Portuguese Nurses' Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak

Self-Perceived Stress in Association with Emotional Experiences Following Patient Death and Coping Adequacy among Clinical Nurses in Lithuania: A Cross-Sectional Study

(1) Background: Stress is defined as a psychological sensation related to a change in both human physiology and behavior in response to a threat or challenge. As the prevalence of stress is increasing globally, nurses represent a risk group for exposure to stress-related psychological alterations. The aim of this study was to explore how clinical nurses in Lithuania cope with the perceived chronic stress in relation to additional emotional experiences following the death of a patient. (2) Methods: During a four-week period of October 2023, a total of 283 female nurses, aged between 20 and 70 years old, were enrolled in a single cross-sectional study. The PSS-10 (perceived stress scale) and the Brief-COPE (Coping Orientation to Problems Experienced) questionnaires were applied to assess the level of self-perceived stress and the use of coping styles along with the adequate strategies. Furthermore, the nurses' emotions, evoked following patient death, were classified depending on their valence. Both the multiple linear and logistic regression statistical analyses were conducted to examine the associations between dependent and independent variables. (3) Results: The study identified that more than half of the nurses experienced patient death several times a month. A moderate-to-high level of the symptoms of mental chronic stress were suffered by 76% of caregivers. The psychological arousal following the death of a patient may induce the occurrence of emotional complexity that refers to competitive feelings, namely, helplessness (adjusted odd ratio (AOR) 1.7, 95% confidence interval (95% CI) 1.1; 2.9), disappointment (AOR 1.9, 95% CI 1.1; 3.5), anxiety (AOR 1.9, 95% CI 1.2; 4.2), and guilt (ORadj 4.7, 95% CI 1.4; 5.7), and can serve as a potential trigger for chronic stress development in clinical nurses. In terms of emotion-focused stress control (β 0.1, 95% CI -0.1; -0.2, R2 = 0.12), Lithuanian nurses had low control of the perceived chronic stress. The use of problem-focused coping (β -0.2, 95% CI -0.3; -0.1, R2 = 0.09) was also not addressed to an appropriate extent. The use of the avoidance coping style was associated with moderate-high levels of chronic stress perceived by nurses (β 0.5, 95% CI 0.4; 0.7, R2 = 0.24). Furthermore, the avoidant coping strategy related to behavioral disengagement was significantly related to resilience to chronic stress in an adverse way. The cognitive process of self-blame was considered as a meaningful maladaptive behavior component for magnifying chronic stress in nurses. (4) Conclusions: The study highlights the need to implement the recommendations for boosting the nurses' mental health. Hospitals should contribute to psychological assistance along with providing necessary training on stress-coping strategies for clinical nurses. In order to promote the sustainability of mental health through additional social support interventions, it would be useful to upgrade the clinical nurses' daily routines with mindfulness-based trainings.

Perceptions, maltreatment and religion as predictors of the psycho-emotional impact on nurses during the COVID-19 pandemic

OBJECTIVES

to analyze the relationship between perceptions, abuse and religion with the psycho-emotional impact on nurses during the COVID-19 pandemic.

METHODS

descriptive-analytical cross-sectional study. It took place between 2020 and 2021 and a total of 319 clinical nurses in Peru were interviewed using the DASS-21. Associations were assessed using Spearman's Rho and multiple regression.

RESULTS

18.5% had some degree of stress; 50.2%, anxiety and 29.1%, depression. Experience of abuse, self-perception of mental health and religion were predictors of stress, anxiety and depression. The length of work experience predicts stress and anxiety. In addition, self-perception of information and gender were predictors of depression.

CONCLUSIONS

peruvian nurses have high levels of stress, anxiety and depression, and this psycho-emotional impact was associated with perceptions, experiences of abuse and religion.

The prevalence of and perception toward mental illness: a cross-sectional study among Indonesian mental health nurses

BACKGROUND

The emergence of the Coronavirus disease 2019 (Covid-19) pandemic has affected nurses' mental and psychological health. This study investigates the prevalence of depression, anxiety, and stress among Indonesian mental health nurses and their perception of mental illness.

METHODS

A cross-sectional study was conducted shortly before the height of the Covid-19 outbreak in Indonesia. The data were collected using the 21 items of the Depression, Anxiety, and Stress Scale (DASS-21), the questionnaire on perception toward mental illness, and demographic information.

RESULTS

Approximately 2.5%, 6.5%, and 1.9% of the nurses had the symptoms of depression, anxiety, and stress, respectively. The vast majority of them perceive that society should treat well people with mental illness (94.8%) and that the government should protect them (94.8%). More than half also believe that they can eat anything but seldom get physically ill (62.1%) and that in Islam, people with mental illness are innocent and are destined for paradise (61.1%).

CONCLUSIONS

A considerably low prevalence of mental distress was discovered, which might be attributed to the nurses' implementation of mental health skills and effective coping mechanisms. Further training and awareness-raising campaigns are needed to address their misconceptions about mental illness.

Exploring coping strategies of emergency medical technicians against COVID-19 stress: a qualitative study

Introduction

The COVID-19 pandemic has been shown to cause enormous psychological burden among health care workers, including first responders. However, the psychological well-being of first responders, essential in the fight against COVID-19 pandemic, has often been ignored. This qualitative study aimed to explore the coping strategies used by EMTs to manage stress during the pandemic.

Methods

The research was designed as a qualitative study, utilizing a thematic analysis framework. Semi-structured interviews were conducted with 15 EMTs from a single geographic area between September 2022 and December 2022. The data were analyzed using Braun and Clarke analytic techniques, and this study used Lincoln and Guba's to assess the reliability of the data.

Results

Four main coping strategies emerged from the data: seeking social support, practicing self-care, utilizing coping mechanisms, and finding meaning and purpose in work. EMTs sought support from both professional and personal sources, engaged in physical and emotional self-care, used humor and distraction as coping mechanisms, and found meaning and purpose in helping others and growing as professionals.

Conclusion

Based on the extracted results from the study on EMTs in Iran, it can be concluded that the importance of social support cannot be overstated, as it serves as a crucial buffer against the negative effects of stress and trauma. The findings suggest that addressing the social and emotional needs of EMTs is important for promoting their mental health and well-being during the pandemic.

The role of sleep quality and perceived stress on depressive symptoms among tertiary hospital nurses: a cross-sectional study

BACKGROUND

Nurses in tertiary hospitals are at high risk for depression. Understanding sleep quality and perceived stress may contribute to nurses' mental health and health-related nursing productivity. The aim of this study was to investigate the role of sleep quality and perceived stress on depressive symptoms among nurses in tertiary hospitals.

METHODS

A total of 2,780 nurses (overall response rate = 91.1%) were recruited through a cross-sectional survey in 23 tertiary hospitals in China. Questionnaires included the Self-Rating Depression Scale, the Pittsburgh Sleep Quality Index, and the Chinese Perceived Stress Scale. Variables that were significant in Chi-square tests were further entered into binary logistic stepwise regression.

RESULTS

The prevalence of depressive symptoms was 60.3% (n = 1,676), of which 97.4% (n = 1,633) were female, and 77.8% were younger than 35 years (n = 1,304). Nurses who had moderate, poor, severe sleep quality and poor perceived pressure were more likely to be depressed. Master's degree, 6-10 years of work, and physical activity were protective factors, while the opposite was the case for shift work and high dissatisfaction.

CONCLUSIONS

More than half of nurses working in tertiary care hospitals reported depressive symptoms, and lower sleep quality and higher perceived stress were more associated with this. Perceived stress is an interesting concept, which may provide a new entry point for the well-known idea that there is a relationship between poor sleep quality and depression. It is possible to reduce depressive symptoms among public hospital nurses by providing information on sleep health and stress relief.

Factors Associated with Turnover Intentions of Nurses Working in Japanese Hospitals Admitting COVID-19 Patients

Three years after the outbreak of the coronavirus disease (COVID-19) pandemic, turnover among frontline nurses has increased. The participants of this study were nurses at two general hospitals in Ishikawa, Japan, receiving COVID-19 patients. An original self-report questionnaire was created based on previous research. The questionnaire was distributed to 400 nurses, and responses were received from 227 nurses (response rate: 56.8%). The factors influencing turnover intention at the facilities were having less time to relax (odds ratio [OR]: 2.88, 95% confidence interval [CI]: 1.12-7.41) and wanting to receive counseling (OR: 5.21, 95% CI: 1.30-20.91). As a strategy to prevent turnover, nurse managers should provide opportunities for nurses to receive counseling during normal working hours and pay particular attention to changes in nurses' daily lives, such as changes in the time available for relaxation.

Sleep Quality between Nurses and the General Population during the COVID-19 Pandemic in Portugal: What Are the Differences?

Although several studies have described the impact of the COVID-19 pandemic, particularly on sleep quality, there are few studies that, in the same time period and using the same assessment tools, compare sleep quality and mental health status between nurses and the general population. Thus, the aim of this study was to (a) examine whether there were differences between nurses and the general population regarding sleep quality and mental health status during the COVID-19 pandemic and (b) identify which factors may explain sleep quality during the COVID-19 pandemic. To do that, we carried out a cross-sectional study in Portugal. Data were collected using an online survey platform during the first COVID-19 wave, from April to August 2020. Nurses presented poorer sleep quality than the general population, as well as higher anxiety levels. Irritability and worries about the future were two of the factors that might explain those differences. Thus, we can conclude that irritability and worries about the future are dimensions of anxiety that were associated with poor sleep quality during the COVID-19 pandemic. Thus, it would be important to adopt regular anxiety and sleep assessments, particularly for nurses, and to implement strategies to reduce this problem.

Levels of Anxiety and Stress Experienced by Nurses in Inpatient Units

Objective: To assess state-trait anxiety levels and their correlation with occupational stress and socio-biographical and occupational factors in nursing professionals. Materials and Methods: This quantitative, cross-sectional, analytical study was conducted in the inpatient units of a university hospital in southern Brazil, with the participation of 162 nursing professionals. For data collection, socio-biographical and occupational forms, the Stress-Symptom Scale, the Workplace Stress Scale, and the State-Trait Anxiety Inventory were used. The data were analyzed based on descriptive and inferential statistics. Results: Nursing professionals have moderate levels of state-trait anxiety. There is a positive correlation between state-trait anxiety scores, stress scores, and stress dimensions (rho = 0.811, p < 0.001). “Trait” anxiety is associated with years of experience in nursing (PR 0.97) and psychic-mental health follow-up (PR 1.97). “State” anxiety is associated with sex (PR 0.54), education (PR 2.26), and hours of sleep (PR 0.92). Conclusions: “State” anxiety is associated with sex, age, higher education level, and psychic-mental health follow-up; however, years of experience in nursing and hours of sleep were found to be protective factors.

Effects of the COVID-19 pandemic on nurses’ psychological well being in an emergency room

ABSTRACT Objectives: to assess the level of anxiety of nurses in an emergency room in view of the new Coronavirus and describe the relationship between the degrees of anxiety and their sociodemographic variables. Methods: quantitative descriptive-correlational study with a sample of 60 nurses. A questionnaire was used as a data collection instrument based on the Hamilton Anxiety Assessment Scale. Results: the nurses’ average anxiety is mild. A statistically significant relationship was found between anxiety and the variables “sex” and “children”, with women having higher levels of anxiety than men, and nurses who do not have children showing mild, moderate, or severe anxiety. Conclusions: COVID-19 triggers anxiety in nurses, sometimes at pathological levels. Being female and not having children increase the anxiety experienced. Sex can be considered the determining factor for the level of anxiety experienced.

The effect of the demonstration-based progressive muscle relaxation technique on stress and anxiety in nurses caring for COVID-19 patients: a randomized clinical trial

BACKGROUND

Caring for patients with coronavirus disease 2019 (COVID-19) challenges nurses and causes them to experience stress and anxiety. From this perspective, it is of utmost importance to develop quick and effective intervention strategies to prevent numerous complications. This study aimed to investigate the effect of the progressive muscle relaxation technique, using the demonstration method on the stress and anxiety of nurses who care for COVID-19 patients.

METHODS

This randomized clinical trial was conducted in 2021. Forty-six nurses working in two referral hospitals with wards for COVID-19 patients in Tehran, Iran recruited by convenience sampling method and then randomly assigned to experimental or control groups. The nurses in the experimental group educated the progressive muscle relaxation by the demonstration method, and they were encouraged to practice it. The Depression Anxiety Stress Scale-21 was utilized to measure the stress and anxiety levels in the nurses.

RESULTS

Before the intervention, the levels of stress in the experimental and control groups were 13.91 ± 2.41 vs. 14.34 ± 2.74 (p = 0.571), and their anxiety was 13.34 ± 3.41 vs. 12.78 ± 2.21 (p = 0.510), respectively. After the intervention, the levels of stress in the experimental and control groups were 10.95 ± 2.01 vs. 14.17 ± 2.34 (p < 0.001), and their anxiety was 9.47 ± 2.37 vs. 12.91 ± 1.85 (p < 0.001), respectively. Moreover, the levels of stress and anxiety in the experimental group significantly diminished after intervention (p < 0.001), but no significant changes were observed in the control group (p > 0.05).

CONCLUSION

Concerning the effectiveness of the progressive muscle relaxation technique in relieving the stress and anxiety of the nurses caring for COVID-19 patients, it is suggested to include this relaxation technique in nursing courses.

Workplace Wellbeing and Quality of Life Perceived by Portuguese Nurses during the COVID-19 Pandemic: The Role of Protective Factors and Stressors

During the COVID-19 pandemic, nurses were exposed to many stressors, which may have been associated with some mental health problems. However, most of the studies carried out on nurses' quality of life and workplace wellbeing during the COVID-19 pandemic took a pathogenic approach. Given that current scientific knowledge in this field presented too many gaps to properly inform preventive and therapeutic action, the aim of this study was to explore whether protective factors (resilience, perceived social support, and professional identification) and stressors (perceived stress and psychosocial risks in the workplace) influenced the quality of life and workplace wellbeing perceived by Portuguese nurses during the COVID-19 pandemic. Data for this cross-sectional study was collected through online self-administered questionnaires. Linear regression models were used to analyze the relationships between variables. Results showed that perceived stress, resilience and job satisfaction were associated with quality of life and workplace wellbeing among Portuguese nurses. The study's findings could serve to inform health policy and should draw the attention of nursing managers to the needs and difficulties reported by nurses, to the importance of providing them with emotional support, and to the relevance of promoting a good work environment.

Predictors burden in mental health workers during the COVID-19 pandemic

OBJECTIVES

to analyze burden predictors in mental health workers during the COVID-19 pandemic.

METHODS

a quantitative study, collected between October and December 2020 through a sociodemographic questionnaire and Mental Health Service Burden Assessment Scale, in four services in a municipality in the state of São Paulo, Brazil, with 108 workers. Descriptive analysis and multiple linear regression of ordinary least squares were performed, in search of predictors for variation in the scale score.

RESULTS

it showed median work burden (2.03). Predictors: psychological or psychiatric follow-up; normal performance of activities during the pandemic; direct action with suspected or confirmed cases of COVID-19; and belonging to the risk group (people over 60 years of age, diabetics, hypertensive, cardiac, respiratory problems) (p<0.05).

CONCLUSIONS

working conditions observed during the pandemic, simultaneously with workers' mental health care needs predict burden at work in health.

Shared trauma during the COVID-19 pandemic: Psychological effects on Israeli mental health nurses

Mental health nurses, tasked with the constant care of clients undergoing mental health treatment, have faced unique challenges arising from the uncertain outcomes of the COVID-19 pandemic. The shared exposure of both nurses and their patients to a traumatic event such this pandemic leads to additional challenges and ways of coping. The psychological effects of this shared trauma on mental health nurses arising from the pandemic are the subject of this study. An online survey was used to examine personal levels of anxiety and concern, personal and national resilience (NR), and posttraumatic growth (PTG) among 183 mental health nurses working in mental health services in Israel. Overall, the study revealed moderate levels of concern and relatively low levels of anxiety, with significant negative correlations between personal and NR and levels of concern and anxiety. Higher levels of personal and NR were related to lower levels of concern and anxiety, and there was a significant positive correlation between assessments of personal resilience and NR. A significant positive correlation was found between personal and NR and PTG. Higher religiosity was associated with higher resilience, and higher professional seniority was related to higher PTG. Finally, results for particular demographic subgroups indicate that in Israel, special attention should be given to those mental health nurses who have immigrated to Israel, are non-Jews or have less professional experience.

Anxiety and Coping Stress Strategies in Researchers During COVID-19 Pandemic

The current COVID-19 pandemic has affected the whole world, leading to changes in one's personal and working life. Researchers have undergone extensive changes in their roles, mainly in the area of health care, with research into the virus now the priority.

Modulating Elements of Nurse Resilience in Population Care during the COVID-19 Pandemic

COVID-19 has significantly affected the work environment of nurses. In the face of the challenges posed by stressors in clinical practice, some nurses adapt and prove to be resilient. In the face of the COVID-19 pandemic, the nature of care itself and the new ways of working are potentially very stressful. We aim to analyze the resilience of care nurses to the psychological impact of the COVID-19 pandemic. This study is a systematic review of nurse caregiver resilience to the COVID-19 pandemic in 2021. Our search was conducted in the WOS, Medline/PubMed, Cochrane, BVS/LILACS, and Cuiden databases. The inclusion criteria were: studies published in Spanish or English; carried out from March 2020 to May 2021 on nurses caring for patients with COVID-19; and investigating the factors influencing the psychological impact, resilience, strategies to develop it, and interventions to promote it during this pandemic and others, such as SARS, MERS, or ebola. The quality of the studies and the risk of bias were evaluated following ICROMS, STROBE and AMSTAR-2 criteria. Twenty-two studies were selected. Most of the studies highlighted the presence of stressors in nurses, emphasizing those of the environment, which converged in dysfunctional responses that hurt their resilience. The most persuasive factors were social and organizational support. Coping strategies developed by nurses and especially interventions by organizations were detected as instruments to foster resilience, but have not been well researched. Resilience has a key moderating role in mitigating the psychological impact of nurses in the face of the COVID-19 pandemic.

Preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19

RESUMO Objetivos: analisar os preditores de sobrecarga dos trabalhadores de saúde mental durante a pandemia de COVID-19. Métodos: estudo quantitativo, coletado entre outubro e dezembro de 2020 por meio de questionário sociodemográfico e Escala de Avaliação da Sobrecarga de Profissionais em Serviços de Saúde Mental, em quatro serviços de um município do estado de São Paulo, Brasil, com 108 trabalhadores. Realizou-se análise descritiva e regressão linear múltipla de mínimos quadrados ordinários, em busca de preditores para a variação no escore da escala. Resultados: evidenciou-se mediana sobrecarga de trabalho (2,03). Preditores: acompanhamento psicológico ou psiquiátrico; desempenho normal das atividades durante a pandemia; atuação direta com casos suspeitos ou confirmados de COVID-19; e pertencer ao grupo de risco (pessoas acima de 60 anos, diabéticos, hipertensos, cardiopatas, problemas respiratórios) (p<0,05). Conclusões: condições de trabalho observadas durante a pandemia, simultaneamente com necessidades de cuidado à saúde mental dos trabalhadores, predizem sobrecarga no trabalho em saúde.

Impact of the COVID-19 pandemic in the Portuguese population: Consumption of alcohol, stimulant drinks, illegal substances, and pharmaceuticals

Background

The measures implemented by governments worldwide to control and prevent the spread of the COVID-19 have impacted the populations and directly influenced individuals’ quality of life and consumption habits.

Objective

This work investigates the Portuguese population’s changes in alcohol, stimulants drinks, illegal substances, and pharmaceutical consumptions habits during the COVID-19 pandemic.

Methods

An online questionnaire comprising seven groups of questions–with one group referring to alcohol, stimulant drinks, illegal substances, and pharmaceuticals consumption habits–was made available to the general adult population of mainland Portugal from the 26^th January through the 31^st of March 2021. After applying the inclusion criteria, 1666 questionnaires were selected and analysed using descriptive and inferential statistics.

Results

Our results show that 48.9% of the participants have alcohol drinking habits and increased their alcohol consumption by 16% after the beginning of the COVID-19 pandemic lockdown. Furthermore, 8.7% of the respondents felt the need to increase their consumption of stimulant drinks, especially coffee, the most consumed stimulant drink (77.9%). We also observed that of the 3.1% of respondents who are usual consumers of illegal substances, 26.9% increased their consumption of these substances during the COVID-19 pandemic. Concerning pharmaceuticals, 23.2% of the respondents expressed their need to take a therapeutic drug after the start of the COVID-19 pandemic. The profile of common consumers of alcohol, stimulant drinks, illegal substances, and pharmaceuticals in the COVID-19 pandemic context is contrasting and varies according to gender, age, and employment status.

Conclusions

The COVID-19 pandemic led to an increase in the consumption of alcohol, stimulant drinks, illegal substances, and pharmaceuticals prescribed to treat anxiety, depression, and sleep changes in the Portuguese population. These new consumption patterns have probably aggravated domestic violence, mental diseases, and impairment of family quality of life in the Portuguese population.

Depression, Anxiety, and Stress Among Nurses During the COVID-19 Wave III: Results of a Cross-Sectional Assessment

Purpose

The current study was aimed to evaluate depression, anxiety, and stress among nurses during the COVID-19 (wave III) at a public hospital in Quetta city, Pakistan.

Participants and Methods

By using the validated Depression, Anxiety and Stress Scale - 21, three hundred and twenty-five nurses practicing at the Sandeman Provincial Hospital, Quetta were approached for data collection. Through SPSS, both descriptive and inferential statistics were used during data analysis. Chi-square test was used to assess the goodness-of-fit between observed values and demographic variables. The factors that were significantly associated with depression, anxiety, and stress were further assessed by binary logistic regression analysis. The statistical significance was set at 0.05.

Results

Out of the 325 nurses, 297 participated in the study with a response rate of 91.3%. Mild depression and stress were reported in the current cohort of nurses (6.00 ± 5.30 and 8.01 ± 4.47), respectively. The mean anxiety score was 6.68 ± 4.86 indicating moderate anxiety among the study respondents. Marital status, working department, and job experience were significantly associated with depression, anxiety, and stress with moderate effect size (>0.3). The logistic regression reported department in which nurses were stationed (adjusted OR = 2.54, 95% CI = 1.118–1.415, p < 0.001) and job experience (adjusted OR = 1.004, 95% CI = 1.001–1.215, p = 0.002) as significant predictors of depression, anxiety and stress. Nurses working in the corona ward were more likely to develop depression, anxiety and stress by a factor of 2.54 and married nurses with a factor of 1.004 provided controlling other confounding factors.

Conclusion

Moderate depression, anxiety, and stress were observed among nurses and it calls for hospital management to consider interventions for all nurses irrespective of their present working departments. Facilitating continuous and comprehensive support mechanisms aimed at protecting nurses’ mental health is of great importance during pandemics. The findings of the study have some clear suggestions for mental health advocacy among nurses that are essential for improving the quality of services and patients’ safety.

The Role of Health Literacy among Outpatient Caregivers during the COVID-19 Pandemic

Health literacy became an important competence during the COVID-19 pandemic. Despite outpatient caregivers being a particularly vulnerable occupational group, their health literacy has hardly been examined yet, especially during the pandemic. Hence, this study aimed to explore this field and provide first empirical insights. Data were collected based on a cross-sectional online survey among 155 outpatient caregivers. In particular, health literacy (HLS-EU-Q16), diet and physical activity, pandemic-related worries, perceived information sufficiency and stress perception were examined. Descriptive and ordinal logistic regression analyses were run to test explorative assumptions. The majority of outpatient caregivers reported high values of health literacy (69% on a sufficient level). Although no significant associations between health literacy and health behaviours or perceived information sufficiency were found, perceived information sufficiency and perceived stress (OR = 3.194; 95% CI: 1.542-6.614), and pandemic-related worries (OR = 3.073; 95% CI: 1.471-6.421; OR = 4.243; 95% CI: 2.027-8.884) seem to be related. Therefore, dissemination of reliable information and resource-building measures to reduce worries may be important parameters for improving outpatient caregivers' health. Our results provide first explorative insights, representing a starting point for further research. Considering outpatient caregivers' mobile work setting, they need to be provided with adequate equipment and comprehensible information to ensure physically and mentally healthy working conditions.

The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health

The COVID-19 pandemic has created great uncertainty around the world, and due to the pandemic, nurses have been exposed to an increase in highly stressful clinical situations. This study examines the relationships between perceived stress and emotional disorders among nurses who have provided direct patient care during the COVID-19 pandemic and explores the mediating role of resilience in these relationships. In an online cross-sectional design, we asked Spanish nurses (N = 214) to complete self-reported scales, and we performed correlation and mediation analyses between perceived stress (Perceived Stress Scale, PSS-4), resilience (Wagnild Resilience Scale, RS-14), wellbeing (World Health Organization Wellbeing Index, five items, WHO-5), anxiety (PHQ-2) and depression (GAD-2). The nurses self-reported moderate levels of perceived stress, considerable psychological distress and high resilience. We found resilience to be significantly negatively correlated with the reported levels of perceived stress, anxiety and depression (p < 0.001). The mediating analysis revealed that resilience played a protective role in the direct relationships of stress with depression, anxiety, and psychological distress. To conclude, our findings supported the hypothesis that resilience mediated the relationship between stress and mental health.

Patient-Centered Care for Patients with Depression or Anxiety Disorder: An Integrative Review

People have specific and unique individual and contextual characteristics, so healthcare should increasingly opt for person-centered care models. Thus, this review aimed to identify and synthesize the indicators for the care process of the person with depression and/or anxiety disorders, based on patient-centered care, going through the stages of diagnostic assessment and care planning, including intervention. An integrative literature review with research in seven scientific databases and a narrative analysis were carried out. Twenty articles were included, with indicators for diagnostic evaluation and care/intervention planning being extracted. Care planning focused on people with depression and/or anxiety disorder must be individualized, dynamic, flexible, andparticipatory. It must respond to the specific needs of the person, contemplating the identification of problems, the establishment of individual objectives, shared decision making, information and education, systematic feedback, and case management, and it should meet the patient’s preferences and satisfaction with care and involve the family and therapeutic management in care. The existence of comorbidities reinforces the importance of flexible and individualized care planning in order to respond to the specific health conditions of each person.

The Health Behaviour of German Outpatient Caregivers in Relation to the COVID-19 Pandemic: A Mixed-Methods Study

The COVID-19 pandemic has affected outpatient caregivers in a particular way. While the German population becomes increasingly older, the number of people in need of care has also increased. The health and, thus, the health behaviour of employees in the outpatient care become relevant to maintain working capacity and performance in the long term. The aims of the study were (1) to examine the health behaviour and (2) to explore pandemic-related perceived change of health behaviour among outpatient caregivers during the COVID-19 pandemic. In a mixed-methods study, 15 problem-centred interviews and a web-based cross-sectional survey (N = 171) were conducted with outpatient caregivers working in Northern Germany. Interviewees reported partially poorer eating behaviour, higher coffee consumption, lower physical activity, skipping breaks more often and less sleep duration and quality during the pandemic. Some quantitative findings indicate the same tendencies. A majority of participants were smokers and reported higher stress perception due to the pandemic. Preventive behaviour, such as wearing PPE or hand hygiene, was increased among interviewees compared to the pre-pandemic period. Our findings indicate that the COVID-19 pandemic could negatively affect outpatient caregivers' health behaviour, e.g., eating/drinking behaviour and physical activity. Therefore, employers in outpatient care should develop workplace health promotion measures to support their employees in conducting more health-promoting behaviours during the COVID-19 pandemic.

Religiosity, Emotions, Resilience, and Wellness during the COVID-19 Pandemic: A Study of Taiwanese University Students

One hard fact of COVID-19 is the uncertainty of all things. Anchoring on the assumption that the religiosity of an individual has a profound impact on their emotions, resilience, and wellness, this study investigated the levels of the centrality of religiosity, emotions towards God, resilience, and wellness among 399 Taiwanese university students. Data analysis included descriptive statistics, factor analysis, group comparisons, multiple regression, and mediation analysis. Findings showed that most of the participants were religious. Furthermore, the 16 emotions towards God were successfully factored into three distinct sub-groups, namely: pleasant, unpleasant, and moral valence, which were later found to be quite related to Asian religions. More importantly, the results suggested that the resiliency of an individual can be attributed to their belief in the existence of God or the Divine, while the wellness indicators of security and satisfaction were related to one’s religiosity. Lastly, structural equation modeling showed that resilience fully mediated the relationship between the ideology dimension of religiosity and the security and satisfaction component of wellness. In addition to discussing these significant results, this paper also included some implications of the study results, particularly the importance of religiosity and emotions toward God or the Divine in sustaining resilience and promoting wellness, especially in the context of crisis, such as the current COVID-19 pandemic.

Investigating the burden of mental distress among nurses at a provincial COVID-19 referral hospital in Indonesia: a cross-sectional study

BACKGROUND

The current outbreak of the COVID-19 pandemic has distorted the physical, mental, and psychological condition of frontline healthcare providers in health facilities. This study aims to investigate the prevalence, and risk factors of depression, anxiety, and stress among nurses working in a COVID-19 referral hospital in Indonesia.

METHODS

A cross-sectional study was conducted among 491 nurses, aged between 31, and 56 years, using a self-administered questionnaire. The Depression Anxiety Stress Scale (DASS21), and demographic questions were used to screen the presence of psychological problems, and their associated factors.

RESULTS

The prevalence of moderate to extremely severe depression, anxiety and stress was 8.5 %, 20.6 and 6.3 %, respectively. Regression analysis showed that anxiety was significantly higher among nurses working in non-COVID wards (p = .01), those who experienced social rejection (p < .05), and those who frequently watched television (p < .05). Those who had temporary contracts were more stressed (p < .05), and those who faced financial hardship during the COVID-19 pandemic significantly experienced depression, anxiety, and stress at 10.5 %, 23.5 %, and 8.1 % respectively(p < .05).

CONCLUSIONS

While the prevalence of mental distress in this hospital is low, it exists, and hospital management should consider training for all nurses, public sensitization on COVID-19, and provision of financial subsidies for frontline workers, in order to manage the risk factors.

History of contact with the SARS-COV-2 virus and the sense of coherence in the development of psychological distress in the occupational health professionals in Spain

The COVID-19 pandemic has affected the psychological well-being of healthcare professionals, among them, on medical and nursing occupational specialists. This study describes the psychological distress that this group has suffered, analyzing the effect that the sense of coherence related with the history of contact with infected people has generated in their mental health. Cross-sectional descriptive study using online questionnaires. Data were collected on a sample of 499 subjects, representing 42.0% and 38.8% of the associations of specialists in Occupational Medicine and Nursing, respectively. A univariate data analysis, independence test, and the CHAID multivariate method were carried out. The percentage of workers with high psychological distress was higher among women than among men; this was also higher in public sector workers than in the private sector. No differences have been observed regarding psychological distress and educational level, coexistence, having children, working away from home, having a pet, or between being a physician or nurse. The most efficient measure to prevent psychological distress was acting regarding the comprehensibility dimension of the sense of coherence. Sex, contact with any infected person, age, living as a couple, working in public or private centers, the availability of diagnostic tests, and the correlation with the manageability dimension were modulating factors. Sense of coherence is an effective measure to prevent psychological distress due to contact with people affected by COVID-19 in Occupational Health professionals.