.3 ± 2.7). The likelihood of experiencing poor mental well-being among the GPs was found to be associated with decreases in their socioeconomic statuses (B = -0.893; p = 0.021). Furthermore, inadequate allocation of time for the review of scientific evidence and guidelines has been correlated with a decline in mental well-being among respondents (B = -1.137; p = 0.033).

CONCLUSIONS

The MWBI effectively assessed GPs' mental well-being amidst COVID-19 in Serbia. GPs with low socioeconomic statuses might most benefit from mental well-being support during crises. For better mental well-being, GPs need adequate time in their agendas to assess scientific evidence and adhere to established guidelines.

Translating theoretical insights into an emotion regulation flexibility intervention: assessing effectiveness

ABSTRACTObjective: Traditional research often categorizes emotion regulation strategies as adaptive or maladaptive, overlooking crucial situational and individual differences that dictate their efficacy. The literature highlights the need for a more nuanced approach, like the role of emotion regulation flexibility. Despite its importance, research on developing and testing interventions that promote this flexibility is scarce. Addressing this gap, our study designed and tested an "Emotion Regulation Flexibility Booster Program" (ERFBP). We aimed to assess its efficacy in improving emotion regulation flexibility (ERF) and its impact on various mental health indicators. Method: We recruited 153 participants with low emotion regulation flexibility, randomly assigning them to experimental, control, and no-treatment groups. The experimental group was provided with an intervention based on an ERF model. The control group received sessions on study habits, whereas no-treatment group received no training. Results: The analysis indicated that participants in the ERFBP group exhibited significant changes in ERF, subjective wellbeing, and emotion regulation goals and psychological distress compared to baseline measurements and post-intervention scores of other two groups. Conclusion: These findings support the effectiveness of the ERFBP in enhancing ERF and wellbeing. However, further research must confirm these findings across diverse contexts and populations.

Connections between job satisfaction and depression, anxiety, and stress among nurses

Introduction

As a cornerstone of overall wellbeing, mental health significantly influences job satisfaction, vital for employee retention and organizational success. Recognizing this, managers prioritize initiatives to enhance job satisfaction and promote a healthy, productive work environment.

Aims

The study aims to explore the connections between depression, anxiety, stress, and job satisfaction among nurses, providing insights to improve their wellbeing and retention in the profession.

Methods

This quantitative survey study was conducted from June to September 2024, involving 643 nurses from healthcare facilities in Klaipėda County. Data were collected using two validated instruments: the Depression, Anxiety Stress Scales (DASS-42) and the Paul Spector Job Satisfaction Survey (JSS). Statistical analysis was performed using IBM SPSS Statistics Version 29.0.1.0.

Results

The study found that while the average levels of depression, anxiety, and stress among nurses were within normal limits, a significant portion of participants exhibited compromised mental health. Nearly one-third of the nurses experienced stress and/or depression, and almost half reported anxiety. Over one-sixth of the participants experienced high or very high levels of anxiety, while severe depression or stress was less common. Factors such as years of experience, workload, and work schedule were identified as significant influences on nurses' psychoemotional state. Moderate to strong positive correlations were observed between depression, anxiety, and stress levels. Additionally, the nurses' mental health was statistically significantly and negatively associated with most components of job satisfaction.

Conclusion

Despite average levels of depression, anxiety, and stress being within normal limits, many nurses face significant mental health challenges, particularly anxiety. Factors like workload and work schedules strongly influence their wellbeing. The negative link between mental health and job satisfaction highlights the need for better support to improve nurses' wellbeing and job satisfaction.

Exploring the Interplay Between Self-Identity, Affective Style, Emotion Regulation, and Anxiety: Based on Bayesian Network Model

OBJECTIVE

This study aimed to explore the complex relationships between self-identity, affective style, emotion regulation, and intolerance of uncertainty (IU) in predicting anxiety. A model was proposed to integrate these factors, investigating their combined influence on anxiety.

METHOD

Involving 608 university students who completed self-report measures of self-identity, affective style, emotion regulation, IU, and anxiety. Network analysis and Bayesian network modeling were used to identify direct and mediating effects among these variables.

RESULTS

Network analysis revealed that self-identity, affective style, and IU directly predicted trait anxiety, with adjusting affective style emerging as a central factor. Bayesian network modeling further showed that IU and affective style mediated the impact of self-identity on anxiety. Notably, emotion regulation did not mediate the relationship between affective style and anxiety, suggesting a possible spurious correlation. The model achieved a predictive accuracy of 90.13% for trait anxiety and 88.49% for state anxiety.

CONCLUSION

The findings highlight the central role of self-identity in anxiety interventions, while also emphasizing the importance of addressing affective styles and IU. The results suggest that emotion regulation strategies alone may not directly reduce anxiety, indicating a need for more comprehensive clinical approaches.

"Direct Me or Leave Me": The Effect of Leadership Style on Stress and Self-Efficacy of Healthcare Professionals

This study aims to investigate the influence of leadership on the self-efficacy of healthcare professionals. Additionally, it seeks to explore whether stress mediates the relationship between leadership and self-efficacy. Specifically, our study is focused on both transactional leadership and laissez-faire leadership, which are commonly practiced by healthcare professionals due to the settings of healthcare environments. This study utilized a structured questionnaire for measuring the leadership, stress, and self-efficacy of healthcare professionals. Data collection involved respondents rating these statements on a Likert scale. The sample consisted of 395 participants employed in healthcare organizations in Serbia. The analysis employed partial least squares structural equation modeling (PLS-SEM). The research findings indicate that laissez-faire leadership is positively associated with stress, while no significant negative impact on self-efficacy was observed. Transactional leadership did not demonstrate a significant relationship with reduced stress but was found to positively influence self-efficacy. Moreover, stress was identified as negatively impacting self-efficacy and mediated the association between laissez-faire leadership and self-efficacy, although no mediating effect was found for transactional leadership. This study underscores the critical role of leadership style in shaping the well-being and self-efficacy of healthcare professionals. By understanding how different leadership approaches impact employee stress and job satisfaction, healthcare organizations can tailor their management practices to foster a supportive work environment and enhance overall performance. The results emphasize the need for leaders to balance organizational objectives with employee needs, demonstrating effective communication and adaptability to promote a positive workplace culture.

Prevalence and Independent Predictors of Anxiety and Depression Among Elementary and High School Educators: Cross-Sectional Study

BACKGROUND

Globally, anxiety and depression are primary contributors to work disability and impact the mental and physical well-being of educators.

OBJECTIVE

This study aims to determine the prevalence and independent predictors of likely generalized anxiety disorder (GAD) and likely major depressive disorder (MDD) among teachers in the Canadian provinces of Newfoundland and Labrador, Alberta, and Nova Scotia.

METHODS

The study used a cross-sectional design. Educators from the 3 Canadian provinces participated by completing a web-based survey after enrolling in the Wellness4Teachers program, a free, self-subscription, daily, supportive SMS text messaging initiative. The program was launched at the beginning of the 2022-2023 academic year, and all teachers in the 3 provinces were eligible to enroll. Likely GAD and likely MDD among subscribers were assessed using the Generalized Anxiety Disorder-7 scale and the Patient Health Questionnaire-9, respectively. Data analysis was conducted using SPSS (version 28.0).

RESULTS

Of the 1912 Wellness4Teachers subscribers, 763 (39.9%) completed the survey. The prevalence of likely MDD was 55.7% (425/763) and that of likely GAD was 46% (349/759). After controlling for all other variables in the regression model, participants who reported high stress were 7.24 times more likely to experience MDD (odds ratio [OR] 7.24, 95% CI 4.22-12.42) and 7.40 times more likely to experience GAD (OR 7.40, 95% CI 4.63-11.80) than those with mild to moderate stress. Participants with emotional exhaustion were 4.92 times more likely to experience MDD (OR 4.92, 95% CI 3.01-8.05) and 4.34 times more likely to experience GAD (OR 4.34, 95% CI 2.47-7.62) than those without. Moreover, respondents with a lack of professional accomplishment were 2.13 times as likely to have MDD symptoms (OR 2.13, 95% CI 1.41-3.23) and 1.52 times more likely to experience GAD symptoms (OR 1.524, 95% CI 1.013-2.293) than those without. Similarly, respondents with low resilience were 1.82 times more likely to have likely MDD than those with normal to high resilience (OR 1.82, 95% CI 1.24-2.66). In addition, respondents with low resilience were 3.01 times more likely to experience likely GAD than those with normal to high resilience (OR 3.01, 95% CI 2.03-7.62). Participants with >20 years of teaching experience were 0.28 times less likely to experience GAD symptoms than those with ≤5 years of teaching experience (OR 0.28, 95% CI 0.12-0.64). Sociodemographic and work-related variables did not independently predict likely GAD and likely MDD.

CONCLUSIONS

This study underscores the need for governments and policy makers in the education sector to implement comprehensive mental health support programs. Addressing the unique stressors faced by educators, reducing emotional exhaustion, and enhancing resilience are crucial steps toward mitigating anxiety and depression, promoting educators' well-being, and improving the quality of educational delivery.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/37934.

The role of caregiver emotion regulation in youth mental health during the COVID-19 pandemic: A longitudinal study

The COVID-19 pandemic has presented youth and families with a broad spectrum of unique stressors. Given that adolescents are at increased risk for mental health and emotional difficulties, it is critical to explore family processes that confer resilience for youth in the face of stress. The current study investigated caregiver emotion regulation (ER) as a familial factor contributing to youth ER and risk for psychopathology following stressful life events. In a longitudinal sample of 224 youth (M age = 12.65 years) and their caregivers, we examined whether caregiver and youth engagement in ER strategies early in the pandemic mediated the associations of pandemic-related stress with youth internalizing and externalizing symptoms six months later. Leveraging serial mediation analysis, we demonstrated that caregiver and youth rumination, but not expressive suppression or cognitive reappraisal, mediated the prospective associations of pandemic-related stress with youth internalizing and externalizing symptoms. Greater exposure to pandemic-related stressors was associated with greater caregiver rumination, which, in turn, related to greater rumination in youth, and higher levels of youth internalizing and externalizing symptoms thereafter. Family interventions that target caregiver ER, specifically rumination, may buffer against the consequences of stress on youth engagement in maladaptive ER strategies and risk for psychopathology.

Mental health impact on healthcare workers from COVID-19 in Vietnam: Suggestions for a preventive program

The COVID-19 pandemic has had a negative impact on the mental health of healthcare workers participating in the prevention and control of the pandemic, thereby reducing their quality of life and affecting the quality of patient outcomes. This study aims to explore and deeply understand the mental health problems among healthcare workers participating in the prevention and control of COVID-19 in Ho Chi Minh City, Vietnam. A mixed methods study was undertaken with a descriptive cross-sectional survey of 2870 healthcare workers who have been participating in the prevention and control of COVID-19 in Ho Chi Minh City in 2021, followed by a qualitative descriptive phenomenological study comprised of in-depth interviews with a purposively sampled subset of 40 healthcare workers. Results showed that of the 2870 survey participants, the majority (60.6%) were female, and the average age was 35.1 (SD = 8.6). The prevalence of stress, anxiety and depression was 17.2%, 20.8%, and 17.6%, respectively. The findings from in-depth interviews revealed that the participants were under extreme mental health issues such as worries, stress, and negative emotions. The worrying was related to risk of infection, being shunned, stigmatised, or assaulted by the community. Stress was due to excessive pressure from work. Negative emotions were identified as sadness, self-pity, feelings of loneliness, entrusting fate, feelings of guilt, anxiety, confusion, obsession, disorientation, physical and mental exhaustion. Promoting mental health among healthcare workers who participated in the crisis is necessary and urgent.

Flexible Regulation of Positive and Negative Emotion Expression: Reexamining the Factor Structure of the Flexible Regulation of Emotional Expression Scale (FREE) Based on Emotion Valence

The Flexible Regulation of Emotional Expression (FREE) Scale assesses individuals' ability to enhance and suppress their emotional expressions across different situations. This study investigates the optimal factor structure of the FREE and emphasizes the importance of distinguishing between the regulation abilities for positive and negative expressions. A sample of 607 undergraduates (Mage = 19.02, SD = 1.02, 72.2% female) from Mainland China completed the questionnaire survey. Confirmatory factor analyses tested eight competing models of the FREE structure. Results indicated that the second-order model, featuring two higher-order factors (expressive enhancement and suppression abilities), fit the data well. An alternative second-order model, with two different higher-order factors (positive and negative emotion expressive abilities) and the same four first-order factors, demonstrated an even better fit. Various types of expressive ability scores showed predictive validity regarding emotion regulation self-efficacy, mental health outcomes, and relationship stress. Regulation of emotional expression can be represented by either regulation type or emotion valence, with the latter providing more informative insights. Flexible regulation of positive and negative emotion expression predicted fewer symptoms of depression, anxiety, stress, and relationship stress beyond emotion regulation self-efficacy. These findings highlight the importance of considering emotional valence in understanding flexibility in expression regulation.

Emotion Regulation Flexibility in Adolescents: A Systematic Review from Conceptualization to Methodology

Considerable attention has been devoted to the concept of flexible emotion regulation, which de-emphasizes the importance of any specific regulatory strategy in favor of the flexible deployment of strategies in response to specific situational challenges. The bulk of research in this area has been conducted on adult samples. Research on emotion regulation flexibility (ERF) in youth has been documented in only a limited number of studies and using various definitions. This systematic review aims to gather and summarize different conceptualizations and methodological approaches of adolescent ERF. We incorporate these findings into a general framework to understand ERF and its role in adolescents' emotional, behavioral and social functioning. Adhering to the PRISMA guidelines, 11 studies were included in the review. While ERF has been defined in various and inconsistent ways, the included studies utilized conceptualizations from two overarching domains: the regulation of expressed emotion and the repertoire of emotion regulation strategies. Promising approaches and future directions will be highlighted.

Assessment of the importance of sleep quality and the effects of deprivation on Sudanese healthcare professionals amidst conflict in Sudan

Background

Quality sleep is vital for well-being, especially for healthcare workers facing high risks of fatigue and burnout. Sleep deprivation impairs cognitive and motor functions, contributing to medical errors. Addressing sleep disorders among healthcare professionals is crucial for enhancing patient care. Tailored interventions are needed to support their well-being and improve healthcare outcomes.

Objective

To evaluate the effect of Sleep Quality and its Deprivation on Sudanese Healthcare Professionals amidst conflict in Sudan.

Methods

A cross-sectional online survey of Sudanese doctors was conducted using convenience sampling. The questionnaire covered sleep quality, daytime sleepiness, and psychological well-being. Pilot testing ensured questionnaire clarity. Data collection utilized Google Forms distributed through social media and professional networks. A minimum sample size of 384 was calculated. Statistical analysis included descriptive statistics and various tests for significance. Data were securely stored and analyzed using SPSS and R software.

Results

Among 649 participants, 404 (62.2%) were women, with a mean age of 30.34 years. Most were single (434, 66.9%). General practitioners constituted the largest professional group (267, 41.1%), followed by registrars/residents (142, 21.9%). Participants took an average of 43.70 minutes to fall asleep and slept an average of 5.90 hours per night. According to the PSQI, 300 (46.2%) reported mild sleep disturbance, 287 (44.2%) moderate, 42 (6.5%) severe, and only 20 (3.1%) normal sleep. The ESS revealed 285 (43.9%) with lower normal daytime sleepiness, 188 (29.0%) with higher normal, and various levels of excessive daytime sleepiness. Stress levels varied, with 398 (61.3%) reporting normal stress, while anxiety ranged from 248 (38.2%) normal to 148 (22.8%) extremely severe.

Conclusion

This study emphasizes the importance of addressing sleep quality, mental health, and performance challenges among Sudanese healthcare professionals. It highlights the need for hospitals to implement measures enabling more time off, adequate sleep, and reduced on-call service days. Healthcare workers must recognize the significance of these factors for their well-being and patient care quality. The research outcomes can raise awareness about the necessity of regulating healthcare practitioners' working hours and ensuring adequate sleep.

Longitudinal associations of depression, anxiety, and stress among healthcare workers assisting patients with end-stage cancer during the COVID-19 pandemic: the moderator role of emotional exhaustion

BACKGROUND

This study aimed to analyze the moderating role of emotional exhaustion in the relationships between longitudinal associations of depression, anxiety, and stress among healthcare workers assisting end-of-life cancer patients during the COVID-19 pandemic.

METHODS

A longitudinal study involving a final sample of 122 healthcare workers (61.5% females, mean age = 39.09 ± 11.04 years) was conducted. These participants completed the Maslach Burnout Inventory (MBI) and the Depression Anxiety Stress Scales-21 (DASS-21).

RESULTS

Results of correlation analysis showed that emotional exhaustion was correlated with both T1 and T2 measures of depression, anxiety, and stress. Results of the moderation analysis indicated that emotional exhaustion moderated the relationships between consecutive measures of depression and anxiety. Each of the moderation models explained about half of the variance for depression and anxiety. When considering stress, results did not show a moderating role for emotional exhaustion.

CONCLUSIONS

Overall, the results of this study highlight that emotional exhaustion moderated depression and anxiety over time. Psychological interventions to promote psychological mental health among healthcare workers assisting patients with end-stage cancer should carefully consider these findings.

Post-Pandemic Insomnia in Healthcare Workers: A Prospective Study including Sociodemographic, Occupational and Psychosocial Variables

Background/Objectives: Previous research points to the prevalence of insomnia during the COVID-19 pandemic among healthcare workers (HCWs). However, longitudinal studies on its evolution, including the post-pandemic stage, are less abundant, with a special lack of research about possible psychosocial risk factors. The aim of the current study is to analyze the evolution of insomnia in Spanish HCWs from the beginning of the pandemic until two years later, examining the influence of sociodemographic, occupational and psychosocial variables. Methods: This was a prospective longitudinal design with three data collection periods in which insomnia was assessed using the Insomnia Severity Index (ISI), in addition to sociodemographic, occupational and psychosocial (i.e., social support, self-efficacy, resilience and cognitive fusion) variables in HCWs (n = 216) who were in direct contact with COVID-19 patients. Results: High scores were observed for insomnia, with a clear decrease throughout the periods studied (F = 30.198, p < 0.001). An association was observed between insomnia and certain sociodemographic and occupational variables (i.e., work category, p = 0.001; availability of Personal Protective Equipment (PPE), p < 0.001; workload, p < 0.001; worry about self or family contagion, p = 0.002, p = 0.003, respectively). Insomnia had negative relationships with social support (p = 0.014), self-efficacy (p < 0.001) and resilience (p < 0.001) and positive relationships with cognitive fusion (p < 0.001). Interaction effects between the evolution of insomnia and social support from friends (p = 0.024, ƞ2 = 0.34) and between the evolution of insomnia and cognitive fusion (p = 0.047; ƞ2 = 0.25) were found. Conclusions: Social support, self-efficacy and resilience act as buffers for insomnia. Cognitive fusion acts as a clear precipitator of insomnia as well as directly influencing its evolution. Social support from friends also affects the evolution of insomnia. Within the specific circumstances of the COVID-19 pandemic, a long-term effect of social support from friends and a short-term effect of cognitive fusion on the evolution of insomnia was observed. The findings emphasize the need to implement specific interventions to promote the mental well-being of HCWs, particularly in crisis contexts that involve an increase in occupational stress, emphasizing the role of certain psychosocial variables as protective factors.

The COVID-19 pandemic related stress and the associated factors among the healthcare workers in Kota Setar District Health Office, Malaysia

BACKGROUND

The COVID-19 pandemic is the most significant worldwide health catastrophe, with massive impacts observed particularly among the healthcare workers. Stress among healthcare workers is a significant and pervasive issue that can have profound implications for both the well-being of healthcare professionals and the quality of patient care. This study aimed to determine the prevalence of stress related to the COVID-19 pandemic and the associated factors among the healthcare workers (HCWs).

METHODS

A retrospective cross-sectional study was conducted involving 533 HCWs in Kota Setar District Health Office. Related data was collected between January and June 2021. Stress was measured using the Depression Anxiety Depression Scale 21 (DASS-21). Other variables included in this study were sociodemographic and employment factors. The associated factors and predictors were determined by employing chi-square test and multivariate logistic models.

RESULTS

COVID-19 related stress was reported at 10.5%. HCWs who work at the district health offices and those with degree or higher qualifications had 2.3 (AOR = 2.310, 95% CI: 1.177-4.535) and 3 (AOR = 2.899, 95% CI: 1.613-5.211) higher odds of experiencing stress compared to those working in the clinics and had lower qualifications (diploma or less).

CONCLUSIONS

The mental wellbeing of the HCWs participated in this study had been affected negatively by the COVID-19 pandemic, resulting in one in 10th of the HCWs were experiencing stress during the COVID-19 pandemic, with higher risk observed among those working at the district health office and HCWs with higher qualifications or ranking. This is expected since COVID-19 was a new and unprecedented outbreak associated with massive number of mortalities that requires active contact tracing and surveillance which commonly conducted at district health office level. Active intervention needed to cope with the overwhelming stress and working condition to ensure effective rehabilitation are in place and quality of work were not jeopardized.

The Impact of Adjustment on Workplace Attitudes and Behaviors Among Health Care Workers During the COVID-19 Pandemic

OBJECTIVE

We examined the impact of health care workers' (HCWs) adjustment to the COVID-19 pandemic on their work-related attitudes and behaviors.

METHODS

HCWs ( n = 1468) participated in an observational longitudinal study in which they completed surveys of anxiety and occupational health between 2020 and 2021.

RESULTS

Most HCWs reported anxiety that was consistently below the diagnostic threshold (68%) or fell below the threshold within a year (16%). Others reported consistently high (14%) or increasing (2%) anxiety, especially women, younger HCWs, those with a weakened immune system, and allied health professionals. Consistently high or increasing anxiety was associated with poorer job satisfaction, work engagement, perceived supervisor support, burnout, and turnover intentions.

CONCLUSIONS

Resources to support HCWs may be focused on those who report consistently high or increasing anxiety to minimize the effects of crises and disasters on the workforce.

Context matters: Exploring the adaptive nature of self-regulation skills in predicting abstinence among veterans with alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) is highly prevalent among veterans in the United States. Self-regulation skills (e.g., coping and emotion regulation) are important biopsychosocial factors for preventing relapse. However, how variation in self-regulation skills supports abstinence based on contextual demands is understudied in veterans with AUD.

METHODS

In a prospective longitudinal design, treatment-seeking veterans (n = 120; 29 females) aged 23-91 with AUD completed the Alcohol Abstinence Self-Efficacy Scale to assess temptation to drink across several high-risk situations (i.e., negative affect, social/positive emotions, physical concerns, and craving/urges) as well as the Brief-COPE and Emotion Regulation Questionnaire to assess self-regulation skills. Abstinence status was assessed at 6 months. T-tests were used to identify self-regulation skills that differed between abstinent and non-abstinent individuals. Multivariate regression with model selection was performed using all possible interactions between each high-risk situation and the self-regulation skills that significantly differed between groups.

RESULTS

Overall, 33.3% of participants (n = 40; nine females) were abstinent at 6 months. Abstinent individuals reported significantly higher use of suppression (p = 0.015), acceptance (p = 0.005), and planning (p = 0.045). Multivariate regression identified significant interactions between (1) planning and physical concerns (p = 0.010) and (2) acceptance, suppression, and craving/urges (p = 0.007). Greater planning predicted abstinence in participants with higher temptation to drink due to physical concerns (e.g., pain). For individuals with lower temptation to drink due to cravings/urges, simultaneous higher suppression and acceptance increased the likelihood of abstinence. Conversely, for participants with higher cravings, greater acceptance with lower suppression was linked to a higher probability of abstinence.

CONCLUSIONS

Results suggest that the adaptiveness of self-regulation skills in predicting AUD recovery is dependent on contextual demands and highlight the need for culturally sensitive treatments. Collectively, these findings indicate that further research on coping and regulatory flexibility may be an important avenue for tailoring AUD treatment for veterans.

Perceived Stress Among Nurses at a Tertiary Care Teaching Hospital in Saudi Arabia During the COVID-19 Pandemic

BACKGROUND

The stress level of nurses, especially frontline staff, directly impacts their physical and mental health as well as work efficiency. However, few studies have been conducted to understand the stress level of nurses related to the coronavirus disease 2019 (COVID-19) pandemic.

AIM

The aim of this study is to assess the level of perceived stress among nurses at a tertiary care teaching hospital (King Abdulaziz University Hospital, Jeddah) in Saudi Arabia during the COVID-19 pandemic.

METHODS

A cross-sectional survey-based descriptive study involved 1044 nurses working at a tertiary care/teaching hospital in Saudi Arabia. The Perceived Stress Scale (PSS) was used to assess nurses' stress levels. The study was conducted in July 2021 by selecting clinical nurses from different nursing units. Considering the current situation of social isolation, an online cross-sectional survey using Google Forms was used. Data analysis was performed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States).

RESULTS

Out of 1044 nursing professionals, 93 (8.9%) reported experiencing low levels of stress, 915 (87.6%) reported moderate levels of stress, and 36 (3.4%) reported high perceived stress during the COVID-19 pandemic. The study found that gender (p=0.001) and nationality (p=0.016) had significant effects on stress levels. The three major causes of stress identified by the nurses were workload, lack of resources, and fear of contracting COVID-19.

CONCLUSION

Job-related stress continues to be an issue in the nursing workforce. The effects of stress experienced by nurses impact job satisfaction and retention, which, in turn, can affect the quality of patient care. This study highlights that nurses in a tertiary care (COVID care) teaching hospital in our setting often experience stress and anxiety during the pandemic. It is worth noting that this is the first study conducted to understand the level of stress perceived by nursing staff during the COVID-19 pandemic in our current study setting. The findings indicate that a considerable number of nurses experienced moderate levels of stress during COVID-19, which can have implications for patient care. Recognizing and understanding the job-related stressors of nurses can help nurse leaders implement more effective strategies aimed at reducing nurses' stress and subsequently improving patient outcomes.

Prevalence and sociodemographic factors of depression, anxiety and stress in Saudi Arabia: a survey of respiratory therapists

Background

Depression, anxiety and stress are prevalent among healthcare providers but limited data is available regarding respiratory therapists (RTs). This study aimed to assess the prevalence of depression, anxiety and stress, and identify the associated sociodemographic factors among RTs in Saudi Arabia.

Methods

A cross-sectional online survey was distributed to RTs in Saudi Arabia. Data were summarized using frequency and percentages. Stress, anxiety, and depression prevalence rates were expressed as proportions with 95% confidence intervals (CI). The associated factors of stress, anxiety, and depression were subjected to logistic regression.

Results

Overall, 988 (91%) RTs, 661 (66.9%) males, completed the online survey. The prevalence (95% CI) of depression, anxiety and stress among RTs was 81.3% (0.787, 0.837), 89.6% (0.875, 0.914), and 45.5% (0.424, 0.487), respectively. RT staff who were ≥41 years old, divorced, widowed or separated, or had > 10 years of clinical experience were more likely to experience stress. RTs who were (divorced, widowed or separated), did not live with their family, were current smokers, or worked the night shift were more likely to experience anxiety. RTs who were (divorced, widowed or separated), were current smokers, had >10 years of clinical experience were more likely to experience depression.

Conclusion

Stress, anxiety and depression are prevalent among RTs. Several sociodemographic factors are associated with the incidence of stress, anxiety and depression.

Resilience and Disaster: Flexible Adaptation in the Face of Uncertain Threat

Disasters cause sweeping damage, hardship, and loss of life. In this article, we first consider the dominant psychological approach to disasters and its narrow focus on psychopathology (e.g., posttraumatic stress disorder). We then review research on a broader approach that has identified heterogeneous, highly replicable trajectories of outcome, the most common being stable mental health or resilience. We review trajectory research for different types of disasters, including the COVID-19 pandemic. Next, we consider correlates of the resilience trajectory and note their paradoxically limited ability to predict future resilient outcomes. Research using machine learning algorithms improved prediction but has not yet illuminated the mechanism behind resilient adaptation. To that end, we propose a more direct psychological explanation for resilience based on research on the motivational and mechanistic components of regulatory flexibility. Finally, we consider how future research might leverage new computational approaches to better capture regulatory flexibility in real time.

Factors associated with anxiety disorders among healthcare workers (HCWS) involved in the first wave of the COVID-19 pandemic

BACKGROUND

In a context of reorganization of the activity, of increase of the psychological, emotional and physical constraints of the nursing staff induced by the first wave of the COVID-19 pandemic, an increase of the anxiety disorders could occur.

OBJECTIVE

This study aims to assess the prevalence of anxiety disorders in healthcare workers (HCWs) by wards and to investigate medical, personal, and occupational factors associated with anxiety disorder.

METHODS

In France, in May 2020, a monocentric observational cross-sectional study was proposed to 285 HCWs of the University Hospital of Saint Etienne, working in 3 types of randomly selected care wards. Information was collected using an anonymous self-questionnaire offered to eligible HCWs. Validated questionnaires were used to assess anxiety (Hospital anxiety and Depression Scale) and burnout (Maslach Burnout Inventory).

RESULTS

Of the 164 HCWs who participated in the study (57% participation rate), 69 (42%) caregivers had anxious symptomatology. The prevalence of anxiety disorders did not differ significantly by type of wards. Anxiety disorders are significantly associated with occupational factors (increased COVID-19 stress level, increased emotional load, increased mental load, high work/life stress during confinement, emotional exhaustion and loss of empathy), with medical factors (medical history of anxiety disorders, psychotropic treatment and impaired sleep quality) and personal factors (concern about working conditions and/or media reports).

CONCLUSIONS

Preventive actions focusing on organizational factors could be carried out to reduce the emotional and mental load, the level of stress and the burnout of HCWs.

Occupational Stress and Burnout Among Healthcare Workers in Saudi Arabia During the COVID-19 Pandemic

The COVID-19 pandemic has caused a lot of stress for healthcare personnel. They are subjected to arduous and stressful working hours and may contract infection. The objectives of this study were to (i) assess the level of occupational stress and the prevalence of burnout among healthcare workers (HCWs) in the Kingdom of Saudi Arabia during the COVID-19 pandemic and (ii) to identify some sociodemographic characteristics and work-related factors that may influence the level of stress and burnout among such HCWs. An online survey was distributed on social media websites and groups of HCWs in KSA. The survey depended on the stress domain of Depression, Anxiety, and Stress Scale-21 (DASS-21) and the work-related burnout domain of Copenhagen Burnout Inventory (CBI). Data were collected using a Google form and then analyzed. Among 478 respondents, 37.7% of studied HCWs reported mild to extremely severe stress, and 47.9% of them reported work-related burnout. Occupational stress and burnout were more prevalent among front-line HCWs (43.9% and 55%) than among second-line HCWs (31.2% and 40.8%). The mean scores of occupational stress and burnout were significantly much higher among frontline physicians and nurses particularly those who are females, of younger age (≤40 years), with few years of work experience (≤15 years), being married, having chronic disease, and those previously infected by COVID-19. HCWs reported a high prevalence of occupational stress and burnout during the COVID-19 pandemic. Establishing policies and guidelines, enhancing working conditions, and providing continuous psychological support and assurance to HCWs are recommended to improve their resilience and increase their coping capacities toward pandemics.

Latent profiles of regulatory flexibility in alcohol use disorder: Associations with delay discounting and symptoms of depression, anxiety, and stress

BACKGROUND

Regulatory flexibility (RF) involves three distinct components of self-regulation: context sensitivity, repertoire, and feedback responsiveness. Subgroups based on differences in RF have been identified in a general sample and are differentially associated with symptoms of anxiety and depression. However, potential RF profiles have not been examined in individuals with substance use disorders. This study examined RF subtypes in individuals with alcohol use disorder (AUD) and their associations with psychosocial outcomes (i.e., depression, anxiety, and stress) and delay discounting (a core feature of addiction).

METHODS

Individuals (n = 200) with an Alcohol Use Disorders Identification Test score of >16 (mean = 24.12 (±6.92)) were recruited from Amazon Mechanical Turk (mean = 37.26 years old (±11.41); 94 (47%) women). Participants completed the Context Sensitivity Index, the Flexible Regulation of Emotional Expression Scale, and the Coping Flexibility Scale to assess RF. Participants also completed an Adjusting Amount Delay Discounting Task and the Depression, Anxiety, and Stress Scale (DASS-21). Latent profile analyses (LPA) were used to identify patterns in RF deficits. Kruskal-Wallis and Dunn's tests were performed to examine differences in discounting rates and symptoms of depression, anxiety, and stress across RF profiles.

RESULTS

The LPA revealed a 2-profile characterization, including (1) context sensitive regulators (CSR; n = 39) and (2) moderate flexibility regulators (MFR; n = 161). CSR demonstrated significantly lower symptoms of depression (p = 0.004), anxiety (p < 0.001), and stress (p < 0.001) than MFR. CSR also displayed significantly lower AUDIT scores (p = 0.031).

CONCLUSIONS

Findings illustrate that among individuals with moderate-severe AUD, those high in context sensitivity coupled with moderate abilities in repertoire and feedback responsiveness have fewer symptoms of depression, anxiety, and stress. Together, context sensitivity may be an important and protective component of RF among individuals with AUD.

The Phenotype of Recovery X: Associations between delay discounting, regulatory flexibility, and remission from substance use disorder

INTRODUCTION

Delay discounting (DD) and self-regulation are important predictors of substance use disorder (SUD) outcomes. Further, regulatory flexibility (RF; i.e., selecting, monitoring, and adapting coping techniques based on contextual demands) is related to psychological resilience. However, studies have yet to examine associations among DD, RF, and remission from SUDs among individuals in recovery.

METHODS

Individuals (N = 148) in SUD recovery completed the Context Sensitivity Index (CSI), the Flexible Regulation of Emotional Expression (FREE) Scale, and the Perceived Ability to Cope with Trauma (PACT) Scale to assess RF and, an $1000 hypothetical reward Adjusting Amount Delay Discounting Task. The study considered individuals to be in remission from SUD if they did not endorse any SUD DSM-5 symptom other than craving (except tobacco use disorder) in the past three months. The study team used t-tests to examine differences in RF and DD by remission status. Univariate linear regressions were used to examine the relationship between RF and DD. Finally, mediation models examined the dynamic relationship among DD, RF, and remission status.

RESULTS

Remitted individuals (n = 82) had significantly lower DD (i.e., greater preference for larger, later rewards) rates (p < .001) and higher context sensitivity (p < .001) and coping flexibility (p < .001). The study found significant negative associations between DD and context sensitivity (p = .008), coping flexibility (p = .002), and emotion regulation flexibility (p < .001). Finally, context sensitivity (p = .023) and coping flexibility (p = .009) mediated the relationship between DD and SUD remission.

CONCLUSIONS

Results suggest that individuals in recovery with broader temporal windows can better identify contextual demands and flexibly cope, contributing to improved SUD recovery outcomes.

The Hidden Impact of Covid-19 on Memory: Disclosing Subjective Complaints

Objective

A significant body of research has suggested that the contraction of SARS-CoV-2 may cause memory impairment, even in the months following recovery. In this regard, studies suggest that COVID-19 predominantly targets structures and cortices within the temporal lobe, and the hippocampus, a critical brain structure for memory and spatial navigation.The purpose of this study was to investigate the potential impact of the COVID-19 pandemic on subjective memory complaints, which represent an individual's perception of subtle changes in memory in the absence of an objective memory impairment.

Method

to explore how the COVID-19 pandemic may affect subjective memory complaints, we incorporated ad hoc self-reported measures of subjective memory complaints, the "Subjective Memory Complaints Questionnaire" (SMCQ) and the "Prospective and Retrospective Memory Questionnaire" (PRMQ), in our cross-sectional study. Both measures referred to two periods: the pre-pandemic period (T0) and the moment of survey administration (T1) (December 28th, 2021, to February 6th, 2022).

Results

207 Italian participants accessed the survey, out of which 189 participants were included in the final sample. The majority of the participants were females, and their age ranged from 55 to 65 years. The study revealed a significant increase in the total PRMQ score at T1 compared to T0 (p = 0.02). However, no significant differences were found between PRMQ and SMCQ scores of COVID-19-negative individuals and those who tested positive for COVID-19 in the last 12 months from the date of completing the survey. McNemar's test showed a statistically significant increase in the score of item 1 ("Do you think that you have a memory problem?" (p = 0.016) and item 10 ("Do you lose objects more often than you did previously") (0.019) of the SMCQ, while for the PRMQ, significant increases were found in several individual items.

Conclusions

our study suggests that subjective memory complaints increased during the pandemic, potentially due to the compound effects of stress and social isolation, rather than solely due to COVID-19 infection. Although a marginal association between COVID-19 and reported prospective memory issues was detected, further investigation is warranted to understand its persistent effects.

Mental health symptoms and their associated factors among pharmacists in psychiatric hospitals during the early stage of the COVID-19 pandemic

As frontline workers, pharmacists often face significant work stress, especially in psychiatric settings. A multicenter cross-sectional design was conducted in 41 psychiatric hospitals. The Depression, Anxiety and Stress Scale-21 (DASS-21) was used to measure the mental health of 636 pharmacists. We also collected demographic data and work-related variables. The prevalence of depression, anxiety and stress was 20.60%, 22.96% and 8.96%, respectively. Multivariate logistic regression showed that several common factors were associated with depression, anxiety and stress, including professional identity (odds ratio [OR] = 0.132, 0.381 and 0.352) and verbal violence (OR = 2.068, 2.615 and 2.490). Those who were satisfied with their job were less likely to develop depression (OR = 0.234) or anxiety (OR = 0.328). We found specific factors associated with mental health. Older age (OR = 1.038) and perceived negative impact (OR = 2.398) of COVID-19 on medical work were associated with anxiety, and those with frontline experience with COVID-19 patients (OR = 2.306) were more likely to experience stress. More than one-fifth of pharmacists in psychiatric hospitals experienced symptoms of depression or anxiety during the pandemic, highlighting the need for policy change to improve workplace conditions and psychological well-being for this professional group.

Stress, depression, anxiety, and quality of life among the healthcare workers during COVID-19 pandemic in Syria: a multi-center study

BACKGROUND

The COVID-19 pandemic emerged as an expected source of stress and anxiety as the healthcare workers had to work for long hours in close contact with infected patients, thus increasing the probability of medical errors and threatening the patients' safety. This study aims to measure the levels of depressive symptoms, anxiety symptoms, and stress among Syrian healthcare workers and their quality of life during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted in six central hospitals in Damascus, Syria. Data were collected from 1 to 30 June-2021. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress among healthcare workers. Quality of life was assessed using the EUROHIS-QOL 8-item index.

RESULTS

A total of 700 participants were included in this study. 61.6% (n = 431) were males and 38.4% (n = 269) were females. Younger ages (18-29 years old) were significantly associated with higher levels of depression and stress (p < 0.0083). Female healthcare workers had higher significant levels of anxiety (p < 0.05). Significant anxiety and stress levels were reported when healthcare workers had contact with COVID-19 patients, even if they had protective equipment (p < 0.05). Half of the participants (50%; n = 349) reported a good quality of life.

CONCLUSION

Stress levels and depressive symptoms were remarkably higher in healthcare workers of ages 18 and 29 years old, whereas anxiety levels were significantly higher and more severe in female healthcare workers. Moreover, direct interaction with COVID-19 patients was associated with higher levels of stress and anxiety symptoms.

Income dissatisfaction and migraine headache. Evidence from a nationwide population-based survey

Objective

We investigate whether and to what extent income dissatisfaction (ID) is an important determinant of migraine. Indeed, ID may play a more relevant role in migraines than realized income, and it may affect both low and high-income people.

Design

We exploit the Italian Statistical Institute (ISTAT) survey covering about 80,000 individuals for this study. On the methodological ground, an instrumental variable probit model has been implemented.

Main Outcome Measures

To measure income dissatisfaction we exploit a self-reported status ranging from 1 to 4, while the migraine variable captures whether the individual suffers from migraine.

Results

The results show that the higher the ID the greater the probability of having a migraine. This relationship is robust to the level of realized income, socioeconomic characteristics of the individual, and the existence of other illnesses.

Conclusions

The high relevance of ID among low-income as well as high-income people opens up a new perspective on the determinants of migraines and provides an explanation of the contrasting evidence in the literature about the income-migraine nexus.

The pandemic's unseen wounds: COVID-19's profound effects on mental health

Objective

This review aims to explore the impact of the COVID-19 pandemic on mental health, with a focus on the physiological and psychological consequences, including comorbidities. The goal is to understand the direct and indirect populations affected by mental distress and identify potential interventions.

Methodology

A comprehensive literature search was conducted using various databases, including Google Scholar, ResearchGate, ScienceDirect, PubMed, PLoS One, and Web of Science. The search utilized relevant keywords to investigate the direct and indirect impacts of COVID-19 on mental health. The selected articles were critically evaluated and analyzed to identify key findings and insights.

Main findings

Mental health, being an intrinsic component of overall well-being, plays a vital role in physiological functioning. The COVID-19 pandemic, caused by the emergence of the novel SARS-CoV-2 virus, has had a devastating global impact. Beyond the respiratory symptoms, individuals recovering from COVID-19 commonly experience additional ailments, such as arrhythmia, depression, anxiety, and fatigue. Healthcare professionals on the frontlines face an elevated risk of mental illness. However, it is crucial to recognize that the general population also grapples with comparable levels of mental distress.

Conclusion

The COVID-19 pandemic has underscored the significance of addressing mental health concerns. Various strategies can help mitigate the impact, including counselling, fostering open lines of communication, providing mental support, ensuring comprehensive patient care, and administering appropriate medications. In severe cases, treatment may involve the supplementation of essential vitamins and antidepressant therapy. By understanding the direct and indirect impacts of COVID-19 on mental health, healthcare providers and policymakers can develop targeted interventions to support individuals and communities affected by the pandemic. Continued research and collaborative efforts are essential to address this pervasive issue effectively.

A predictive model of perceived stress during the first wave of the COVID-19 pandemic in university students Ecuadorians

Background and objectives

The situation caused by the confinement due to the COVID-19 pandemic and the mobility restriction implemented by governments worldwide had a significant impact on people's routines. Stressors are known to increase emotional imbalance, uncertainty, and frustration in the general population. This study explores the factors that predispose to the risk of perceived stress from COVID-19 and determines the underlying mediating mechanisms in the Ecuadorian population.

Method

The cross-sectional study an incidental non-probabilistic sample of n = 977 participating student volunteers from the four regions of the Republic of Ecuador (68.6% women and 31.4% men). Data on emotional regulation (ERQ), perceived stress (PSS), active procrastination (APS), diagnosis and symptoms related to COVID-19, social isolation, coexistence, and a sociodemographic questionnaire (biological sex, marital status, and age) were recruited. Statistical analysis was based on a structural equation model.

Results

The risk of suffering perceived stress in the COVID-19 pandemic was higher for single women who have lived longer in social isolation, have lived with more people, have poor emotional regulation and high rates of procrastination. This structural model is similar in all Ecuadorian regions χ² = 21.54 (p = 0.760), RMSEA = 0.001 (95%CI, 0.00-0.02), CFI = 0.998; TLI = 0.999; SRMR = 0.020.

Discussion

Although our findings are consistent and revealing for the scientific community, the lack of discrimination of the data due to strict isolation measures, taken at different periods by the Ecuadorian government against positive cases of COVID-19, is discussed. The research was applied to the university population, it would be representative to extend the study to schools and colleges.

Conclusion

We consider this work as a starting point for the creation of preventive models against perceived stress in the university environment in the event of health emergencies.

Trait-Anxious People Take Longer to Search for Happy Faces in the Presence of Neutral and Fearful Distractors

A large body of evidence suggests that processing of affective information is typically disrupted in anxiety. It has also been hypothesized that anxious individuals are less able to evaluate contextual cues and to respond in an adaptive way to stress. In the present study, 25 participants (16 females; 9 males) scoring high (scores of 45 or above) and 26 participants (13 females; 13 males) scoring low (scores of 35 and below) on a standardized measure of trait anxiety performed an emotion search task to investigate attentional biases when the task provides an explicit emotional context. An emotional context was set in each block by asking participants to look as quickly as possible at a face expressing a specific emotion, while eye movements were being recorded. On each trial, two faces appeared, one of them expressing the target emotion and the other one expressing a distractor emotion. High trait-anxious participants showed slower response times (time to look at the instructed emotion), regardless of the affective context, compared to the control group. Additionally, we found slower responses to happy faces (positive context) in the anxious group in the presence of neutral and fearful distractors. Cognitive control may therefore be disrupted in anxiety, as anxious people take longer to process (search for) happy faces, presumably because attentional resources are drawn by neutral and fearful distractors. Those differences were not observed in a simple reaction times task, which suggests that attentional biases, and not differential processing of low-level facial features, are responsible for those differences.

Age and gender differences in expressive flexibility and the association with depressive symptoms in adolescents

Objective

This study investigated age and gender differences in the ability to flexibly enhance and suppress facial expressions according to situational demands, known as expressive flexibility (EF), as well as its relationship with depressive symptoms in adolescents.

Methods

The participants included 766 Chinese high school students aged between 12 and 18 years (mean age = 14.96 years, standard deviation = 2.04; 52.2% female). Data on EF and depressive symptoms were collected using self-report questionnaires.

Results

Girls scored higher on enhancement abilities than boys, but with no significant gender difference in suppression abilities. There were also no significant age-related differences in enhancement and suppression abilities. Only enhancement ability was negatively associated with depressive symptoms.

Conclusion

The development of EF abilities was stable among adolescents, with varying effects in terms of gender, and the importance of EF and enhancement abilities in reducing depressive symptoms in adolescents was highlighted.

Impact of the COVID pandemic on mental health and training opportunities of Public Health Residents from 4 European countries: A cross-sectional study

Objectives

There is little evidence on the impact of the COVID-19 pandemic on Public Health Residents' (PHR) mental health (MH). This study aims at assessing prevalence and risk factors for depression, anxiety and stress in European PHR during the COVID-19 pandemic.

Methods

Between March and April 2021, an online survey was administered to PHR from France, Italy, Portugal and Spain. The survey assessed COVID-19 related changes in working conditions, training opportunities and evaluated MH outcomes using the Depression Anxiety Stress Scales-21. Multivariable logistic regressions were applied to identify risk factors.

Results

Among the 443 respondents, many showed symptoms of depression (60.5%), anxiety (43.1%) and stress (61.2%). The main outcome predictors were: female gender for depression (adjOR = 1.59, 95%CI [1.05-2.42]), anxiety (adjOR = 2.03, 95%CI [1.33-3.08]), and stress (adjOR = 2.35, 95%CI [1.53-3.61]); loss of research opportunities for anxiety (adjOR = 1.94, 95%CI [1.28-2.93]) and stress (adjOR = 1.98, 95%CI [1.26-3.11]); and COVID-19 impact on training (adjOR = 1.78, 95%CI [1.12-2.80]) for depression.

Conclusions

The pandemic had a significant impact on PHR in terms of depression, anxiety and stress, especially for women and who lost work-related opportunities. Training programs should offer PHR appropriate MH support and training opportunities.

Prolonged Grief Disorder and Symptoms of Anxiety and Depression among Bereaved Family Caregivers in the Context of Palliative Home Care

Background: This study aimed to investigate the prevalence and the psychological comorbidity of PGD among bereaved family caregivers of palliative care cancer patients. We also examined the discriminant validity of two simple and reliable tools in correctly categorized individuals with PGD. Methods: A cross-sectional study was conducted with 157 bereaved participants (77.1% females, mean age = 43.50 ± 14.04 years, mean time since the loss = 3.59 years) recruited from three palliative home care services. These participants completed the Prolonged Grief Scale (PG-13) and the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of PGD within the sample was 4.46% (i.e., = 7/157). Participants scored higher than the cut-off on the PG-13 and the HADS-D. Symptoms of PGD were positively correlated with depression levels. The ROC curve analysis showed that the HADS-D was outstanding in categorizing individuals with prolonged grief disorder from those without PGD. A HADS-D score of ≥7.5 was able to categorize participants with a sensitivity of 0.90 and a specificity of 0.73. Conclusions: Overall, these results highlight the relationship between grief and depression symptoms and their exceptional discriminant validity among correctly identified individuals with PGD.

Mental Health Status and Coping among Portuguese Higher Education Students in the Early Phase of the COVID-19 Pandemic

Globally, the COVID-19 outbreak had an adverse effect on higher education students' mental health and psychological well-being. This study aims to assess the prevalence of stress, anxiety, depression and associated factors in a sample of students in the early phase of the COVID-19 pandemic and determine the predictive effect of mental health status on coping. The sample was collected between March and July 2020 and included 392 higher education students in Portugal. An online cross-sectional study was conducted using a survey that included an information form, the Depression, Anxiety, and Stress Scale, and the Brief Resilient Coping Scale. The prevalence of mild-to-extremely severe depression, anxiety and stress was 24.2%, 32.7% and 33.4%, respectively. About 60% of the sample had poor coping abilities. Masters students, participants older than 30 years and female participants had significantly greater resilient coping compared to undergraduate students and younger and male participants (p < 0.05). Resilient coping correlated negatively with depression, anxiety and stress. The regression analysis showed that age together with overall levels of depression, anxiety and stress explained 16.9% of the variance in coping. The results should inform the implementation of interventions to mitigate the impact of psychological distress and promote mental health.

Worsening general health and psychosocial wellbeing of Australian hospital allied health practitioners during the COVID-19 pandemic

Objective To describe self-reported general and psychological health for allied health practitioners at an Australian acute public health service over three time points within the coronavirus disease 2019 (COVID-19) pandemic. Methods This study collected data from cross-sectional online surveys at three time points: May-June 2020 (T 1 ), October-November 2020 (T 2 ) and November-December 2021 (T 3 ). The self-report questionnaire consisted of demographic questions, a general health question and the 21-item version of the Depression Anxiety Stress Scales (DASS-21). Results A total of 308 responses were received (T 1 n  = 135, T 2 n  = 78, T 3 n  = 95) from representatives of eight allied health professions. The proportion of allied health practitioners reporting poor general health significantly increased over time, as did mean scores on all DASS-21 sub-scales. General health status was also significantly associated with DASS-21 subscale scores. Anxiety scores increased significantly between T 1 and T 2 , while depression scores increased significantly between T 2 and T 3 . Significant increases in stress scores were recorded across all time intervals. Between T 1 and T 3 , the proportion of allied health practitioners reporting moderate, severe, or extremely severe symptoms increased for depression (10.3-30.9%), anxiety (5.2-18.2%) and stress (13.3-36.3%). Conclusion The general and psychological health of allied health practitioners appears to be worsening as the COVID-19 pandemic continues. Organisational strategies to support the health of the allied health workforce in acute care settings must address the cumulative effects of prolonged pressure on their general and psychosocial health. Support strategies need to be responsive to changes in psychological wellbeing at different phases of the pandemic.

Mental Health and Sleep Quality of Healthcare Providers After Partial Relief of COVID-19 in Saudi Arabia: A Cross-Sectional Study

Purpose

We aimed to assess sleep quality and psychological distress among healthcare workers (HCWs) in the context of mitigated governmental restrictions during COVID-19 pandemic in Saudi Arabia.

Methods

This cross-sectional study included 370 HCWs from a single tertiary healthcare institution in Riyadh, Saudi Arabia. Sleep quality and psychological distress were measured using the Pittsburgh Sleep Quality Index (PSQI) and the Depression, Anxiety and Stress Scale - 21 (DASS-21).

Results

The median stress score for HCWs aged between 20 and 29 years was higher compared to HCWs aged between 30 and 39 years (p=0.002) and HCWs aged between 50 and 59 years (p<0.001). The median anxiety score of the age group between 20 and 29 years was also significantly higher compared to the age groups between 40 and 49 and 50-59 years (all p<0.05). HCWs living with family showed higher anxiety and depression scores compared to those living with non-family members (p=0.006 and p=0.005, respectively). Handling COVID-19 patients on multiple occasions during routine patient care was significantly associated with higher anxiety and depression scores among HCWs. The results also showed higher PSQI scores among younger HCWs (20-29 years) and trainees (all p<0.05). In addition, PSQI correlate significantly with depression (r=0.268) and anxiety (r=0.278) scores of DASS-21 scale (all p<0.001).

Conclusion

Poor psychological well-being and sleep quality were observed among certain groups of HCWs, even after the mitigation of COVID-19 restrictions. This study highlights the need for strategies to manage HCWs at risk of developing psychological distress during future catastrophes.

Prevalence of and risk factors associated with depression among nursing students acting on the frontline of COVID-19 pandemic: A cross-sectional study

Introduction

The widespread devastation caused by the ongoing waves of COVID-19 imposed a significant burden on the healthcare labor force. At the frontline in the battle against the deadly COVID-19 virus, nursing students in Vietnam were at a much-increased risk of developing mental health conditions. This study aims to identify the prevalence of depression and its related factors, along with coping strategies used by nursing students in the COVID-19 pandemic in Vietnam.

Materials and methods

The study was cross-sectional in nature, with convenient sampling at the epicenters of COVID-19 outbreaks in Vietnam (N = 191) from April to November 2021. After conducting a questionnaire pilot, the data was collected strictly using an internet-based approach. The Depression, Anxiety, and Stress Scale-21 items were used to identify the risk of depression among nursing students. The Chi-square test was used to assess the differences between coping strategies among nursing students. A multivariate logistic regression model was used to identify risk factors associated with depression.

Findings

The percentage of nursing students affected by depression was 21.5%, and almost half of the nursing students (49.2%) had no coping strategies for dealing with mental health concerns. Among the remaining nursing students, video-based mental consultation was the most popular method (25.7%). Being females (AOR: 2.7, 95% CI: 1.1-6.7), collecting bio-samples (AOR: 2.9, 95% CI: 1.4-6.2), providing support to vaccination spots (AOR: 2.3, 95% CI: 1.1-5.1), and not vaccinating against COVID-19 (AOR: 3.1, 95% CI: 1.1-9.1) were found as risk factors for depression among nursing students.

Conclusion

Our research revealed a significant number of nursing students suffering from depressive symptoms and underscoring the need for more effective methods of dealing with this condition. Depression management and coping skills focusing on female populations and those whose direct contacts with infectious sources should be implemented in the nursing curricula and continuous training credits. Those trainings, would support future nurses in handling crisis situations better.

Alawad A. Stress and Burnout Among Frontline Nurses During COVID-19 Pandemic in a Middle Eastern Country

INTRODUCTION

The COVID-19 pandemic has resulted in an unanticipated shift in nursing practice to meet the sudden increase in demand for pandemic-related care, leaving nurses unable to provide acceptable services to patients in the way they were taught and expected to do. It put the nurses under more stress and most of them were dissatisfied with their work due to excessive burnout.

OBJECTIVES

The study determined the level of stress and burnout among front-line nurses working at the Ministry of Health Hospitals in Najran, Saudi Arabia during the COVID-19 pandemic.

METHODS

A total of 1594 nurses were chosen using a convenience sampling approach. Google Forms were used to collect data from the nurses. COVID-19 stressors questionnaire and an abbreviated Maslach Burnout Inventory were used to assess stress and burnout among nurses.

RESULTS

Our study reported that the majority of nurses experienced extreme levels of stress as their colleagues became ill; that they would spread COVID-19 infection to their family and friends; upsetting to see COVID-19 patients dying in front of them; not knowing when the COVID-19 pandemic will be under control; and emotional exhaustion and physical fatigue. A vast majority of nurses felt there were not adequate protective measures; there was a shortage of staff at times; were nervous and scared and thought of quitting their job; and they would quit their job if a COVID-19 outbreak recur and they would fall sick. Likewise, 41.9% of the nurses experienced a high level of burnout. A significant association was found between the area of working and the level of burnout among nurses.

CONCLUSION

As nurses experienced extreme levels of stress and severe burnout, it is vital to design regular programs to assist frontline nurses in maintaining their mental health.

Characterizing the mental health and functioning of Canadian respiratory therapists during the COVID-19 pandemic

Introduction: Healthcare professionals (HCPs) appear to be at increased risk for negative psychological outcomes [e.g. depression, anxiety, post-traumatic stress disorder (PTSD), moral distress] and associated impacts on functioning throughout the COVID-19 pandemic. HCPs working on designated COVID-19 units may be further impacted than their colleagues not on these units given added demands of patient care and risk of contracting COVID-19. Little is known, however, about the mental health and functioning of specific professional groups beyond nurses and physicians, including respiratory therapists (RTs), over the course of the pandemic. Accordingly, the purpose of the present study was to characterize the mental health and functioning of Canadian RTs and compare profiles between RTs working on and off designated COVID-19 units.Methods: Canadian RTs completed an online survey between February and June 2021, including demographic information (e.g. age, sex, gender,) and measures of depression, anxiety, stress, PTSD, moral distress and functional impairment. Descriptive statistics, correlation analyses and between-groups comparisons were conducted to characterize RTs and compare profiles between those on and off COVID-19 units.Results: Two hundred and eighteen (N = 218) RTs participated in this study. The estimated response rate was relatively low (6.2%) Approximately half of the sample endorsed clinically relevant symptoms of depression (52%), anxiety (51%) and stress (54%) and one in three (33%) screened positively for potential PTSD. All symptoms correlated positively with functional impairment (p's < .05). RTs working on COVID-19 units reported significantly greater patient-related moral distress compared to those not on these units (p < .05).Conclusion: Moral distress and symptoms of depression, anxiety, stress and PTSD were prevalent among Canadian RTs and were associated with functional impacts. These results must be interpreted with caution given a low response rate, yet raise concern regarding the long-term impacts of pandemic service among RTs.

Association of fear of COVID-19 and resilience with psychological distress among health care workers in hospitals responding to COVID-19: analysis of a cross-sectional study

Background

It remains unclear how fear of COVID-19 and resilience are related to psychological distress based on occupations among healthcare workers (HCWs) in hospitals treating patients with COVID-19. We conducted a survey on the mental health of HCWs during the COVID-19 pandemic to determine the relationship between factors such as fear of COVID-19 and resilience as well as mental distress in each occupation of HCWs.

Methods

We conducted a web-based survey among HCWs at seven hospitals treating COVID-19 patients in Japan from December 24, 2020 to March 31, 2021. A total of 634 participants were analyzed, and information regarding their socio-demographic characteristics and employment status was collected. Several psychometric measures were used, including the Kessler's Psychological Distress Scale (K6), the fear of COVID-19 Scale (FCV-19S), and the Resilience Scale (RS14). Factors related to psychological distress were identified by logistic regression analysis. The association between job title and psychological scales was examined by one-way ANOVA, and t-tests were conducted to examine the association between the FCV-19S and hospital initiatives.

Results

It was found that nurses and clerical workers were associated with psychological distress without considering FCV-19S or RS14; in a model that included FCV-19S, FCV-19S was associated with psychological distress, but job title was not; when RS14 was considered, resilience was protective. In terms of occupation, FCV-19S was lower among physicians and higher among nurses and clerical workers, while RS14 was higher among physicians and lower among other occupations. Having access to in-hospital consultation regarding infection control as well as to psychological and emotional support was associated with lower FCV-19S.

Conclusion

Based on our findings, we can conclude that the level of mental distress differed by occupation and the differences in the fear of COVID-19 and resilience were important factors. In order to provide mental healthcare for HCWs during a pandemic, it is important to create consultation services that enable employees to discuss their concerns. In addition, it is important to take steps to strengthen the resilience of HCWs in preparation for future disasters.

Prevalence of Perceived Stress, Anxiety, and Depression in HCW in Kosovo during the COVID-19 Pandemic: A Cross-Sectional Survey

A pandemic may have a negative impact on healthcare workers' (HCW) mental health. In this cross-sectional study, we assess the self-reported prevalence of stress, anxiety, and depression and identify their predictive factors among HCW in Kosovo. The online questionnaire collected data on socio-demographics (sex, age, occupation, education, workplace) and the presence and severity of depression, anxiety, and stress through the 21-item Depression, Anxiety, and Stress Scale (DASS-21) questionnaire. Descriptive statistics, t-test, and linear logistic regression were used to analyze the data. Of the 545 respondents, the majority were male (53.0%), under 60 years of age (94.7%), and married (81.7%). Most of them were physicians (78.2%), while the remaining were nurses, midwives, and other health professionals (22%). Prevalence rates for moderate to extremely high stress, anxiety, and depressive symptoms were 21.9%, 13.0%, and 13.9%, respectively. The nurses reported significantly higher mean scores for depression and anxiety than the physicians (p < 0.05). Being married, having poor health, not exercising, and reporting "burnout" from work significantly predicted higher levels of depressive, anxiety, and stress symptoms among health workers (p < 0.05). Most HCWs (71.6%) reported a mild, moderate, or severe mental health burden, and certain factors predicted higher levels of such burden.

Adaptive responding to prolonged stress exposure: A binational study on the impact of flexibility on latent profiles of cognitive, emotional and behavioural responses to the COVID-19 pandemic

The high level of uncertainty brought about by the COVID-19 pandemic has affected the general population's well-being and capacity for adaptive responding. Studies indicate that flexibility, defined as the ability to choose and employ a variety of emotional, cognitive and behavioural strategies in accordance with changing contextual demands, may significantly contribute to adaptive responding to long-term stressors such as COVID-19. In the current study, we aimed to investigate which facets of flexibility predict different latent profiles of adaptive responding to the COVID-19 pandemic in Israel and Germany. A total of 2330 Israelis and 743 Germans completed online questionnaires measuring cognitive and coping regulatory flexibility and cognitive, emotional and behavioural responding to the COVID-19 pandemic. Analyses revealed three distinct response profiles in each country (high, medium and low). These profiles differed in both anxiety and depression symptoms with the non-adaptive response group experiencing clinically relevant symptoms both in Israel and Germany. Additionally, cognitive flexibility and coping flexibility emerged as significant predictors of response profiles in both countries. Training cognitive and coping flexibility may thus help individuals respond more adaptively to psychosocial stressors such as COVID-19. Such training could be selectively administered to less flexible subpopulations as well as adapted to the specific population characteristics.

Is This All COVID-19's Fault? A Study on Trainees in One of the Most Affected Italian Cities

Many studies have investigated the state of the health of healthcare workers during the acute period of the pandemic. Yet, few studies have assessed the health of such professionals after the pandemic and in a less dramatic period. This study involved a particular sample represented by residents in anaesthesia-resuscitation and psychiatry at a university in northern Italy particularly affected by the pandemic. The objectives were to investigate some indicators of health and well-being and compare the two groups of trainees. Using Google Forms, the following tests were proposed: the General Health Questionnaire, Maslach Burnout Inventory, Subjective Happiness Scale, Satisfaction with Life Scale, Coping Inventory for Stressful Situations, Brief Resilience Scale, State-Trait Anxiety Inventory, as well as an ad hoc questionnaire. A qualifying element of the work was the discussion of the results with the trainees. Various strengths have emerged, such as high values of resilience and job satisfaction; a positive assessment of the support received from the work team; an articulate use of coping strategies; and good levels of happiness and satisfaction with life, in both specialities. However, a widespread anxiety also emerged, which appears to be more attributable to concerns about professional evaluation, rather than the pandemic itself. In summary, the trainees seem to have found a fair amount of personal balance, whereas the relationship with the patient seems to be more compromised. In the comparison between specialities, the only significant differences are the levels of depersonalisation and resilience, both of which are higher in anaesthetists.

Validity and Reliability of Cultural Mix Coping Inventory for Stressful Situations among Healthcare Professionals in Ghana Amidst COVID-19

The Cultural Mix Coping Inventory for Stressful Situations is one of the recent coping measures developed to overcome the weaknesses of existing coping scales. Since its development and validation, the inventory has been used by previous studies to measure coping among teachers and students in stressful situations. Health professionals are workers who typically encounter stressful situations due to their work demands. In this study, we assessed the validity and reliability of cultural mix inventory for stressful situations among healthcare professionals in Ghana. The research was guided by three major objectives: (1) to assess the factor structure of the cultural mix coping inventory, (2) to evaluate the construct validity and reliability of the cultural mix coping inventory based on internal structure and (3) to test for evidence of criterion validity based on the external structure of the measure. Approximately 312 health workers were purposefully sampled to participate in the study. The study confirmed the original four-factor solution of the coping inventory with evidence of the construct validity based on the internal structure. Validity evidence based on the external structure of the measure was found to be sufficient. Given the COVID-19 pandemic and coupled with the stressful nature in the line of duty of healthcare professionals, this inventory provides a useful and sound measure of coping options among this cohort.

Effects of the COVID-19 Pandemic on the Mental Health of Anesthesiologists: A Cross-Sectional Study

Introduction

In the COVID-19 pandemic, frontline health-care workers (HCWs) including anesthesiologists have been fatigued due to long working hours in critical care units or operation theaters and necessity to remain available on call at odd hours. In addition, the exposure to numerous diseased and morbid patients throughout the prolonged pandemic period has predisposed them to psychological distress.

Materials and Methods

This is a cross-sectional study to evaluate the depression and anxiety among the HCWs during COVID. The demographic and general information of 237 HCWs across India, through an online survey was collected and analyzed.

Results

The male: female ratio of the studied population was 53:47. In addition, 50% of the participants were aged <35 years, and 80% of participants were married and living with family and parents. The consultants working in combined (COVID and non-COVID) areas exhibited maximum participation in the survey, with 80% of them involved in aerosol-generating procedures. Of the total, 73.1% of participants exhibited depression, 45.8% of participants exhibited anxiety, 36.2% of participants exhibited stress, and 25.3% of participants exhibited disturbed sleep patterns.

Conclusions

Most HCWs on COVID-19 duty exhibited emotional disorders such as anxiety, depression, stress, and insomnia. Addressing risk factors identified in the present study with targeted interventions and psychosocial support will allow health-care workers to cope better.

Expressive flexibility and health-related quality of life: The predictive role of enhancement and suppression abilities and relationships with trait emotional intelligence

This study aims to examine the ability to flexibly enhance and suppress emotional expression, known as expressive flexibility, in relation to physical and psychological health, as well as trait emotional intelligence (EI). A sample of 503 Italian (M_age  = 28.65 ± 9.26 years, 85.1% females) participants completed the Italian version of Flexible Regulation of Emotional Expression (FREE) Scale, the TEIQue-SF, and the Short Form-12 Health Survey. Confirmatory factor analysis indicated that the Italian version of FREE showed adequate psychometric properties. In both genders, results of correlational analyses indicated that enhancement ability was associated with well-being, emotionality, and sociability, whereas suppression ability was associated with self-control. Regression analyses, controlling for age and gender, indicated that suppression and inversely enhancement abilities, predicted the perceived psychological but not physical health. Well-being, self-control, and sociability also contributed to explaining variance in the model. The interaction effect of enhancement and suppression was not significantly associated with either physical or psychological health. Overall, these results suggest that enhancement and suppression abilities differentially contribute to psychological health when trait EI is accounted for. Clinical implications and future directions for research on expressive flexibility are discussed.

Positive Orientation and Fatigue Experienced by Polish Nursing Students during the COVID-19 Pandemic: The Mediatory Role of Emotional Control

This study aimed to investigate the mediatory role of emotional control with respect to the control of anger, depression, and anxiety in the relationship between positive orientation and tiredness/fatigue occurring in a group of Polish nursing students during the COVID-19 pandemic. The study included 894 nursing students from six universities in Poland. A diagnostic survey was applied as the research method, and the data were collected using the Fatigue Severity Scale (FSS), the Courtauld Emotional Control Scale (CECS) and the Positive Orientation Scale (SOP). The mean participant age was 20.73 years (SD = 1.81). More than half of the students in the study showed a low level of positive orientation. Correlational analyses revealed a significant negative correlation between positive orientation and tiredness/fatigue experienced by the students participating in the study (r = −0.336; p < 0.001), and correlation between positive orientation and the overall emotional control index (r = −0.317; p < 0.001), and the indices of control of anger (r = −0.154; p < 0.01), depression (r = −0.376; p < 0.001), and anxiety (r = −0.236; p < 0.01). Analysis of the results also revealed the occurrence of significant, positive links between the controlled emotions and their components and the tiredness/fatigue experienced by nursing students. It is important to take action associated with the prevention of tiredness/fatigue among students and to reinforce a positive orientation and the capacity to control emotions to effectively minimize the effects of the COVID-19 pandemic on nursing students.