Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence

A study on the willingness and influencing factors of non-EPI vaccines recommendations among Chinese vaccination staff under major infectious disease outbreaks

WHO had warned of the impending "X disease," emphasizing the need to quickly establish an immune barrier. The willingness of vaccination staff to recommend vaccines was crucial in such scenarios. This study aimed to investigate willingness and influencing factors of Non-EPI Vaccines recommendations among Chinese vaccination staff in Hangzhou, China. We selected vaccination staff in 191 vaccination clinics from Hangzhou for a questionnaire-based survey using a cross-sectional survey. Descriptive statistics were made on the characteristics of participants. Univariate and multivariable analyses were used to determine the influencing factors of Non-EPI Vaccines recommendations. The overall recommendation rate was 76.2%. Compared to Supplementary and Individual Non-EPI Vaccines, vaccination staff were more willing to recommend Alternative (x 2  = 215.655, P < 0.05) and Combined Non-EPI Vaccines (x 2  = 214.998, P < 0.05). Multivariate logistic regression analysis showed that vaccination staff who did not participate in COVID-19 vaccination work (OR = 2.942, 95%CI:1.121 ~ 9.302), believe they had an obligation to recommend Non-EPI Vaccines (OR disagree = 7.957, 95%CI:1.238 ~ 87.69; OR neutrality = 4.187, 95%CI:1.66 ~ 10.563), and think that the effects of non-routine immunization vaccines were very good (OR disagree = 3.133, 95%CI:1.677 ~ 14.495; OR neutrality = 2.512, 95%CI:1.164 ~ 5.418) were more willing to recommend Non-EPI Vaccines. On the contrary, vaccination staff who believe that recommending Non-EPI vaccines increased their workload (OR disagree = 0.307, 95%CI:0.11 ~ 0.856; OR neutrality = 0.642, 95%CI:0.258 ~ 0.986) would decrease willingness to recommend them. The most of vaccination staff were willing to recommend non-EPI vaccines under major infectious disease outbreaks. To further control the pandemic of major infectious diseases, the health management departments should enhance the knowledge of vaccines among vaccination staff and alleviate their workload.

Psychological distress in health care workers during the beginning, the middle, and the last part of the COVID-19 pandemic

The COVID-19 pandemic placed significant psychological strain on healthcare workers. Our study tracked health care workers in the Czech Republic throughout the pandemic to examine the impact of stressors on psychological distress over time and explore gender differences in these associations. We studied health care workers from the Czech arm of the international COVID-19 HEROES Study who took part in all three waves of data collection in 2020, 2021 and 2022 (n = 264). We employed a path model to examine the relationships among six stressors (low trust in workplace, assignment of new tasks, prioritization of patients, experience of death due to COVID-19, experience of discrimination or violence, contact with COVID-19 patients), psychological distress (measured by General Health Questionnaire), and covariates (age, gender, occupation). We incorporated autoregressive paths and interactions to assess the longitudinal impact of stressors. Prior levels of distress predicted subsequent distress, with significant carry-over effects observed between each wave. Stressors had direct association to distress in the same wave of data collection (2020 and 2021), but not in subsequent waves, and stressors in 2022 did not have a significant direct effect to distress. Men reported lower distress in 2020 and 2021, but not in 2022. Furthermore, no significant interactions between stressors and gender were found. Age and occupation were not related to distress levels. There is a need for adaptable mental health support that addresses current stressors through targeted interventions, while also providing ongoing monitoring beyond crises, particularly for individuals with high distress levels.

Predictors of post-traumatic stress disorder among healthcare workers during the COVID-19 pandemic in Poland

The COVID-19 pandemic has significantly impacted the mental health of healthcare workers globally. Given the critical role these professionals play, understanding the prevalence and predictors of post-traumatic stress disorder (PTSD) among healthcare workers is crucial for developing targeted interventions. Comprehensive data on the predictors of PTSD symptoms within this population remain limited. This cross-sectional study surveyed 852 healthcare workers across 4 Polish regions between 2021 and 2022. Data were collected using the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), which was culturally adapted and validated for Polish respondents. To identify key predictors of PTSD symptoms, researchers employed various statistical methods: Descriptive Statistics summarized key variables (e.g. age, job tenure) to provide an overview of data distribution and sample characteristics. Pearson Correlations examined linear relationships among variables like age, work experience, and PTSD severity, ensuring no multicollinearity through variance inflation factor checks. t-Tests and Mann-Whitney U tests compared PTSD symptom severity across demographic and professional subgroups, accounting for normality using the Kolmogorov-Smirnov test. And Hierarchical Regression Analysis identified significant predictors, incorporating demographic factors first and work-related variables (e.g. fear for personal health) in a second step. A total of 88.1% of participants were female, and 82.6% were nurses. The overall prevalence of PTSD symptoms was high, with a mean total PTSD score of 37.87. Gender differences were significant, with women reporting higher scores across the PTSD subscales, including avoidance and hyperarousal. Nurses had significantly higher intrusion symptoms compared to other professionals. Fear for personal health was the strongest predictor of PTSD symptoms (β = 0.15, P < .001), explaining 11% of the variance in the final regression model (R2 = 0.11, P < .001). The findings underscore the urgent need for targeted mental health interventions, particularly for women and nurses, who are disproportionately affected by PTSD during the pandemic. Predictive models should guide the development of support programs to mitigate the long-term psychological impact of COVID-19 and ensure better preparedness for future pandemics. The significant influence of fear for personal health on PTSD outcomes highlights the importance of protective measures and psychological support for frontline healthcare workers.

Psychological distress symptoms in nurses and their intention to leave: A cross-sectional secondary data analysis

AIM

This study aimed to examine the psychological symptoms of distress among nurses in relation to their intention to leave.

DESIGN

This study was a secondary data analysis of a cross-sectional survey collected between November 2020 and March 2021.

METHODS

Chi-square was used to examine the associations between the demographic characteristics and intention to leave and psychological distress symptoms-feeling depressed, anxious and worried. Multiple linear regression analyses were performed to examine if work settings, position (staff, charge, administrators, educators/researchers and advanced practice registered nurses) and years of experience were associated with psychological distress and intention to leave. A mediation analysis examined if psychological distress mediated the relationship between years of experience and intention to leave.

RESULTS

Overall, psychological distress was significantly positively associated with intention to leave and negatively associated with years of experience. Nurses with less than 2 years of experience had increased psychological distress, while nurses with >25 years of experience had decreased psychological distress. Both groups of nurses had increased intention to leave compared to those with 16-25 years of experience. Psychological distress partially mediated intention to leave in nurses with less than 2 years of experience and more so among nurses with >25 years of experience.

CONCLUSIONS

This study suggests that nurses encounter psychological distress symptoms, such as feeling anxious, depressed and worried, that contribute to an increased intention to leave. Among the workplace locations, nurses practicing in nursing homes had the highest intention to leave.

IMPACT

The study emphasizes that organizations need to focus on mitigating distress across all levels of nurses to promote retention efforts and intention to stay.

REPORTING METHOD

The authors adhered to the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient contribution. Completion of the survey in the original study (NWWS) implied consent from the participating nurses.

Prevalence and Factors Associated with Common Mental Disorders and Posttraumatic Stress Disorder Among Healthcare Workers in a Reference Center for Infectious Diseases During the COVID-19 Pandemic: A Survey-Based Cross-Sectional Study

A cross-sectional survey conducted between July and September 2020 and August and September 2021 estimated the prevalence and predictors of common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) among healthcare workers (HCWs) at an infectious disease referral center during the COVID-19 pandemic. CMDs were assessed using the General Health Questionnaire (GHQ-12), and PTSD using the Impact of Event Scale-Revised (IES-R). Multivariate logistic regressions identified predictors of CMD and PTSD. The study included 371 HCWs in 2020 and 167 in 2021. The CMD prevalence was 34.3% (95% confidence interval (CI): 29.5-39.4) in 2020 and 30.5% (95% CI: 23.7-38.1) in 2021. The PTSD prevalence was 25.4% (95% CI: 21.0-30.2) in 2020 and 32.7% (95% CI: 25.6-40.5) in 2021. Factors increasing CMD odds included lower education (adjusted odds ratio (AOR) = 3.71, 95% CI: 1.60-8.61), lack of physical activity (AOR = 2.23, 95% CI: 1.33-3.73), and experiencing COVID-19 symptoms (AOR = 1.64, 95% CI: 1.02-2.64) in 2020; chronic diseases (AOR = 3.14, 95% CI: 1.34-7.35) and SARS-CoV-2 testing (AOR = 3.39, 95% CI: 1.13-10.17) raised CMD odds in 2021. Frontline HCWs had lower CMD odds in 2020 (AOR = 0.60, 95% CI: 0.36-1.00) and 2021 (AOR = 0.33, 95% CI: 0.14-0.75). PTSD was associated with having COVID-19 symptoms (AOR = 2.06, 95% CI: 1.23-3.45), living with high-risk individuals (AOR = 1.75, 95% CI: 1.03-2.95), and losing loved ones (AOR = 1.86, 95% CI: 1.09-3.17) in 2020. Chronic diseases increased PTSD odds in 2020 (AOR = 2.20, 95% CI: 1.25-3.86) and 2021 (AOR = 2.30, 95% CI: 1.03-5.13), while age decreased them in 2020 (AOR = 0.95, 95% CI: 0.93-0.98) and 2021 (AOR = 0.95, 95% CI: 0.91-0.99). Younger HCWs with chronic conditions living with high-risk individuals were particularly affected. These findings highlight the urgent need for targeted emotional support and stress management programs for HCWs.

Self-compassion and psychological distress in chronic illness: A meta-analysis

OBJECTIVES

Self-compassion is a positive psychological factor linked to improved physical and psychological outcomes across different chronic illness populations. However, the extent to which self-compassion contributes to reduced distress across different conditions or as a function of participant factors is not clear. The current meta-analysis aimed to quantify the association between self-compassion and psychological distress in different chronic illness populations and evaluate the factors that moderate this association.

METHODS

A systematic search of three electronic databases identified research reporting associations between self-compassion and psychological distress in chronic illness. A random effects meta-analysis was conducted to evaluate the association between self-compassion and psychological distress. Moderator analyses were conducted for sample characteristics and distress types. A bespoke tool evaluated study quality.

RESULTS

Searches yielded 51 eligible studies with 57 effect sizes. Meta-analysis revealed that self-compassion was negatively associated with psychological distress (r = -.516; 95% CIs [-.55, -.48]; p = .000). Moderator analyses were significant for distress type and chronic illness group, with effects being largest for stress and neurological conditions. Effects did not vary by sex, age or illness duration.

CONCLUSIONS

Findings from this first comprehensive investigation of the link between self-compassion and distress in chronic illness highlight the protective role of self-compassion for chronic illness populations. These results lay the foundation for further research into understanding the processes that link self-compassion to lower psychological distress, and that examine the effectiveness of self-compassion interventions in chronic illness populations, to further advance knowledge and inform practice in this area.

Motivating healthcare workers (HCWs) to ensure service delivery during public health emergencies: Insights from a discrete choice experiment during the COVID-19 pandemic in Bangladesh

The disruption of health service delivery during public health emergencies, like Ebola and COVID-19, due to hesitancy among healthcare workers (HCWs) is well-documented. While previous studies have identified motivating factors for HCWs, accommodating all is often unfeasible due to resource limitations. Thus, identifying precise preferences is crucial from a policy standpoint. This study aims to discern HCWs' preferences regarding working conditions and fringe benefits to ensure continued service during emergencies. Additionally, we investigate potential variations in preferences among HCWs who served in dedicated COVID-19 units versus those who did not, considering differences in perceived and realized risks. Conducting a discrete choice experiment (CE) and in-person interviews with 370 HCWs from four tertiary-level hospitals in Bangladesh, our findings reveal HCWs prioritize improving working conditions over fringe benefits. Notably, those in dedicated COVID-19 units exhibit a divergent preference pattern, indicating significant influence of perceived and realized risks. These insights offer valuable guidance for policymakers to address HCWs hesitancy and ensure optimal service delivery during national health crises.

A Serial Mediation Model of Perceived Social Class and Cyberbullying: The Role of Subjective Vitality in Friendship Relations and Psychological Distress

Objective: The link between individuals' perceptions of social class (PSC) and various forms of bullying, including cyberbullying, has not been extensively studied. Additionally, the mechanisms through which PSC impact aggressive behaviors like cyberbullying remain unclear. Therefore, this study aimed to explore the influence of perceived social class on cyberbullying, considering subjective vitality and psychological distress as serial mediators. Method : Utilizing a cross-sectional design, the research involved 584 Iranian students (Mage = 20.59, SD = 1.99) from several universities who completed questionnaires assessing Subjective Social Class (SSC), Subjective Vitality Scale (SVS), Psychological Distress Scale (K6), and Cyberbullying Involvement Scale (CIS). Hayes' PROCESS macro (Model 6) in SPSS was employed to analyze the chain mediation effects. Results: The Results demonstrated that the direct impact of PSC on cyberbullying was significant (Effect = -0.229, 95% CI: -0.294 to -0.164). Subjective vitality and psychological distress serially mediated the link between PSC and cyberbullying (Effect = -0.022, 95% CI: -0.035 to -0.012). In addition, both subjective vitality (Effect = -0.046, 95% CI: -0.080 to -0.017), and psychological distress (Effect = -0.09, 95% CI: -0.123 to -0.059), independently mediated the association between PSC and cyberbullying. Conclusion: This research not only broadens the theoretical understanding of how individuals' perceptions of their social rank influence cyberbullying behaviors, but also provides actionable strategies for officials and experts to deploy effective interventions in higher education to mitigate cyberbullying.

Nurses Supporting Nurses: A Model for Providing Mental Health Services During War

Nurses routinely face psychological challenges as part of their work, acutely so during times of crises when nurses may treat many severely injured and dying patients. While the need for such support is well documented in the literature, mental health support programmes aimed at healthcare workers, even when available, are often underutilised, especially by nurses. To gain insights about needed mental health supports for nurses and programme implementation, this study examines a programme launched following a surprise attack on Israel on 7 October, 2023, resulting in thousands of deaths and injuries and precipitating a war. The programme deployed 30 volunteer nurses trained in cognitive behavioural therapy, trauma support and mental health first aid to offer up to three, anonymous, 30-min online therapy sessions to nurses around Israel in December 2023. Using a qualitative descriptive design, we engaged 22 of these volunteers in one of the three focus groups lasting 60-90 min each. Our findings highlight a range of mental health issues-among both the volunteers and therapy recipients-as well as barriers to providing mental health support to nurses. The importance of normalising the pursuit of mental health support in nursing education and ensuring the availability of support in healthcare organisations was emphasised.

The Effect of Ethical Leadership on Nurse Bullying, Burnout, and Turnover Intentions

The bullying of nurses by patients, doctors, and employees is common in the healthcare industry. Nurses who are bullied are more likely to experience burnout, and nurses who experience burnout are more likely to intend to quit. However, few studies investigate how leadership can mitigate workplace incivility and nurse bullying as a way to improve nurse retention. A cross-sectional study was conducted using a sample of 216 nurses recruited from various regions across the United States from different specialties. A moderated mediation model using path analysis was used to examine the relationships between bullying, burnout, and ethical leadership in predicting intentions to stay. Bullying significantly and positively related to burnout (β = 0.22, p=0.02), and burnout significantly and negatively related to intent to stay (β = -0.18,p=0.01). Perceived ethical leadership predicted intentions to stay (β = 0.62, p=0.00), and ethical leadership moderated the effect of bullying on burnout (β = 0.20, p=0.03). The results of our study also suggest that nurses are less likely to quit when ethical leadership is present, and ethical leadership weakens the effect of bullying on burnout.

Procrastination and Health in Nurses: Investigating the Roles of Stress, Health Behaviours and Social Support

Objectives: Evidence linking chronic procrastination to a range of poor health outcomes and trajectories continues to build. Yet, much of this research has been conducted in academic contexts or in non-student samples. Despite theory indicating that high-stress contexts increase vulnerability for procrastination, the pathways linking chronic procrastination to health outcomes proposed by the procrastination-health model have not been examined in a high stress environment. Accordingly, we tested the contribution of procrastination to health in nurses and whether social support was a protective factor. Design: Pre-registered cross-sectional study using a random sample of nurses recruited from the membership of a regional nursing association, supplemented by nurses and nurse trainees recruited from online nursing associations, conferences and forums. Methods: Nurses and nurse trainees (N = 597) completed measures of chronic procrastination, stress, health behaviours, social support and self-rated health. Results: Chronic procrastination was associated with perceived stress, health behaviours, self-rated health and social support in the expected directions. Consistent with the procrastination-health model, structural equation modelling revealed significant indirect effects linking chronic procrastination to poor self-rated health through higher stress and fewer health behaviours. Contrary to our hypotheses, social support did not moderate these pathways. Conclusions: This study is the first to demonstrate the relevance of procrastination for health in high-stress, non-academic contexts and to find support for both the stress and behavioural pathways linking procrastination to poor health outcomes. Findings further highlight the importance of addressing chronic procrastination as a vulnerability factor for poor health in nurses.

Adverse Childhood Experiences and Autism: A Meta-Analysis

Evidence suggests that autistic children have a higher probability of experiencing adverse childhood experiences (ACEs) compared to their non-autistic peers. This meta-analysis (PROSPERO: CRD42022262635) aimed to quantify the association of autism and ACEs. Eight databases and Google Scholar were searched for studies that reported dichotomous outcomes regarding the associations between ACEs and autistic individuals, compared to non-autistic individuals. A random-effects model was used to calculate the average Odds Ratio (OR) of the relationship between a diagnosis of autism and ACEs. A total of 40 studies with 5,619,584 participants were included, generating an overall average OR 2.11 (CI 1.61, 2.77). Significant differences in the magnitude of association were found across studies with regards to the type of ACEs studied, comparison groups, and population type. Overall, moderate certainty evidence (downgraded for bias) indicates that autistic individuals are at greater risk of experiencing ACEs, compared to non-autistic individuals. Appropriate support for autistic individuals and their families are required to prevent ACEs and treat the impact of ACEs.

Association between organizational justice and serious psychological distress among hospital nursing staff during the COVID-19 pandemic: A cross-sectional study

AIM

Amidst the COVID-19 pandemic, the association between organizational justice and psychological distress among hospital nursing staff is underexplored. Thus, this cross-sectional study, conducted in Fukuoka Prefecture, Japan, examined the relationship between organizational justice and serious psychological distress (SPD) among hospital nursing staff during COVID-19.

METHODS

The study surveyed 783 hospital nursing staff using the Organizational Justice Questionnaire and Effort-Reward Imbalance Questionnaire. The Kessler K6 scale was used to measure SPD. Sociodemographic and occupational characteristics were controlled for as potential confounders.

RESULTS

The prevalence of SPD was 14.4%, with a mean K6 score of 6.5. Moderate procedural justice (odds ratio [OR] = 2.38, 95% confidence interval [CI] = 1.14-4.94, p = .021) and low distributive justice (effort-reward imbalance) (OR = 3.66, 95% CI = 2.01-6.67, p < .001) were associated with SPD, even after adjustment for confounders. Interactional justice showed significance only in the crude model. Effort-reward imbalance had the strongest association with SPD.

CONCLUSIONS

The findings showed that moderate procedural justice and low distributive justice were associated with SPD, highlighting the need for organizational interventions to address these factors. Imbalances in effort/reward had the greatest impact, highlighting the critical role of distributive justice in mental health. Thus, in the context of a pandemic, extreme procedural justice is not necessarily associated with mental health, and efforts to ensure distributive justice are critical to improving the mental health of hospital nursing staff. Moreover, organizational stressors should be addressed during disruptive conditions such as infectious disease outbreaks.

Trajectories of symptoms of depression, distress, and resilience in healthcare workers during the COVID-19 pandemic and toward its end in Czechia

BACKGROUND AND OBJECTIVES

The mental health of healthcare workers (HCWs) may have improved after the COVID-19 pandemic. We aimed to model the trajectories of psychological distress, depressive symptoms, and resilience during the COVID-19 pandemic and toward its end in HCWs in Czechia and investigate, which COVID-19 work stressors were associated with these trajectories.

METHODS

The study included 322 HCWs from the Czech arm of the international HEROES Study who participated in an online questionnaire in two waves during the pandemic and one wave toward its end. Growth mixture modeling identified trajectory patterns of depressive symptoms (measured with Patient Health Questionnaire), distress (General Health Questionnaire), and resilience (Brief Resilience Scale). Logistic regression was applied to estimate the association of COVID-19 stressors with mental health trajectories, adjusting for baseline characteristics.

RESULTS

Trajectory classes revealed both high and low depressive symptoms (high in 61% of participants), distress (high in 82% of participants), and resilience (low in 32% of participants). Depressive symptoms and distress trajectories demonstrated the same shape, first increasing during the pandemic and decreasing toward its end, while resilience remained constant. Exposure to COVID-19 stressors, in particular, the experience of stigmatization, discrimination, and violence, was associated with high depressive symptoms and distress trajectories, but not with resilience.

CONCLUSIONS

Interventions provided to HCWs during crises such as pandemic should target distress and depressive symptoms and need to address stigmatization, discrimination, and violence.

Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic

Health care workers have been exposed to COVID-19 more than people in other professions, which may have led to stigmatization, discrimination, and violence toward them, possibly impacting their mental health. We investigated (1) factors associated with stigma, discrimination, and violence, (2) the association of stigma, discrimination, and violence with mental health, (3) everyday experiences of stigmatization, discrimination, and violence. We chose a combination of a quantitative approach and qualitative content analysis to analyze data collected at three time points: in 2020, 2021 and 2022. A higher age was associated with lower odds of experiencing stigma, discrimination, and violence, whereas female gender was related to more negative experiences. The intensity of exposure to COVID-19 was associated with greater experience with stigmatization, discrimination, and violence across all three years (for example in 2022: odds ratio, 95% confidence interval: 1.74, 1.18-2.55 for mild exposure; 2.82, 1.95-4.09 for moderate exposure; and 5.74, 3.55-9.26 for severe exposure, when compared to no exposure). Stigma, discrimination, and violence were most strongly associated with psychological distress in 2020 (odds ratio = 2.97, 95% confidence interval 2.27-3.88) and with depressive symptoms in 2021 (odds ratio = 2.78, 95% confidence interval 2.12-3.64). Attention should be given to the destigmatization of contagious diseases and the prevention of discrimination, violence, and mental health problems, both within workplaces and among the public.

A Model for Providing Psychological Support to Healthcare Leaders and Teams in Times of Crisis

OBJECTIVE

Pre-pandemic, the healthcare workforce was already at risk for higher burnout than the general population and, in some roles (e.g., physicians, nurses), at higher risk for clinical distress and suicide. Studies of healthcare workforce well-being during and after past pandemics reflect that distress can persist after a pandemic subsides, if adequate support within the workplace is not forthcoming and accessible. The current report presents the rationale for and development of a wellness consult service to provide support to leaders and teams in an academic medical center during the COVID-19 pandemic and now as teams work to recover and rebuild after years of significant pandemic and other stressors.

METHODS

Healthcare workers who participated in supportive Listening Sessions or Interactive Workshops facilitated by the wellness consult service were invited to complete an anonymous post-session survey.

RESULTS

Between March 2020 and November 2022, 185 leaders and teams participated in 342 supportive Listening Sessions and Interactive Workshops. Of the respondents to the post-session survey (N = 701), 89% rated the intervention as "good to excellent" and 84% were likely or very likely to recommend this service. Leaders rated the experience more highly than non-leaders (F (1,307) = 13.99, p < 0.001) and were more likely to report feeling emotionally supported (F (1,304) = 19.836, p < 0.001).

CONCLUSIONS

Supporting leader and team well-being may be critical to post-pandemic recovery of the healthcare workforce. The current report presents a feasible, theory-driven model for doing so, which was rated as highly satisfactory by participants.

Perceived stress, burnout, and resilience among healthcare workers in a multiple disaster-impacted setting during the COVID-19 pandemic

OBJECTIVE

Current literature on coronavirus disease 2019 (COVID-19) research presents gaps and opportunities to investigate the psychological experiences of healthcare workers (HCWs) serving in mass trauma situations. We aimed to measure perceived stress, burnout, and resilience in Kashmiri HCWs and explore the relationship of burnout with sociodemographic, work-related, and pandemic-related factors.

DESIGN, SETTING, AND PARTICIPANTS

This was a cross-sectional descriptive study. Data were collected by circulating a web-based questionnaire among HCWs across primary, secondary, and tertiary healthcare levels in Kashmir, India. The questionnaire consisted of sections on personal, work-related, and pandemic-related variables as well as validated instruments to measure perceived stress, burnout, and resilience.

RESULTS

A total of 514 valid responses were received. More than 80 percent of HCWs had moderate to high perceived stress. The prevalence of personal, work-related, and client-related burnouts was 68, 48.6, and 46 percent, respectively. Resilience was negatively correlated with stress and burnout. Younger (18-28 years), unmarried HCWs, especially junior residents and nurses, had higher burnout levels. Redeployment to deliver COVID-19 duties, unpredictability in work schedule, tested positive for COVID-19, and spending time in isolation/quarantine were also found to be significant risk factors for developing burnout.

CONCLUSIONS

Nearly half of the HCWs suffered from burnout, and more than half had moderate to high perceived stress. In addition to pre-existing risk factors of burnout, the pandemic seems to have introduced more occupational risk factors in this disaster-affected area. Lessons learnt from COVID-19 pandemic may help guide need-based intervention strategies designed for specific target population rather than a one size fits all approach.

Association of COVID-19 preventive behavior and job-related stress with the sleep quality of healthcare workers one year into the COVID-19 outbreak: a Japanese cross-sectional survey

BACKGROUND

This study aimed to evaluate the association of COVID-19 preventive behavior and job-related stress with sleep quality among healthcare workers (HCWs). We conducted a cross-sectional survey using a questionnaire at the National Center of Neurology and Psychiatry, Tokyo, Japan.

METHODS

A total of 586 participants who completed the questionnaire were eligible for the study. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. We examined the level of engagement between poor sleep and COVID-19-related infection preventive behaviors, such as avoiding closed spaces, crowded places, and close contact (three Cs), a distance of at least one meter from others, wearing a face mask regularly, washing hands regularly, and working remotely, as well as job-related stress in the work environment, exposure to patients, potential risk of infection, fear of infecting others, need for social confinement, and financial instability. We conducted a hierarchical logistic regression analysis to examine the relationship between poor sleep and COVID-19 preventive behavior, job-related stress, and other covariates, including age, sex, and the Kessler Psychological Distress Scale (K6), which was used to measure non-specific psychological distress.

RESULTS

Poor sleep was observed in 223 (38.1%) participants. Adherence to COVID-19 preventive measures was relatively high: 84.1% of participants answered "always" for wearing a face mask regularly and 83.4% for washing hands regularly. In the multivariate logistic regression analysis, stress in the work environment (odds ratio [OR] = 2.09, 95% confidence interval [CI], 1.37-3.20; p < 0.001), financial instability (OR = 1.73, 95% CI, 1.12-2.67; p < 0.05), and low adherence to working remotely (OR = 1.65, 95% CI, 1.06-2.57; p < 0.05) were independently and significantly associated with poor sleep after controlling for the covariates.

CONCLUSIONS

One year into the COVID-19 pandemic, the poor sleep rates of HCWs remained high. These results emphasize the need to protect HCWs from work environment stress and financial concerns.

Social stigma during COVID-19: A systematic review

Objectives

Stigmatization was reported throughout the COVID pandemic for COVID-19 patients and close contacts. The aim of this systematic review was to comprehensively examine the prevalence and impact of stigmatization during COVID-19 pandemic.

Methods

English articles were searched using online databases that included PubMed, Scopus, Embase, and Web of Science up to 24 August 2022. A two-step screening and selection process was followed utilizing an inclusion and exclusion criteria and then data was extracted from eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, and the risk of bias was assessed using the Newcastle-Ottawa Scale.

Results

Seventy-six studies were eligible for inclusion. Twenty-two studies reported the prevalence of social stigma due to COVID-19 infection with social isolation being the most commonly reported stigma. There were 20 studies that reported the majority of participants experienced stigma due to COVID-19 infection, which was as high as 100% of participants in two studies. Participants in 16 studies reported blaming from others as the second most common type of stigma, with various other types reported such as psychological pressure, verbal violence, avoidance, and labeling. The most common effect of the stigma was anxiety followed by depression, and then reduction of socialization.

Conclusion

Findings from the present review have identified that COVID-19-related stigma studies have generally focused on its prevalence, type, and outcome. Greater awareness of this topic may assist with improving public education during pandemics such as COVID-19 as well as access to support services for individuals impacted by stigmatization.

The power of connected clinical teams: from loneliness to belonging

BACKGROUND

We need to preserve the lessons of the COVID-19 pandemic in caring for the mental health of clinicians, of shared experiences, interdependence, team cohesion and vulnerability, among others. We need reform in the way that clinicians are cared for, and a resistance to the idea of a post-pandemic 'return to normal'.

MAIN TEXT

To build connected and optimally functioning clinical teams, we need to create an inclusive culture in which difficult conversations and caring are the expectation. If we are to be better at solving problems and better at serving our patients, we should be vigilant about creating a psychologically safe medical culture in which colleagues feel safe, seen, heard, and respected.

CONCLUSION

Going forward, each of us, regardless of seniority, needs to take responsibility for this culture change. We need to create and participate in weekly collegial peer support sessions that feel nurturing and safe, that allow us to reveal parts of ourselves, to be vulnerable with each other in a way that reduces loneliness, and encourages and maintains social connections and a sense of belonging within clinical teams, improves clinician well-being and reduces the risk of burnout. "Care is a practice of informed responsive actions on behalf of the one cared for and authentically aimed toward their growth and flourishing." Care Ethics in the Age of Precarity; Maurice Hamington and Michael Flower.

Quarantine experience of healthcare workers in close contact with COVID-19 patients in China: a qualitative study

BACKGROUND

This study investigated the experiences of front-line healthcare workers who had been in close contact with COVID-19 patients and had been quarantined in order to provide guidance on quarantine measures with more humanistic care when dealing with future public health emergencies.

METHODS

We conducted a qualitative study using semistructured, qualitative, in-depth interviews between April and June 2022. The interviews were recorded and transcribed, followed by a thematic analysis. The study followed the Standards for Reporting Qualitative Research.

RESULTS

This study identified the following four themes: (1) personal psychological changes, (2) increased reflection on life and work during quarantine, (3) the important role of others' support and (4) different types of demands during quarantine and isolation. Each theme is supported by several subthemes that further illustrate the participants' experiences.

CONCLUSIONS

Quarantine of close contacts is necessary to prevent outbreaks. Front-line doctors and nurses are at a greater risk of COVID-19 infection than others. The results showed the psychological reactions of ordinary close contacts, and the unique feelings and experiences of doctors and nurses during the epidemic. Therefore, future research should cooperate with multiple departments to assess their needs, provide them with individualised care and love and give them incentives in order to reduce their psychological burden, improve their quality of life and allow them to engage in healthcare with a healthy mind.

The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress: a longitudinal study of Canadian health care workers during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate potential for the development of moral distress. However, no research to date has considered the mechanisms by which leadership might have an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs' perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress.

Methods

A total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace support, perceptions of an ethical work environment, and moral distress.

Results

Associations between both organizational and supervisory leadership and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment.

Discussion

To ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as an ethical workplace environment.

Psychosocial impact of COVID-19 pandemic on front-line healthcare workers in Sierra Leone: an explorative qualitative study

INTRODUCTION

The COVID-19 pandemic has wide-reaching health and non-health consequences, especially on mental health and psychosocial well-being. Healthcare workers involved in COVID-19 patient care are particularly vulnerable to psychosocial distress due to increased pressure on healthcare systems. We explored the psychosocial experiences of front-line healthcare workers during the COVID-19 pandemic in Sierra Leone.

METHODS

This qualitative study used purposive sampling to recruit 13 healthcare workers from different cadres across 5 designated COVID-19 treatment centres in Freetown, Sierra Leone. In-depth interviews were conducted remotely in July and August 2020, transcribed verbatim and analysed using the framework approach.

RESULTS

This study identified three overarching themes: vulnerability, resilience and support structures. Participants expressed vulnerability relating to the challenging work environment and lack of medications as key stressors resulting in anxiety, stress, anger, isolation and stigmatisation. Signs of resilience with experiences drawn from the 2014 Ebola outbreak, teamwork and a sense of duty were also seen. Peer support was the main support structure with no professional psychosocial support services available to healthcare workers.

CONCLUSIONS

This is the first study to provide evidence of the psychosocial impacts of COVID-19 among front-line healthcare workers in Sierra Leone. Despite signs of resilience and coping mechanisms displayed, they also experienced adverse psychosocial outcomes. There is a need to focus on enhancing strategies such as psychosocial support for healthcare workers and those that overall strengthen the health system to protect healthcare workers, promote resilience and guide recommendations for interventions during future outbreaks.

Factors associated with suicide in physicians: a silent stigma and public health problem that has not been studied in depth

Suicide is a complex and multifaceted public health issue that affects individuals from all walks of life, including healthcare professionals such as physicians. According to research, physicians have a higher risk of suicide compared to the general population, with an estimated suicide rate that is two to three times greater than that of the general population. Suicide in physicians can have devastating consequences, not only for the individual but also for their patients and colleagues. The factors contributing to suicide in physicians are numerous and often interrelated. Physicians are exposed to numerous stressors in their daily lives, including long work hours, high workload, burnout, and exposure to traumatic events. These stressors can lead to mental health problems such as depression, anxiety, and substance use disorders, which in turn can increase the risk of suicide. In addition to work-related stressors, personal factors such as relationship problems, financial stress, and a history of mental health problems can also contribute to suicide risk in physicians. Stigma and shame around seeking help for mental health issues may also prevent physicians from seeking treatment, exacerbating the problem. Understanding the complex factors that contribute to suicide in physicians is crucial for developing effective prevention strategies. For this reason, it is necessary to know the behavior of this phenomenon and the factors associated with a higher risk of suicide in this population. However, taking into account that different regions of the world vary in socioeconomic, cultural, professional, occupational, and health attributes, it is to be expected that the behavior of these risk factors will also be heterogeneous. At present, it is presumed that there is a significant gap in the evidence, due to a predominance of evidence on this topic from high-income countries. Considering the importance of having a comprehensive understanding of the risk factors for suicide in the medical population and possible strategies to mitigate this condition, the aim of this review is to analyze the most recent evidence on these factors, and to assess the quality of the evidence and gaps that need to be studied further.

The Effects of Social Media Addiction, Psychological Distress, and Loneliness on Suicide Ideations and Attempts Among Healthcare Professionals in Saudi Arabia

INTRODUCTION

Recently, there has been an alarming increase in psychological distress in many populations. One of the reasons can be attributed to the rapid development of technology and social media, which could adversely affect the mental health of individuals, including those working in healthcare. This study aimed to assess the influence of social media addiction, psychological distress, and loneliness on suicidal ideations and suicide attempts among healthcare students and professionals in Saudi Arabia.

MATERIALS AND METHODS

This cross-sectional study collected data from healthcare students and professionals using a five-part questionnaire: (i) demographics, (ii) the Bergen Social Media Addiction Scale (BSMAS), (iii) the Kessler Psychological Distress Scale (K10), (iv) the De Jong Gierveld Loneliness Scale (DGLS), and (v) suicide ideation and attempts scale.

RESULTS

There were 800 participants from 33 cities who completed the questionnaire. A total of 31.37% reported lifelong thoughts of suicide, regardless of whether they would actually go through with it (S1), 18.38% had suicidal thoughts within the last 12 months (S2), and 11% had attempted suicide (S3). Of those who attempted suicide, 79 (89.77%) reported seeking help. Multiple logistic regression showed that lifetime suicidal thoughts were predicted by psychological distress, emotional loneliness (EL), social loneliness (SL), and age. Having had suicidal thoughts within the prior 12 months was predicted by psychological distress, SL, and age. Suicidal attempts were predicted by psychological distress, EL, age, and social media addiction.

CONCLUSIONS

Our findings demonstrated that psychological distress and loneliness are strongly associated with suicidal ideas and suicide attempts. Such results could serve as a warning call that assists healthcare professionals and mental health teams in arranging and planning effective interventions and actions to raise awareness, as well as reduce the levels of psychological distress and loneliness that could lead to grave consequences.

Social and Emotional Wellbeing of Aboriginal Community Controlled Health Services Staff during the COVID-19 Pandemic

This study explores the impact of the COVID-19 pandemic on the work and social and emotional well-being (SEWB) of staff at Aboriginal Community Controlled Health Services (ACCHS) in Australia. Between September and November 2021, staff from three ACCHSs in New South Wales completed an online survey to report changes to their roles, concerns about becoming infected with the COVID-19 virus, and job satisfaction in the last month. The survey measured emotional exhaustion and psychological distress by using the Maslach Burnout Inventory-Human Services Survey and Kessler-5 scale, respectively. The survey determined staff's access to SEWB support. Descriptive statistics were calculated for each variable. Among 92 staff from three ACCHSs, 36% reported a COVID-19-related change in their role and 64% were concerned about becoming infected. In spite of the pandemic, most staff (69%) were satisfied with their job. While most staff were not burnt out or psychologically distressed, 25% had high emotional exhaustion and 30% had high to very high psychological distress. Relatedly, 37% had accessed SEWB support at least once in their lifetime and 24% had accessed support in the last month. As the pandemic continues, it is important to identify factors influencing burnout or psychological distress among ACCHS staff and implement evidence-based solutions.

Mental health outcomes in health care providers during the COVID-19 pandemic: an umbrella review

As we head into the third year of the COVID-19 pandemic, there is an increasing need to consider the long-term mental health outcomes of health care workers (HCWs) who have experienced overwhelming work pressure, economic and social deprivation, burnout, and post-traumatic stress disorder (PTSD). This scoping umbrella review summarizes the mental health outcomes of published evidence syntheses on HCWs worldwide. We analyzed 39 evidence syntheses representing the findings from 1297 primary studies. We found several persistent fears and concerns (job-related fears, fear of stigmatization, worries about the pandemic, and infection-related fears) that shaped HCW experiences in delivering health care. We also describe several risk factors (job-related, social factors, poor physical and mental health, and inadequate coping strategies) and protective factors (individual and external factors). This is the first scoping umbrella review comprehensively documenting the various risk and protective factors that HCWs have faced during the COVID-19 pandemic. HCWs continue to fear the risk that they may infect their family and friends since they regularly interact with COVID-19 patients. This places HCWs in a precarious situation requiring them to balance risk to their family and friends and potential social deprivation from isolation.

Procrastination and Stress: A Conceptual Review of Why Context Matters

Research over the past two decades has continued to highlight the robust associations between procrastination and stress across multiple populations and contexts. Despite this burgeoning evidence base and theory linking procrastination to higher levels of stress, as well as the reverse, the role of context in this potentially dynamic association has received relatively little attention. In this conceptual review I argue that from a mood regulation perspective of procrastination, stressful contexts necessarily increase risk for procrastination because they deplete coping resources and lower the threshold for tolerating negative emotions. Drawing on insights from coping and emotion regulation theory, the new stress context vulnerability model of procrastination proposes that the risk for procrastination increases in stressful contexts primarily because procrastination is a low-resource means of avoiding aversive and difficult task-related emotions. The new model is then applied to evidence on the primary and secondary sources of stress during the COVID-19 pandemic and how they may have increased vulnerability for procrastination. After discussing potential applications of the new model for understanding how and why risk for procrastination may increase in other stressful contexts, approaches that might mitigate vulnerability for procrastination in high-stress contexts are discussed. Overall, this new stress context vulnerability model underscores the need for taking a more compassionate view of the antecedents and factors that may increase the risk for procrastination.

Emotional distress and burnout at a fever clinic in China: Comparison between different periods of COVID-19

Background

Frontline healthcare workers (FHWs) experienced psychological stress and heavy workload during COVID-19 pandemic. This study examined the psychological symptoms and occupational burnout of FHWs in a fever clinic during different periods of the pandemic.

Methods

A cross-sectional survey of FHWs in the fever clinic of a tertiary hospital was carried out during both the outbreak period and regular period of COVID-19. Psychological measurement instruments including Generalized Anxiety Disorder 7-item, the 9-Question Patient Health Questionnaire, the Maslach Burnout Inventory-Human Service Survey, and the General Self-Efficacy Scale were used to evaluate anxiety, depression, burnout, and self-efficacy, respectively. The correlation between clinical variables was explored.

Results

A total of 162 participants were involved in this study, including 118 FHWs during the outbreak period (Group 1) and 44 FHWs during the regular period (Group 2). Anxiety symptoms were more prevalent in Group 2 (x 2 = 27.477) while depressive symptoms were significantly more prevalent in Group 1 (x 2 = 69.538). Burnout rate was higher in Group 2 (x 2 = 29.526). Self-efficacy was higher in Group 1 (t = 3.194). Burnout was positively correlated with anxiety symptoms (r 2 = 0.424) and negatively correlated with self-efficacy (r 2 = -0.312).

Conclusion

Anxiety, depressive symptoms and burnout were prevalent in FHWs during different periods of the COVID-19 pandemic. There is a tendency to be less depressed, but more anxious and burned out over time, although the severity of the pandemic is decreasing. Self-efficacy may be an important factor in protecting FHWs from occupational burnout. Support and intervention plans for FHWs should be made at the institutional level.

A hidden pandemic? An umbrella review of global evidence on mental health in the time of COVID-19

Background

The mental health impacts of the COVID-19 pandemic remain a public health concern. High quality synthesis of extensive global literature is needed to quantify this impact and identify factors associated with adverse outcomes.

Methods

We conducted a rigorous umbrella review with meta-review and present (a) pooled prevalence of probable depression, anxiety, stress, psychological distress, and post-traumatic stress, (b) standardised mean difference in probable depression and anxiety pre-versus-during the pandemic period, and (c) comprehensive narrative synthesis of factors associated with poorer outcomes. Databases searched included Scopus, Embase, PsycINFO, and MEDLINE dated to March 2022. Eligibility criteria included systematic reviews and/or meta-analyses, published post-November 2019, reporting data in English on mental health outcomes during the COVID-19 pandemic.

Findings

Three hundred and thirty-eight systematic reviews were included, 158 of which incorporated meta-analyses. Meta-review prevalence of anxiety symptoms ranged from 24.4% (95%CI: 18–31%, I2: 99.98%) for general populations to 41.1% (95%CI: 23–61%, I2: 99.65%) in vulnerable populations. Prevalence of depressive symptoms ranged from 22.9% (95%CI: 17–30%, I2: 99.99%) for general populations to 32.5% (95%CI: 17–52%, I2: 99.35) in vulnerable populations. Prevalence of stress, psychological distress and PTSD/PTSS symptoms were 39.1% (95%CI: 34–44%; I2: 99.91%), 44.2% (95%CI: 32–58%; I2: 99.95%), and 18.8% (95%CI: 15–23%; I2: 99.87%), respectively. Meta-review comparing pre-COVID-19 to during COVID-19 prevalence of probable depression and probable anxiety revealed standard mean differences of 0.20 (95%CI = 0.07–0.33) and 0.29 (95%CI = 0.12–0.45), respectively.

Conclusion

This is the first meta-review to synthesise the longitudinal mental health impacts of the pandemic. Findings show that probable depression and anxiety were significantly higher than pre-COVID-19, and provide some evidence that that adolescents, pregnant and postpartum people, and those hospitalised with COVID-19 experienced heightened adverse mental health. Policymakers can modify future pandemic responses accordingly to mitigate the impact of such measures on public mental health.

Sources, diffusion and prediction in COVID-19 pandemic: lessons learned to face next health emergency

Scholars and experts argue that future pandemics and/or epidemics are inevitable events, and the problem is not whether they will occur, but when a new health emergency will emerge. In this uncertain scenario, one of the most important questions is an accurate prevention, preparedness and prediction for the next pandemic. The main goal of this study is twofold: first, the clarification of sources and factors that may trigger pandemic threats; second, the examination of prediction models of on-going pandemics, showing pros and cons. Results, based on in-depth systematic review, show the vital role of environmental factors in the spread of Coronavirus Disease 2019 (COVID-19), and many limitations of the epidemiologic models of prediction because of the complex interactions between the new viral agent SARS-CoV-2, environment and society that have generated variants and sub-variants with rapid transmission. The insights here are, whenever possible, to clarify these aspects associated with public health in order to provide lessons learned of health policy that may reduce risks of emergence and diffusion of new pandemics having negative societal impact.

Using Technology to Facilitate Evidence-Based Practice During the COVID-19 Pandemic

The COVID-19 pandemic brought many challenges to the health care workforce. A novel infectious disease, COVID-19 uncovered information gaps that were essential for frontline staff, including nurses, to care for patients and themselves. The authors developed a Web-based solution consisting of saved searches from PubMed on clinically relevant topics specific to nurses' information needs. This article discusses the objectives, development, content, and usage of this Internet resource and also provides tips for hospitals of all sizes to implement similar tools to evidence-based practice during infectious disease outbreaks.

Burnout and occupational stress among Hungarian radiographers working in emergency and non-emergency departments during COVID-19 pandemic

INTRODUCTION

The increased workload caused by the coronavirus pandemic may have had a significant impact on the mental health of radiographers. The aim of our study was to investigate burnout and occupational stress in radiographers working in emergency departments (ED) and non-emergency departments (NED).

METHODS

Quantitative, cross-sectional, descriptive research was carried out among radiographers working in the public health sector in Hungary. Due to the cross-sectional nature of our survey, there was no overlap between the ED and NED groups. For data collection, we used simultaneously the Maslach Burnout Inventory (MBI), the Effort-Reward Imbalance questionnaire (ERI), and our self-designed questionnaire.

RESULTS

We excluded incomplete questionnaires from our survey; finally, 439 responses were evaluated. Significantly higher scores for depersonalisation (DP; 8.43 (SD = 6.69) vs. 5.63 (SD = 4.21) and emotional exhaustion (EE; 25.07 (SD = 11.41) vs. 19.72 (SD = 11.72)) were observed in radiographers working in ED (p = 0.001; p = 0.001) when compared to NED. Male radiographers working in ED aged 20-29 and 30-39 years with experience of 1-9 years were more affected by DP (p ≤ 0.05). Worrying about one's own health had a negative effect on DP and EE (p ≤ 0.05). Having close friend with a COVID-19 infection had a negative effect on EE (p ≤ 0.05); not being infected with coronavirus, not being quarantined and relocating within the workplace had a positive effect on personal accomplishment (PA); radiographers who were 50 years or older with 20-29 years of experience were more affected by depersonalisation (DP); and those who worried about their health had significantly higher stress scores (p ≤ 0.05) in both ED and NED settings.

CONCLUSION

Male radiographers at the beginning of their careers were more affected by burnout. Employment in EDs had a negative impact on DP and EE.

IMPLICATIONS FOR PRACTICE

Our results support the implementation of interventions to counter the effects of occupational stress and burnout among radiographers working in ED.

Impact of Multiple COVID-19 Waves on Gynaecological Cancer Services in the UK

BACKGROUND

This study aimed to assess the impact of multiple COVID-19 waves on UK gynaecological-oncology services.

METHODS

An online survey was distributed to all UK-British-Gynaecological-Cancer-Society members during three COVID-19 waves from 2020 to2022.

RESULTS

In total, 51 hospitals (including 32 cancer centres) responded to Survey 1, 42 hospitals (29 centres) to Survey 2, and 39 hospitals (30 centres) to Survey 3. During the first wave, urgent referrals reportedly fell by a median of 50% (IQR = 25-70%). In total, 49% hospitals reported reduced staffing, and the greatest was noted for trainee doctors, by a median of 40%. Theatre capacity was reduced by a median of 40%. A median of 30% of planned operations was postponed. Multidisciplinary meetings were completely virtual in 39% and mixed in 65% of the total. A median of 75% of outpatient consultations were remote. By the second wave, fewer hospitals reported staffing reductions, and there was a return to pre-pandemic urgent referrals and multidisciplinary workloads. Theatre capacity was reduced by a median of 10%, with 5% of operations postponed. The third wave demonstrated worsening staff reductions similar to Wave 1, primarily from sickness. Pre-pandemic levels of urgent referrals/workload continued, with little reduction in surgical capacity.

CONCLUSION

COVID-19 led to a significant disruption of gynaecological-cancer care across the UK, including reduced staffing, urgent referrals, theatre capacity, and working practice changes. Whilst disruption eased and referrals/workloads returned to normal, significant staff shortages remained in 2022, highlighting persistent capacity constraints.

Intolerance of uncertainty, fear of contamination and perceived social support as predictors of psychological distress in NHS healthcare workers during the COVID-19 pandemic

Psychological distress has been repeatedly quantified over the course of the pandemic, however this has not always included broader healthcare workers, and has mostly focused on prevalence and occupational factors. This study investigated intolerance of uncertainty (IOU), fear of contamination and perceived social support as key predictors of psychological distress in healthcare professionals, between the 10^th and 23 June 2020, during the first wave of the COVID-19 pandemic. This study was a cross-sectional, online survey design. Opportunity sampling was used to recruit to the study, primarily using social media sites and snowballing techniques. The final sample included 342 National Health Service (NHS) healthcare workers. IU (p < .001), gender (p < .001), fear of contamination (p = .007), perceived social support (p = .012), and age (p = .017) significantly predicted psychological distress in the sample and accounted for 36.2% of variance in psychological distress scores. IOU accounted for 28.2% of this variance. A two-way post hoc ANOVA, looking at gender and profession, showed a significant main effect of gender on psychological distress scores (F(1,218) = 7.156, p = .008, η_p² = .032), with females reporting significantly higher psychological distress scores compared to males. In conclusion, higher levels of intolerance of uncertainty, fear of contamination and lower levels of perceived social support significantly influenced higher scores of psychological distress. These factors should be considered when adapting and delivering evidence-based interventions to healthcare staff during this crisis.

Psychological distress experienced by nurses amid the fifth wave of the COVID-19 pandemic in Hong Kong: A qualitative study

Introduction

The fifth wave of COVID-19 has significantly overburdened the health care system in Hong Kong. Health care professionals, particularly nurses continue to experience significant levels of psychological distress when tackling this ongoing outbreak. Yet, no study has explored the psychological experiences of nurses during the most recent outbreak of the highly transmissible Omicron variant in Hong Kong. The aim of this qualitative study was to explore the psychological distress experienced by nurses during the fifth wave of the COVID-19 pandemic in Hong Kong.

Methods

Twenty-two nurses (14 female and 8 male nurses; average age, 36.7 ± 8.5 years) were recruited to attend the one-to-one semi-structured telephone interviews from June to July, 2022. Data were analyzed using thematic analysis.

Results

Four main themes emerged from the interview: (1) Intense fear, worry, and anxiety; (2) Feeling worn out and psychologically distress; (3) Impact on psychosocial and physical health; and (4) Limited options to cope with psychological distress during the difficult times.

Discussion

Our study findings may provide concerned stakeholders with useful insights into reducing the psychological distress experienced by nurses in Hong Kong. Offering psychological support is of paramount importance to address the unmet psychological needs of nurses and reduce their psychological distress during the pandemic, particularly when they are working under high levels of workplace stress.

Cognitive appraisals and coping strategies of registered nurses in the emergency department combating COVID-19: A scoping review

OBJECTIVE

Explore the relevant evidence about stress-related cognitive appraisal and coping strategies among registered nurses in the emergency department (EDRNs) coping with the COVID-19 pandemic.

METHODS

This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus electronic databases for related studies from inception through February 2, 2022. This review further conducted study selection based on the PRISMA flow diagram and applied Lazarus and Folkman's Psychological Stress and Coping Theory to systematically organize, summarize, and report the findings.

FINDINGS

Sixteen studies were included for synthesis. Most of the studies showed that the majority of EDRNs were overwhelmed by the COVID-19 pandemic. Depression, triaging distress, physical exhaustion, and intention to leave ED nursing were cited as major threats to their wellness. Additionally, comprehensive training, a modified triage system, a safe workplace, psychological support, promotion of resilience, and accepting responsibility may help EDRNs cope with pandemic-related challenges effectively.

CONCLUSION

The long-lasting pandemic has affected the physical and mental health of EDRNs because they have increased their effort to respond to the outbreak with dynamically adjusted strategies. Future research should address a modified triage system, prolonged psychological issues, emergency healthcare quality, and solutions facing EDRNs during the COVID-19 or related future pandemics.

CLINICAL RELEVANCE

EDRNs have experienced physical and psychological challenges during the pandemic. The ED administrators need to take action to ensure EDRNs' safety in the workplace, an up-to-date triage system, and mental health of frontline nurses to provide high-quality emergency care for combating COVID-19.

Psychiatric Issues Among Health Professionals

COVID-19 has increased the interest in the wellbeing of health professionals (HPs) as they have experienced stress, loss, and fatigue-related symptoms. Research evidence from previous epidemics points to an increase in the prevalence of affective, anxiety, and addictive disorders among them. HPs are trained to care for others and to recover from severe stressors. However, they tend to neglect self-care and have difficulties in seeking appropriate help when need it. This new scenario becomes an opportunity to promote a new culture of professionalism whereby caring for the caregivers becomes a priority both at a personal and institutional level.

The impact of COVID-19 pandemic on the psychological well-being among health care workers: A 6-month cohort longitudinal survey study

Introduction

Health care workers (HCW) have been identified as a risk group to suffer psychological burden derived from Coronavirus Disease 19 (COVID-19) pandemic. In addition, possible gender differences in the emotional reactions derived from COVID-19 pandemic have been suggested in this population. The aims of the study were to explore the impact of COVID-19 as well as possible gender differences on mental health status and suicidality in a cohort of HCW.

Materials and methods

One thousand four hundred and thirty-two HCW responded to an online survey including sociodemographic, clinical, and psychometric tests in May 2020 while 251 HCW answered in November 2020. Mental health status was measured by General Health Questionnaire 28 (GHQ-28) in both time periods.

Results

HCW informed of a worsening in somatic symptomatology over the follow up period. Gender differences were found in all GHQ-28 dimensions as well in the total score of the questionnaire. Post hoc analyses displayed significant interaction between the time and gender in somatic and anxiety dimensions as well as in GHQ-28 total score. Stress produced by COVID-19 spreading and the feeling of being overwhelmed at work resulted the main predictors of psychological distress although each domain is characterized by a specific set of predictors.

Conclusions

Somatic reactions represent the most sensitive dimension over the follow-up period. Moreover, women are characterized by a greater psychological distress at the beginning, although these differences tend to disappear over time. Finally, a complex network of factors predicted different dimensions of psychological distress, showing the complexity of prevention in high-risk populations facing major disasters.

Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study

BACKGROUND

Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews.

METHODS

We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD.

FINDINGS

The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1).

INTERPRETATION

The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention.

FUNDING

UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.

Associated factors of burnout among Chinese vaccination staff during COVID-19 epidemic: A cross-sectional study

Objective

During the COVID-19 epidemic, vaccination staff had three main aspects of work: routine vaccination for children and adults, COVID-19 vaccination and COVID-19 prevention and control. All these works significantly increased the workload of vaccination staff. This study aimed to investigate the prevalence and influencing factors of burnout among vaccination staff in Hangzhou, China.

Methods

A total of 501 vaccination staff from 201 community/township healthcare centers in Hangzhou were recruited using a cross-sectional survey through WeChat social platform. The Maslach Burnout Inventory-General Scale (MBI-GS) was used to assess the level of burnout. Descriptive statistics were made on the characteristics of participants. Univariate analysis using the chi-square test and multivariable analysis using binary logistic regression were conducted to determine the relative predictors of burnout. Univariate analysis and multiple linear regression were used to determine the relative predictors of exhaustive emotion, cynicism, and personal accomplishment.

Results

During the COVID-19 pandemic, 20.8% of the vaccination staff experienced burnout. Educational level above undergraduate education level, medium professional title, and more working time in COVID-19 vaccination work reported a higher degree of job burnout. The vaccination staff was experiencing a high degree of exhaustive emotion, cynicism, and low personal accomplishment. Professional title, working place, and working time for COVID-19 vaccination were associated with exhaustive emotion and cynicism. Professional title and participation time for COVID-19 prevention and control were associated with personal accomplishment.

Conclusions

Our findings suggest that the prevalence rate of burnout is high among vaccination staff during the COVID-19 pandemic, especially with a low level of personal accomplishment. Psychological intervention for vaccination staff is urgently needed.

The relationship between fear of COVID-19 infection, fear of COVID-19 vaccination and Big Five personality traits: a mediation model

BACKGROUND

The primary objective of our correlational, cross-sectional study was to determine the relationship between fear of COVID-19 infection and fear of COVID-19 vaccination and the role of the Big Five personality traits in this relationship.

PARTICIPANTS AND PROCEDURE

The study sample consisted of 462 participants, including 286 women and 176 men, aged 18 to 75, recruited from the general population. The Big Five personality traits were diagnosed using the Polish version of the Ten-Item Personality Inventory. We used an 11-point numerical rating scale to measure the intensity of fear of COVID-19 infection as well as fear of COVID-19 vaccination.

RESULTS

The results indicate that fear of infection has a weak positive correlation with fear of vaccination. Both types of fear have a weak negative correlation with emotional stability and openness to experience. People diagnosed with COVID-19 have significantly higher levels of fear of vaccination and lower levels of emotional stability compared to those without a COVID-19 diagnosis. Fear of infection proves a good predictor of fear of vaccination and a likely mediator between emotional stability and fear of vaccination against COVID-19.

CONCLUSIONS

The results may increase our understanding of the role of personality traits, such as emotional stability, in the fear of infection and COVID-19 vaccination hesitancy.

Lived Experiences of Female Nurses with COVID-19 Deaths on Their Watch

The COVID-19 pandemic has had a tremendous effect on health systems, leading to a spike in stress, anxiety, and depression conditions among healthcare workers worldwide. Considering the mental health status of nurses, a pillar of the health system, is crucial for assuring the quality of the healthcare provided during and after pandemics. This study aimed to explore the experiences of female nurses who witnessed their patients dying of COVID-19. Seven female COVID-19 nurses were interviewed in person. Thematic analysis of the respondents' verbatim answers was implemented. Six main themes were identified. Theme 1 illustrates nurses' experience of emotional and psychological trauma as they witnessed their patients with COVID-19 die under their care. Theme 2 reveals aftershock reactions, including somatization, isolation, and emotional disengagement. Theme 3 highlights the hindrances and difficult situations related to the in-hospital care of COVID-19 patients. Theme 4 demonstrates victorious feelings and celebration of the patient's survival. Theme 5 emphasizes the nurse's ability to be calm and recognize the takeaways or lessons they have learned from this phase for their careers and lives. Theme 6 sheds light on nurses' emerging abilities and competencies. This study will hopefully provide a basis for a debriefing program that might be beneficial to the nurses and the health system. This might affect nurses' ability to work closely with patients, cope emotionally with challenges, and fulfil their professional tasks.

Psychological Distress, Anxiety, Depression, and Associated Factors Among Nigerian Healthcare Workers During COVID-19 Pandemic: A Cross-Sectional Study

Objectives: We determined the prevalence of psychological distress, and the associations between sociodemographic factors, anxiety, depression, COVID-19-related experiences, and psychological distress, among nurses and doctors in Nigeria. Methods: The study was a cross-sectional descriptive study, conducted over a month (1st of July-31st of July 2021) among 434 Health Care Workers (HCWs) [225 (51.8%) nurses and 209 (48.2%) doctors] from two tertiary health facilities in southwestern Nigeria. Binary logistic regression was carried out to determine the factors associated with psychological distress (dependent variable), while the independent variables were anxiety, depression, and COVID-19 experience-related factors. Results: The prevalence of moderate and severe psychological distress was 49.1% and 5.8%, respectively. Individuals who had the first degree had significantly lower odds (AOR: 0.43; p = 0.037) of experiencing psychological distress while being a nurse (AOR: 2.03; p = 0.014), higher levels of anxiety (1.28; p < 0.001), and depression (AOR: 1.17; p = 0.005) were associated with significantly higher odds of experiencing moderate to severe levels of psychological distress. Conclusion: There is a high level of psychological distress experienced by these health workers. Hence, they will benefit from strategies to reduce their distress.

The psychological distress and suicide-related ideation in hospital workers during the COVID-19 pandemic: Second results from repeated cross-sectional surveys

The COVID-19 pandemic has been affecting the mental health of hospital workers. During the prolonged pandemic, hospital workers may experience much more severe psychological distress, leading to an increased risk of suicide. This study aimed to investigate changes in psychological effects on hospital workers over 12 months from the beginning of the pandemic and clarify factors associated with psychological distress and suicide-related ideation 1-year after the pandemic's beginning. These repeated, cross-sectional surveys collected demographic, mental health, and stress-related data from workers in 2 hospitals in Yokohama, Japan. The first survey, conducted in March-April 2020, contained the 12-item General Health Questionnaire (GHQ-12) assessing general distress and the Impact of Event Scale-Revised (IES-R) assessing event-related distress. In the second survey in March 2021, hospital workers at the same two hospitals were reassessed using the same questionnaire, and Item 9 of the Patient Health Questionnaire (PHQ-9) was added to assess their suicide-related ideation. The findings of the first and second surveys revealed that the average score of GHQ-12 (3.08 and 3.73, respectively), the IES-R total score (6.8 and 12.12, respectively), and the prevalence rates of severe general distress (35.0% and 44.0%, respectively) and severe event-related distress (7.0% and 17.1%, respectively) deteriorated. The second survey showed that 8.6% of the hospital workers were experiencing suicide-related ideation. Both the general and event-related distress were associated with suicide-related ideation. In these surveys, mental health outcomes among the hospital workers deteriorated over one year from the pandemic's beginning, and their severe psychological distress was the risk factor for the suicide-related ideation. Further studies are needed to compare the psychological effects on hospital workers during and after the prolonged pandemic and to explore appropriate measures to support hospital workers' mental health.

Nurses' recovery experiences during the COVID-19 pandemic in Isfahan, Iran: A qualitative study

AIM

The aim of this study is to explore and describe the recovery experiences of nurses working in COVID-19 wards.

BACKGROUND

The global outbreak of coronavirus in 2020 has extracted job stress for nurses. Job stress has impacts on physical and mental health and performance, so recovery is essential to restore the lost energy resources.

METHOD

Semi-structured interviews were conducted with 12 nurses in Isfahan city of Iran.

RESULTS

The research results were extracted as 5 main themes, 14 subthemes and 54 items. The main themes are detachment from work, relaxation, non-work activities, affiliation and meaning. The combination of these themes led to the clear statement that using recovery experiences is a major step toward relieving the nurses' COVID-19-related stress and their physical and mental resuscitation.

CONCLUSION

The use of recovery experiences, including detachment from work, relaxation, non-work activities, affiliation and meaning by nurses, helps them cope with job stressors and regain their resources.

IMPLICATIONS FOR NURSING MANAGEMENT

It is the responsibility of health system policy makers, hospital managers and nurse managers to design and implement training programmes for nurses to use recovery experiences as stress management techniques in their profession.

Psychological impact, coping behaviors, and traumatic stress among healthcare workers during COVID-19 in Taiwan: An early stage experience

OBJECTIVE

This study investigated the psychological impact on, coping behaviors of, and traumatic stress experienced by healthcare workers during the early stage of the COVID-19 pandemic and formulated effective support strategies that can be implemented by hospitals and government policymakers to help healthcare staff overcome the pandemic.

METHODS

This cross-sectional study recruited clinical healthcare workers at a regional hospital in Nantou County, Taiwan. The questionnaire collected personal characteristics, data on the impact and coping behaviors of the pandemic, and Impact of Event Scale-Revised (IES-R). A total of 354 valid questionnaires were collected. The statistical methods employed were univariate and multivariate stepwise regression, and logistic regression.

RESULTS

Perceived impact and coping behaviors were found to be moderate in degree, and traumatic stress was lower than that in other countries. However, our data identified the following subgroups that require special attention: those with young age, those living with minor children, nurses, those with self-rated poor mental health, and those with insufficient COVID-19-related training.

CONCLUSION

Managers should pay particular attention to helping healthcare workers in high-risk groups, strengthen COVID-19 training, provide adequate protective equipment and shelter, and offer psychological counseling.

Causes of Stress among Healthcare Professionals and Successful Hospital Management Approaches to Mitigate It during the COVID-19 Pandemic: A Cross-Sectional Study

The outbreak of the COVID-19 pandemic posed an immediate challenge to the management of hospitals in Germany and elsewhere. The risk of stress for front-line healthcare professionals forced occupational health and safety units to adopt a variety of protective measures, not all of which have been thoroughly validated. The main objective of the present analysis is to assess what the most important sources of stress were and which of the protective measures applied to counteract stress among healthcare staff had the greatest impact. A better understanding of these factors will improve hospital management and worker safety in a future health crisis situation and may also prove to be beneficial in non-crisis situations. For this purpose, in 2020, an exploratory, cross-sectional and quantitative study using a questionnaire created for this purpose was carried out on a total of 198 professionals-133 nurses and 65 physicians-at the Klinikum Mittelbaden Balg hospital in Baden-Baden, Germany, during the first wave of the pandemic. Statistical analyses showed that nurses suffer more stress than physicians and that stress is higher among professionals in critical care and emergency units than in units that are less exposed to infected patients. It was also found that measures such as salary incentives, encouragement of work in well-integrated teams, and perceived support from hospital management mitigate stress. These findings highlight the importance of support measures from management and superiors. Knowing the actual effectiveness of the measures applied by management and the factors mentioned above could help to protect healthcare professionals in the event of another pandemic or similar situations and may still be of value in dealing with the continuing COVID-19 pandemic.

Stressors on frontline healthcare workers during the COVID-19 pandemic: a focus on moral injury and implications for the future

OBJECTIVE

The COVID-19 pandemic has placed a psychological strain on health care workers (HCWs). To provide effective support, it is important to explore the stressors that HCWs face that place them at risk of negative psychological outcomes. However, there is a limited number of systematic qualitative studies on the stressors that HCWs faced in the United States of America (USA) during the first wave of the pandemic. Therefore, we explored the stressors that frontline HCWs in the USA experienced during the initial phase of the pandemic.

METHODS

We performed a qualitative study based on open-ended, semi-structured, one-on-one interviews conducted virtually among HCWs from June 1st to July 18th, 2020. We interviewed frontline HCWs (N = 45) including physicians, nurses, respiratory therapists, and patient care assistants who worked in various specialties and roles in 3 health systems across Connecticut, USA. We offered participants a $25 gift card as a token of appreciation. We used inductive techniques derived from grounded theory to develop themes.

RESULTS

We identified 3 main themes related to stressors experienced by HCWs during the initial phase of the pandemic namely: (1) Stress of witnessing an unprecedented number of deaths and the impact on patient families; (2) Stress of changing work environment and unmet professional expectations and; (3) Concern for safety in personal life. Furthermore, we highlight experiences that HCWs faced that place them at risk of developing a moral injury.

CONCLUSIONS

Our findings highlight stressors faced by HCWs that could aid in the provision of well-guided support to HCWs in the present and post-pandemic era.