The Impact of Epidemics and Pandemics on the Mental Health of Healthcare Workers: A Systematic Review

Feasibility of a virtual safety officer in detecting PPE donning and doffing violations

A safety officer (SO) can assist healthcare workers in minimizing respiratory transmission of communicable diseases through verification of compliance with safety protocols, such as appropriately donning and doffing personal protective equipment (PPE). This project sought to determine if observation of PPE donning and doffing for detection of protocol violations by a virtual safety officer (VSO) was a feasible option to improve the safety of the workplace. Five healthcare workers with experience serving as safety officers were enrolled in a feasibility study in which they observed actors donning and doffing PPE in-person and noted errors using a curated checklist for documentation. One month later, the same participants viewed recordings of the in-person sessions and again recorded errors for seven trials. Five hundred and twenty-three responses recorded from the SOs across the in-person and virtual trials aligned 88.7% of the time. SOs were more accurate in the virtual setting than in the in-person setting (87.6% vs. 82.4%, respectively). However, Cohen's kappa showed lower inter-rater reliability when observing virtually than in-person, especially in the doffing steps of the protocol. A VSO may be a feasible option when assessing whether participants can correctly follow PPE donning and doffing protocols. Future work includes incorporating real-time observation, 360-degree cameras, virtual reality (VR), and augmented reality (AR) to increase visualization, thereby increasing inter-rater reliability.

Prevalence of the symptoms of post-traumatic stress disorder (PTSD) and burnout syndrome (BOS) among intensive care unit (ICU) healthcare workers during the COVID-19 pandemic

Pandemic COronaVIrus Disease-19 (COVID-19) was a traumatic event that had a significant impact on the mental health of healthcare workers (HCWs), especially intensive care units (ICUs). Months of exposure and the threat of death can lead to post-traumatic stress disorder (PTSD), and high physical and emotional strain can lead to burnout syndrome (BOS). The purpose of this study was to assess the prevalence of PTSD and BOS among ICU HCWs during the COVID-19 pandemic. A case-control study was conducted in 2022 using a diagnostic survey method with 148 hCWs from two intensive care units: a temporary intensive care unit (tICU, n = 93) and a general intensive care unit (gICU, n = 55) in Cracow, Poland. The Impact of Events Scale (IES-R), Oldenburg Burnout Inventory (OLBI) and a proprietary questionnaire were used. The results obtained indicate that 46.62% (69) of HCWs had pronounced PTSD symptoms. In the tICU HCWs, 47.31% (44) had severe symptoms of PTSD, and in the gICU HCWs, 45.45% (25) were affected. HCWs in the tICU reported the highest score in the Hyperarousal domain (x = 1.52; SD = 0.87), while HCWs from the gICU reported higher scores in the Avoidance domain (xx = 1.45 SD = 0.81). HCWs presented moderate levels of job BOS in the domains of exhaustion (50.68%; 75) and lack of commitment (64.86%; 96). It was shown that lack of commitment to work was significantly more frequent in the tICU group than in the gICU group (p = 0.022). It was shown that the greater the level of exhaustion or withdrawal, the greater the severity of each PTSD symptom. Activity responsibility and fatigue were found to be the most stressful in the workplace. PTSD symptoms co-occurred with BOS. It is necessary to provide employees with targeted psychological support in dealing with the post-pandemic emotional crisis and support the retention of nurses in the profession.

A wave of COVID-19 related PTSD? Disentangling the impact of exposure to COVID-19 related events on probable posttraumatic stress disorder in the general Dutch population

INTRODUCTION

The COVID-19 pandemic highlighted a critical gap in our knowledge on the impact on mental health, especially trauma-related disorders like PTSD. With future pandemics anticipated due to global health risks, it is essential to rigorously study the prevalence of PTSD resulting from COVID-19. Such research will help us understand the psychological effects of pandemics and develop better strategies for mental health support in future crises.

METHODS

This study uses data from the Dutch Public Health Monitor Adults and Elderly 2022, consisting of 365,000 Dutch adults recruited using random sampling. Pandemic-related and non-COVID related potentially traumatic events were assessed and anchored to a validated screening instrument for PTSD, the Dutch version of the PCL-5.

RESULTS

Two-thirds of participants reported experiencing traumatic events during the pandemic. Exposure to pandemic-related traumatic events was reported more frequently than non-COVID related traumatic events. Overall probable PTSD prevalence due to these events was 2.4%, evenly split between pandemic-related and non-COVID related traumatic events. Among exposed individuals, probable PTSD prevalence was 3.7%. The risk was higher for exposure to non-COVID related events such as sexual violence, physical violence and life-threatening accidents than exposure to pandemic-related traumatic events like hospitalization or death of someone significant. Risk factors for developing probable PTSD after exposure to a traumatic event during the pandemic were younger age, financial difficulties, loneliness, low resilience, and experiencing multiple events.

DISCUSSION

Exposure to traumatic events during the pandemic influenced the prevalence of probable PTSD. Despite the lower relative impact of pandemic-related traumatic events compared to non-COVID related traumatic events, exposure to pandemic-related traumatic events accounted for 1.1% of probable PTSD in the population and is thereby comparable in impact to five commonly occurring traumatic events. This emphasizes the need to address mental health consequences and risk factors during pandemics and, potentially, other crises with population-wide exposure to events.

A cross-sectional analysis of occupational stress and mental health among migrant healthcare workers in Ireland

Background

The migration of healthcare workers (HCWs) to European countries has witnessed a recent increase in both number and diversity. While facing various socio-cultural challenges in the host country, it becomes imperative to investigate the mental health of these workers, given the significance for their well-being and the safety of patients. This study aims to assess the extent of occupational stress and psychological distress among migrant healthcare workers in Ireland, along with exploring the contributing factors.

Methods

A cross-sectional online survey, utilizing Google Forms, was conducted via social media platforms among overseas nursing and Healthcare Assistants currently employed in the Republic of Ireland. Occupational stress and psychological distress were assessed using the Brief Job Stress Questionnaire (BJSQ) and the Kessler Psychological Distress Scale (K6). Multivariable linear regression models were employed to identify significant predictors of occupational stress and psychological distress.

Results

The response rate was 35.8 (n = 447) from 1250 invitees. The majority of participants were nurses (93 %), largely from India (72.7 %), followed by the Philippines (17.7 %). The healthcare workers reported moderate to high job stress, with elevated scores in quantitative overloads, mental demands at work, and physical work demands. Migrant healthcare workers with <10 years of work experience in Ireland perceived higher job stress (t = 2.826; β = 0.154; p = 0.005) and psychological distress (t = 5.666; β = 0.303; p = 0.000). Working in private healthcare sectors was associated with a lower perception of job stress (t = -3.077; β = 0.15; p = 0.002) and psychological distress (t = -2.643; β = 0.126; p = 0.009).

Conclusion

The findings highlight that HCWs experience moderate to high job stress, particularly those with <10 years of experience. Psychological distress was also prevalent, with private-sector employment associated with lower stress levels. These results emphasize the need for targeted interventions to support migrant HCWs' well-being.

Prevalence of Anxiety, Depression, and Insomnia Among Medical Workers in Emergency Medical Services in Eastern Kazakhstan

Introduction: Studying the prevalence of anxiety, depression, and insomnia among medical workers in emergency medical services is a relevant task that will improve our understanding of scope of the problem and develop effective strategies to support and prevent psychological problems among medical staff. Insomnia is closely linked to anxiety and depression, as sleep disturbances can exacerbate emotional distress, while persistent anxiety and depressive symptoms contribute to sleep disruptions. Individuals suffering from insomnia are at a higher risk of developing anxiety and depression, creating a bidirectional relationship that negatively impacts overall mental well-being. This raises a crucial question: "What specific measures and intervention strategies can be implemented to reduce the levels of anxiety, depression, and insomnia among EMS personnel?" Methods: A cross-sectional study was conducted with the participation of 592 medical workers employed in emergency medical services in the East Kazakhstan and Abay regions of the Republic of Kazakhstan. This study included questions regarding the socio-demographic data of the respondents, questions assessing the severity of insomnia using the Insomnia Severity Index (ISI), and questions from the Hospital Anxiety and Depression Scale (HADS) scale assessing the level of anxiety and depression among the participants. Results: Nearly a third of the EMS personnel reported symptoms of insomnia (28.2% subthreshold, 16.2% insomnia, and 3.0% severe), anxiety (22.1% subclinical, and 13.0% clinical), or depression (20.4% subclinical, and 9.8% clinical). Feldshers (nursing staff) and those with higher education had elevated levels of these conditions. The insomnia was strongly correlated with anxiety (r = 0.539, p < 0.001) and depression (r = 0.415, p < 0.001), emphasizing the need for targeted mental health interventions. Conclusions: This study found elevated levels of insomnia, anxiety, and depression among emergency medical service (EMS) personnel-especially nursing staff and those with higher education. We recommend comprehensive mental health support, routine screenings, stress management training, and integrating sleep hygiene into wellness programs.

Evolution of Spanish population well-being during the COVID-19 pandemic: Results from the COSMO-Spain study

Introduction

The COVID-19 pandemic affected mental health worldwide. The COSMO-Spain study analyses risk perceptions, behaviours, knowledge and other pandemic related variables, such as well-being. This work aimed to assess the evolution of self-reported well-being in Spain from May 2021 to September 2022 and its association with demographic and COVID-19 related factors.

Methods

An online, nationwide cross-sectional panel survey was applied in seven rounds with 1000+ participants each, with a total sample of 7266 participants, representative of the Spanish adult general population. The main variable was well-being, measured with the World Health Organization Well-Being Index (WHO-5) total score, an index with a total score from 0 to 100 (0 = worst well-being, 100 = best well-being). Other variables included in the survey were: sociodemographic data, concern about COVID-19, feelings of depression and fear, COVID-19-related worries, risk perception, self-efficacy, preventive behaviours, pandemic fatigue, health literacy, information search behaviours, and trust in several institutions. A multiple linear regression was run to analyse the associated factors with the WHO-5 total score.

Results

The WHO-5 total score showed a significant increase from rounds 6 (May-June 2021) to 8 (September-October 2021). Women (standardized b coefficient (b) = -0.10), youth or people with lower socioeconomic status (worsened financial situation (b = -0.10) or unemployed/furloughs (b = -0.04)) reported lower well-being levels, whereas having a university-level education showed the opposite (b = 0.11). Feeling less depressed was associated with higher well-being (b = 0.31).

Conclusions

This study shows rising levels of well-being until a plateau was reached in October 2021. Vulnerable groups may be at higher risk of worsened mental health and should be addressed by policymakers. Further longitudinal studies should evaluate causality and evolution patterns of well-being throughout the COVID-19 pandemic.

International healthcare workers' experiences and perceptions of the 2022 multi-country mpox outbreak

In May 2022, the most widespread outbreak of sustained transmission of mpox outside of countries historically affected countries in Western and Central Africa occurred. We aimed to examine the personal and clinical experiences of international healthcare workers (HCWs) during this public health emergency. We conducted an international cross-sectional survey study between August and October 2022, examining the experiences and perceptions of HCWs clinically involved in the 2022 mpox response. Respondents were recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness; training and support at work; psychological well-being and vaccination. 725 multi-national healthcare workers across 41 countries were included in the analysis. 91% were physicians specialised in Sexual Health or Infectious Diseases; with 34% (n = 247) of all respondents involved in mpox policy. A substantial proportion of respondents (n = 296, 41%) reported working longer hours during the mpox outbreak, with no concomitant removal of other clinical responsibilities. 30% (n = 218) of respondents reported that they had never heard of mpox before the outbreak and over 25% of the respondents reported that they had misdiagnosed someone initially. This culminated in a high prevalence of moral distress at thirty percent. Less than 9% of HCWs in the region of the Caribbean, Central America and South America had been offered a vaccine as compared to almost one-third in the other regions. Where offered, there were high levels of uptake across all regions. The findings highlight a critical need for addressing the profound gaps in HCW knowledge about re-emerging diseases with pandemic potential. Strengthening the resilience of global health systems and prioritising internationally coordinated approaches to global vaccine deployment is imperative.

Monkeypox awareness and public health challenges in conflict affected syria 2024

Monkeypox (MPOX) is a zoonotic viral disease that has re-emerged and spread to non-endemic regions, drawing global attention. Understanding the knowledge, attitudes, and practices (KAP) of vulnerable populations, particularly in conflict-affected areas, is crucial for effective public health responses. This community-based cross-sectional study evaluates the KAP of the general Syrian population regarding MPOX, focusing on areas affected by conflict. The study was conducted between October 25 and November 22, 2024, using a culturally adapted and validated structured online and paper-based questionnaire. A total of 2,035 responses were collected. The sample included predominantly female participants (63.8%), aged 21-30 years (41.9%), mostly married (73.4%), and urban residents (72.4%). Statistical analysis included confidence intervals (95%) and significance levels (p < 0.05). The study revealed that while 80.3% of participants understood causative factors, 81.2% transmission, 89% prevention, and 78.2% symptoms, significant knowledge gaps were identified in vaccination (13.4%) and diagnostic tests (42.7%), with 58.9% of respondents demonstrating poor overall knowledge. Negative attitudes were reported in 65.8% of participants, although urban residents exhibited slightly more positive attitudes. Good practices were observed in 73.6% of respondents, with common behaviors including isolation and frequent handwashing (58.8%). However, practices did not significantly differ across genders or marital status. Higher knowledge scores were associated with males (OR = 1.721, 95% CI= [1.42-2.07]), higher education levels (OR = 1.324, 95% CI= [1.07-1.62]), and higher incomes (OR = 2.550, 95% CI= [1.56-4.15]). The conflict-affected context likely exacerbated knowledge gaps and negative attitudes, underscoring the urgent need for culturally tailored educational campaigns and public health initiatives. These efforts are critical for improving MPOX preparedness in vulnerable populations.

Strengthening Primary Health Care for Epidemic and Pandemic Response: A Scoping Review

AIMS

Epidemics strain healthcare systems and reduce care quality, making primary healthcare a crucial frontline component in combating pandemics. The aim of this paper was to explore the experiences of countries in strengthening primary health care to address epidemics and pandemics of infectious diseases.

DESIGN

It was a scoping review conducted in 2024. The research was qualitative in nature.

METHODS

Multiple databases were searched including PubMed, Scopus, and ProQuest. Upon screening the references, the Boyatzis approach to thematic analysis was utilised to analyse and categorise the acquired data based on the fundamental building blocks of healthcare systems as presented by the World Health Organisation (WHO).

RESULTS

Sixty-seven studies were included in the study, reporting widespread strategies and interventions implemented in primary healthcare systems around the globe. The majority of these strategies and interventions were within the context of service delivery, leadership/governance, and health workforce.

CONCLUSION

The strategies and interventions implemented by primary healthcare systems worldwide during the pandemic crisis are extensive and varied. Further research is required to provide a comprehensive understanding of the potential impacts of such interventions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

There are numerous strategies and interventions reported in the literature for epidemic and pandemic response, which healthcare policymakers and managers can utilise to improve patient care during times of crisis.

IMPACT

The study examined challenges in primary healthcare during crises, such as pandemics. It identified various strategies and interventions aimed at addressing these challenges, primarily in service delivery, leadership/governance, and health workforce management. Healthcare policymakers and managers can leverage these findings to enhance patient care during crises.

REPORTING METHOD

PRISMA 2020 guideline for review studies.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Healthcare workers' well-being and perspectives on support during the COVID-19 pandemic: a systematic review and meta-synthesis of qualitative studies

BACKGROUND

Since the outbreak of the COVID-19 pandemic, healthcare workers (HCWs) have faced multiple difficulties in their work and personal lives. However, most of the quantitative reviews have focused on the extent of the pandemic's impact on the HCWs and have thus failed to fully capture the HCWs' experiences and the complexity of the problems they encountered. Therefore, this qualitative systematic review elucidates the HCWs' challenges brought about by the pandemic, their perceptions of the existing support and the support that require further attention.

METHODS

The literature search spanned five databases: Scopus, PubMed, Web of Science, CINAHL and PsycInfo, targeting qualitative studies of HCWs' pandemic experiences from December 2019 to December 2023. These studies underwent strict quality and relevance assessment, emphasising critical appraisal and selection. Findings were unified through meta-synthesis, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was registered in PROSPERO.

RESULTS

This study analysed 29 qualitative studies on HCWs' experiences during the pandemic and their perceptions of support, identifying four themes of HCWs' physical and mental well-being, the impact of the pandemic on their professional and personal lives, their work environments and the support they received. These themes encompassed 8 main categories and 25 codes. The research revealed that the pandemic and work conditions negatively influenced their health, affecting their professional and personal lives. Current support has lessened the pandemic's effects on HCWs but should also address future requirements like long-term psychological support.

CONCLUSION

The studies identified the challenges faced by HCWs during the pandemic, and the existing support. However, due to the complex interactions between the work and environmental factors, the effectiveness of the existing support remains challenging. To improve their effectiveness, the future support should target the interactions between the HCWs and the work system.

PROSPERO REGISTRATION NUMBER

CRD42023426238.

Predictors of dropout in cognitive behavior and interpersonal online brief psychotherapies for essential professionals during the COVID-19 pandemic

Premature dropout from psychotherapy can harm patients and increase mental health costs. This study identified predictors of dropout in brief online psychotherapy for essential workers during the COVID-19 pandemic. This was a secondary analysis of a randomized trial on 4-week CBT or IPT protocols. Participants provided sociodemographic data and completed the Patient-Reported Outcomes Measurement Information System and Burnout Assessment Tool Short-Form. Predictors were analyzed in three blocks: sociodemographic, clinical, and therapist characteristics using bivariable and multivariable analyses. The sample included 804 individuals who attended at least the first session of either CBT (n = 403) or IPT (n = 401). A total of 17.2% (n = 138) of the participants dropped out during the protocol. Significant predictors of dropout included having children (IRR = 1.48; 95% CI: 1.07-2.05; p = 0.016), residing in specific regions of Brazil (Northeast IRR = 1.44; 95% CI:1.04-2.00; p = 0.02 and Midwest IRR = 1.73; 95%CI: 1.13-2.64; p = 0.01), therapist male sex (IRR = 2.04; 95% CI: 1.47-2.83; p = < 0.001), second wave of Covid-19 (IRR = 1.54; 95% CI: 1.01-2.34; p = 0.04) and low life satisfaction (IRR = 1.63; 95% CI: 1.06-2.50; p = 0.02). Our findings underscore the necessity for culturally tailored strategies, support for those with children, and targeted therapy for individuals with low life satisfaction. Implementation of these strategies may reduce dropout rates and improve treatment outcomes for essential workers in crisis.

Enhancing hospital protection measures reduces frontline medical workers' stress during the pandemic

Frontline medical workers (FMWs) faced high stress levels in frontline clinics during the COVID-19 pandemic. This study aims to alleviate FMWs' psychological stress by enhancing protection measures, which includes refining the selection process, improving protective measures for their work in frontline clinics, and determining the appropriate time for evacuation. A Chinese-language-version stress questionnaire, covering stress-related issues and sociodemographic characteristics, was administered to FMWs in Shanghai during the COVID-19 pandemic in 2022, yielding 107 valid responses. The questionnaire's reliability and validity were subsequently confirmed. Exploratory factor analysis (EFA) was applied to the stress-related questions, with the KMO and Bartlett's test values of 0.886, 877.8522 (df = 120, p < 0.0001), respectively. Structure equation modeling (SEM) was used to confirm the factors and measure the relationships among the stress-related questions, factors and sociodemographic characteristics. The parameters of SEM named SOFAIDC were significant with SRMSR, RMSEA, AGFI, NFI, and PNFI being 0.0422, 0.0507, 0.9946, 0.9958, and 0.7615, respectively. Paired sample t-tests revealed the significant decrease in FMWs' stress score of the current week and the previous week, with all t-values being negative and significant (p < 0.01). A latent growth model (LGM) named LGM30 verified the overall decreasing stress trend over the weeks, with high R-squares (> 0.80), significant positive linear and negative quadratic time parameters. Based on the trajectory analysis, a stress scorecard with an AUC of 0.856 was developed. This study found that there are four factors for FMWs' psychological stress (anxiety about infection, exhaustion, lack of cognition for infection, and hesitant feeling), and improving targeted hospital protection could alleviate FMWs' psychological stress through SOFAIDC, as all the total effect of factors or items from the feeling of being protected by hospital were negative. Meanwhile, although overall FMWs' stress trend has decreased, 22.43% of FMWs have maintained or experienced a high stress trend, and the stress might increase over weeks in frontline clinics. To perfect hospital protection to alleviate FMWs' psychological stress, the scorecard could be used to select FMWs with low-stress trends, LGM30 could be used to determine the withdrawal time (such as week 8), and targeted hospital protections could be designed based on the relationships between feeling of being protected by the hospital and factors in SOFAIDC, such as providing adequate protective equipment, improving the rationality of FMWs' work schedules, recruiting personnel with higher education levels, and paying adequate monetary compensation.

A Multiple Mediator Model of Depression, Dysfunctional Beliefs about Sleep, and Sleep Effort in the Relationship between Psychological Inflexibility and Insomnia in Shift Working Nurses

The aims of this study were to explore the influence of shift working nursing professionals' psychological inflexibility on their level of insomnia. Additionally, we investigated the mediation effect of depression and sleep-related cognitions on this association. An online survey was conducted among 202 nursing professionals at Asan Medical Center from July to August, 2023. Participants responded to questionnaires including the Insomnia Severity Index (ISI), Acceptance and Action Questionnaire-II (AAQ-II), Dysfunctional Beliefs and Attitudes about Sleep - 16 (DBAS-16), Glasgow Sleep Effort Scale (GSES), Patient Health Questionnaire-9 items (PHQ-9), and the Discrepancy between desired time in bed and desired total sleep time index (DBST index). Pearson's correlation and linear regression were performed to explore the factors predicting ISI scores. Mediation analysis was implemented. Linear regression revealed that insomnia severity was predicted by DBAS-16 (β = 0.15, p = 0.008), GSES (β = 0.48, p < 0.001), and PHQ-9 (β = 0.26, p < 0.001). Mediation analysis showed that the relationship between the psychological inflexibility of shift-working nursing professionals' and insomnia severity was fully mediated by depression, dysfunctional beliefs about sleep, and sleep effort. Psychological inflexibility does not directly influence insomnia severity, but depression, dysfunctional beliefs about sleep, and sleep effort fully mediate the relationship.

Addressing Mental Health Symptoms Among COVID-19 Healthcare Workers: A Heart Rate Variability Biofeedback Pilot Study

Psychological stress among frontline healthcare workers (HCWs) increased during the COVID-19 pandemic, elevating mental health risks. Heart rate variability biofeedback (HRV-BF) is an evidence-based intervention with potential to reduce psychological burden on frontline HCWs; however, no studies have examined its use among this population since the pandemic began. We designed a trial to assess the effects of a brief HRV-BF intervention delivered via telemedicine on measures of anxiety, depression and stress, and heart rate variability, compared to an in-person intervention. We hypothesised that the telemedicine intervention would be non-inferior to the in-person intervention. Using a randomized comparison trial design, we tested a 10-day brief heart rate variability biofeedback intervention among frontline HCWs during the COVID-19 pandemic. They received remote, 30-min guided sessions every other day and were taught methods of heart rate variability biofeedback. Depression, anxiety and stress were assessed at baseline, 10 days, and 40 days with additional measures of anxiety measured before and after each session. HRV scores were collected at baseline, as well as during the course of the 10 days. Multilevel modelling was used to examine the change in depression, anxiety, stress and HRV scores across multiple time points and session types (telemedicine vs. in-person). There was no significant differences between telemedicine (n = 32) and in-person (n = 15) interventions on the main outcomes. Both session types showed a significant decrease in depression, anxiety and stress scores across the entire intervention, and HRV scores significantly increased across both groups. Anxiety levels also significantly decreased after each session. The non-inferiority of the telemedicine intervention to a comparable in-person intervention affirms its promise for decreasing anxiety, depression and stress among frontline HCWs and may offer a cost-effective and feasible tool to use in crises situations.

New graduate nurses' perspectives on well-being and transitioning into the workforce

BACKGROUND

The COVID-19 pandemic profoundly impacted nurses' well-being and the transition of new nurses into the workplace. The National Academy of Medicine and American Nurses Foundation has announced the need to prioritize well-being research.

PURPOSE

To explore new nurses' perspectives related to factors that influenced their well-being and transition to practice.

METHODS

New graduate nurses (1-2years post graduation) in Hawaii were invited to participate in a qualitative study, September 2023.

DISCUSSION

Participants (N = 25) were predominantly female (84%), Asian (80%), and had 1year of experience (76%). Participants described the effect of the pandemic on their well-being, individual factors they needed to develop, external factors that were barriers or facilitators, and considerations for future interventions to support well-being and transition to practice.

CONCLUSION

The findings highlighted components of interventions needed in the academic and professional setting to support new nurses' successful and sustained transition to the workplace.

Beyond the Pandemic: Longitudinal Lessons on Social Support, Sleep Quality, and Burnout Among Healthcare Workers

OBJECTIVES

To assess occupational burnout (OB) changes among Brazilian healthcare workers (HCWs) from COVID-19 onset to 6 months later (T1) and identify risk and protective factors.

METHODS

Using the Copenhagen Burnout Inventory and hierarchical multivariate linear regression in a two-stage online survey (initial n = 1054; T1 n = 316), this study examined the impact of various factors on OB.

RESULTS

Significant increases in personal and work-related OB were observed by T1. Psychiatric diagnosis and workload emerged as risk factors ( P < 0.01), while having a partner, good family relations, workplace well-being, and adequate sleep were protective ( P < 0.001).

CONCLUSIONS

OB levels among Brazilian HCWs increased during the COVID-19 pandemic. Interventions should target personal and organizational wellness to alleviate burnout, emphasizing the importance of strong relationships, workplace health, and good sleep practices.

Evaluating GenAI systems to combat mental health issues in healthcare workers: An integrative literature review

BACKGROUND

Mental health issues among healthcare workers remain a serious problem globally. Recent surveys continue to report high levels of depression, anxiety, burnout and other conditions amongst various occupational groups. Novel approaches are needed to support clinician well-being.

OBJECTIVE

This integrative literature review aims to explore the current state of research examining the use of generative artificial intelligence (GenAI) and machine learning (ML) systems to predict mental health issues and identify associated risk factors amongst healthcare professionals.

METHODS

A literature search of databases was conducted in Medline then adapted as necessary to Scopus, Web of Science, Google Scholar, PubMed and CINAHL with Full Text. Eleven studies met the inclusion criteria for the review.

RESULTS

Nine studies employed various machine learning techniques to predict different mental health outcomes among healthcare workers. Models showed good predictive performance, with AUCs ranging from 0.82 to 0.904 for outcomes such as depression, anxiety and safety perceptions. Key risk factors identified included fatigue, stress, burnout, workload, sleep issues and lack of support. Two studies explored the potential of sensor-based technologies and GenAI analysis of physiological data. None of the included studies focused on the use of GenAI systems specifically for providing mental health support to healthcare workers.

CONCLUSION

Preliminary research demonstrates that AI/ML models can effectively predict mental health issues. However, more work is needed to evaluate the real-world integration and impact of these tools, including GenAI systems, in identifying clinician distress and supporting well-being over time. Further research should aim to explore how GenAI may be developed and applied to provide mental health support for healthcare workers.

Pivoting Continuing Professional Development During the COVID-19 Pandemic: A Narrative Scoping Review of Adaptations and Innovations

INTRODUCTION

Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic.

METHODS

The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period.

RESULTS

Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives.

DISCUSSION

This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.

Effects of the Brief Simha Kriya Breathing Practice for Health Care Workers During the COVID-19 Pandemic

Introduction: During the COVID-19 pandemic, health care workers (HCWs) experienced increased anxiety, depression, loneliness, and other mental health issues. HCWs need additional resources to cope with the mental health impact of their work. Yoga techniques could be helpful strategies to manage different stressors during times of uncertainty. Methods: This prospective, single-arm, trial examined the effects of a brief pranayama yoga practice on the wellbeing of HCWs during the height of COVID-19. HCWs were recruited through announcements and institutional websites at a large major cancer center in the southern United States. A short, prerecorded, 5-min breathwork video intervention called "Simha Kriya" was provided to participants, and they were encouraged to practice one to two times daily for 4 weeks. Participants completed self-report instruments at baseline and weeks 1 and 4, including: (1) Perceived Stress Scale (PSS); (2) Brief Resilient Coping Scale (BRCS); and (3) a questionnaire assessing the experience of COVID-19 among HCWs that had five subscales. HCWs also conducted a measure of breath holding time. Paired sample t-tests and mixed-effects analysis of variance models examined changes over time. Results: One hundred participants consented to the study, with 88 female, 60 white, 39 worked remotely, and 27 were clinical staff. Sixty-nine participants provided data at week 1 and 56 at week 4. Participants' adherence to the breathing exercises between weeks 1 and 4 was similar, with a mean of six times per week. At week 4, there were significant decreases in the COVID-19 Distress score (p < 0.0001) and COVID-19 Disruption (p = 0.013), yet no changes in the PSS. There were also significant increases in COVID-19 Stress Management (p = 0.0001) and BRCS scores (p = 0.012), but no changes in Perceived Benefits of COVID-19 and no changes in breath holding time. Discussion: Brief yoga-based breathing practices helped reduce pandemic-specific stress, improved resilience, and stress management skills in HCWs. Trial Registration Number: NCT04482647.

Impact of the COVID-19-pandemic and perception of self-efficacy on the mental health of out-of-hospital emergency healthcare professionals by modality of care

OBJECTIVE

To analyse the influence of the COVID-19 pandemic and the perception of self-efficacy on the health professionals of the Spanish out-of-hospital emergency services.

DESIGN

Observational, cross-sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February-30 April, 2021).

METHODS

The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self-efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self-efficacy on mental health.

RESULTS

The means of the sample for stress, anxiety, depression and self-efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self-efficacy. Self-efficacy had a direct effect on the mental health for working in patient care.

CONCLUSIONS

Healthcare workers showed moderate stress, severe anxiety, mild depression and good self-efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self-efficacy is a determining factor of mental health in the direct care modality.

IMPLICATIONS

The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out-of-hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self-efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk.

REPORTING METHOD

We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros - ASISA Foundation (Spain). PATIENT OR PUBLIC CONTRIBUTION: 'No patient or public involvement'.

Understanding the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

There is limited evidence about the mental health and intention to leave of the public health workforce in Canada during the COVID-19 pandemic. The objectives of this study were to determine the prevalence of burnout, symptoms of anxiety and depression, and intention to leave among the Canadian public health workforce, and associations with individual and workplace factors.

METHODS

A cross-sectional study was conducted using data collected by a Canada-wide survey from November 2022 to January 2023, where participants reported sociodemographic and workplace factors. Mental health outcomes were measured using validated tools including the Oldenburg Burnout Inventory, the 7-item Generalized Anxiety Disorder scale, and the 2-item Patient Health Questionnaire to measure symptoms of depression. Participants were asked to report if they intended to leave their position in public health. Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the associations between explanatory variables such as sociodemographic, workplace factors, and outcomes of mental health, and intention to leave public health.

RESULTS

Among the 671 participants, the prevalence of burnout, and symptoms of depression and anxiety in the two weeks prior were 64%, 26%, and 22% respectively. 33% of participants reported they were intending to leave their public health position in the coming year. Across all outcomes, sociodemographic factors were largely not associated with mental health and intention to leave. However, an exception to this was that those with 16-20 years of work experience had higher odds of burnout (aOR = 2.16; 95% CI = 1.12-4.18) compared to those with ≤ 5 years of work experience. Many workplace factors were associated with mental health outcomes and intention to leave public health. Those who felt bullied, threatened, or harassed because of work had increased odds of depressive symptoms (aOR = 1.85; 95% CI = 1.28-2.68), burnout (aOR = 1.61; 95% CI = 1.16-2.23), and intention to leave (aOR = 1.64; 95% CI = 1.13-2.37).

CONCLUSIONS

During the COVID-19 pandemic, some of the public health workforce experienced negative impacts on their mental health. 33% of the sample indicated an intention to leave their role, which has the potential to exacerbate pre-existing challenges in workforce retention. Study findings create an impetus for policy and practice changes to mitigate risks to mental health and attrition to create safe and healthy working environments for public health workers during public health crises.

Evaluation of the effects of pandemic-related fears on anxiety and depression: the mediating roles of traumatic stress and loneliness

BACKGROUND

The detrimental mental health effects which emerged from COVID-19 have profoundly affected healthcare workers (HCWs) worldwide. The aim of this study was to investigate the mediating effects of traumatic stress and loneliness on the fears of contracting and dying from COVID-19, and anxiety and depression of HCWs during the pandemic.

METHODS

A cross-sectional online survey was completed by HCWs in a province of Turkey. The Hospital Anxiety Depression Scale, Impact of Events Scale-Revised and numerical rating scales (for fears of COVID-19 and loneliness) were used and a bootstrap approach was used in the analyses with SPSS PROCESS macro software.

RESULTS

Of the HCWs evaluated, 150 (34.4%) were doctors, with a mean duration of work experience of 10.6 ± 7.5 years. The results indicated that fear of contracting COVID-19 was directly related to anxiety (β = 0.244, p < 0.001) and depression (β = 0.135, p < 0.01) and that traumatic stress and loneliness mediated the relationships between the fear of contracting COVID-19 and anxiety (β = 0.435, p < 0.001; β = 0.235, p < 0.001, respectively) and depression (β = 0.365, p < 0.001; β = 0.294, p < 0.001, respectively). The fear of dying from COVID-19 was determined to be directly associated with anxiety (β = 0.190, p < 0.001) but not with depression (β = 0.066, p = 0.116), and traumatic stress and loneliness mediated the relationships between the fear of dying from COVID-19 and anxiety (β = 0.476, p < 0.001; β = 0.259, p < 0.001, respectively) and depression (β = 0.400, p < 0.001; β = 0.311, p < 0.001, respectively).

CONCLUSIONS

The study results demonstrated the important roles of traumatic stress and loneliness in exacerbating the negative consequences of fears of COVID-19 on anxiety and depression, and provide insights for identifying HCWs at greater risk.

The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review

OBJECTIVE

To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing.

METHODS

Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible.

RESULTS

We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type "Job and task modifications" and a moderate level of evidence for the types "Flexible work and scheduling" and "Changes in the physical work environment". For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed.

CONCLUSION

Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses.

Burnout, moral injury, and suicidal/self-harm ideation among healthcare professionals in Mainland China: Insights from an online survey during the COVID-19 pandemic

OBJECTIVE

This survey explored the relationships between burnout, moral injury, and suicidal/self-harm ideation among Chinese health professionals in mainland China.

METHODS

Health professionals were surveyed online using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, Patient Health Questionnaire-9, and the Moral Injury Symptom Scale-Health Professional version.

RESULTS

A total of 6,146 health professionals participated in the study. The average age of participants was 34.9 ± 8.5 years, and suicidal/self-harm ideation was present in 2,338 participants (38.0%). The prevalence of suicidal/self-harm ideation was more common among those with severe burnout (vs. mild burnout), particularly in the dimensions of emotional exhaustion, depersonalization, and decreased personal accomplishment. The prevalence of suicidal/self-harm ideation among those with significant moral injury symptoms was higher than in those without moral injury. Unconditional logistic regression analysis demonstrated that those with moderate or severe emotional exhaustion, moderate or severe reduced sense of professional accomplishment, and moderate or severe depersonalization were at increased risk of suicidal/self-harm ideation.Structural equation modelling demonstrated that burnout significantly mediated the relationship between moral injury and suicidal/self-harm ideation. The proportion of mediation (PM) by burnout was 43.0%.

CONCLUSIONS

This study found that burnout and moral injury were significant predictors of suicidal/self-harm ideation among health professionals in China. Both moral injury and burnout had positive and direct effects on suicidal/self-harm ideation, and burnout mediated the relationship between moral injury and suicidal/self-harm ideation. Interventions to address moral injury and subsequent burnout in Chinese healthcare workers may enhance the mental health of these healthcare professionals and increase the quality of care that they provide.

Psychological distress among healthcare professionals in Mbarara, following the 2022 Ebola Virus Disease outbreak in Uganda: a mixed methods study

BACKGROUND

The 2022 Ebola Virus Disease (EVD) outbreak occurred at a time when Uganda was still battling the social and psychological challenges of the COVID-19 pandemic; placing health care professionals (HCPs) at a much higher risk of developing psychological distress. Psychological distress among HCPs can cause decreased workplace productivity and ineffective management of their patients. The current study aimed to investigate and understand psychological distress among HCPS in Mbarara city in Southwestern Uganda following the 2022 EVD outbreak.

METHOD

We enrolled 200 HCPs through convenient sampling from one private and one public health facility in Mbarara city in Southwestern Uganda, in a cross-sectional convergent parallel mixed method approach where qualitative and quantitative data were collected concurrently. Quantitative data, utilizing the Kessler Psychological Distress (K10) Scale, provided us with a quantitative measure of the prevalence of psychological distress among HCPs, and were analyzed using STATA version 16. Qualitative data, on the other hand, offered deeper insights into the nature, perceptions, and contextual factors influencing this distress, and were analyzed using emergent theme analysis.

RESULTS

The prevalence of psychological distress was 59.5% and it was higher among females (63.9%) compared to males (36.1%). HCPs vividly expressed distress and anxiety, with heightened suspicion that every patient might be an EVD carrier, creating a pervasive sense of unsafety in the workplace. However, the outbreak had an educational affect where concerns about the announcement of another EVD outbreak were diverse, with HCPs expressing anxiety, despair, and dissatisfaction with the country's management of potential outbreaks.

CONCLUSION

High levels of psychological distress were experienced by HCPs in Southwestern Uganda as a result of the 2022 EVD pandemic. HCPs express a wide range of feelings, such as dread, anxiety, despair, pessimism, and discontent with the way the outbreaks are handled throughout the nation. We recommend implementation of comprehensive psychosocial support programs tailored to the unique needs of HCPs, including counseling services, stress management workshops, and peer support networks.

Efficacy of the my health too online cognitive behavioral therapy program for healthcare workers during the COVID-19 pandemic: A randomized controlled trial

Background

Healthcare workers' mental health has been impacted by the COVID-19 pandemic, emphasizing the need for mental health interventions in this population. Online cognitive behavioral therapy (CBT) is efficient to reduce stress and may reach numerous professionals. We developed "MyHealthToo", an online CBT program to help reduce stress among healthcare workers during the COVID-19 pandemic.

Objective

The aim of our study is to investigate the efficacy of an online CBT program on stress and mental health conditions among healthcare workers during a health crisis.

Methods

We performed a multicentric randomized controlled trial among 155 participants allocated either to the experimental or active control group (bibliotherapy). The primary outcome was the decrease of perceived stress scores (PSS-10) post-treatment. Secondary outcomes included depression, insomnia and PTSD symptoms along with self-reported resilience and ruminations. Assessments were scheduled pretreatment, mid-treatment (4 weeks), post-treatment (8 weeks), and at 1-month and 4-months follow-up.

Results

For both interventions, mean changes on the PSS-10 were significant post-therapy (W8), as at 1-month (W12) and 4-months (W24) follow-ups. The between-group comparison showed no difference at any time point (ps > 0.88). Work-related ruminations significantly decreased in the experimental group with a significant between-group difference at W8 (Δ = -1.83 [-3.57; -0.09], p = 0.04). Posttraumatic stress symptoms significantly decreased in the experimental group with a significant between-group difference at W12 (Δ = -1.41 [-2.68; -0.14], p = 0.03). The decrease in work-related ruminations at W8 mediated the decrease in posttraumatic stress symptoms at W12 (p = 0.048).

Conclusion

The "MyHealthToo" online CBT intervention may help reduce ruminations about work and posttraumatic stress symptoms among healthcare workers during a major health crisis. Work-related ruminations may represent a relevant target of online interventions to improve mental health among healthcare workers.

Frontline health workers' experiences of providing care for people living with non-communicable diseases during the COVID-19 pandemic in Ghana: a qualitative study

BACKGROUND

The COVID-19 pandemic has significantly impacted frontline health workers. However, a neglected dimension of this discourse was the extent to which the pandemic impacted frontline healthcare workers providing non-communicable diseases (NCDs) care. This study aims to understand the experiences of healthcare workers with no prior exposure to pandemics who provided care to people living with NCDs (PLWNCDs).

METHODS

A qualitative study design was employed, using a face-to-face in-depth interviews. Interviews were conducted in primary healthcare facilities in three administrative regions of Ghana, representing the Northern, Southern and Middle Belts. Only frontline health workers with roles in providing care for PLWNCDs were included. Purposive snowballing and convenience sampling methods were employed to select frontline health workers. An open-ended interview guide was used to facilitate data collection, and thematic content analysis was used to analyse the data.

RESULTS

A total of 47 frontline health workers were interviewed. Overall, these workers experienced diverse patient-driven and organisational challenges. Patient-level challenges included a decline in healthcare utilisation, non-adherence to treatment, a lack of continuity, fear and stigma. At the organisational levels, there was a lack of medical logistics, increased infection of workers and absenteeism, increased workload and burnout, limited motivational packages and inadequate guidelines and protocols. Workers coped and responded to the pandemic by postponing reviews and consultations, reducing inpatient and outpatient visits, changing their prescription practices, using teleconsultation and moving to long-shift systems.

CONCLUSION

This study has brought to the fore the experiences that adversely affected frontline health workers and, in many ways, affected the care provided to PLWNCDs. Policymakers and health managers should take these experiences into account in plans to mitigate the impact of future pandemics.

Comparison of the Stress and Anxiety to Viral Epidemic-9 and SAVE-6 scales among healthcare workers in Peru

Introduction

Peru is a country that has a high incidence of viral outbreaks and epidemics, which is why it is necessary to validate a scale that measures anxiety and stress in professionals who are on the front lines of these events. Therefore, our objective was to validate the Peruvian-Spanish version of the Stress and Anxiety to Viral Epidemics-9 items (SAVE-9) scale and to concurrently compare its validity and internal consistency with the SAVE-6 scale among healthcare workers (HCWs).

Materials and methods

We conducted a cross-sectional study based on data collected from a self-reported survey in paper-and-pencil format between April and July 2023. A total of 203 HCWs participated in the research. We developed a confirmatory factor analysis (CFA) and item response theory (IRT). We calculated Cronbach's α coefficient and McDonald's ω to assess the internal consistency of the scales.

Results

The results show that SAVE-9 (a two-factor model) and SAVE-6 (a one-factor model) provided an excellent fit in the confirmatory factor analysis. Both scales demonstrated strong internal consistency (Cronbach's α 0.85 and 0.86, respectively). Significant correlations were found between the SAVE-9 and SAVE-6 scales and Generalized Anxiety Disorder-7 items scale (r = 0.44 and r = 0.38, respectively, p < 0.001) as well as the Patient Health Questionnaire-9 items (r = 0.39 and r = 0.35, respectively, p < 0.001). The optimal cutoff points for SAVE-9 and SAVE-6 were identified for assessing anxiety, aligned with a GAD-7 score ≥5 points.

Conclusion

The Peruvian-Spanish SAVE-9 and SAVE-6 scales are reliable and valid rating scales to assess the anxiety response of HCWs in response to viral epidemics. Though COVID-19 is diminished, these scales will be useful for other viral epidemics in the future.

Social support and suicidality during the COVID-19 pandemic among Brazilian healthcare workers: a longitudinal assessment of an online repeated cross-sectional survey

OBJECTIVE

The risk of suicide is higher among health care workers than other workers. This study investigated the association between social support and suicidal ideation and behavior during the COVID-19 pandemic among Brazilian health care workers.

METHODS

This study used data from 10,885 respondents to the first (time point 1 - between May and June of 2020) and second (time point 2 - between December 2020 and February 2021) cross-sectional online surveys about mental health and quality of life among Brazilian health care workers during the COVID-19 pandemic. The relationship between social support as the independent variable (time point 1) and suicidal ideation and behavior as the outcomes (time point 2) was investigated through logistic regression analysis.

RESULTS

Greater social support was associated with a significantly lower risk of reporting suicidal ideation and behavior in the month prior to follow-up assessment (adjusted OR: 0.71, 95%CI 0.66-0.76 and adjusted OR 0.61, 95%CI 0.54-0.68, respectively). These associations were independent of sex, age, feelings of loneliness, and self-reported psychiatric disorders.

CONCLUSION

Social support is associated with a lower risk of suicidality among health care workers, and its protective role appears more closely related to suicidal behavior.

Interventions to reduce burnout and improve the mental health of nurses during the COVID-19 pandemic: A systematic review of randomised controlled trials with meta-analysis

This systematic review aims to investigate and determine the effectiveness of interventions on improving mental health (anxiety, depression, stress or mental well-being) and/or reducing burnout of nurses working in hospitals during the COVID-19 pandemic. A search was conducted on studies from conception to December 2022 in databases: PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus and Web of Science and in ProQuest Thesis & Dissertations Global Database, Google Scholar and ClinicalTrials.gov. A total of 17 randomised controlled trials that evaluated different interventions were included. The outcomes were anxiety (n = 11), depression (n = 5), stress (n = 13) mental well-being (n = 7) and burnout (n = 7). Not all interventions led to positive outcomes. Grading of Recommendations Assessment, Development and Evaluation (GRADE) appraisal and risk of bias assessment using the Cochrane tool for randomised controlled trials (RoB 2.0) revealed poor quality of currently available literature, with low to very low certainty. Meta-analysis showed high heterogeneity among the five different outcomes, with subgroup analysis showing greater success in interventions conducted on nurses involved in the care of COVID-19 patients. More well-designed trials are necessary to reinforce current evidence to improve the mental health of nurses, to not only protect their quality of life but also to ensure the quality of patient care.

Testing an Intervention to Improve Health Care Worker Well-Being During the COVID-19 Pandemic: A Cluster Randomized Clinical Trial

Importance

Stress First Aid is an evidence-informed peer-to-peer support intervention to mitigate the effect of the COVID-19 pandemic on the well-being of health care workers (HCWs).

Objective

To evaluate the effectiveness of a tailored peer-to-peer support intervention compared with usual care to support HCWs' well-being at hospitals and federally qualified health centers (FQHCs) during the COVID-19 pandemic.

Design, Setting, and Participants

This cluster randomized clinical trial comprised 3 cohorts of HCWs who were enrolled from March 2021 through July 2022 at 28 hospitals and FQHCs in the US. Participating sites were matched as pairs by type, size, and COVID-19 burden and then randomized to the intervention arm or usual care arm (any programs already in place to support HCW well-being). The HCWs were surveyed before and after peer-to-peer support intervention implementation. Intention-to-treat (ITT) analysis was used to evaluate the intervention's effect on outcomes, including general psychological distress and posttraumatic stress disorder (PTSD).

Intervention

The peer-to-peer support intervention was delivered to HCWs by site champions who received training and subsequently trained the HCWs at their site. Recipients of the intervention were taught to respond to their own and their peers' stress reactions.

Main Outcomes and Measures

Primary outcomes were general psychological distress and PTSD. General psychological distress was measured with the Kessler 6 instrument, and PTSD was measured with the PTSD Checklist.

Results

A total of 28 hospitals and FQHCs with 2077 HCWs participated. Both preintervention and postintervention surveys were completed by 2077 HCWs, for an overall response rate of 28% (41% at FQHCs and 26% at hospitals). A total of 862 individuals (696 females [80.7%]) were from sites that were randomly assigned to the intervention arm; the baseline mean (SD) psychological distress score was 5.86 (5.70) and the baseline mean (SD) PTSD score was 16.11 (16.07). A total of 1215 individuals (947 females [78.2%]) were from sites assigned to the usual care arm; the baseline mean (SD) psychological distress score was 5.98 (5.62) and the baseline mean (SD) PTSD score was 16.40 (16.43). Adherence to the intervention was 70% for FQHCs and 32% for hospitals. The ITT analyses revealed no overall treatment effect for psychological distress score (0.238 [95% CI, -0.310 to 0.785] points) or PTSD symptom score (0.189 [95% CI, -1.068 to 1.446] points). Post hoc analyses examined the heterogeneity of treatment effect by age group with consistent age effects observed across primary outcomes (psychological distress and PTSD). Among HCWs in FQHCs, there were significant and clinically meaningful treatment effects for HCWs 30 years or younger: a more than 4-point reduction for psychological distress (-4.552 [95% CI, -8.067 to -1.037]) and a nearly 7-point reduction for PTSD symptom scores (-6.771 [95% CI, -13.224 to -0.318]).

Conclusions and Relevance

This trial found that this peer-to-peer support intervention did not improve well-being outcomes for HCWs overall but had a protective effect against general psychological distress and PTSD in HCWs aged 30 years or younger in FQHCs, which had higher intervention adherence. Incorporating this peer-to-peer support intervention into medical training, with ongoing support over time, may yield beneficial results in both standard care and during public health crises.

Trial Registration

ClinicalTrials.gov Identifier: NCT04723576.

Determinants of intention to leave among nurses and physicians in a hospital setting during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The global outbreak of COVID-19 has brought to light the profound impact that large-scale disease outbreaks can have on healthcare systems and the dedicated professionals who serve within them. It becomes increasingly important to explore strategies for retaining nurses and physicians within hospital settings during such challenging times. This paper aims to investigate the determinants of retention among nurses and physicians during the COVID-19 pandemic.

METHOD

A systematic review of other potential determinants impacting retention rates during the pandemic was carried out. Secondly, a meta-analysis on the prevalence of intention to leave for nurses and physicians during the COVID-19 pandemic.

FINDINGS

A comprehensive search was performed within four electronic databases on March 17 2023. Fifty-five papers were included in the systematic review, whereas thirty-three papers fulfilled the eligibility criteria for the meta-analysis. The systematic review resulted in six themes of determinants impacting intention to leave: personal characteristics, job demands, employment services, working conditions, work relationships, and organisational culture. The main determinants impacting the intention to leave are the fear of COVID-19, age, experience, burnout symptoms and support. Meta-analysis showed a prevalence of intent to leave the current job of 38% for nurses (95% CI: 26%-51%) and 29% for physicians (95% CI: 21%-39%), whereas intention to leave the profession for nurses 28% (95% CI: 21%-34%) and 24% for physicians (95% CI: 23%-25%).

CONCLUSION

The findings of this paper showed the critical need for hospital managers to address the concerning increase in nurses' and physicians' intentions to leave during the COVID-19 pandemic. This intention to leave is affected by a complex conjunction of multiple determinants, including the fear of COVID-19 and the confidence in and availability of personal protective equipment. Moreover, individual factors like age, experience, burnout symptoms, and support are maintained in this review. Understanding the influence of determinants on retention during the COVID-19 pandemic offers an opportunity to formulate prospective strategies for retaining nurses and physicians within hospital settings.

Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon)

This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.

Impact of COVID-19 on mental health of health care workers in Spain: a mix-methods study

BACKGROUND

Spain's lockdown measures couldn't prevent the severe impact of the COVID-19 first wave, leading to high infections, deaths, and strain on healthcare workers (HCWs). This study aimed to explore the mental health impact on HCWs in the Balearic Islands during the initial months of the pandemic, the influencing factors, and the experiences of those in a COVID-19 environment.

METHODS

Using a mixed-methods approach, the study encompassed quantitative and qualitative elements. Cross-sectional survey data from April to June 2020 comprised HCWs who were emailed invitations. The survey covered demographics, work, clinical and COVID-19 variables, along with psychological distress and PTSD symptoms, using validated measures. Additionally, semi-structured interviews with HCWs offered qualitative insights.

RESULTS

Three hundred thirty-six HCWs averaging 46.8 years, mainly women (79.2%), primarily nurses in primary care with over 10 years of experience. Anxiety symptoms were reported by 28.8%, 65.1% noted worsened sleep quality, and 27.7% increased psychoactive drug usage. Psychological distress affected 55.2%, while 27.9% exhibited PTSD symptoms. Gender, age, experience, COVID-19 patient contact, and workload correlated with distress, PTSD symptoms, sleep quality, and psychoactive drug usage. Interviews uncovered discomfort sources, such as fear of infection and lack of control, leading to coping strategies like information avoidance and seeking support.

LIMITATIONS

Static cross-sectional design, non-probabilistic sample, and telephone interviews affecting non-verbal cues, with interviews conducted during early pandemic lockdown.

CONCLUSIONS

HCWs faced significant psychological distress during the pandemic's first wave, underscoring the necessity for robust support and resources to counteract its impact on mental health.

The association between mental health symptoms and alcohol use among Chinese psychiatrists during the early stage of the COVID-19 pandemic

AIM

To investigate the association between mental health symptoms, alcohol use, and alcohol misuse among psychiatrists in China during the early stage of the COVID-19 pandemic.

METHODS

We conducted an online survey to collect data regarding mental health symptoms and alcohol use among psychiatrists in early 2020. The Depression Anxiety Stress Scale-Chinese Version (DASS-21) was used to assess depression, anxiety, and stress symptoms, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was used to assess alcohol use.

RESULTS

In total, 3774 psychiatrists completed the survey. AUDIT-C scores were positively correlated with DASS total and depression, anxiety, and stress subscales (total: r = 0.015, depression: r = 0.121, anxiety: r = 0.103, and stress: r = 0.096, all p < 0.05). Alcohol misuse was associated with male sex (OR = 4.754), cigarette smoking (OR = 2.441), administrative position (OR = 1.811), depression (OR = 1.489), and stress (OR = 1.504). Those who reported increased alcohol use during the pandemic were more likely to be male (OR = 2.174), endorse anxiety symptoms (OR = 2.386), or increased stress (OR = 2.402).

CONCLUSIONS

Mental health symptoms were common among psychiatrists during the COVID-19 pandemic. Depression and stress symptoms were significantly associated with alcohol misuse. Anxiety and stress symptoms were associated with reported increases in alcohol use. Though a causal relationship cannot be inferred, our findings suggest that strategies promoting healthcare professionals' mental well-being should include alcohol use.

The impact of the global COVID-19 pandemic on risk factors for suicide in healthcare workers: A narrative review

BACKGROUND

Suicide is a leading cause of death in the United States. Worldwide, over 700,000 people die by suicide each year. Healthcare workers are more vulnerable to suicide risk factors than the general population. The global COVID-19 pandemic presents additional workplace and health concerns that relate to suicide risk factors in healthcare workers. It is important to recognise suicide risk factors in healthcare workers and to implement strategies to reduce these risk factors.

OBJECTIVES

This study describes the impact of the global COVID-19 pandemic on risk factors for suicide in healthcare workers and identifies evidence-based strategies and resources to reduce suicide risk factors in healthcare workers.

DESIGN

The authors conducted a thematic analysis and narrative review of the literature.

METHODS

Using health science databases, the authors searched the literature, selected and analyzed studies, identified themes, synthesised findings and created a narrative review. The STROBE checklist was used in this study.

RESULTS

Two themes were identified (1) The impact of the COVID-19 pandemic on work-related suicide risk factors in healthcare workers; (2) The impact of the COVID-19 pandemic on mental health-related suicide risk factors in healthcare workers. The pandemic has affected suicide risk factors in healthcare workers. Many studies discussed evidence-based strategies and resources that can be used to reduce suicide risk factors.

CONCLUSION

The global COVID-19 pandemic has negatively impacted suicide risk factors in healthcare workers. It is time for individuals and healthcare delivery systems to implement suicide risk prevention strategies to protect healthcare workers now and in the future.

RELEVANCE TO CLINICAL PRACTICE

This review increases awareness of the pandemic's impact on healthcare workers' risk factors for suicide and identifies evidence-based suicide risk prevention strategies and resources for healthcare workers.

PATIENT OR PUBLIC CONTRIBUTION

Library services supported this research by generating search strategies and providing resources and tools.

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.

Burnout syndrome and anxiety among healthcare workers during global pandemics: An umbrella review

BACKGROUND

Burnout syndrome and anxiety are two mental health symptoms experienced by healthcare workers (HCWs) that can be exacerbated during pandemics due to increased job demands and the global health workforce crisis.

AIM

To provide a comprehensive review and summary of evidence on burnout and anxiety in HCWs during previous global pandemics.

METHODS

A systematic search on electronic databases such as PubMed Central and MEDLINE was conducted to identify high-quality systematic review studies that reported on the prevalence of burnout and/or anxiety in HCWs during any previous global pandemic.

RESULTS

Twenty-four high quality systematic review articles were found to be suitable for inclusion. Twenty articles focused merely on Coronavirus disease 2019, while four articles examined multiple pandemics. Burnout was examined in nine articles, while anxiety was examined in the remaining 21 articles. Female HCWs and nurses were identified to be at a higher risk of developing burnout and anxiety during pandemic. We also observed a variation in the prevalence of burnouts and anxiety across different studies due to different mental health instruments were used in different studies.

CONCLUSION

Nurses and females HCWs had a high prevalence of burnout syndrome and anxiety during pandemic. More emphasis and attention should be paid to safeguarding the psychological well-being of these at-risk populations in the future pandemics.

Predictors of somatic symptom burden in healthcare professionals during the COVID-19 pandemic: an 8-week follow-up study

BACKGROUND

Literature investigating the impact of COVID-19 on healthcare professionals barely addresses predictors of somatic symptom burden during the COVID-19 pandemic.

AIMS

As biopsychosocial models propose that not only the disease but also sociodemographic and psychosocial factors contribute to the development and maintenance of symptoms, this study investigates the predictive value of these factors for bothersome somatic symptoms in SARS-CoV-2 negative healthcare professionals.

METHODS

German healthcare professionals were assessed with self-rating questionnaires and underwent SARS-CoV-2 IgG antibody tests at baseline and 8 weeks later between April and August 2020. Differences in psychosocial variables between the time points were analyzed and regression analyses were performed to predict somatic symptoms at follow-up.

RESULTS

1185 seronegative healthcare professionals completed both assessments. Previous somatic symptom burden, higher levels of anxiety, being a nurse, younger age, higher psychological symptom burden, lower efficiency, and higher fatigability at baseline predicted somatic symptom burden at follow-up. Comparisons between baseline and follow-up showed a significant improvement in psychological impairment and deterioration of physical exhaustion.

CONCLUSIONS

Our study applies a biopsychosocial perspective to bothersome somatic symptoms during the COVID-19 pandemic and contributes to the identification of potential risk factors as a starting point for future interventions that could support the handling of symptoms.

Enhancing the work engagement of frontline nurses during the COVID-19 pandemic: the mediating role of affective commitment and perceived organizational support

BACKGROUND

Overload and anxiety were common phenomena among frontline nurses during the pandemic. Understanding the potential pathway for fostering engagement in high-stress working conditions can provide evidence of targeted intervention to facilitate nurses' well-being and safety practices. This study aims to investigate the level of nurses' work engagement during nucleic acid collection tasks in the COVID-19 pandemic and identify its potential antecedents.

METHODS

A cross-sectional design was adopted. A sample of 824 nurses who engaged in nucleic acid collection tasks completed an online self-report questionnaire between 1 March and 31 May 2022. Descriptive and path analyses were utilized to analyse the interrelationships among anxiety, perceived workload, affective commitment, perceived organizational support and work engagement. This study was conducted and reported under the guidelines for Strengthening the Reporting of Observational Studies in Epidemiology.

RESULTS

The results showed that frontline nurses engaged in such tasks reported high levels of anxiety and task load and low levels of work engagement. Path analysis identified anxiety symptoms, perceived workload, perceived organizational support, and affective commitment as associated with work engagement, and among these factors, perceived organizational support and affective commitment played key roles in mediating the relationship of anxiety, workload and work engagement in high-stress working conditions.

CONCLUSIONS

Affective commitment and perceived organizational support were associated with frontline nurses' level of work engagement during the COVID-19 pandemic; these two variables might explain how engagement is generated in high-anxiety and high-workload situations. When healthcare organizations give more attention to frontline nurses' physical and psychological conditions and are able to innovatively motivate affective commitment and facilitate organizational support, nurses' work engagement in high-level tasks may increase, thus enhancing work safety and personal well-being.

Factors associated with suicide risk among Brazilian graduate students during the COVID-19 pandemic

Though pandemic-related suicides are a concern, little is known about factors potentially linking graduate student life and suicide risk. This study identified factors associated with suicide risk among Brazilian graduate students (N = 5,344) during the COVID-19 pandemic. Utilizing the Mini International Neuropsychiatric Interview, this study revealed that 31.5% of participants presented some risk for suicide: 16.6% "low risk," 4.7% "moderate risk," and 10.2% "high risk." Higher income and religious affiliation were identified as protective factors. Identified risk factors encompass non-heterosexual orientation, a history of depression or posttraumatic stress or common mental disorders diagnoses, the use of medications-both general and psychopharmaceuticals-without medical prescription, antipsychotics use, alcohol consumption, lack of health insurance, and dissatisfaction with life as a result of accessing social media networks. The high vulnerability of graduate students to suicide risk highlights the need for institutional suicide prevention initiatives.

Mental Health of Healthcare Workers During the Third Wave of the COVID-19 Pandemic: Did We Forget them after the First Wave?

Background

Since December 2019, countries experienced different numbers of COVID-19 pandemic waves. The COVID-19 pandemic led to adverse psychologic problems in the communities and among healthcare workers (HCWs), but the dynamic of these problems through different waves needs to be established more.

Materials and Methods

This cross-sectional study was conducted in October 2020, through the third wave of the COVID-19 pandemic, in Isfahan, Iran. We studied HCWs' depression, anxiety, and stress using Depression, Anxiety, Stress Scale-21 (DASS-21) and insomnia using Insomnia Severity Index (ISI) questionnaires. Multiple linear regression was used to evaluate the association of some characteristic factors with different psychologic symptoms.

Results

Our results showed that about 80% of HCWs had one or more psychological problems. The prevalence of depression, anxiety, stress, and insomnia was 46.0%, 50.2%, 44.6%, and 66.5%, respectively. Female sex, working in ICU, and having a history of chronic disease were predictors of psychological symptoms in our participants.

Conclusion

HCWs' mental health state could be underestimated or neglected. The third pandemic wave negatively affected the mental health of the HCWs. Since mental health problems of HCWs may reduce the quality of care, the potential impact of not addressing this issue should be highlighted.

Changes in hospital staff' mental health during the Covid‑19 pandemic: Longitudinal results from the international COPE-CORONA study

This longitudinal study aimed to explore anxiety and depressive symptoms, individual resources, and job demands in a multi-country sample of 612 healthcare workers (HCWs) during the COVID-19 pandemic. Two online surveys were distributed to HCWs in seven countries (Germany, Andorra, Ireland, Spain, Italy, Romania, Iran) during the first (May-October 2020, T1) and the second (February-April 2021, T2) phase of the pandemic, assessing sociodemographic characteristics, contact with COVID-19 patients, anxiety and depressive symptoms, self-compassion, sense of coherence, social support, risk perception, and health and safety at the workplace. HCWs reported a significant increase in depressive and anxiety symptoms. HCWs with high depressive or anxiety symptoms at T1 and T2 reported a history of mental illness and lower self-compassion and sense of coherence over time. Risk perception, self-compassion, sense of coherence, and social support were strong independent predictors of depressive and anxiety symptoms at T2, even after controlling for baseline depressive or anxiety symptoms and sociodemographic variables. These findings pointed out that HCWs during the COVID-19 outbreak experienced a high burden of psychological distress. The mental health and resilience of HCWs should be supported during disease outbreaks by instituting workplace interventions for psychological support.

Dentists' Stress During the COVID-19 Pandemic: A Repeated Cross-Sectional Study

OBJECTIVES

Although studies have revealed that dentists' mental health was initially affected by the COVID-19 pandemic, there are no reports on how this notion has evolved during the pandemic years. The aim of this study therefore was to compare Thai dentists' stress prevalence and levels due to the pandemic over a three period of the pandemic, 2020, 2021, and 2022. The associated risk and protective factors were also investigated.

METHODS

A questionnaire was distributed to Thai dentists via social media, that is, Facebook pages and Line groups, from April 24 through May 5, 2020, June 10 through 30, 2021, and April 10 through July 11, 2022. The Self-Administered Stress Evaluation Form-20 (SASEF-20) was used to evaluate the dentists' stress levels.

RESULTS

Higher stress levels and prevalence were found in 2021 and 2022 compared with 2020. Sex, age, religion, specialty, working status, and cash flow during the pandemic were identified as stress predictors.

CONCLUSION

The extended COVID-19 pandemic resulted in increased mental health deterioration. National and regional bodies overseeing dentists should be aware of vulnerable groups of dentists, such as younger dentists whose financial status might be unstable. Internet-based cognitive behavioural therapy may be a useful tool to reduce stress in this situation.

Sleep Quality and Its Relationship to Anxiety and Hardiness in a Cohort of Frontline Italian Nurses during the First Wave of the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has had a considerable impact on the psychological and psychopathological status of the population and health care workers in terms of insomnia, anxiety, depression, and post-traumatic stress disorder. The primary aim of this study was to describe and evaluate the impact of the pandemic on insomnia levels of a cohort of Italian nurses, particularly those involved in the care of COVID-19 patients. The secondary aim was to identify the interaction between insomnia and hardiness, anxiety, and sleep disturbances.

MATERIALS AND METHODS

A descriptive-exploratory study was conducted using an online survey during the first wave of the COVID-19 pandemic (March to July 2020). The questionnaire consisted of multiple-choice, open-ended, closed, and semi-closed questions. The psychometric tools administered were the Dispositional Resilience Scale (DRS-15), the State-Trait Anxiety Inventory (STAI-Y), and the Insomnia Severity Index (ISI).

RESULTS

a cohort of 1167 nurses fully completed the questionnaire (86.2% of total respondents). The insomnia scale survey showed an increase in post-pandemic scores compared to those before the pandemic, implying that insomnia levels increased after the first pandemic wave. Insomnia scores were directly correlated with anxiety levels (r = 0.571; p ≤ 0.05) and inversely correlated with hardiness levels (r = -0.324; p < 0.001). Multivariate analysis revealed the following protective factors: not having worked in COVID-19 wards, high levels of hardiness (commitment), and the presence of high pre-pandemic insomnia disorder. The main risk factor for insomnia reported in the analysis was a high anxiety score.

DISCUSSION AND CONCLUSION

Anxiety represented the main risk factor for insomnia severity in our sample, while hardiness was confirmed as a protective factor. Thus, it is necessary to design further studies to identify additional risk factors for poor sleep quality and to develop educational courses and strategies aimed at enhancing rest and sleep quality, especially for frontline nurses.

Work-life boundary management of peer support workers when engaging in virtual mental health support during the COVID-19 pandemic: a qualitative case study

BACKGROUND

Mental health care needs have increased since the COVID-19 pandemic was declared. Peer support workers (PSWs) and the organizations that employ them have strived to provide services to meet increasing needs. During pandemic lockdowns in Ontario, Canada, these services moved online and were provided by PSWs from their homes. There is paucity of research that examines how providing mental health support by employees working from home influences their work-life boundaries. This research closes the gap by examining experiences of work-life boundary challenges and boundary management strategies of PSWs.

METHODS

A qualitative case study approach was adopted. Interviews with PSWs who held formal, paid positions in a peer support organization were conducted. Data was analyzed thematically using both inductive and deductive approaches. Descriptive coding that closely utilized participants' words was followed by inferential coding that grouped related themes into conceptual categories informed by boundary theory. Member checking was conducted.

RESULTS

PSWs provided accounts of work-life boundary challenges that we grouped into three categories: temporal (work schedule encroachments, continuous online presence), physical (minimal workspace segregation, co-presence of household members and pets) and task-related (intersecting work-home activities). Strategies used by PSWs to manage the boundaries consisted of segmenting the work-life domains by creating separate timescapes, spaces and tasks; and integrating domains by allowing some permeability between the areas of work and life.

CONCLUSION

The findings from this study can help inform management, practices, future research and policy on health care workforce. The study highlights the need to attend to the consequences of greater work-life integration for mental health workers since their successful practice is largely dependent on maintaining self-care. Training regarding work-life boundary management is highlighted as one of the ways to approach situations where work from home is required.

Bariatric surgeons' experiences of working in the first year of the pandemic

Background

The first year of the Covid-19 pandemic saw drastic changes to bariatric surgical practice, including postponement of procedures, altered patient care and impacting on the role of bariatric surgeons. The consequences of this both personally and professionally amongst bariatric surgeons has not as yet been explored.

Aims

The aim of this research was to understand bariatric surgeons' perspectives of working during the first year of the pandemic to explore the self-reported personal and professional impact.

Methods

Using a retrospective, two phased, study design with global participants recruited from closed, bariatric surgical units. The first phase used a qualitative thematic analytic framework to identify salient areas of importance to surgeons. Themes informed the construction of an on-line, confidential survey to test the potential generalizability of the interview findings with a larger representative population from the global bariatric surgical community.

Findings

Findings of the study revealed that the first year of the pandemic had a detrimental effect on bariatric surgeons both personally and professionally globally.

Conclusion

This study has identified the need to build resilience of bariatric surgeons so that the practice of self-care and the encouragement of help-seeking behaviors can potentially be normalized, which will in turn increase levels of mental health and wellbeing.

Prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic: a systematic review and meta-analysis

OBJECTIVE

The COVID-19 pandemic has had a significant impact on the burnout and mental health of medical staff. This meta-analysis aims to provide additional (and updated) evidence related to burnout and mental health problems among medical staff using a broader data pool.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library, CNKI, Wanfang data and three preprint databases (SSRN, bioRxiv and medRxiv) were searched from 1 January 2020 to 17 May 2021.

ELIGIBILITY CRITERIA

We included observational studies investigating the prevalence of burnout and mental health problems among medical staff during the COVID-19 pandemic, including cross-sectional study, cohort study and case-control study.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used a self-designed form to extract the primary data. The Joanna Briggs Institute quality appraisal tool was used to assess the quality of selected studies. Heterogeneity among studies was assessed by I² statistic. A random-effects model was used to pool the prevalence. Subgroup analysis was performed to explore between-group differences.

RESULTS

250 studies were included, with a sample of 292 230 participants from 46 countries. The pooled prevalence of burnout, anxiety, depression, insomnia, stress, post-traumatic stress disorder symptoms and somatic symptoms was 43.6% (95% CI 36.3% to 51.2%), 37.1% (95% CI 34.7% to 39.7%), 37.6% (95% CI 35.0% to 40.4%), 43.7% (95% CI 39.1% to 48.5%), 41.3% (95% CI 35.1% to 47.9%), 30.6% (95% CI 23.6% to 38.5%) and 25.0% (95% CI 16.7% to 35.6%), respectively. Subgroup analysis showed a higher prevalence of anxiety, depression and insomnia in frontline workers than in non-frontline workers, and a higher prevalence of anxiety in females than males. Mild cases accounted for the most significant proportion of the outcomes except for stress.

CONCLUSIONS

This study highlights that identifying the risks of burnout and mental health problems and adopting preventive interventions are priorities for policymakers and medical staff to avoid long-term occupational, health and social impacts.

PROSPERO REGISTRATION NUMBER

CRD42021254425.

Correlation between COVID-19-related health anxiety and coping styles among frontline nurses

BACKGROUND

The long-term epidemic of COVID-19 and its recurrence has exposed frontline nurses to mental disorders such as stress and health anxiety. High levels of health anxiety associated with COVID-19 may lead to maladaptive behaviors. There is no agreement on which coping styles are most effective against stress. Therefore, more evidence is required to find better adaptive behaviors. The present study was conducted to investigate the correlation between the level of health anxiety and the type of coping strategies used by frontline nurses fighting COVID-19.

METHODS

This is a cross-sectional study that was performed on a convenience sample of 386 nurses who are working in the COVID department from October to December 2020, coinciding with the outbreak of the third COVID-19 peak in Iran. Data were collected through a demographic questionnaire, the short version of the health anxiety questionnaire, and coping inventory for stressful situations. Data were analyzed using independent T-test, U-Mann-Whitney, and Kruskal-Wallis statistical tests with SPSS version 23 software.

RESULTS

The mean score of nurses' health anxiety was 17.61 ± 9.26 which was more than the cut-off point for health anxiety and 59.1% of nurses had COVID-19-related health anxiety. The mean score of problem coping style (26.85 ± 5.19), was higher than emotion (18.48 ± 5.63) and avoidance (19.64 ± 5.88) coping styles and nurses mostly used problem-coping strategies to deal with anxiety caused by COVID-19. There was a positive significant correlation between the scores of health anxiety and emotion coping style (r = 0.54; P < 0.001).

CONCLUSION

Based on the findings of this study, COVID-19-related health anxiety was high in front-line nurses and those with high health anxiety were more likely to use emotion-based coping strategies, which are ineffective. Therefore, considering strategies to reduce nurses' health anxiety and holding training programs on effective coping methods in epidemic conditions are recommended.