Healthcare Professionals, Post-traumatic Stress Disorder, and COVID-19: A Review of the Literature

Mental Health, Mentalising and Empathy in Australian Healthcare Workers During COVID-19: A Cross-Sectional Study

Since the outbreak of a Coronavirus Disease (COVID-19), healthcare workers have consistently exhibited increased stress, anxiety and depression. However, no study to date, has yet examined whether these symptoms are associated with social cognitive skills, known to be paramount in delivering high quality patient care. This cross-sectional study aimed to investigate whether the symptoms of stress, anxiety and depression were related to both empathy and mentalising in healthcare workers who worked during the COVID-19 outbreak in Australia. Participants were healthcare workers with an average age of 31.9 years (N = 177). Participants completed the Depression, Anxiety and Stress Scale-21 (DASS-21), the Interpersonal Reactivity Index (IRI) and the Reading the Mind in The Eyes Test (RMET) between May 24th and June 21st, 2021. We found that higher stress levels in healthcare workers were associated with improved abilities in understanding others' emotions and mental states, showing affective empathy and engaging in imaginative thinking. Conversely, increased anxiety was linked to reduced understanding of others' emotions and mental states in this cohort. No other significant associations were observed. Our findings suggest that organisational initiatives are needed to deliver targeted interventions and specialised programs to support social cognitive skills in healthcare workers. Future studies with longitudinal designs are needed to better characterise mental health-social cognition associations and disentangle its directionality.

Clinical team debriefing post-critical events: perceptions, benefits, and barriers among learners

Background

Clinical team debriefings (TD) following critical events are pivotal in promoting team learning and enhancing patient outcomes. Despite their importance, perceptions and practices surrounding these debriefings remain under-researched. The purpose of this study was to explore learners' perceptions and experiences regarding debriefing practices, investigate correlations or discrepancies within those perceptions and experiences, and identify recommendations and potential practice improvements for clinical educators.

Methods

This was a cross-sectional anonymous survey of healthcare professionals, including medical students, medical residents, nursing students, and respiratory therapy students. The survey was sent to respiratory therapy programs, nursing programs, internal and emergency medicine and pediatric residency programs in southern California and Michigan. The variables surveyed included demographics, team debriefing experience, code experience, TD perceptions, emotional status, cognitive load, and the benefits and barriers of conducting post-code TD. Emotional status and cognitive load were assessed using validated surveys by Paas et al. and Barrett and Russell.

Results

Of the 184 participants, 56% (n = 104) were female. The mean cognitive load was 6.14 ± 1.6. A notable negative correlation was found between mental effort in recent real code experiences and emotional scales: "tense: calm" (r = -0.210; p = 0.018), "nervous: relaxed" (r = -0.234; p = 0.008), and "stressed: serene" (r = -0.258; p = 0.004). While 68.5% had attended a cardiopulmonary arrest event, only 34.9 had TD after their most recent code, and only 48.4% reported ever having a post-code TD. Notably, nurses (75.4%) and attending physicians (73.8%) predominated these debriefings. Debriefings averaged 9.30 min (SD = 7.30) with a median of 6 min. The most recognized benefits were identifying areas of systems/process improvement and promoting teamwork and solidarity within the code team participants. The most commonly recognized barriers were lack of time and wanting a more senior person to initiate TD.

Conclusion

The results of this study show a relatively low TD occurrence despite the high value learners attribute to TD. Addressing this inconsistency requires structured approaches, dedicated time, and an understanding of barriers. Recognizing the significant cognitive and emotional loads on learners further accentuates the need for structured post-event debriefings. Addressing these challenges with multi-disciplinary participation can enhance debriefing outcomes.

Long-lasting effects of post-traumatic stress disorder in Yazidi women living in Northern Iraqi camps

The severity of post-traumatic stress disorder and its long-lasting effects among the Yazidi population has not yet been investigated.

Objectives

This study evaluated the impact of PTSD severity and chronicity on physiological and anthropometric parameters in women survivors of the genocide-related events after the so-called Islamic State of Iraq and Syria (ISIS) attack in 2014.

Methods

The diagnosis PTSD was assessed using PTSD Checklist for DSM-5 (PCL-5). Participants were divided into: External control (healthy individuals living outside the camps), Internal control (healthy individuals living in the camps), and PTSD group (individuals diagnosed with PTSD). The PTSD group was subdivided according to chronicity <2 years, 2-5 years, and >5 years and subdivided according to PTSD severity into "Moderate", "Severe" and "Extreme". Systolic blood pressure (SBP), diastolic blood pressure (DBP), blood oxygen saturation (SPO2) and heart rate (HR) were evaluated. Weight, height and waist circumference were measured. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated.

Results

The PTSD group showed significant increases in SBP, DBP, heart rate, BMI, WC, weight, and WHtR compared to the control groups. SPO2 values decreased in the PTSD group. As the disease progressed, there were further increases in SBP, DBP, heart rate, BMI, WC, WHtR, and weight. Similar increases were observed with the severity of the disease.

Conclusion

Our data indicates that a long-term impact on physiological and anthropometric parameters is present in women diagnosed with PTSD which might be aggravated by the severity and chronicity of the disease.

The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia

Background

Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia.

Methods

This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire.

Results

The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001).

Conclusion

The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.

Did the COVID-19 pandemic affect levels of burnout, anxiety and depression among doctors and nurses in Bangladesh? A cross-sectional survey study

INTRODUCTION

COVID-19 has caused severe disruption to clinical services in Bangladesh but the extent of this, and the impact on healthcare professionals is unclear. We aimed to assess the perceived levels of anxiety, depression and burnout among doctors and nurses during COVID-19 pandemic.

METHODS

We undertook an online survey using RedCap, directed at doctors and nurses across four institutions in Bangladesh (The Sheikh Russel Gastro Liver Institute & Hospital (SRNGIH), Dhaka Medical College Hospital (DMCH), Mugda Medical College Hospital (MMCH) and M Abdur Rahim Medical College (MARMC) Hospital). We collected information on demographics, awareness of well-being services, COVID-19-related workload, as well as anxiety, depression and burnout using two validated questionnaires: the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI).

RESULTS

Of the 3000 participants approached, we received responses from 2705 (90.2%). There was a statistically significant difference in anxiety, depression and burnout scores across institutions (p<0.01). Anxiety, depression and burnout scores were statistically worse in COVID-19 active staff compared with those not working on COVID-19 activities (p<0.01 for HADS anxiety and depression and MBI emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA)). Over half of the participants exhibited some level of anxiety (SRNGIH: 52.2%; DMCH: 53.9%; MMCH: 61.3%; MARMC: 68%) with a high proportion experiencing depression (SRNGIH: 39.5%; DMCH: 38.7%; MMCH: 53.7%; MARMC: 41.1%). Although mean burnout scores were within the normal range for each institution, a high proportion of staff (almost 20% in some instances) were shown to be classified as experiencing burnout by their EE, DP and PA scores.

CONCLUSION

We identified a high prevalence of perceived anxiety, depression and burnout among doctors and nurses during the COVID-19 pandemic. This was worse in staff engaged in COVID-19-related activities. These findings could help healthcare organisations to plan for future similar events.

Prevalence of post-traumatic stress disorder risk post-COVID-19 in 12 countries in Latin America: a cross-sectional survey

Introduction

Latin America was the region most affected by COVID-19 in the second quarter of 2020, and consequently, the impact on mental health requires evaluation. The aim of this study was to assess the risk of post-traumatic stress disorder (PTSD) caused by bereavement due to COVID-19 in 12 countries in Latin America.

Methods

The current study was an analytical cross-sectional study. Validated tests were applied for PTSD, depression, anxiety, and stress (DASS-21), questions about the respondent's condition or their environment, and demographic questions, as well as the length of the mourning period of suffering.

Results

The outcomes demonstrated that the PTSD risk increased for women (p < 0.001), when a friend or acquaintance had COVID-19 (p = 0.002), when a close relative died from COVID-19 (p = 0.010), having severe depression (p <0.001), severe anxiety (p  <0.001), severe stress (p  <0.001), residing in Chile (p  <0.001), Paraguay (p  <0.001), Bolivia (p  <0.001), Costa Rica (p  <0.001) or El Salvador (p  = 0.005). On the other hand, there was less risk of PTSD at an older age (p  <0.001) or if respondents had a sentimental partner (p  = 0.025). In the case of severe PTSD, there was a greater gender risk for women (p  <0.001), a close relative dying from COVID-19 (p  = 0.017), having severe depression (p  <0.001), severe anxiety (p  <0.001), severe stress (p  <0.001), residing in Chile (p  <0.001), Paraguay (p  <0.001), Bolivia (p  <0.001) and Costa Rica (p  = 0.002). It was also observed that there was less risk of severe PTSD at an older age demographic (p  <0.001).

Discussion

It can be concluded that the percentages of PTSD are high in its clinical presentation as severe, especially among Latin American women.

After the first lockdown due to the COVID-19 pandemic: Perceptions, experiences, and effects on well-being in Italian people

Background

Since the COVID-19 pandemic and the subsequent measures of containment, multiple studies have been conducted aimed at assessing the impacts on people's psychophysical well-being; however, few studies have investigated the general population's perceptions, experiences, and effects by adopting a mixed-method approach.

Methods

A total of 855 Italian participants completed an online survey, conducted in the period following the first lockdown in Italy. Psychological well-being, perceived stress and COVID-19-related fears were assessed by standardized questionnaires (Psychological General Well-Being Index-Short version, Perceived Stress Scale 10, and Multidimensional Assessment of COVID-19-Related Fears). The process of sense-making of the experience during the lockdown period was also evaluated by means of an open-ended question.

Results

Participants reported a lower level of general well-being, and a higher level of both perceived stress and COVID-19-related fear during the lockdown period compared to the time of the survey (1 month after the resumption of activities). The thematic analysis of responses to the open-ended question revealed two factors and five clusters, which explain the thematic variance among the narratives: the first factor refers to the type of experience (emotional states and feelings vs. objective descriptions of daily activities), while the second concerns positive or negative connotations of the experiences reported.

Conclusions

This study explored the psychological impact of the first lockdown on people's well-being, and described the process of making sense of the experience during the lockdown 1 month after going back to previous habits. Results highlighted the effectiveness of the mixed-method approach for an in-depth and exhaustive investigation of people's psychological condition during and after the first lockdown.

Our Patients Need Empathy Training across Healthcare Professions

Vulnerable populations are those who experience disparity at a disproportionate rate. For this article, specific vulnerable populations of interest include people who experience intellectual or developmental disorders, mental illness, or substance misuse. Vulnerable populations are some of the most stigmatized populations in our society. Research shows that vulnerable populations receive less empathic care than general health care populations, resulting in reduced quality of care and disparities in health outcomes. Empathy, a necessary health care competency, is associated with improved patient outcomes, enhanced job satisfaction, and increased retention and resilience across health care professions. However, there is no current standard for how empathy is taught, assessed, or sustained. Even when empathy education is implemented in healthcare professions curricula, research has demonstrated that it appears to erode with experience and time. In addition, the COVID-19 pandemic has exacerbated inequities in health care systems, with consequences for both patients and providers. There is an urgent need to develop efficacious training in empathy across health care professions to foster and sustain a robust workforce and improve health care experiences and outcomes.

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.

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.

It's What We Do: Experiences of UK Nurses Working during the COVID-19 Pandemic: Impact on Practice, Identity and Resilience

The COVID-19 pandemic increased pressure on a nursing workforce already facing high levels of stress, burnout, and fatigue in the United Kingdom (UK) and internationally. The contribution of nurses to keeping the public safe was widely recognised as they met the challenges of delivering complex patient care during the healthcare crisis. However, the psychological impact of this on nurses' health and wellbeing has been substantial, and the number of nurses leaving the profession in the UK is rising. The aim of this study was to explore the experiences of nurses working during the COVID-19 pandemic and the impact of this on their psychological health, wellbeing and resilience. The study is part of a wider project to develop and pilot an online resilience intervention for nurses during COVID-19. Five focus groups with 22 nurses were carried out online. Data was analysed thematically using the Framework Method. Four key themes relating to positive and negative impacts of working during the pandemic were identified: Rapid changes and contexts in flux; loss and disruption; finding opportunities and positive transformation; and reinforcing and strengthening identity. Implications for coping and resilience in nursing, nursing identities and workforce development are discussed.