Mental health symptoms in a cohort of hospital healthcare workers following the first peak of the COVID-19 pandemic in the UK

AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation

BACKGROUND

The impact that the COVID-19 pandemic has had on health care workers' mental health, in particular, cannot be ignored. Not only did the pandemic exacerbate mental health challenges through elevated stress, anxiety, risk of infection, and social isolation, but regulations to minimize infection additionally hindered the conduct of traditional in-person mental health care.

OBJECTIVE

This study explores the feasibility of using Wysa, an artificial intelligence-led mental health app, among health care workers.

METHODS

A national tertiary health care cluster in Singapore piloted the use of Wysa among its own health care workers to support the management of their mental well-being during the pandemic (July 2020-June 2022). The adoption of this digital mental health intervention circumvented the limitations of in-person contact and enabled large-scale access to evidence-based care. Rates and patterns of user engagement were evaluated.

RESULTS

Overall, the opportunity to use Wysa was well-received. Out of the 527 staff who were onboarded in the app, 80.1% (422/527) completed a minimum of 2 sessions. On average, users completed 10.9 sessions over 3.80 weeks. The interventions most used were for sleep and anxiety, with a strong repeat-use rate. In this sample, 46.2% (73/158) of health care workers reported symptoms of anxiety (Generalized Anxiety Disorder Assessment-7 [GAD-7]), and 15.2% (24/158) were likely to have symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]).

CONCLUSIONS

Based on the present findings, Wysa appears to strongly engage those with none to moderate symptoms of anxiety. This evaluation demonstrates the viability of implementing Wysa as a standard practice among this sample of health care workers, which may support the use of similar digital interventions across other communities.

Depression and anxiety among nurses during the COVID-19 pandemic: Longitudinal results over 2 years from the multicentre VOICE-EgePan study

AIMS

To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population.

BACKGROUND

The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain.

DESIGN

A multicentre prospective longitudinal study.

METHODS

Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April-July 2020, T2: November 2020-January 2021, T3: May-July 2021, T4: February-May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined.

RESULTS

Throughout the study (T1-T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4).

CONCLUSION

During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health.

RELEVANCE TO CLINICAL PRACTICE

The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals.

IMPLICATIONS FOR THE PROFESSION

Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems.

REPORTING METHOD

The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method.

PATIENT CONTRIBUTION

Five hundred and seven nurses completed the questionnaire and provided data for analysis.

TRIAL AND PROTOCOL REGISTRATION

The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.

Differential impact of COVID-19 on mental health and burnout

BACKGROUND

There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles.

AIMS

To examine mental health and burnout rates, and possible drivers for any disparities between professional roles.

METHODS

In this cohort study, online surveys were distributed to HCPs in July-September 2020 (baseline) and re-sent 4 months later (follow-up; December 2020) assessing for probable major depressive disorder (MDD), generalized anxiety disorder (GAD), insomnia, mental well-being and burnout (emotional exhaustion and depersonalization). Separate logistic regression models (at both phases) compared the risk of outcomes between roles: healthcare assistants (HCAs), nurses and midwives (nurses), allied health professionals (AHPs) and doctors (reference group). Separate linear regression models were also developed relating the change in scores to professional role.

RESULTS

At baseline (n = 1537), nurses had a 1.9-fold and 2.5-fold increased risk of MDD and insomnia, respectively. AHPs had a 1.7-fold and 1.4-fold increased risk of MDD and emotional exhaustion, respectively. At follow-up (n = 736), the disproportionate risk between doctors and others worsened: nurses and HCAs were at 3.7-fold and 3.6-fold increased risk of insomnia, respectively. Nurses also had a significantly increased risk of MDD, GAD, poor mental well-being and burnout. Nurses also had significantly worsened anxiety, mental well-being and burnout scores over time, relative to doctors.

CONCLUSIONS

Nurses and AHPs had excess risk of adverse mental health and burnout during the pandemic, and this difference worsened over time (in nurses especially). Our findings support adoption of targeted strategies accounting for different HCP roles.

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems.

METHODS

Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale.

RESULTS

A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder.

CONCLUSIONS

The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

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.

Understanding Moral Injury in Frontline Health Care Professionals 2 Years After the Onset of COVID-19

ABSTRACT

Throughout the COVID-19 pandemic, health care professionals have worked in morally challenging situations. The aim of this research was to investigate the predictors of moral injury in United Kingdom frontline health care professionals working in a variety of roles 2 years after the onset of the pandemic. A cross-sectional survey was conducted January 25-February 28, 2022. A total of 235 participants answered sociodemographic, employment, health, COVID-19-related questions, and the 10-item Moral Injury Symptom Scale-Healthcare Professional version. Nearly three quarters had experienced moral injury. Twelve significant predictors of moral injury were entered into a backward elimination binominal logistic regression. The final model included five independent predictors that explained 25.4% variance in moral injury (χ 2 [5, N = 235] = 45.7, p < 0.001). Odds of moral injury were significantly raised in young health care professionals (<31 years), smokers, and those reporting low workplace confidence, not feeling appreciated, and feeling burned out. The findings support interventions to relieve moral injury in frontline health care professionals.

Initial response to SARS-CoV-2 (COVID-19) outbreak in Sri Lanka; views of public health specialists through an International Health Regulations lens

The COVID-19 pandemic affected Sri Lanka despite having developed an International Health Regulations (IHR) steering committee in 2016 and a national action plan for health security following the Joint External Evaluation in 2018. Many steps were taken to improve the disaster management skills of healthcare workers even before the COVID-19 outbreak. We interviewed seven public health specialists to obtain their views on the country's response to the pandemic. A thematic analysis was conducted, leading to the emergence of three major themes and seven subthemes. The major themes included health security preparedness; COVID-19 management; and effects of COVID-19. The subthemes were; preparedness prior to pandemic and gaps in the preparedness (under health security preparedness); dual burden for the curative sector, strategies to reduce transmission and barriers to managing COVID-19 (under COVID-19 management) and negative and positive effects of COVID-19 (under effects of COVID-19). When COVID-19 reached Sri Lanka, healthcare workers, border control authorities and those involved with infectious disease control were overwhelmed by the magnitude of the pandemic. Healthcare workers' hesitation to work amidst the pandemic due to fear of infection and possible transmission of infection to their families was a major issue; the demand for personal protective equipment by health workers when stocks were low was also a contributory factor. Lockdowns with curfew and quarantine at government regulated centers were implemented as necessary. Perceptions of the public including permitting healthcare workers to perform field public health services, logistical barriers and lack of human resources were a few of the barriers that were expressed. Some persons did not declare their symptoms, fearing that they would have to be quarantined. The pandemic severely affected the economy and Sri Lanka relied on donations and loans to overcome the situation. Pandemic also brought about innovative methods to maintain and upgrade health service provision. Individuals with non-communicable diseases received their regular medications through the post which reduced their risk of being infected by visiting hospitals. Improvement of laboratory services and quarantine services, a reduction of acute respiratory infections and diarrhoeal diseases, improved intersectoral coordination and public philanthropic response were other positive effects.

Risk factors of developing psychological problems among frontline healthcare professionals working in the COVID-19 pandemic era: a meta-analysis

BACKGROUND

This study sought to evaluate the risk factors behind developing psychological problems as per specific mental health assessment instruments. This study focuses specifically on frontline healthcare professionals of the COVID-19 pandemic era, and evaluated the psychological assessment of frontline healthcare professionals.

METHODS

Studies reporting on the psychological assessment of frontline healthcare professionals were retrieved from the PubMed, Embase, Web of Science, Ovid, EBSCO, and Cochrane Library databases. The recommended method was used to assess the risk of bias of the included studies. The random-effects method was applied when significant heterogeneity was observed.

RESULTS

The combined results from the 20 included articles indicated that frontline healthcare professionals had a higher risk of developing anxiety in comparison with non-frontline healthcare workers, with similar levels of depression scoring were observed. Healthcare providers aged > 40 years had a lower probability of developing anxiety and seemed to experience minimal depression. Conversely, frontline workers had a higher incidence of anxiety than that of depression. Being single (not in a relationship) could influence the PHQ-9 scores instead of those concerning the GAD-7. The gender gap was not proven to be significantly wide between healthcare professionals with or without anxiety; however, being male was proven to be positively correlated with depression.

CONCLUSION

In general, the risk factors for susceptibility to psychological problems among frontline healthcare professionals during the COVID-19 pandemic concerned those of a lower age, being single, being male, and being engage in frontline healthcare work.

Frontline Health Care Workers' Mental Health and Well-Being During the First Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data

BACKGROUND

The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being.

OBJECTIVE

This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels).

METHODS

We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs' mental health during the first year of the COVID-19 pandemic.

RESULTS

The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW's coping strategies; negative mental health effects; organizational support; social network and support; and public and government support.

CONCLUSIONS

These findings demonstrate the need for open conversations, where staff's well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW's well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers.

Mental health burden for NHS healthcare staff during the COVID-19 pandemic: First results of a longitudinal survey

Background

The current investigation aimed to assess the mental health burden on healthcare workers during the early stages of the COVID-19 pandemic.

Methods

A link to an online survey was sent to an estimate of 18,100 employees of Sheffield Teaching Hospitals NHS Foundation Trust (STH) who had access to email. The survey was completed between 2nd and June 12, 2020.1390 healthcare workers (medical, nursing, administrative and other professions) participated in the first survey. Data from a general population sample (n = 2025) was used for comparison. Severity of somatic symptoms was measured by the PHQ-15. Severity and probable diagnosis of depression, anxiety, and PTSD were measured by the PHQ-9, GAD-7, and ITQ. Linear and logistic regressions were performed to determine if population group predicted the severity of mental health outcomes, and probable diagnosis of depression, anxiety, and PTSD. Additionally, ANCOVAs were performed to compare mental health outcomes between occupational roles in HCWs. Analysis was performed using SPSS.

Findings

Healthcare workers are more likely to experience greater severity of somatic symptoms, as well as severity and probable diagnosis of depression and anxiety, compared to the general population, but not increased traumatic stress symptoms. Scientific and technical, nursing and admin staff were more likely to experience worse mental health outcomes, compared to medical staff.

Interpretation

The COVID-19 pandemic has led to increased mental health burden in some, but not all healthcare workers during the first acute phase of the pandemic. The findings from the current investigation provide valuable insights into which healthcare workers are particularly vulnerable to developing adverse mental health outcomes during and after a pandemic.

The Impact of COVID-19 Pandemic First Wave on Healthcare Workers: A New Perspective from Qualifying PTSD Criterion A to Assessing Post-Traumatic Growth

Post-traumatic growth (PTG) and specific traumatic events have been poorly explored in the literature focusing on post-traumatic stress disorder (PTSD) among healthcare workers (HWs) tackling the COVID-19 pandemic. In a large sample of Italian HWs, we investigated the kinds of traumatic events and whether PTG affects the risk of PTSD, along with its prevalence and features, during the first COVID-19 wave. COVID-19-related stressful events, Impact of Event Scale-Revised (IES-R) and PTG Inventory-Short Form (PTGI-SF) scores were collected through an online survey. Out of 930 HWs included in the final sample, 257 (27.6%) received a provisional PTSD diagnosis based on IES-R scores. Events referring to the overall pandemic (40%) and to a threat to a family member (31%) were reported as the most stressful events. Female sex, previous mental disorders, job seniority, unusual exposure to sufferance and experiencing a threat to one's family significantly increased the provisional PTSD diagnosis' risk, while being a physician, the availability of personal protective equipment and moderate/greater scores on the PTGI-SF spiritual change domain were found to be protective factors.

Mental Health of Healthcare Professionals: Two Years of the COVID-19 Pandemic in Portugal

The COVID-19 pandemic increased psychosocial risk factors among healthcare professionals (HCPs). Objective: To characterize Portuguese HCPs mental health (MH), estimate anxiety, depression, post-traumatic stress disorder (PTSD) and burnout symptoms, and identify risk/protective factors. A cross-sectional online survey and a longitudinal assessment were conducted in 2020 (T0) and 2021 (T1). Sociodemographic and occupational variables, COVID-19-related experiences and protective behavior data were collected from a non-probabilistic sample of HCPs in Portugal. Symptoms of anxiety, depression, PTSD, burnout and resilience were assessed using the Portuguese versions of the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-9), the Post-traumatic Stress Disorder Checklist (PCL-5), the Shirom-Melamed Burnout Measure (MBSM) and the Connor-Davidson Resilience Scale (CD-RISC-10), respectively. Risk and protective factors were identified through simple and multiple logistic regression models. Overall, 2027 participants answered the survey in T0 and 1843 in T1. The percentage of moderate-to-severe symptoms decreased from T0 to T1; however, a considerable proportion of HCPs reported symptoms of distress in both years. Being a woman, working in a COVID-19-treatment frontline position and work-life balance increased the odds of distress. High resilience, good social/family support, and hobbies/lifestyle maintenance were found to be protective factors. Globally, our results show that performing as a HCP during the pandemic may result in long-term effects on MH.

Perceived workplace support and mental health, well-being and burnout among health care professionals during the COVID-19 pandemic: a cohort analysis

BACKGROUND

Little is known about the relationship between workplace support and mental health and burnout among health care professionals (HCPs) during the COVID-19 pandemic. In this cohort study, we sought to evaluate the association between perceived level of (and changes to) workplace support and mental health and burnout among HCPs, and to identify what constitutes perceived effective workplace support.

METHODS

Online surveys at baseline (July-September 2020) and follow-up 4 months later assessed the presence of generalized anxiety disorder (using the 7-item Generalized Anxiety Disorder scale [GAD-7]), clinical insomnia, major depressive disorder (using the 9-item Patient Health Questionnaire), burnout (emotional exhaustion and depersonalization) and mental well-being (using the Short Warwick-Edinburgh Mental Wellbeing Score). Both surveys assessed self-reported level of workplace support (single-item Likert scale). For baseline and follow-up, independently, we developed separate logistic regression models to evaluate the association of the level of workplace support (tricohotomized as unsupported, neither supported nor unsupported and supported) with mental health and burnout. We also developed linear regression models to evaluate the association between the change in perceived level of workplace support and the change in mental health scores from baseline and follow-up. We used thematic analyses on free-text entries of the baseline survey to evaluate what constitutes effective support.

RESULTS

At baseline (n = 1422) and follow-up (n = 681), HCPs who felt supported had reduced risk of anxiety, depression, clinical insomnia, emotional exhaustion and depersonalization, compared with those who felt unsupported. Among those who responded to both surveys (n = 681), improved perceived level of workplace support over time was associated with significantly improved scores on measures of anxiety (adjusted β -0.13, 95% confidence interval [CI] -0.25 to -0.01), depression (adjusted β -0.17, 95% CI -0.29 to -0.04) and mental well-being (adjusted β 0.19, 95% CI 0.10 to 0.29), independent of baseline level of support. We identified 5 themes constituting effective workplace support, namely concern or understanding for welfare, information, tangible qualities of the workplace, leadership and peer support.

INTERPRETATION

We found a significant association between perceived level of (and changes in) workplace support and mental health and burnout of HCPs, and identified potential themes that constitute perceived workplace support. Collectively, these findings can inform changes in guidance and national policies to improve mental health and burnout among HCPs. Trial registration: ClinicalTrials.gov, no. NCT04433260.

High Prevalence of Post-Traumatic Stress Disorder and Psychological Distress Among Healthcare Workers in COVID-19 Field Hospitals: A Cross-Sectional Study from Vietnam

Objective

To evaluate the prevalence of post-traumatic stress disorder (PTSD) and other psychological disturbances in the Vietnamese healthcare workers (HCWs) at COVID-19 field hospitals.

Methods

A cross-sectional study was conducted using the Impact of Event Scale-Revised (IES-R) to measure PTSD and the Depression Anxiety Stress scale (DASS) to measure other psychological disturbances. The anxiety about COVID-19 was evaluated by the fear of COVID-19 (FOC) scale. A self-developed questionnaire was used to assess work conditions and HCW's major concerns and preparedness. Ordinal logistic regression was used to identify factors associated with the severity of PTSD. A structural modeling equation (SEM) model was fitted to examine the correlation between PTSD and other psychological disturbances.

Results

A total of 542 HCWs participated in this study. The prevalence of PTSD was 21.2%, most cases were mild. In the ordinal logistic regression analysis, a history of mental illness, poor preparedness, working in a condition with poor resources, a greater number of concerns, and greater fear of COVID-19 were independently associated with higher severity of PTSD. The prevalence of depression, anxiety, and stress was 46.8%, 38.3%, and 60.2, respectively. In the SEM model, PTSD and psychological disturbances had a strong correlation (standardized covariance 0.86).

Conclusion

The prevalence of PTSD and other psychological disturbances was alarmingly high among HCWs who worked at COVID-19 field hospitals. The reported associated factors can be useful for policymakers and health authorities in the preparation for future pandemics.

Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study

BACKGROUND

Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews.

METHODS

We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD.

FINDINGS

The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1).

INTERPRETATION

The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention.

FUNDING

UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.

Major depressive episode in hospital workers during the Covid-19 pandemic in Brazil

OBJECTIVES

To estimate prevalence and factors associated with major depressive episode (MDE), emphasizing occupational aspects, in workers of a public teaching hospital that is a reference for Covid-19 treatment.

METHODS

A cross-sectional study was carried out between October and December 2020, after the first peak of the pandemic, interviewing 1,155 workers. The prevalence of MDE was estimated using the Patient Health Questionnaire (PHQ-9) algorithm. Multivariate hierarchical analysis was conducted using Poisson regression to assess associated factors.

RESULTS

MDE prevalence was 15.3% (95%CI: 13.3-17.5) and was higher among young, white and female workers, those with a family history of depression, resident professionals, nursing professionals, workers who were exposed to three or more situations of moral dilemma, and those who had to put off a physiological need until later. Having a risk factor for Covid-19, being a smoker and being physically inactive were also positively associated with MDE.

CONCLUSIONS

The study points to the considerable prevalence of MDE among tertiary health care workers; reviewing work processes is essential to reduce occupational stress and minimize the effects of the pandemic on mental health, preventing those problems from becoming chronic.

Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

The SARS-CoV-2 (COVID-19) pandemic has increased healthcare worker (HCW) susceptibility to mental illness. We conducted a meta-analysis to investigate the prevalence and possible factors associated with post-traumatic stress disorder (PTSD) symptoms among HCW during the COVID-19 pandemic. We searched PubMed, SCOPUS and EMBASE databases up to May 4th, 2022. We performed random effects meta-analysis and moderator analyses for the prevalence of PTSD-relevant symptoms and severe PTSD symptoms. We identified 1276 studies, reviewed 209 full-text articles, and included 119 studies (117,143 participants) with a total of 121 data points in our final analysis. 34 studies (24,541 participants) reported prevalence of severe PTSD symptoms. Approximately 25.2% of participants were physicians, 42.8% nurses, 12.4% allied health professionals, 8.9% auxiliary health professionals, and 10.8% "other". The pooled prevalence of PTSD symptoms among HCWs was 34% (95% CI, 0.30-0.39, I² >90%), and 14% for severe PTSD (95% CI, 0.11 - 0.17, I² >90%). The introduction of COVID vaccines was associated with a sharp decline in the prevalence of PTSD, and new virus variants were associated with small increases in PTSD rates. It is important that policies work towards allocating adequate resources towards protecting the well-being of healthcare workers to minimize adverse consequences of PTSD.

Capturing the experiences of UK healthcare workers during the COVID-19 pandemic: A structural topic modelling analysis of 7,412 free-text survey responses

BACKGROUND

Healthcare workers (HCWs) have provided vital services during the COVID-19 pandemic, but existing research consists of quantitative surveys (lacking in depth or context) or qualitative interviews (with limited generalisability). Structural Topic Modelling (STM) of large-scale free-text survey data offers a way of capturing the perspectives of a wide range of HCWs in their own words about their experiences of the pandemic.

METHODS

In an online survey distributed to all staff at 18 geographically dispersed NHS Trusts, we asked respondents, "Is there anything else you think we should know about your experiences of the COVID-19 pandemic?". We used STM on 7,412 responses to identify topics, and thematic analysis on the resultant topics and text excerpts.

RESULTS

We identified 33 topics, grouped into two domains, each containing four themes. Our findings emphasise: the deleterious effect of increased workloads, lack of PPE, inconsistent advice/guidance, and lack of autonomy; differing experiences of home working as negative/positive; and the benefits of supportive leadership and peers in ameliorating challenges. Themes varied by demographics and time: discussion of home working decreasing over time, while discussion of workplace challenges increased. Discussion of mental health was lowest between September-November 2020, between the first and second waves of COVID-19 in the UK.

DISCUSSION

Our findings represent the most salient experiences of HCWs through the pandemic. STM enabled statistical examination of how the qualitative themes raised differed according to participant characteristics. This relatively underutilised methodology in healthcare research can provide more nuanced, yet generalisable, evidence than that available via surveys or small interview studies, and should be used in future research.

Emotional Burden among Pharmacists and Pharmacy Technicians during the COVID-19 Lockdown: A Cross Sectional Study

This study aims to investigate the prevalence of depression and anxiety symptoms among Spanish community pharmacists and pharmacy technicians during the coronavirus disease 2019 (COVID-19) lockdown. A descriptive cross-sectional quantitative study was designed. An online survey was administered to participants from 4 to 21 April 2020 using a questionnaire assessing sociodemographic information and the Spanish version of the Hospital Anxiety and Depression Scale (HADS). Informed consent to participate was requested. Participants comprised 1162 pharmacy staff from Spain with an average age of 39.15 ± 9.718, from 20 to 65 years old, of whom 83% were women, and 50.6% were married. More than half of the participants expressed symptoms of depression (62.7%) and anxiety (70.9%). An important prevalence of anxiety and depression symptoms has been detected among Spanish pharmacists and pharmacy technicians during the COVID-19 lockdown. Being a woman, smoking, feeling fear, feeling stress and believing that pharmacists/pharmacy technicians are very exposed to COVID-19 seem to be associated with higher HADS scores.

Human Factors and Airway Management in COVID-19 Patients: The Perfect Storm?

The SARS-CoV-2 pandemic heavily impacted healthcare workers, increasing their physical and psychological workload. Specifically, COVID-19 patients’ airway management is definitely a challenging task regarding both severe and acute respiratory failure and the risk of contagion while performing aerosol-generating procedures. The category of anesthesiologists and intensivists, the main actors of airway management, showed a poor psychological well-being and a high stress and burnout risk. Identifying and better defining the specific main SARS-CoV-2-related stressors can help them deal with and effectively plan a strategy to manage these patients in a more confident and safer way. In this review, we therefore try to analyze the relevance of human factors and non-technical skills when approaching COVID-19 patients. Lessons from the past, such as National Audit Project 4 recommendations, have taught us that safe airway management should be based on preoperative assessment, the planning of an adequate strategy, the optimization of setting and resources and the rigorous evaluation of the scenario. Despite, or thanks to, the critical issues and difficulties, the “take home lesson” that we can translate from SARS-CoV-2 to every airway management is that there can be no more room for improvisation and that creating teamwork must become a priority.

Sustained Negative Mental Health Outcomes Among Healthcare Workers Over the First Year of the COVID-19 Pandemic: A Prospective Cohort Study

Objective: To characterize the evolution of healthcare workers' mental health status over the 1-year period following the initial COVID-19 pandemic outbreak and to examine baseline characteristics associated with resolution or persistence of mental health problems over time. Methods: We conducted an 8-month follow-up cohort study. Eligible participants were healthcare workers working in Spain. Baseline data were collected during the initial pandemic outbreak. Survey-based self-reported measures included COVID-19-related exposures, sociodemographic characteristics, and three mental health outcomes (psychological distress, depression symptoms, and posttraumatic stress disorder symptoms). We examined three longitudinal trajectories in mental health outcomes between baseline and follow-up assessments (namely asymptomatic/stable, recovering, and persistently symptomatic/worsening). Results: We recruited 1,807 participants. Between baseline and follow-up assessments, the proportion of respondents screening positive for psychological distress and probable depression decreased, respectively, from 74% to 56% and from 28% to 21%. Two-thirds remained asymptomatic/stable in terms of depression symptoms and 56% remained symptomatic or worsened over time in terms of psychological distress. Conclusion: Poor mental health outcomes among healthcare workers persisted over time. Occupational programs and mental health strategies should be put in place.

The mental health of staff working on intensive care units over the COVID-19 winter surge of 2020 in England: a cross sectional survey

BACKGROUND

The COVID-19 pandemic generated a surge of critically ill patients greater than the capacity of the UK National Health Service (NHS). There have been multiple well-documented impacts associated with the national COVID-19 pandemic surge on ICU staff, including an increased prevalence of mental health disorders on a scale potentially sufficient to impair high-quality care delivery. We investigated the prevalence of five mental health outcomes; explored demographic and professional predictors of poor mental health outcomes; and describe the prevalence of functional impairment; and explore demographic and professional predictors of functional impairment in ICU staff over the 2020/2021 winter COVID-19 surge in England.

METHODS

English ICU staff were surveyed before, during, and after the winter 2020/2021 surge using a survey which comprised validated measures of mental health.

RESULTS

A total of 6080 surveys were completed, by ICU nurses (57.5%), doctors (27.9%), and other healthcare staff (14.5%). Reporting probable mental health disorders increased from 51% (before) to 64% (during), and then decreased to 46% (after). Younger, less experienced nursing staff were most likely to report probable mental health disorders. During and after the winter, >50% of participants met threshold criteria for functional impairment. Staff who reported probable post-traumatic stress disorder, anxiety, or depression were more likely to meet threshold criteria for functional impairment.

CONCLUSIONS

The winter of 2020/2021 was associated with an increase in poor mental health outcomes and functional impairment amongst ICU staff during a period of peak caseload. These effects are likely to impact on patient care outcomes and the longer-term resilience of the healthcare workforce.

Influencing factors of high PTSD among medical staff during COVID-19: evidences from both meta-analysis and subgroup analysis

Background

PTSD (Post-traumatic stress disorder, PTSD) had a great impact on health care workers during the COVID-19 (Corona Virus Disease 2019, COVID-19). Better knowledge of the prevalence of PTSD and its risk factors is a major public health problem. This study was conducted to assess the prevalence and important risk factors of PTSD among medical staff during the COVID-19.

Methods

The databases were searched for studies published during the COVID-19, and a PRISMA (preferred reporting items for systematic review and meta-analysis) compliant systematic review (PROSPERO-CRD 42021278970) was carried out to identify articles from multiple databases reporting the prevalence of PTSD outcomes among medical staff. Proportion random effect analysis, I² statistic, quality assessment, subgroup analysis, and sensitivity analysis were carried out.

Results

A total of 28 cross-sectional studies and the PTSD results of doctors and nurses were summarized from 14 and 27 studies: the prevalences were 31% (95% CI [confidence interval, CI]: 21%–40%) and 38% (95% CI: 30%–45%) in doctors and nurses, respectively. The results also showed seven risks (p < 0.05): long working hours, isolation wards, COVID-19 symptoms, nurses, women, fear of infection, and pre-existing mental illness. Two factors were of borderline significance: higher professional titles and married.

Conclusion

Health care workers have a higher prevalence of PTSD during COVID-19. Health departments should provide targeted preventive measures for medical staff away from PTSD.

Living with COVID-19: emotions and health during the pandemic

BACKGROUND

COVID-19 has led and still leads all nations to adopt virus containment plans, considering possible strategies that help to live with the virus. The present study aimed to investigate the practical, psychological and emotional aspects of living with COVID-19.

PARTICIPANTS AND PROCEDURE

A total of 250 young adults (86% female), who lived in north-western Italy, took part in an online photovoice study, in respect of social distancing. They participated in a group discussion following the method SHOWeD. The researchers analyzed the photographs along with comments and transcripts from the SHOWeD group discussions using the triangulation process of visual and textual data. The collected data were analyzed on the basis of grounded theory, with the support of the NVivo 12 software.

RESULTS

From the analysis of the emotions concerning the psychological health of participants, 4 categories were identified. The results reveal benefits and emotional aspects that have stimulated the increase of individual and community empowerment. COVID-19 has led and still leads all nations to adopt virus containment plans, considering possible strategies that help to live with the virus.

CONCLUSIONS

From the analysis of the results it emerged how the online photovoice was a tool that allowed on the one hand the sharing of experiences and emotions related to living with COVID-19 and on the other hand to maintain social ties despite physical distance.

Healthcare workers use of psychological support resources during COVID-19; a mixed methods approach utilising Pillar Integration Analysis

Objectives

We sought to examine healthcare workers (HCWs) utilisation of formal and informal psychological support resources in the workplace during the first and third waves of the COVID-19 pandemic in Ireland.

Methods

A convergent mixed methods approach was undertaken. Four hundred and thirty HCWs in the Mid West and South of Ireland responded to an online survey in terms of their use of psychological support resources during Wave 1 (April/May 2020) of COVID-19. Thirty-nine HCWs undertook in depth interviews at Wave 3 (January/February 2021), and a further quantitative survey was distributed and completed by 278 HCWs at this time. Quantitative data arising at Wave 1 and Wave 3, were synthesised with Qualitative data collected at Wave 3. A Pillar Integration Process (PIP) was utilised in the analysis of the quantitative and qualitative data.

Results

Five pillars were identified from the integration of results. These were: a) the primacy of peer support, b) the importance of psychologically informed management, c) a need to develop the organisational well-being ethos, d) support for all HCWs, and e) HCWs ideas for developing the well-being path. These pillars encapsulated a strong emphasis on collegial support, an emphasis on the need to support managers, a questioning of the current supports provided within the healthcare organisations and critical reflections on what HCWs viewed as most helpful for their future support needs.

Conclusions

HCWs who utilised supportive resources indicated ‘in house’ supports, primarily collegial resources, were the most frequently used and perceived as most helpful. While formal psychological supports were important, the mechanism by which such psychological support is made available, through utilising peer support structures and moving towards psychologically informed supervisors and workplaces is likely to be more sustainable and perceived more positively by HCWs.

The impact of the COVID-19 pandemic on pediatric developmental services: a cross-sectional study on overall burden and mental health status

BACKGROUND

The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health.

METHODS

This cross-sectional web-based study was part of a large multicenter VOICE study conducted among employees ((neuro-)pediatricians, psychologists, speech therapists, occupational therapists, etc.) from various pediatric developmental services between June and July 2020. A total of 1291 questionnaires regarding overall burden, mental health status (depression, generalized anxiety disorder and emotional exhaustion) and risk and protective factors for mental health (working conditions, potential problems during the COVID-19 pandemic and psychological resources) were analyzed. Descriptive statistics and multiple linear regression were used for data analysis.

RESULTS

A total of 44.5% (574/1291) participants felt a high or very high overall burden during the COVID-19 pandemic. Of all the participants, 14.6% (171/1173) reported clinically significant levels of depressive symptoms, 17.0% (199/1173) reported generalized anxiety disorder symptoms and 44.6% (532/1192) reported emotional exhaustion. Multiple linear regression analyses identified several common risk and protective factors for mental health status variables. The burden of an increase in the quantity of work, fear of work and fear of becoming infected showed the strongest negative associations, whereas psychological resources and sufficient relaxation in leisure time exhibited the strongest positive associations.

CONCLUSION

Employees who were not directly involved in the care of acutely ill patients were also exposed to considerable stress, some of which was not different from that experienced by professionals who were directly affected. These employees should not be lost sight of and must be offered appropriate support.

The role of social support and resilience in the mental health impact of the COVID-19 pandemic among healthcare workers in Spain

BACKGROUND

Healthcare workers (HCWs) from COVID-19 pandemic hotspots across the globe have reported mental health problems, including anxiety, depression, or sleep problems. Many studies have focused on identifying modifiable risk factors, such as being afraid of getting infected or reporting shortage of personal protective equipment, but none have explored the role of protective factors.

METHOD

This cross-sectional study used an online survey to describe the association between three potentially protective factors (self-reported resilience, self-perceived social support from colleagues at work, and self-perceived social support from relatives and friends) and three mental health outcomes, namely psychological distress, depression symptoms, and death thoughts in a large sample of Spanish HCWs during the first wave of the COVID-19 pandemic.

RESULTS

We recruited 2372 respondents between April 26th and June 22nd, 2020. Resilience and self-perceived social support were inversely associated with mental health problems (psychological distress, depression symptoms, and death thoughts), after adjusting for potential sources of confounding.

CONCLUSIONS

Resilience and self-perceived social support might protect HCWs against negative mental health outcomes. Public health strategies targeting these modifiable determinants might help to reduce the impact of the pandemic on HCWs' mental health.

Assessment of post-traumatic stress disorder symptoms during COVID-19 pandemic among medical students

Introduction and Aim: Post traumatic stress disorder is known to be a usual response to distressing experiences. Common symptoms include recurrent events of anxiousness, emotional insensibility and escape mechanism. The COVID-19 pandemic is one such recent occasion that is likely to have an enormous psychological impact on medical student based on extreme social restrictions worldwide. This study therefore aims to investigate the post pandemic PTSD symptoms among first year medical students . Materials and Methods: Department of Physiology, Lord Buddha Koshi Medical College, Saharsa, conducted this observational study for a period of four months starting from September 2020 to December 2020. One hundred and forty-six students completed the most advanced Impact Event Scale -Revised (IES-R) questionnaire. Student’s t-test was performed to analyze the strength of association between PTSD symptoms among the participants.   Results: The study concurs high level of PTSD between age-matched medical students after the occurrence of COVID-19 pandemic. The IES-R method of PTSD scoring system was used to arrive at this conclusion. However, this area of research requires multi-centric results to verify the outcome measures.   Conclusion: Post pandemic PTSD symptoms were high among the first year medical students.

Approach of an Academic Ophthalmology Department to Recovery During the Coronavirus Pandemic

Introduction

A methodology for safe recovery of an ophthalmology department during a pandemic does not currently exist. This study describes successful recovery strategies for an urban, multi-specialty ophthalmology department serving a high-risk patient population.

Methods

The study took place at a large multi-specialty tertiary care academic ophthalmology department in a metropolitan city during a seven-month period (March–October 2020). Five recovery ad hoc committees were charged with formulating metrics and initiatives to manage clinical volumes while maintaining safe practices, providing patient access, and minimizing financial damage. A six-tier system was created to resume non-urgent appointments in May 2020. Educational and research activities were maintained through the development of virtual curricula and research platforms.

Results

The number of clinical and surgical visits per month in 2020 compared to 2019 and the time to reach ≥95% of pre-COVID patient volumes were monitored. In October 2020, ≥95% of pre-COVID volumes were attained (11,975 vs 12,337 patient visits in October 2019; 266 vs 272 surgical cases in October 2019). Despite significant financial losses, the department surpassed December 2019 collections in December 2020. No faculty, staff, or trainees received furloughs or pay cuts. There was no COVID-19 transmission between faculty, staff, and patients.

Discussion

With strategic implementation of recovery strategies following CDC safety measures, it was possible to safely deliver care to patients with urgent and non-urgent eye conditions. Patient volumes were fully recovered in an ambulatory urban healthcare setting within a high-risk COVID-19 population within seven months while educational and research missions were successfully sustained.

Guilt, tears and burnout—Impact of UK care home restrictions on the mental well‐being of staff, families and residents

Aims

The aim of this study was to explore the impact of the pandemic on the emotional and mental well‐being of family carers, care home staff and residents, in light of changing restrictions, increased testing and vaccination rollout in the UK.

Design

Longitudinal, qualitative semi‐structured interview study.

Methods

Remote semi‐structured interviews were conducted with family carers of care home residents with dementia and care home staff from different care homes across the UK. Baseline and follow‐up interviews were conducted in October/November 2020 and March 2021, respectively. Data were analysed using inductive thematic analysis involving members of the public with caring experiences.

Results

In all, 42 family carers and care home staff participated at baseline, with 20 family carers and staff followed up. We identified four themes: (1) Developing anger and frustration; (2) Impact on relationships; (3) Stress and burnout; and (4) Behavioural changes, and perceived impact on residents. The mental health of everyone involved, including family carers, care home staff and residents, has been negatively affected, and relationships between family carers and staff have been severely strained. There was a general lack of adequate mental health support, with little relief.

Conclusions

The pandemic has had a detrimental impact on the lives of those surrounding care homes—from residents and staff to family carers. Consideration should be given on how to best support the mental health needs of all three groups, by providing adequate easily accessible mental health care for all. This should also focus on rebuilding the relationships between family carers and care home staff.

Impact

This is the first paper to highlight the effects of the long‐lasting and miscommunicated restrictions on residents, carers and care home staff, and highlight the urgent need for continued mental health support.

PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak

Background:

Increasing evidence highlights the susceptibility of Healthcare Workers to develop psychopathological sequelae, including Post-Traumatic Stress Disorder (PTSD) and depression, in the current COronaVIrus Disease-19 (COVID-19) pandemic, but little data have been reported in the acute phase of the pandemic.

Objective:

To explore Healthcare Workers’ mental health reactions in the acute phase of the COVID-19 pandemic in the first European epicenter (Lodi/Codogno, Italy), with particular attention to post-traumatic stress and depressive symptoms and their interplay with other psychological outcomes.

Methods:

74 Healthcare Workers employed at the Azienda Socio Sanitaria Territoriale of Lodi (Lombardy, Italy) were recruited and assessed by means of the Impact of Event Scale- Revised, the Professional Quality of Life Scale-5, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 item, the Resilience Scale and the Work and Social Adjustment Scale. Socio-demographic and clinical variables were compared across three subgroups of the sample (No PTSD, PTSD only, PTSD and depression).

Results:

A total of 31% of subjects endorsed a diagnosis of PTSD and 28.4% reported PTSD comorbid with major depression. Females were more prone to develop post-traumatic stress and depressive symptoms. Subjects with PTSD and depression groups showed high levels of PTSD, depression, burnout and impairment in functioning. Anxiety symptoms were higher in both PTSD and depression and PTSD groups rather than in the No PTSD group.

Conclusion:

Our results showed high rates of PTSD and depression among Healthcare Workers and their comorbidity overall being associated with worse outcomes. Current findings suggest that interventions to prevent and treat psychological implications among Healthcare Workers facing infectious outbreaks are needed.

Anxiety Linked to COVID-19: A Systematic Review Comparing Anxiety Rates in Different Populations

The COVID-19 pandemic has incited a rise in anxiety, with uncertainty regarding the specific impacts and risk factors across multiple populations. A qualitative systematic review was conducted to investigate the prevalence and associations of anxiety in different sample populations in relation to the COVID-19 pandemic. Four databases were utilised in the search (Medline, EMBASE, CINAHL, and PsycINFO). The review period commenced in April 2021 and was finalised on 5 July 2021. A total of 3537 studies were identified of which 87 were included in the review (sample size: 755,180). Healthcare workers had the highest prevalence of anxiety (36%), followed by university students (34.7%), the general population (34%), teachers (27.2%), parents (23.3%), pregnant women (19.5%), and police (8.79%). Risk factors such as being female, having pre-existing mental conditions, lower socioeconomic status, increased exposure to infection, and being younger all contributed to worsened anxiety. The review included studies published before July 2021; due to the ongoing nature of the COVID-19 pandemic, this may have excluded relevant papers. Restriction to only English papers and a sample size > 1000 may have also limited the range of papers included. These findings identify groups who are most vulnerable to developing anxiety in a pandemic and what specific risk factors are most common across multiple populations.

Narrative review of the COVID-19, healthcare and healthcarers thematic series

This review covers the thematic series of 22 papers selected from among manuscripts published by BJPsych Open concerning coronavirus disease 2019 (COVID-19) and healthcare. We report nine papers that cover concepts and epidemiology relating to the public and patients. We review 11 papers about the impact of COVID-19 on healthcare services and their staff in 15 countries. Two papers consider the psychosocial impact on staff working in mental health services in the UK. Most papers report cross-sectional analyses of data collected from convenience samples by self-reported surveys conducted at single times. They have limitations of generalisability, do not enable conclusions about diagnosis or causality, and many are likely to have attendant bias and noise. BJPsych Open published these papers to meet requirements for early indications of the mental health impact of COVID-19 on the public and on healthcare staff. They claim high prevalence of symptoms of anxiety, depression and post-traumatic stress. We contrast these findings with selected reports of studies with different methodologies published elsewhere. We emphasise the need for longitudinal clinical studies with refined sampling and methodological rigour. We identify several longitudinal research programmes; two in this series. We advocate tuning advice offered about caring for the public and healthcare staff to the realities of their circumstances and their perceptions of need in the context of findings from further longitudinal studies. We draw attention to the importance of the social, relationship and environmental circumstances of the public and healthcare staff in order to understand their distress and their risks of developing mental health disorders.

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

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.

Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey

PURPOSE

The COVID-19 pandemic affects mental health and sleep, resulting in frequent nightmares. Therefore, identifying factors associated with nightmare frequency is important, as it can indicate mental health issues. The study aimed to investigate increases in nightmare frequency comparing the pre-pandemic and pandemic period, and identify its risk factors. Further, the mediating role of post-traumatic stress disorder symptoms between the pandemic and nightmares is explored.

PATIENTS AND METHODS

For this cross-sectional survey data were obtained via self-rating online survey (ICOSS: details in Partinen et al, 2021), which was open to anyone older than 18 years. The final volunteer sample consisted of 15,292 participants, divided according to their nightmare frequency (high: ≥1-2 nights/week; low: <1-2 nights/week). A total of 9100 participants were excluded if answers on variables of interest were missing or receiving rewards for participation. Chi-square tests identified changes of nightmare frequency. Predictors of high nightmare frequency were assessed using logistic regression and presented as Odds Ratios. Post-hoc mediation models were used to investigate the role of post-traumatic stress symptoms (PTSS).

RESULTS

The mean age was 41.63 (SD=16.55) with 64.05% females. High nightmare frequency increased significantly from 13.24% to 22.35% during the pandemic. Factors associated with it included self-reported PTSS (OR=2.11), other mental disorders and various sleep disorders or problems. Financial burden due to the pandemic, confinement, having had COVID-19, and work situation during the pandemic were associated with nightmare frequency, those relations were partly mediated through PTSS.

CONCLUSION

Our results display the pandemic influence on nightmare frequency, which in turn connects to multiple mental health and sleep factors. These relations were partly mediated through PTSS. The COVID-19 pandemic appears to have caused traumatization of a substantial proportion of society. Health care workers should consider nightmares in their screening routines, as it might indicate PTSS and/or other mental and sleep disorders.

Stress, anxiety, depression and burnout in frontline healthcare workers during two peaks of COVID-19 pandemic in Russia

PURPOSE

In this study we aimed to assess the range of psychopathological symptoms (anxiety, stress, depression, burnout) and risk factors in frontline HCWs during spring and autumn outbreaks of the new coronavirus infection in Russian Federation.

METHODS

We conducted two independent, cross-sectional hospital-based online surveys. Data of 2195 HCWs were collected between May 19th and May 26th 2020 and between October 10th and October 17th 2020. Stress, anxiety, depression, burnout and perceived stress were assessed using the Russian versions of SAVE-9 and GAD-7, PHQ-9, MBI and PSS-10 scales. Logistic regression analysis was performed to determine the influence of different variables.

RESULTS

The study revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7%,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The rate of anxiety was higher in October 2020 compared with May 2020. Revealed risk factors included: female gender, younger age, being a physician, working for over a week, living outside of Moscow or Saint Petersburg, being vaccinated against COVID-19.

CONCLUSION

These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups and its increasing importance over time.

The experience of diagnostic radiography students during the early stages of the COVID-19 pandemic - a cross-sectional study

INTRODUCTION

The rationale for this study was to ascertain the impact of the COVID-19 pandemic on Undergraduate B.Sc (Hons) Diagnostic Radiography students at the University of Hertfordshire in the UK. This would provide an ideal opportunity for students to reflect on their experience and indicate if they required additional support from the University.

METHODS

An online anonymous cross-sectional survey was deployed to all year groups (n = 283) during the first nationwide lockdown in May 2020, eliciting qualitative responses on questions about the effect of the pandemic; emotions experienced; support required and consideration of their choice of a career in the health sector.

RESULTS

Two hundred and one students responded to the survey, with many having experienced the illness or loss of a loved one. Trying to balance family commitments and study was a concern to some students, as well as struggling with the financial burden of job losses or furlough. Many students commented that educational support was a requirement with the move to online teaching and assessment. The main focus of student responses was the emotions that they had experienced, many of which were negative. Anxiety and fear were commonly expressed feelings, along with sadness and feelings of isolation. A small number of students reported feeling grateful, happy and relieved. An overwhelming majority of respondents commented that they were proud to be healthcare students and they were resolute in wanting to continue the course and join the frontline of the NHS workforce.

CONCLUSION

Some students have been deeply affected by their experiences of the pandemic, and University support mechanisms should be refined to better assist with their ongoing challenges.

Prevalence and predictors of burnout among nurses during COVID-19: a cross-sectional study in hospitals in central Uganda

OBJECTIVE

To determine the prevalence of burnout and associated factors among nurses during COVID-19 in central Uganda.

DESIGN

A cross-sectional design.

SETTING

Nurse from one referral and four general hospitals. These were reception centres and cared for patients with COVID-19 in central Uganda.

PARTICIPANTS

395 nurses.

MAIN OUTCOME MEASURES

Burnout scores.

RESULTS

Of the total 395 participants, 65.1% (n=257) were female; 40% (n=158) had a diploma; 47.1% (n=186) were single; and 39.2% (n=155) had worked for 11-15 years. The results show that 40% (n=158), 41.77% (n=165) and 18.23% (n=77) reported high, average and low levels of burnout, respectively. The results show that the predictors of nurses' burnout were personal protective equipment (PPE) (OR: 7.1, 95% CI 4.08 to 12.31) and increased workload (OR 4.3, 95% CI 2.43 to 7.93).

CONCLUSION

This study of nurses working in hospitals dealing with patients with COVID-19 in central Uganda reported high rates of burnout, and it was associated with PPE and workload. Interventions like contracting new nurses to reduce workload, the WHO guidelines on PPE, adjusting working hours and ensuring hours of effective rest should be adapted.

The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH): protocol for a prospective longitudinal cohort study of healthcare and ancillary workers in UK healthcare settings

INTRODUCTION

The COVID-19 pandemic has resulted in significant morbidity and mortality and devastated economies globally. Among groups at increased risk are healthcare workers (HCWs) and ethnic minority groups. Emerging evidence suggests that HCWs from ethnic minority groups are at increased risk of adverse COVID-19-related outcomes. To date, there has been no large-scale analysis of these risks in UK HCWs or ancillary workers in healthcare settings, stratified by ethnicity or occupation, and adjusted for confounders. This paper reports the protocol for a prospective longitudinal questionnaire study of UK HCWs, as part of the UK-REACH programme (The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers).

METHODS AND ANALYSIS

A baseline questionnaire will be administered to a national cohort of UK HCWs and ancillary workers in healthcare settings, and those registered with UK healthcare regulators, with follow-up questionnaires administered at 4 and 8 months. With consent, questionnaire data will be linked to health records with 25-year follow-up. Univariate associations between ethnicity and clinical COVID-19 outcomes, physical and mental health, and key confounders/explanatory variables will be tested. Multivariable analyses will test for associations between ethnicity and key outcomes adjusted for the confounder/explanatory variables. We will model changes over time by ethnic group, facilitating understanding of absolute and relative risks in different ethnic groups, and generalisability of findings.

ETHICS AND DISSEMINATION

The study is approved by Health Research Authority (reference 20/HRA/4718), and carries minimal risk. We aim to manage the small risk of participant distress about questions on sensitive topics by clearly participant information that the questionnaire covers sensitive topics and there is no obligation to answer these or any other questions, and by providing support organisation links. Results will be disseminated with reports to Government and papers submitted to pre-print servers and peer reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN11811602; Pre-results.

Prevalence of SARS-CoV-2 IgG antibodies in health care workers at a tertiary care academic medical center - An assessment of occupational infection risk

Background

The purpose of this study was to assess the occupational SARS-CoV-2 infection risk among health care workers (HCW) at University of Kentucky HealthCare (UKHC) by evaluating the prevalence of SARS-CoV-2 antibodies.

Methods

This is a prospective cohort study of HCW at UKHC. SARS-CoV-2 IgG antibody seropositivity was measured in a CLIA-certified laboratory utilizing the Abbott Architect SARS-CoV-2 IgG antibody assay. Demographics and work type were self-reported by study participants via an emailed survey.

Results

The overall antibody positivity rate of HCW was 1.55% (5/322; 95% confidence interval: 0.65%-3.71%) at cohort entry. There were no differences in antibody positivity between those that worked directly with SARS-CoV-2 infected patients and those that did not. The antibody rate of positivity of patients during the same time period was similar, 1.8% (9/499; 95% confidence interval 0.94%-3.45%).

Conclusions

Antibody positivity was low and similar between HCW and patients tested during a similar time period. HCW positivity rates did not appear to be impacted by caring for known SARS-CoV-2 infected patients suggesting that appropriate use of personal protective equipment is effective in protecting individuals from transmission.

The perceived global impact of the COVID-19 pandemic on doctors' medical and surgical training: An international survey

INTRODUCTION

The COVID-19 pandemic has resulted in a significant burden on healthcare systems causing disruption to the medical and surgical training of doctors globally.

AIMS AND OBJECTIVES

This is the first international survey assessing the perceived impact of the COVID-19 pandemic on the training of doctors of all grades and specialties.

METHODS

An online global survey was disseminated using Survey Monkey^® between 4th August 2020 and 17th November 2020. A global network of collaborators facilitated participant recruitment. Data were collated anonymously with informed consent and analysed using univariate and adjusted multivariable analyses.

RESULTS

Seven hundred and forty-three doctors of median age 27 (IQR: 25-30) were included with the majority (56.8%, n = 422) being male. Two-thirds of doctors were in a training post (66.5%, n = 494), 52.9% (n = 393) in a surgical specialty and 53.0% (n = 394) in low- and middle-income countries. Sixty-nine point two percent (n = 514) reported an overall perceived negative impact of the COVID-19 pandemic on their training. A significant decline was noted amongst non-virtual teaching methods such as face-to-face lectures, tutorials, ward-based teaching, theatre sessions, conferences, simulation sessions and morbidity and mortality meetings (P ≤ .05). Low or middle-income country doctors' training was associated with perceived inadequate supervision while performing invasive procedures under general, local or regional anaesthetic. (P ≤ .05).

CONCLUSION

In addition to the detrimental impact of the COVID-19 pandemic on healthcare infrastructure, this international survey reports a widespread perceived overall negative impact on medical and surgical doctors' training globally. Ongoing adaptation and innovation will be required to enhance the approach to doctors' training and learning in order to ultimately improve patient care.

Mental Health Outcomes Among British Healthcare Workers-Lessons From the First Wave of the Covid-19 Pandemic

OBJECTIVE

To ascertain the level of psychological distress, using validated psychology tools, among British National healthcare workers (HCW) during the first wave of the Covid-19 crisis.

METHODS

A multi-centre, anonymized, all-comer staff survey across 3 hospitals in Lancashire, England during the Covid-19 first wave (April to June 2020), consisting of Patient Health Questionnaire (PHQ-9), Perceived Stress Scale-10 (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), and Impact of Events Scale (IES-6).

RESULTS

Among 1113 HCW, median (IQR) PHQ-9, GAD-7, PSS-10, and IES-6 score was 7 (3 to 11), 6 (3 to 11), 19 (13 to 24), and 9 (5 to 14), respectively. Potential predictors of higher levels of psychological distress included living alone, disabled dependents, history of depression/anxiety, and being female.

CONCLUSIONS

The study indicates a high prevalence of psychological distress during the acute Covid-19 period among HCW, identifies groups at risk and areas of future research.

Post-Traumatic Stress and Coping Strategies of South African Nurses during the Second Wave of the COVID-19 Pandemic

Prior to the 2019 novel coronavirus (COVID-19) outbreak, the South African healthcare system was already under severe strain due to amongst others, a lack of human resources, poor governance and management, and an unequal distribution of resources among provinces and between the public and private healthcare sectors. At the center of these challenges are nurses, the backbone of the healthcare system, and the first point of call for most patients in the country. This research investigated post-traumatic stress and coping strategies of nurses during the second wave of COVID-19 in the country. A structured self-administered questionnaire captured the biographic characteristics, perceived risk factors for COVID-19, and views on infection control of 286 nurses Data were subjected to descriptive and binomial logistic regression analyses. More than four in every 10 nurses screened positive for higher levels of post-traumatic disorder (PTSD). Self-reported risk for contracting COVID-19 mainly centered on being a health worker and patients’ non-adherence to infection prevention guidelines. Unpreparedness to manage COVID-19 patients, poorer health, and avoidant coping were associated with PTSD. Nurses voiced a need for emotional support and empathy from managers. Emotional, psychological, and debriefing intervention sessions that focus on positive coping strategies to actively address stress are recommended.

Impact of the coronavirus disease 2019 pandemic on healthcare workers: systematic comparison between nurses and medical doctors

PURPOSE OF REVIEW

The COVID-19 outbreak has had major impact on individual's psychological health and overall well being worldwide. Evidence shows that these psychological challenges are especially prominent in healthcare workers (HCW); especially in nurses. Indeed, several studies report that nurses suffer more psychologically because of the consequences of the pandemic compared with medical doctors. To further look into this, we systematically review the recent literature to see whether the psychological impact of the COVID-19 pandemic differs between medical doctors and nurses across studies and which aspects of mental health are especially affected in nurses.

RECENT FINDINGS

Across studies, there is solid evidence that nurses show poorer mental health outcomes compared with medical doctors during the COVID-19 pandemic. This is especially true for symptoms of depression, anxiety and posttraumatic stress disorder (PTSD). Here, prevalence rates in nurses are often higher than 50%. In contrast, general stress levels and burnout seem to be comparable between nurses and medical doctors.

SUMMARY

Given that nurses suffer more from depression, anxiety and PTSD symptoms during the COVID-19 pandemic, special programs addressing their needs are required.

The Impact of COVID-19 Restrictions on Mental Well-Being and Working Life among Faroese Employees

The societal changes caused by COVID-19 have been far-reaching, causing challenges for employees around the world. The aim of this study was to assess the effect of the COVID-19 restrictions on mental well-being, working life, family life and social life among Faroese employees within a broad range of professions. A total of 1328 Faroese employees answered an anonymous self-report survey from 13 April to 4 May 2020. Employee mental well-being was only modestly affected by the restrictions and the respondents had a mean score of 50.7 on the Warwick-Edinburgh Mental Wellbeing Scale where a score between 41-44 is found to correspond with possible depression. Work commitment, work and family life, work satisfaction and work ability were all rated significantly worse after the COVID-19 outbreak than before (all p values < 0.005). Contrary to previous research, employees in health services assessed their work ability significantly higher than employees in teaching, and child and youth care (p < 0.05). Working parents had higher levels of stress and assessed their work ability significantly lower than employees without children (p < 0.05), and women tended to be more worried than men because of the pandemic. In conclusion, the overall mental well-being of Faroese employees was on an average level during lock-down in April and May 2020. Their working life seemed, however, to be worse than usual.

Tired, Worried and Burned Out, but Still Resilient: A Cross-Sectional Study of Mental Health Workers in the UK during the COVID-19 Pandemic

The burden of the COVID-19 pandemic on health systems and the physical and mental health of healthcare workers (HCWs) has been substantial. This cross-sectional study aims to assess the effects of COVID-19 on the psychological wellbeing of mental health workers who provide care to a vulnerable patient population that have been particularly affected during this crisis. A total of 387 HCWs from across a large urban mental health service completed a self-administered questionnaire consisting of socio-demographic, lifestyle and work-based information and validated psychometric scales. Depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively; sleep problems with the Athens Insomnia Scale (AIS); burnout with the Maslach Burnout Inventory (MBI); and resilience with the Resilience Scale-14 (RS-14). Multivariable logistic regression analysis was performed to determine potential mediating factors. Prevalence of burnout was notable, with 52% recording moderate/severe in Emotional Exhaustion, 19.5% moderate/severe in Depersonalisation, and 55.5% low/moderate Personal Accomplishment. Over half of all respondents (52%) experienced sleep problems; the presence of depressive symptoms was a significant predictor of insomnia. An increase in potentially harmful lifestyle changes, such as smoking, alcohol consumption and overeating was also observed. However, high Resilience was reported by 70% of the samples and the importance of this is highlighted. Female gender was associated with increased levels of depression and emotional exhaustion while those with a history of mental health conditions were most at risk of affective symptoms, insomnia, and burnout. Overall, our study revealed considerable levels of psychological distress and maladaptive coping strategies but also resilience and satisfaction with organizational support provided. Findings can inform tailored interventions in order to mitigate vulnerability and prevent long-term psychological sequelae.

Levels and Predictors of Anxiety, Depression, and Burnout Syndrome in Physicians During the COVID-19 Pandemic

This study intended to observe mental symptoms among physicians in Turkey during the COVID-19 pandemic and to investigate the factors leading to such symptoms. The study participants were contacted via their smartphones between April 23 and 27, 2020, and invited to fill out an online questionnaire which included questions from the Hospital Anxiety and Depression Scale (HADS) and the Maslach Burnout Inventory (MBI). The mean age of the 406 physicians who participated in the study was 42.9 ± 10.1 years, and 53.4% were men (n: 217). During the pandemic, 66.7% had decreased working hours. Lack of COVID-related training, difficulty obtaining personal protective equipment (PPE), working in a COVID unit, and current psychiatric disease were found to be among the predictors of emotional burnout. Female gender, lack of COVID training, difficulty obtaining PPE, working in a COVID unit, and current psychiatric disease predicted desensitization. Facilitating continuous and comprehensive support mechanisms aimed at protecting physicians’ mental health is of great importance during epidemics.

Experiences of mental health professionals supporting front-line health and social care workers during COVID-19: qualitative study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is having a well-documented impact on the mental health of front-line health and social care workers (HSCWs). However, little attention has been paid to the experiences of, and impact on, the mental health professionals who were rapidly tasked with supporting them.

AIMS

We set out to redress this gap by qualitatively exploring UK mental health professionals' experiences, views and needs while working to support the well-being of front-line HSCWs during the COVID-19 pandemic.

METHOD

Mental health professionals working in roles supporting front-line HSCWs were recruited purposively and interviewed remotely. Transcripts of the interviews were analysed by the research team following the principles of reflexive thematic analysis.

RESULTS

We completed interviews with 28 mental health professionals from varied professional backgrounds, career stages and settings across the UK. Mental health professionals were motivated and driven to develop new clinical pathways to support HSCWs they perceived as colleagues and many experienced professional growth. However, this also came at some costs, as they took on additional responsibilities and increased workloads, were anxious and uncertain about how best to support this workforce and tended to neglect their own health and well-being. Many were professionally isolated and were affected vicariously by the traumas and moral injuries that healthcare workers talked about in sessions.

CONCLUSIONS

This research highlights the urgent need to consider the mental well-being, training and support of mental health professionals who are supporting front-line workers.

Prevalence of stress, depression, anxiety and sleep disturbance among nurses during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The new coronavirus disease's (COVID-19) high risk of infection can increase the workload of healthcare workers, especially nurses, as they are most of the healthcare workforce. These problems can lead to psychological problems. Therefore, the aim of this systematic review and meta-analysis to ascertain the present impact of the COVID-19 outbreak on the prevalence of stress, anxiety, depression and sleep disturbance among nurses.

METHODS

A systematic review and meta-analysis were conducted. The following databases were searched: PubMed, CHINAL, MEDLINE, EMBASE, PsycINFO, MedRxiv and Google Scholar, from January 2020 up to 26th October 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics.

RESULTS

A total of 93 studies (n = 93,112), published between January 2020 and September 2020, met the inclusion criteria. The overall prevalence of stress was assessed in 40 studies which accounted for 43% (95% CI 37-49). The pooled prevalence of anxiety was 37% (95% CI 32-41) in 73 studies. Depression was assessed in 62 studies, with a pooled prevalence of 35% (95% CI 31-39). Finally, 18 studies assessed sleep disturbance and the pooled prevalence was 43% (95% CI 36-50).

CONCLUSION

This meta-analysis found that approximately one third of nurses working during the COVID-19 epidemic were suffering from psychological symptoms. This highlights the importance of providing comprehensive support strategies to reduce the psychological impact of the COVID-19 outbreak among nurses under pandemic conditions. Further longitudinal study is needed to distinguish of psychological symptoms during and after the infectious disease outbreaks.