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Palladini M, Mazza MG, Scalabrini A, Rovere Querini P, Poletti S, Benedetti F. The Burden of Survivorship: Survivor Guilt and Its Association with Psychiatric Sequelae in COVID-19 Patients. J Clin Med 2023; 12:jcm12093117. [PMID: 37176557 PMCID: PMC10178947 DOI: 10.3390/jcm12093117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 05/15/2023] Open
Abstract
COVID-19 survivors struggle with intense depressive and post-traumatic symptoms in sub-acute stages. Survivor guilt may affect post-acute psychopathology. Herein, we aim to unveil the potential affective mechanism underpinning post-COVID psychiatric implications by focusing on the association of survivor guilt with psychopathology and maladaptive attributional style. At one month after discharge, we evaluated symptoms of depression on The Zung Severity Rating Scale (ZSDS), post-traumatic distress on Impact of Event Scale-Revised (IES-R), and sleep disturbances on the Women's Health Initiative Insomnia Rating Scale (WHIIRS) in 195 COVID-19 survivors. Interpersonal Guilt Rating Scale (IGRS-15) rated survivor guilt. A discrepancy score between the burden of depression and post-traumatic distress symptoms was computed individually. Dysfunctional depressive attributions were assessed through the Cognition Questionnaire (CQ). Survivor guilt significantly predicts all evaluated psychopathological dimensions. Moreover, higher rates of survivor guilt were associated with an overlap between post-traumatic and depressive symptomatology, thus suggesting that survivor guilt equally sustains both psychiatric manifestations. Finally, survivor guilt fully mediated the relationship between dysfunctional depressive attributions and the discrepancy index. Our results confirm survivor guilt as a clinically relevant form of suffering related to psychopathological dimensions of post COVID-19 infection, gaining the status of a specific phenomenon and a promising treatment target.
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Affiliation(s)
- Mariagrazia Palladini
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, 20127 Milan, Italy
- PhD Program in Cognitive Neuroscience, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mario Gennaro Mazza
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, 20127 Milan, Italy
| | - Andrea Scalabrini
- Department of Human and Social Sciences, University of Bergamo, 24129 Bergamo, Italy
| | - Patrizia Rovere Querini
- Vita-Salute San Raffaele University, 20132 Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Sara Poletti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, 20127 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Francesco Benedetti
- Psychiatry & Clinical Psychobiology, Division of Neuroscience, IRCCS Scientific Institute Ospedale San Raffaele, 20127 Milan, Italy
- Vita-Salute San Raffaele University, 20132 Milan, Italy
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Moscou-Jackson G, Homme M, Day J. Non-Direct Care Nurses: Professional Identity and Role in the COVID-19 Pandemic. J Nurs Adm 2022; 52:211-216. [PMID: 35348485 DOI: 10.1097/nna.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND During times of need, hospital-based nurses in nonclinical jobs support organizations through a variety of roles. OBJECTIVE The aim of this study was to explore the experience of hospital-based nurses who did not provide direct patient care during the COVID-19 pandemic, focusing on role and professional identity. METHODS Seventeen nurses participated in individual semistructured interviews. RESULTS Participants filled a variety of pandemic-related roles as an extension of their job. Others were placed in roles that were different but perceived as professionally beneficial. Many did not question their professional identity as a "nurse," yet for a few, it was before they received a pandemic-related assignment. All appreciated having role choice and their skills recognized. CONCLUSION Nurses in nonclinical roles desire to be involved in responses to emergency events, but not as direct care providers. Involvement enables them to feel valuable despite nonclinical roles. During emergency events, nursing leaders should mobilize the talents of this workforce segment, offering role choice when feasible.
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Affiliation(s)
- Gyasi Moscou-Jackson
- Author Affiliations: Nurse Scientist (Dr Moscou-Jackson), Clinical Nurse II (Ms Homme), and Director of Nursing Research (Dr Day), University of Maryland Medical System, Baltimore
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Xue Y, Lopes J, Ritchie K, D'Alessandro AM, Banfield L, McCabe RE, Heber A, Lanius RA, McKinnon MC. Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review. Front Psychiatry 2022; 13:863232. [PMID: 35770054 PMCID: PMC9234401 DOI: 10.3389/fpsyt.2022.863232] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
Healthcare workers (HCWs) and public safety personnel (PSP) across the globe have continued to face ethically and morally challenging situations during the COVID-19 pandemic that increase their risk for the development of moral distress (MD) and moral injury (MI). To date, however, the global circumstances that confer risk for MD and MI in these cohorts have not been systematically explored, nor have the unique circumstances that may exist across countries been explored. Here, we sought to identify and compare, across the globe, potentially morally injurious or distressful events (PMIDEs) in HCWs and PSP during the COVID-19 pandemic. A scoping review was conducted to identify and synthesize global knowledge on PMIDEs in HCWs and select PSP. Six databases were searched, including MEDLINE, EMBASE, Web of Science, PsychInfo, CINAHL, and Global Health. A total of 1,412 articles were retrieved, of which 57 articles were included in this review. These articles collectively described the experiences of samples from 19 different countries, which were comprised almost exclusively of HCWs. Given the lack of PSP data, the following results should not be generalized to PSP populations without further research. Using qualitative content analysis, six themes describing circumstances associated with PMIDEs were identified: (1) Risk of contracting or transmitting COVID-19; (2) Inability to work on the frontlines; (3) Provision of suboptimal care; (4) Care prioritization and resource allocation; (5) Perceived lack of support and unfair treatment by their organization; and (6) Stigma, discrimination, and abuse. HCWs described a range of emotions related to these PMIDEs, including anxiety, fear, guilt, shame, burnout, anger, and helplessness. Most PMIDE themes appeared to be shared globally, particularly the 'Risk of contracting or transmitting COVID-19' and the 'Perceived lack of support and unfair treatment by their organization.' Articles included within the theme of 'Stigma, discrimination, and abuse' represented the smallest global distribution of all PMIDE themes. Overall, the present review provides insight into PMIDEs encountered by HCWs across the globe during COVID-19. Further research is required to differentiate the experience of PSP from HCWs, and to explore the impact of social and cultural factors on the experience of MD and MI.
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Affiliation(s)
- Yuanxin Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Jillian Lopes
- Psychology, Neuroscience and Behaviour Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Kimberly Ritchie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | | | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Alexandra Heber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Veterans Affairs Canada, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, ON, Canada.,Department of Psychiatry, Western University of Canada, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada.,St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Affiliation(s)
- David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, Division of Geriatrics, David Geffen School of Medicine at University of California, Los Angeles
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Affiliation(s)
- Henry S Kahn
- Emory University School of Medicine, Atlanta, Georgia
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Affiliation(s)
- Kurt Kroenke
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
- Regenstrief Institute, Inc., Room 221, 1101 W. 10th Street, Indianapolis, IN, 46202, USA.
| | - Matthew J Bair
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Regenstrief Institute, Inc., Room 221, 1101 W. 10th Street, Indianapolis, IN, 46202, USA
- VA HSR&D Center for Health Information and Communication, Roudebush VAMC, Indianapolis, USA
| | - Greg A Sachs
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Regenstrief Institute, Inc., Room 221, 1101 W. 10th Street, Indianapolis, IN, 46202, USA
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Butler CR, Wong SPY, Vig EK, Neely CS, O'Hare AM. Professional roles and relationships during the COVID-19 pandemic: a qualitative study among US clinicians. BMJ Open 2021; 11:e047782. [PMID: 33766845 PMCID: PMC7995668 DOI: 10.1136/bmjopen-2020-047782] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic has transformed healthcare delivery in the USA, but there has been little empirical work describing the impact of these changes on clinicians. We conducted a study to address the following question: how has the pandemic impacted US clinicians' professional roles and relationships? DESIGN Inductive thematic analysis of semi-structured interviews. SETTING Clinical settings across the USA in April and May of 2020. PARTICIPANTS Clinicians with leadership and/or clinical roles during the COVID-19 pandemic. MEASURES Emergent themes related to professional roles and relationships. RESULTS Sixty-one clinicians participated in semi-structured interviews. Study participants were practising in 15 states across the USA, and the majority were White physicians from large academic centres. Three overlapping and inter-related themes emerged from qualitative analysis of interview transcripts: (1) disruption: boundaries between work and home life became blurred and professional identity and usual clinical roles were upended; (2) constructive adaptation: some clinicians were able to find new meaning in their work and described a spirit of collaboration, shared goals, open communication and mutual respect among colleagues; and (3) discord and estrangement: other clinicians felt alienated from their clinical roles and experienced demoralising work environments marked by division, value conflicts and mistrust. CONCLUSIONS Clinicians encountered marked disruption of their professional roles, identities and relationships during the pandemic to which they and their colleagues responded in a range of different ways. Some described a spirit of collaboration and camaraderie, while others felt alienated by their new roles and experienced work environments marked by division, value conflicts and mistrust. Our findings highlight the importance of effective teamwork and efforts to support clinician well-being during the COVID-19 pandemic.
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Affiliation(s)
- Catherine R Butler
- Department of Medicine, Division of Nephrology and the Kidney Research Institute, University of Washington, Seattle, Washington, USA
- Department of Hospital and Specialty Medicine, Nephrology Section and Health Services Research & Development, Seattle-Denver Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Susan P Y Wong
- Department of Medicine, Division of Nephrology and the Kidney Research Institute, University of Washington, Seattle, Washington, USA
- Department of Hospital and Specialty Medicine, Nephrology Section and Health Services Research & Development, Seattle-Denver Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Elizabeth K Vig
- Department of Hospital and Specialty Medicine, Geriatrics and Extended Care Section, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Claire S Neely
- Institute for Clinical Systems Improvement, Bloomington, Minnesota, USA
| | - Ann M O'Hare
- Department of Medicine, Division of Nephrology and the Kidney Research Institute, University of Washington, Seattle, Washington, USA
- Department of Hospital and Specialty Medicine, Nephrology Section and Health Services Research & Development, Seattle-Denver Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
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