A Survey of Psychiatric Healthcare Workers' Perception of Working Environment and Possibility to Recover Before and After the First Wave of COVID-19 in Sweden

Digitally transforming community mental healthcare: Real-world lessons from algorithmic workforce integration

Community-based high intensity services for people living with severe and enduring mental illnesses face critical workforce shortages and workflow efficiency challenges. The expectation to monitor complex, dynamic patient data from ever-expanding electronic health records leads to information overload, a significant factor contributing to worker burnout and attrition. An algorithmic workforce, defined as a suite of algorithm-driven processes, can work alongside health professionals assisting with oversight tasks and augmenting human expertise. This selective review summarises lessons learned from our five-year experience (2018-22) of algorithmic workforce implementation research in two community mental health services in Australia covering both rural and urban populations. We retrace our implementation journey to illustrate four foundational processes: (i) algorithm design (ii) proof-of-concept validation (iii) workflow integration and (iv) optimization. By examining our previous studies, we discuss insights gained regarding intended human-centricity of services, potential algorithm-human misalignments, and unintended workload and accountability consequences for clinicians and organizations.

Changes in internalizing and externalizing problems in Dutch children and adolescents receiving outpatient youth care before and during the COVID-19 pandemic

The COVID-19 pandemic significantly impacted the mental health of children and adolescents, but its effects on treatment outcomes in youth care remain unclear. This study examines whether the pandemic influenced treatment outcomes for internalizing and externalizing problems in children receiving outpatient youth care. We analyzed data from three groups of children who received outpatient youth care (N = 1090, Mage = 12.85): those treated entirely before the pandemic, those who transitioned into pandemic-related measures during treatment, and those treated entirely during the pandemic. The Child Behavior Checklist was used to assess internalizing and externalizing problems at the start and end of treatment. Repeated measures ANCOVAs and χ2 tests of independence were conducted to evaluate changes in problem severity and clinical status, and ANCOVAs were used to compare between-group differences. The results suggest that while overall treatment outcomes were not directly affected by the pandemic, fewer children treated during the pandemic recovered from externalizing problems compared to those treated before the pandemic. Additionally, children treated entirely during the pandemic exhibited higher levels of internalizing and externalizing problems at both the start and end of treatment, and those transitioning into the pandemic also had elevated externalizing problems at both time points. Although the pandemic did not affect the change in problems during treatment, the increased severity of issues at both the start and end of treatment indicates a deterioration in child mental health since the pandemic. Appropriate support, preventive interventions, and regular monitoring of mental health problems may mitigate future impacts.

Depression, anxiety and coping mechanisms among mental healthcare practitioners during COVID-19

Background

The coronavirus disease 2019 (COVID-19) pandemic has placed the psychological functioning of mental healthcare practitioners under severe strain. Coping methods may affect mental health outcomes.

Aim

The study examined the relationship between depression, anxiety, stress, and coping styles utilised by mental healthcare practitioners during the COVID-19 pandemic.

Setting

Three private and one public mental healthcare facility in Bloemfontein, South Africa.

Methods

Respondents completed the Depression, Anxiety and Stress Scale (DASS-21) and Brief Coping Orientation to Problems Experienced (Brief-COPE) inventories. An ordinal regression model was used to assess the relationship between coping styles, anxiety and depression.

Results

A total of 212 practitioners were included in the analysis. According to DASS-21 measures, approximately 41% and 28% of respondents had moderate to severe depressive and anxiety symptoms, respectively, with the highest prevalence among younger female respondents and nurses. The association between stress severity, anxiety and depression was significant. Avoidant coping methods and two approach coping strategies (planning and acceptance) were associated with depression and anxiety. Anxiety was linked to an increased likelihood of transitioning to higher avoidant categories, while participants with depression were less likely to move to higher avoidant or approach categories.

Conclusion

Mental healthcare practitioners, especially nurses, experienced significant COVID-19-related psychological distress during the pandemic. Avoidant coping mechanisms may increase the risk of poor mental health outcomes.

Contribution

This study added data on the mental health effects of COVID-19 on mental healthcare practitioners, as well as psychological methods used to cope during the pandemic.

Beyond theoretical courses - A study of Swedish psychiatric residents' collegial learning through conversations in the workplace

BACKGROUND

Collegial conversations are important for sustainable learning to last beyond a course. Research on collegial conversations and peer learning in the workplace during psychiatric residency courses remains sparse, however. In this study, the aim was to explore residents' opportunities for collegial conversations during and after national courses in psychiatry.

METHODS

Residents in psychiatry completed an online survey including questions on opportunities for collegial conversations in their workplaces. Logistic regression was used for multivariate analysis and thematic content analysis was used for the open-ended answers where a theoretical framework of communities of practice was employed for the interpretation of the findings.

RESULTS

The survey was completed by 112 residents out of 725 (15,4%). The participants reported few structured forums for collegial discussion. The results of multivariate analysis suggest that more women than men feel it is advantageous to attend courses with others from the same workplace or from the same group of residents, described here as a team. The analysis of qualitative data identified how opportunities for collegial conversations differ across contexts and the type of values that are attached to team participation in residency courses.

CONCLUSIONS

This study highlights the importance of collegial conversations as a way to sustain the learning from residency courses into the workplace. By learning about residents' perceptions of collegial conversations during and after courses, teachers and directors may be more able to support residents' lifelong learning and professional development.

Higher Subjective Burden in Psychiatric Compared to Somatic Healthcare Workers in Germany During the first wave of the COVID-19 Pandemic

The COVID-19 pandemic has posed unprecedented challenges for health care workers (HCWs) worldwide. While the adverse effects of the pandemic on the well-being of HCWs in general have now been established, little is known about the impact on HCWs of psychiatric hospitals (PHCWs). PHCWs are of special interest, given that they faced both an increase in infection rates among psychiatric patients as well as in mental strain of the general public due to consequences of the pandemic. The aim of the present study was to investigate how the pandemic affected PHCWs as well as possible differences between PHCWs and other health care workers (OHCWs) in Germany during the first wave of the pandemic. We conducted a country-wide anonymous online survey early during the first pandemic wave between April 15th and May 1st, 2020, to assess different aspects of subjective burden and perceived stress using 5-point Likert-scale questions. We analysed data of 1530 PHCWs and 2114 OHCWs and showed that PHCWs reported higher subjective burden and stress compared to OHCWs (p<0.001). Overall, nurses from both groups of HCWs showed higher ratings in subjective burden and stress than physicians. These higher ratings for subjective burden were even more pronounced for nurses working in psychiatric hospitals. Future research is needed to investigate the causes for PHCWs' increased stress and subjective burden, especially when taking into account the long-term effects of the pandemic, which may lead to further challenges and an ever-increasing workload, especially for PHCWs.

Resilience Capability and Capacity in Unexpected Crises: Experiences and Lessons Learned in a Healthcare Organisation during the COVID-19 Pandemic

Aim

The current article aims to gain insight into (a) what characterises organisational resilience during an unexpected crisis such as COVID-19 and (b) how organisations respond to developments in their environments.

Background

In times of societal crises, such as the COVID-19 pandemic, the resilience of the healthcare organisation is tested.

Method

This research is based on a case study in a university hospital and a county hospital in Sweden using surveys with both structured and open answers.

Results

The result shows ambiguity and "polarised" experiences, emphasising flexibility vs. structure, clear hierarchical information vs. spaces for peer learning through dialogue, and focus on acute care vs. determination to continue with core operations.

Conclusion

The article concludes that the pandemic resulted in paradoxes, tensions, and new experiences in organisational processes and interactions. These create opportunities for learning not only during crises but also for improving nursing management in both acute and planned care. Three relations are important in building organisational resilience in crises: resilience capability, resilience capacity, and sustainable resilience practices. Implications for Nursing Management. Organisational resilience under extraordinary circumstances, such as a pandemic, as well as enhancing the previous literature on nursing management that offer a more individually oriented perspective.

Working conditions for healthcare workers at a Swedish university hospital infectious disease department during the COVID-19 pandemic: barriers and facilitators to maintaining employee wellbeing

Background

Healthcare workers (HCWs) at infectious disease departments have held the frontline during the COVID-19 pandemic. This study aimed to identify barriers and facilitators to maintaining the employees' wellbeing that may be used to increase preparedness for future pandemics within ID Departments.

Methods

In September 2020, a web-based survey on demographics and work environment was distributed to all HCWs at the Infectious Disease Department at Sahlgrenska University Hospital. Results were compared with a pre-COVID-19 survey from October 2019. A quantitative analysis of the overall effects of the pandemic on the working conditions of HCWs was conducted; in addition, a qualitative content analysis of open-ended responses was performed.

Results

In total, 222 and 149 HCWs completed the pre-COVID-19 and COVID-19 surveys (84 and 54% response rate), respectively. Overall, we found significant changes regarding increased workload, lack of emotional support in stressful work situations, and inability to recover after shifts. These factors correlated both with younger age and concern of becoming infected. The open-ended answers (n = 103, 69%) revealed five generic categories (Workload; Organizational support; Worry and ethical stress; Capability; and Cooperation and unity) with a total of 14 identified factors representing plausible individual and organizational-level barriers or facilitators to sustained employee wellbeing.

Conclusion

Younger HCWs as well as those expressing worries about contracting the infection were found to be particularly affected during the COVID-19 pandemic and these groups may require additional support in future outbreaks. Factors both increasing and decreasing the pandemic-induced negative health consequences for HCWs were identified; this knowledge may be utilized in the future.

Impact of the COVID-19 pandemic on psychosocial work factors and emotional exhaustion among workers in the healthcare sector: a longitudinal study among 1915 Dutch workers

OBJECTIVES

This study aims to investigate across subgroups of healthcare workers (1) the changes in psychosocial working conditions and emotional exhaustion during the pandemic compared with the situation before, and (2) the impact of different stages of the COVID-19 pandemic in terms of hospital pressure on psychosocial working conditions and emotional exhaustion.

METHODS

Five questionnaire measurements during 2 years from 1915 healthcare workers in the longitudinal study 'the Netherlands Working Conditions Survey-COVID-19' were used. At each measurement, three subgroups were defined: working with patients with COVID-19, working with other patients and not working with patients. For each measurement, hospital pressure was determined by number of hospitalisations per day. Linear mixed models were fitted to analyse differences across subgroups of healthcare workers.

RESULTS

During COVID-19, psychosocial working conditions deteriorated among healthcare workers working with patients, in particular with patients with COVID-19, compared with healthcare workers not working with patients after correcting for the situation before COVID-19. No changes were observed for emotional exhaustion in any of the subgroups. An increasing hospital pressure improved job autonomy and reduced emotional demands among healthcare workers in COVID-19 wards, but had no influence on other psychosocial working conditions and emotional exhaustion.

CONCLUSION

Psychosocial working conditions deteriorated for healthcare workers working with (COVID-19) patients during the pandemic, while emotional exhaustion did not change among all groups of healthcare workers.

Fear of COVID-19 Impact on Professional Quality of Life among Mental Health Workers

Several studies have examined the impact of the COVID-19 pandemic on healthcare workers' mental health, but only a few have investigated its detrimental effect on the mental well-being of mental health workers (MHWs).

BACKGROUND

The current study aimed to explore the effect of the fear of COVID-19 (FCV-19) on professional quality of life dimensions, namely compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in MHWs above and beyond sociodemographic and professional factors.

METHODS

Hierarchical linear regression models were employed to examine the relationship of extreme FCV-19 with CS, BO, and STS in MHWs (n = 224), after considering sociodemographic variables as potential confounding factors. Extreme FCV-19 was operationalized as a binary variable with a cut-off score of ≥16.5 considered as extreme fear.

RESULTS

We found that extreme FCV-19 in MHWs is linked with increased compassion fatigue (BO and STS), and this relationship is exacerbated by younger age in regard to BO and by female gender concerning STS. CS remains unaffected by severe FCV-19, and it is higher in older participants.

CONCLUSION

Organizational support is required to protect MHWs' mental well-being and ensure the quality of care they provide during prolonged crises, such as the COVID-19 pandemic. Measures that intensify a sense of safety, protection, and control against COVID-19 infections in mental health services should be included in the recommendations that may reduce BO and STS among MHWs.

Mental health in Italy after two years of COVID-19 from the perspective of 1281 Italian physicians: looking back to plan forward

BACKGROUND

The COVID-19 pandemic has generated an unprecedented global crisis that is profoundly affecting mental health and mental health care. The aim of this study was to survey a relatively large group of Italian physicians about their perceived impact of COVID-19 on the mental health of the Italian population and about their suggestions on the best strategies to address the current and future challenges.

METHODS

One thousand two hundred eighty-one (1,281) physicians were surveyed between November 2021 and February 2022.

RESULTS

Eighty-one percent of respondents reported an increase in the number of people with mental illness presenting to their practice during the COVID-19 pandemic. Thirty-four percent reported a 26-50% increase in the number of people with mental illness in their community; approximately 33% reported a 1-25% increase; and 26.9% reported a 51-75% increase. The most commonly reported mental issues that increased because of COVID-19 were agitation, mood and anxiety disorders. Regarding the suggested strategies to address future challenges related to the COVID-19 pandemic, 34.6% of respondents recommended providing psychoeducation to the general population for early detection of mental illness and developing strategies to reduce the impact of COVID-19-related stress. In addition, 12.6% of respondents suggested improving telehealth services, while 12.3% suggested the need for increased funding for community-based care. When asked about physicians' opinion on the possibility of an increased prevalence of mental illness in the next 12 months, more than 30% of them predicted an increase in stress-related illnesses, while 25.2% were more concerned about a worsening of the ongoing clinical conditions of patients with previous psychiatric disorders. However, 21% of respondents believed that people's ability to cope with the pandemic would increase in the next 12 months.

CONCLUSIONS

This study confirmed a strong and negative impact on the mental health of the past 2 years of COVID-19 pandemic in the Italian population. Providing psychoeducation to the general population and improving the availability of telemedicine services could reduce the impact of future challenges related to the pandemic.

Different Impacts of COVID-19 on Quality of Therapy, Psychological Condition, and Work Life Among Occupational Therapists in Physical and Mental Health Fields

Background

The negative impacts of the coronavirus disease 2019 (COVID-19) pandemic have worsened the quality of therapy, psychological condition, and work life of second-line healthcare workers and occupational therapists (OTs). However, no study has investigated whether the impact of COVID-19 varies among OTs working in different fields. This study aimed to investigate the differences on the impact of COVID-19 between OTs in the physical and mental health fields.

Methods

A cross-sectional online survey was conducted in Japan between January 20 and January 25, 2021. A total of 4,418 registered OTs who were members of the Japanese Association of Occupational Therapists volunteered for this study. After screening using the exclusion criteria, 1,383 participants were classified into two groups based on their field (mental health and physical health), and their quality of therapy, psychological condition, and work life were analyzed.

Results

OTs in the mental health field showed a greater decrease in therapy quality and increase in workload and a lower rate of decrease in working hours than those in the physical health field. In the multinomial logistic regression analysis, decreased and increased therapy quality and decreased therapy quality were significantly associated with depression in the physical health field, and decreased therapy quality was associated with insomnia in the mental health field. Furthermore, insomnia and anxiety were commonly associated with increased workload and working hours, respectively, in both fields, whereas anxiety and depression were associated with increased workload only in the physical health field.

Conclusions

These results demonstrate that COVID-19 differently impacted quality of treatment, workload, work time, and psychological condition in the physical and mental health fields; moreover, the relationships among these are different in these two fields. These results highlight the importance of investigating the field-specific negative impacts of COVID-19 on OTs and may provide helpful information for devising tailored and effective prevention and intervention strategies to address these challenges.

The Work Environment during Coronavirus Epidemics and Pandemics: A Systematic Review of Studies Using Quantitative, Qualitative, and Mixed-Methods Designs

We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.

Working as a Healthcare Professional and Wellbeing During the COVID-19 Pandemic: Work Recovery Experiences and Need for Recovery as Mediators

Considering the high impact strain that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has put on medical personnel worldwide, identifying means to alleviate stress on healthcare professionals and to boost their subjective and psychological wellbeing is more relevant than ever. This study investigates the extent to which the relationships between the status of working in healthcare and the subjective and psychological wellbeing are serially mediated by work recovery experiences and the need for recovery. Data were collected from 217 Romanian employees (44 health professionals and 173 employees from other domains) using a cross-sectional design with self-report instruments, during the first stage of the nationwide lockdown. The results of the serial mediation analyses revealed that working in the medical field is indirectly related to subjective and psychological wellbeing through the following: (i) mastery experiences and (ii) mastery experiences as an antecedent of the need for recovery. As such, our findings indicate that (i) working in the medical field is, in fact, linked to healthcare professionals’ subjective and psychological wellbeing, and they provide some input on (ii) how recovery experiences and the need for recovery intervene in these relationships. Based on these findings, theoretical, methodological, and practical implications were suggested, and future research directions were proposed to maximize healthcare professionals’ wellbeing.

Changes in Psychiatric Inpatient Service Utilization During the First and Second Waves of the COVID-19 Pandemic

The COVID-19 pandemic has caused societal restrictions and public fear which may have impacted the pattern of seeking psychiatric care. There has generally been a decrease in the numbers seeking acute psychiatric care. It is important to investigate which groups seeking psychiatric treatment have decreased in number. The aim of our investigation was to identify which groups have a changed pattern in acute psychiatric service utilization during the first two waves of the COVID-19 pandemic. The study investigated changes in the rate and pattern of visits and hospital admissions for psychiatric disorders at a large Swedish hospital. A register-based study was conducted using administrative data on adult psychiatric emergency department visits (PEVs) and hospital admission rates. Data during the first two COVID-19 waves were compared to corresponding control periods in 2018-2019. Furthermore, a survey was performed among patients visiting the Psychiatric Emergency Department on their views of COVID-19 and acute psychiatric care. During the COVID-19 periods, PEVs were reduced overall by 16 and 15% during the first and second wave, respectively (p < 0.001 in both cases), while the rate of admissions remained unaltered. PEVs were significantly reduced for most psychiatric diagnosis subgroups except for patients with schizophrenia and other related psychotic disorders as well as for those who required ongoing outpatient care. Most of the survey respondents disagreed that the pandemic affected their visit and about a quarter thought a video call with a doctor could have replaced their visit. In conclusion, there was a significant reduction in overall PEVs during both COVID-19 waves but this did not affect the numbers requiring admission for psychiatric inpatient care.

Experiences of COVID-19-Recovered Healthcare Workers in a Tertiary Hospital in the Philippines: A Mixed-Method Inquiry

COVID-19 pandemic affected the mental health of the global population. Among the most vulnerable are the healthcare workers (HCWs) who got infected but returned to the frontline after recovery. Currently, there is a dearth of information and understanding on the psychological status and actual lived experience of the recovered HCWs in the Philippines. The present study investigated the psychological status and experiences of 93 COVID-19-recovered HCWs from a tertiary hospital in the Philippines using a mixed-method approach, particularly the explanatory-sequential design. Participants completed the Impact of Event Scale-Revised, and the Depression, Anxiety, and Stress Scale-21 in the quantitative phase. Selected participants took part in focus group discussions in the qualitative phase. Integrated results showed that our participants experienced significant COVID-19-related distress (mean IES-R score = 25.5; partial impact), anxiety (mean subscale score = 7.4; mild), and depression (mean subscale score = 8.1; mild). Certain sociodemographic and professional characteristics and the length of quarantine days appear to affect the psychometric scores. The quantitative results are supported by the participant’s description of recovery experiences as living in uncertainty, distress, fatigue, dissociation, and valuation of life. In summary, adequate psychological support and intervention program should be prioritized and provided by hospital management for recovered HCWs to prevent the development of more serious mental health concerns that may significantly affect their tasks in caring for patients and in-hospital management.