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Stress, Burnout and Depression in Women in Healthcare during COVID-19 Pandemic: Rapid Scoping Review
Abstract
Objectives The overall objectives of this rapid scoping review are to (a) synthesize the common triggers of stress, burnout, and depression faced by women in health care during the COVID-19 pandemic, and (b) identify individual-, organizational-, and systems-level interventions that can support the well-being of women HCWs during a pandemic.
Design This scoping review is registered on Open Science Framework (OSF) and was guided by the JBI guide to scoping reviews and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping reviews. A systematic search of literature databases (Medline, EMBASE, CINAHL, PsycInfo and ERIC) was conducted from 2003 until June 12, 2020. Two reviewers independently assessed full-text articles according to predefined criteria.
Interventions We included review articles and primary studies that reported on stress, burnout, and depression in HCWs; that primarily focused on women; and that included the percentage or number of women included. All English language studies from any geographical setting where COVID-19 has affected the population were reviewed.
Primary and secondary outcome measures Studies reporting on mental health outcomes (e.g., stress, burnout, and depression in HCWs), interventions to support mental health well-being were included.
Results Of the 2,803 papers found, 31 were included. The triggers of stress, burnout and depression are grouped under individual-, organizational-, and systems-level factors. There is a limited amount of evidence on effective interventions that prevents anxiety, stress, burnout and depression during a pandemic.
Conclusions Our preliminary findings show that women HCWs are at increased risk for stress, burnout, and depression during the COVID-19 pandemic. These negative outcomes are triggered by individual level factors such as lack of social support; family status; organizational factors such as access to personal protective equipment or high workload; and systems-level factors such as prevalence of COVID-19, rapidly changing public health guidelines, and a lack of recognition at work.
Keywords
Coronavirus, COVID-19, women in health care, stress, burnout, depression
... After the pilot, two research team members (R1, R2) will screen all titles and abstracts independently (Hartling et al., 2017;Lunny et al., 2021). If the two reviewers disagree, a third reviewer will resolve the discrepancy (R3) (Lunny et al., 2021;Sriharan et al., 2020). Only the studies that meet or potentially meet the inclusion criteria will be considered for the next phase. ...
... The reviewers will develop descriptive thematic summaries (Lunny et al., 2021;Sriharan et al., 2020;Wollscheid & Tripney, 2021). The research team will ensure that the limitations and biases Canadian Perspectives on Academic Integrity (2023), Vol 5, Iss 2 Peer-reviewed Article https: //doi.org/10.11575/cpai.75990 ...
This paper presents a protocol with methodological considerations for a rapid scoping review of academic integrity and artificial intelligence in higher education. This protocol follows Joanna Brigg Institute's (JBI) updated manual for scoping reviews and the Preferred Reporting Items for Systematic reviews Meta-Analysis (PRISMA) reporting standards. This rapid scoping review aims to identify the breadth of the literature reflecting the intersection of academic integrity and artificial intelligence in higher education institutions. The included studies in the review will be analyzed for insight concerning this emerging area, particularly its ethical implications. Our findings will be relevant for academic staff, administration, and leadership in higher education and academic integrity researchers.
... These results . Higher levels of stress and burnout among female participants could be due to several reasons such as little or no support from family, limited access to PPE kits, increased workload, and longer duration of work (Sriharan et al., 2020). Although women make up 75% of the healthcare workers, during the pandemic they had lesser access to personal protection equipment as compared to men. ...
During the COVID-19 pandemic, doctors and other healthcare workers are at a significantly greater risk of contracting the virus than almost anyone else. They have been jeopardizing their lives ever since this pandemic began and they have greater chances of infection and passing on the virus to their families and loved ones. Female doctors run a higher chance of showing symptoms of stress, burnout, and anxiety during the COVID-19 pandemic as they often have a dual role in running the house and fulfilling their professional duties. This study aims to assess the level of anxiety, burnout, and stress, and to see if there was any difference in their levels between male and female doctors working in Delhi-NCR during the COVID-19 pandemic. The total sample comprised 108 doctors (M=54 F=54) in the age range of 30-50 years. Beck Anxiety Inventory, Oldenburg Burnout Inventory, and the Perceived Stress Scale were used. Results indicate that there is a significant difference in the level of anxiety, burnout, and stress between male and female doctors. Results showed that female doctors experienced a higher level of anxiety, burnout, and stress than male doctors during the COVID-19 pandemic. The research was concluded by briefly foregrounding some of the study's implications and future suggestions.
... Women are the dominant gender group among healthcare workers in Canada. A recent scoping review (27) indicates that female healthcare workers show high anxiety, depression, and burnout during the pandemic. ...
The COVID-19 pandemic has highlighted the mental health care needs of health care workers. The primary aim of this study was to explore the effects of an online mindfulness program on resiliency in health care workers during the pandemic using a mixed-methods approach. An online 4-week mindfulness program was delivered to healthcare workers (N = 130) in Ontario, Canada. Resiliency was assessed at 3-time points (i.e., pre, post, and 1-month follow-up), and the mindfulness program's efficacy on resiliency was analyzed using linear regression. Semi-structured interviews (N = 10) were conducted to substantiate their experiences. Healthcare workers' resiliency significantly increased after the mindfulness program compared to the baseline, maintaining the effect after 1 month in both unadjusted and adjusted regression models. These findings were further bolstered by the positive experiences shared by participants highlighting the program's efficacy on empathy and resiliency. Evidence suggests that mindfulness is associated with promoting resiliency in healthcare workers and may be an important strategy to promote resiliency in this population.
... Women are the dominant gender group among healthcare workers in Canada. A recent scoping review (27) indicates that female healthcare workers show high anxiety, depression, and burnout during the pandemic. ...
... In the UK, deaths from domestic violence have more than doubled during the coronavirus epidemic [29]. Considering the importance of physical and mental health of people in the community and the adverse effects of isolation and fear caused by this epidemic, and the women's role during the COVID-19 epidemic in bearing the heavy burden of home quarantine and resulting psychological damage [27,[30][31][32], this study examines the relationship between social support and preventive behaviors of COVID-19 through mental wellbeing and hope in the statistical population of women. ...
Background: According to the World Health Organization, preventive measures are the only non-pharmacological method to combat the COVID-19 epidemic. This study aimed to investigate the relationship between perceived social support and preventive behaviors mediated by the variables of life expectancy and mental wellbeing.
Materials and Methods: This study is applied in terms of purpose and was conducted by survey method. The statistical population included women living in Tehran City, Iran, with a sample size of 428. The study data were collected using the preventive behavior scale, mental wellbeing scale, Snyder hope scale, and multidimensional perceived social support scale. The obtained data were analyzed using SPSS 25 and AMOS 23 software.
Results: The study results showed a positive and significant relationship between perceived social support and mental wellbeing, between perceived social support and life expectancy, and between mental wellbeing and life expectancy. Also, life expectancy and mental wellbeing variables mediate between perceived social support and preventive behaviors.
Conclusion: Considering the critical role of women in family management and preventive measures during the COVID-19 epidemic, strengthening social support networks, hope, and mental wellbeing should be considered.
... Firsthand accounts and reports of healthcare workers' experiences during the initial phase of the pandemic suggest that health-care workers were weathering threats across Maslow's hierarchy of needs. Specifically, health-care workers were reporting high workloads and exhaustion, social isolation, physical and psychological insecurity, diminished ability to perform work activities with efficacy and confidence, and barriers to living as desired (Gold, 2020;Kang et al., 2020;Shechter et al., 2020;Siriharan et al., 2020). The chronic, unrelenting nature of the pandemic in many places in the world has maintained or exacerbated these issues, and threats to basic needs remain a concern. ...
The pandemic has threatened core human needs. The pandemic provides a context to study psychological injury as it relates to unmet basic human needs and traumatic stressors, including moral incongruence. We surveyed 1,122 health-care workers from across the United States between May 2020 and August 2020. Using a mixed-methods design, we examined moral injury and unmet basic human needs in relation to traumatic stress and suicidality. Nearly one third of respondents reported elevated symptoms of psychological trauma, and the prevalence of suicidal ideation among health-care workers in our sample was roughly 3 times higher than in the general population. Moral injury and loneliness predict greater symptoms of traumatic stress and suicidality. We conclude that dehumanization is a driving force behind the psychological injury resulting from moral incongruence in the context of the pandemic. The pandemic most frequently threatened basic human motivations at the foundational level of safety and security relative to other higher order needs.
... Healthcare workers have struggled with the competing demands of caring for their patients, educating learners and conducting research while also ensuring the health and safety of themselves and their families, particularly acute for the healthcare worker population which is approximately 80% of the females in Canada. 1 Multiple demands continue to test their resilience and capacity, including the threat of new variants; an increased volume of work to meet the pent-up demand for deferred care due to COVID-related restrictions; challenges related to vaccine supply access and uptake; ongoing challenges in daily life related to lockdownsand staff absences; redeployment and changes in staffing models. ...
Traditional models of health leadership are characterized by top-down structures dependent on hierarchy – which emerged historically from military models. With supporting evidence, many of today’s leaders are now working hard to shift their organizations to models of empowered teams and servant leadership with the hopes of inciting a broader cultural shift. The concern is that these early signs of progress could unravel due to the many challenges now exacerbated by COVID-19 and its implications. One such example is fostering respect and civility (i.e. the pillars of empowerment and servant leadership) which is placed at risk during times of change and crisis – more so during a pandemic when command-and-control structures are deemed necessary. The evolution of modern health leadership must be implemented with plans for mitigating related risks. Ultimately, the behaviours that are tolerated during times of stress are what become the value system of any organization.
... Although the problem was well recognised and described, little research has explored the possible intervention methods to help healthcare workers to cope with stress, burnout, and depression issues. Some measures, such as psychological support, exercise, online-push messages for mental health issues, provision of rest areas, have been used, but the uptake of these interventions has been limited and the effects of these interventions were often unevaluated (Sriharan et al. 2020). We think introducing motion and touch is a readily accessible but under-explored strategy among these emotion regulation strategies. ...
Healthcare personnel suffer from an increased risk of stress, burnout, and depression due to the challenges of the COVID-19 pandemic. Studies show that interactive smart textiles help people alleviate their emotions. In this research, we investigate how to utilise interactive textiles to help healthcare workers mitigate their negative feelings. We have designed a smart t-shirt that encourages its wearers to perform body movements to enhance their positive emotions, stimulated by vibrotactile and audio feedback mechanisms. We demonstrate our smart t-shirt’s utility by asking healthcare workers (including physicians and nurses) to use it for five consecutive days. Our prototype design supports using it anywhere, including work, home, and other places. We evaluated our smart t-shirt prototype for emotion regulations at work for healthcare workers through an in-situ user study conducted at three hospitals. Results show that using the smart t-shirt positively impacts the healthcare workers’ immediate emotion regulation when they experienced emotion fluctuation and provided a more positive attitude towards their work. We conclude by analysing the potential factors that influence emotions and outline the design space of e-textiles for emotion regulation in real-life use.
... Anxiety has been widely measured in the hospital context (Easton et al. 2016). Sriharan et al. (2020) refer to stress as the degree to which one feels overwhelmed and unable to cope as a result of unmanageable pressures. Stress has been measured in the context of infectious diseases such as severe acute respiratory syndrome and COVID-19, and the most commonly used scale of stress is the seven items within the Depression Anxiety Stress Scale (Zhang et al. 2019). ...
This study investigates the relationships between psychosocial risk, relationship quality, need for cognition, and quarantine intentions. Empirical data were collected from quarantine hotel guests in Guangzhou. The results show that depression, anxiety, and stress have a negative influence on satisfaction and that trust and intimacy have a positive influence on satisfaction. Trust has a positive influence on intimacy. Trust and intimacy have a positive influence on commitment. Commitment, satisfaction, and intimacy have a positive influence on quarantine intentions. Intimacy mediates the effect of trust on quarantine intentions. Need for cognition moderates the relationship between satisfaction and quarantine intentions. The theoretical and managerial implications of these results are discussed.
... Lastly, the small but notable endorsement of feelings of burnout is important to acknowledge. Most research examining burnout during the pandemic has focused on frontline works, primarily health, and mental health care workers Heath et al., 2020;Sriharan et al., 2020). Far fewer studies have examined burnout in the general population as a result of lockdowns and shelter-in-place orders. ...
Background
The mental health impact of Covid-19 from the perspective of individuals experiencing psychological distress during lockdown period in marginalized, high-risk communities remains underinvestigated.
Aims
This study aims to identify key factors related to psychological distress resulting from the Covid-19 pandemic across highly vulnerable districts in Guatemala.
Methods
The Covid Care Calls (CCC) survey was administered to households in 11 districts in Guatemala to gather information about medical, mental health, and psychosocial status during the lockdown period; provide referral for care; and disseminate information on evidence-based protective measures to stem the spread of the virus. The 330 individuals participated the survey. Conventional content analysis was used to analyze survey data.
Results
Most commonly reported mental health issues since the start of the pandemic were anxiety (46%), stress (36%), and exacerbation of pre-Covid-19 mental health conditions (19%). Depression and burnout were equally reported by 12% of participants. Only 2% reported issues with safety in the home. Concerns about catching the virus and economic worries were the most commonly reported sources of psychological distress.
Conclusion
Results of this study indicate a high prevalence of anxiety, stress, and increased prior mental health symptoms resulting from the onset of the Covid-19 pandemic in low-income, high-risk communities across Guatemala. Efforts focused on enhancing coping strategies as well as psychoeducation to address stigma and increase help-seeking for depression are particularly important.
... Recent studies show that women's emotional burnout levels are higher in the pandemic context since they suffer from a higher financial impact and are more susceptible to work-family role conflict [45][46][47][48][49][50][51][52][53][54][55][56][57][58]. Also, the emotional dimension of workload was more affected in women. ...
This study analyzed the levels of mental workload and the presence of burnout on a sample of fashion retailing workers from Spain and its relationship with the current CoViD-19 (Corona-virus disease-19) pandemic. We established a cross-sectional design. Participants (n = 360) answered an online survey including questions about sociodemographic data, perception of CoViD-19, Car-Men-Q questionnaire (workload), and MBI (burnout syndrome). The survey campaign took place in October and November 2020. The results showed that participants exhibited deep concern about the CoViD-19 pandemic and its influence in the workplace. Although the mental workload was near the middle point of the scale, participants showed moderate to high burnout levels, revealing that the sample was at risk of experiencing higher burnout levels over time as the pandemic and associated economic crisis continued. The multiple regression analysis results indicated that environmental changes, work overload, somatic symptoms, insomnia, negative job expectations, and uncertainty constituted significant mental workload predictors. Insomnia, somatic symptoms, and negative job expectations constituted significant predictors for burnout. Differences between job positions and genders in mental workload and burnout were found. In conclusion, the uncertainty at work derived from the CoViD-19 pandemic harms fashion retailing workers' psychological well-being in Spain.
... As for the organizational level, the most important factors that were reported as common triggers of stress were the lack of infection control guidelines and protocols, the lack of access to personal protective equipment, and the absence of support and appreciation by supervisors [36] and more in general by the management of the hospitals [37]. Furthermore, working in a different department, the changing of roles in order to cope with the emergency, and taking care of patients with a disease that had not been treated before, and in general the changing of the work purpose, led to a large number of negative emotions such as inadequacy, incompetence, and emotional destabilization. ...
The COVID-19 pandemic put the Italian health system under great stress. The sudden
reorganization of work practices and the emotional impact of the large number of the victims had many consequences on the well-being of the healthcare professionals (HCPs) involved in managing the crisis. In the available literature, most studies have focused on the risk aspects while only few studies also take into account protective factors. For this reason, it was decided to conduct, within psycho-sociological perspective, a qualitative study with the aim to explore in depth the protective and risk factors as experienced by HCPs who worked in the Italian healthcare system during the COVID-19 outbreak. A total of 19 semi-structured interviews were conducted with HCPs–9 nurses and 10 physicians (7M and 12F) with an average age of 43 (SD = 13.4)–selected using snowball sampling. Considering three different levels of analysis the results highlight the protective and risk factors: personal history level (intrinsic/ethical motivation and flexible role versus extrinsic motivation and static role), interpersonal level (perception of supportive relationships with colleagues, patients, and family versus bad relationships), and organizational level (good leadership and sustainable work purpose versus absence of support from management and undefined or confused tasks).
... Therefore, it is likely that significant changes in sleep architecture among HCWs will occur later and will be observed by prospective studies. In concordance with previous studies, our subgroup analysis by gender revealed that females had a higher prevalence of anxiety and depression compared to males [14,15,27,28,[89][90][91][92]. The current meta-analysis found higher levels of anxiety and depression among nurses compared to doctors, which may be because nurses have closer and prolonged contact with patients compared to doctors [3,93]. ...
Previous meta-analyses were conducted during the initial phases of the COVID-19 pandemic, which utilized a smaller pool of data. The current meta-analysis aims to provide additional (and updated) evidence related to the psychological impact among healthcare workers. The search strategy was developed by a medical librarian and bibliographical databases, including Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for studies examining the impact of the COVID-19 pandemic on the psychological health of healthcare workers. Articles were screened by three reviewers. Heterogeneity among studies was assessed by I 2 statistic. The random-effects model was utilized to obtain the pooled prevalence. A subgroup analysis by region, gender, quality of study, assessment methods, healthcare profession, and exposure was performed. Publication bias was assessed by Funnel plot and Egger linear regression test. Sixty-five studies met the inclusion criteria and the total sample constituted 79,437 participants. The pooled prevalence of anxiety, depression, stress, post-traumatic stress syndrome, insomnia, psychological distress, and burnout was 34.4%, 31.8%, 40.3%, 11.4%, 27.8%, 46.1%, and 37.4% respectively. The subgroup analysis indicated higher anxiety and depression prevalence among females, nurses, and frontline responders than males, doctors, and second-line healthcare workers. This study highlights the need for designing a targeted intervention to improve resilience and foster post-traumatic growth among frontline responders.
... Authors acknowledge the contribution by Sabine Caleja who helped with article retrieval and screening. This manuscript has been released as a pre-print at medRxiv (50). ...
Objectives: The overall objectives of this rapid scoping review are to (a) identify the common triggers of stress, burnout, and depression faced by women in health care during the COVID-19 pandemic, and (b) explore individual-, organizational-, and systems-level interventions that can support the well-being of women HCWs during a pandemic.
Design: This scoping review is registered on Open Science Framework (OSF) and was guided by the JBI guide to scoping reviews and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension to scoping reviews. A systematic search of literature databases (Medline, EMBASE, CINAHL, PsycInfo and ERIC) was conducted from inception until June 12, 2020. Two reviewers independently assessed full-text articles according to predefined criteria.
Interventions: We included review articles and primary studies that reported on stress, burnout, and depression in HCWs; that primarily focused on women; and that included the percentage or number of women included. All English language studies from any geographical setting where COVID-19 has affected the population were reviewed.
Primary and secondary outcome measures: Studies reporting on mental health outcomes (e.g., stress, burnout, and depression in HCWs), interventions to support mental health well-being were included.
Results: Of the 2,803 papers found, 28 were included. The triggers of stress, burnout and depression are grouped under individual-, organizational-, and systems-level factors. There is a limited amount of evidence on effective interventions that prevents anxiety, stress, burnout and depression during a pandemic.
Conclusions: Our preliminary findings show that women HCWs are at increased risk for stress, burnout, and depression during the COVID-19 pandemic. These negative outcomes are triggered by individual level factors such as lack of social support; family status; organizational factors such as access to personal protective equipment or high workload; and systems-level factors such as prevalence of COVID-19, rapidly changing public health guidelines, and a lack of recognition at work.
This presentation provides insight into the development and findings of a rapid scoping review centred on the intersections of academic integrity and artificial intelligence, with particular attention to algorithmic writing technologies (e.g., ChatGPT) involving faculty, students, teaching assistants, academic student support staff, and educational developers in higher education contexts. This rapid scoping review was developed by a transdisciplinary team including Communication studies, Education, Engineering, and English, and followed Joanna Brigg Institute’s (JBI) updated manual for scoping reviews and the Preferred Reporting Items for Systematic reviews Meta-Analysis (PRISMA) reporting standards. JBI provides a high-quality, trusted framework for conducting these kinds of studies. This inquiry’s study design includes qualitative, quantitative, mixed methods, theoretical and opinion studies; additionally, this inquiry did not restrict studies by geographic location and focused on sources written in English. This review’s studies involved faculty, students, teaching assistants, academic support staff, and educational developers in higher education. It also included studies about artificial intelligence in the context of academic integrity, focusing on artificial intelligence tools that assist text generation and writing developed in Tertiary type A and B postsecondary education. Studies excluded from this review were related to primary and secondary education contexts, did not address the ethical implications of artificial intelligence, and focused on text plagiarism software. The protocol of this rapid review was published in the Canadian Perspectives on Academic Integrity Journal. Its implementation helped this team identify various ethical implications signalled by scholars between 2007 and 2022. Considering the expansive emergence of these technologies and the multiple positionings derived from these new and unprecedented encounters with such technology, we believe that the implications identified in this rapid scoping review are particularly relevant to inform academic staff, administration, students, and academic integrity researchers’ ethical decision-making and practices when teaching, learning, designing, and implementing assessments, and doing research. The findings of this rapid scoping review encompass nuanced perspectives concerning the ethical and unethical uses of these emerging technologies and insights into equity, diversity, and inclusion issues.
To perform a mental health evaluation and an early psychological intervention for healthcare workers (HCWs) during the coronavirus disease 2019 (COVID-19) epidemic, an online survey was conducted among 3055 HCWs in the paediatric intensive care units (PICUs) of 62 hospitals in China on March 26, 2020, by the Neurology and Sedation Professional Group, Emergency Department, Paediatrics Branch, Chinese Medical Association. The questionnaire was divided into three parts, including general information, the Impact of Event Scale-Revised (IES-R), and the Depression Anxiety Stress Scale-21 (DASS-21). The results show that a total of 970 HCWs (45.99%) were considered to meet the clinical cut-off scores for posttraumatic stress (PTS), and the proportions of participants with mild to extremely severe symptoms of depression, anxiety and stress were 39.69%, 36.46% and 17.12%, respectively. There was no significant difference in the psychological impact among HCWs of different genders. Married HCWs were 1.48 times more likely to have PTS than unmarried HCWs (95% Cl: 1.20–1.82, p <0.001). Compared with junior professional title participants, the PTS-positive rate of HCWs with intermediate professional titles was 1.91 times higher (90% Cl: 1.35–2.70, p<0.01). Those who had been in contact with confirmed COVID-19 cases were 1.40 times (95% Cl: 1.02–1.92, p <0.05) more likely to have PTS than those who did not have contact with COVID-19 cases or did not know the relevant conditions. For depression, the proportion of HCWs with intermediate professional titles was significantly higher, at 1.65 times (90% Cl: 1.17–2.33, p <0.01) that of those with junior professional titles. The depression of HCWs at work during the epidemic was 1.56 times that of HCWs on vacation (95% Cl: 1.03–2.37, p <0.05), and their anxiety was 1.70 times greater (95% Cl: 1.10–2.63, p <0.05). Participants who had been in contact with confirmed COVID-19 cases had more pronounced anxiety, 1.40 times that of those who did not have contact with COVID-19 cases or did not know the relevant conditions (95% Cl: 1.02–1.92, p <0.05). There was no significant correlation between the variables and the positive results of stress symptoms. In total, 45.99%, 39.69%, 36.46% and 17.12% of PICU HCWs were affected by PTS, depression, anxiety and stress, respectively, to varying degree. Married status, intermediate professional titles and exposure history were independent risk factors for PTS. Intermediate professional titles and going to work during the epidemic were independent risk factors for depression, and going to work and exposure history during the epidemic were independent risk factors for anxiety. In the face of public health emergencies, HCWs not only specialize in paediatric intensive care but also, as a high-risk group, must actively take preventive measures and use mitigation strategies.
The increased participation of women in the healthcare sector is a fundamental development in labour markets around the world. It has been reported that women make up 70% of those employed in the health sector for close to 100 countries. Shortages of Personal Protective Equipment (PPE), long working hours, increased risk of infection, social and family impacts are among of challenges faced by them during the pandemic. Beside that they also need to balance their
obligations as professionals with their duties to their family members too. Social protection plays a critical role in empowering women healthcare worker during the pandemic. By providing the adequate health and safety measures for working condition and support system from them during the crisis are able to support them as front liner. By using qualitative approaches and content analysis on primary and secondary data, this paper is aims to analysis the concept of social protection in empowering women healthcare workers. The discussion covers the relevant guidelines and policies on women and healthcare workers by International Labour Organization (ILO), World Health (WHO) and Occupational Safety and Health Organization (OSHA). Even though the original concept of social protection is a matter of right and plays a critical role in reducing and preventing poverty and leveling out inequalities but this concept also may be enhanced for the purpose of the empowerment women healthcare worker. The adequate good working conditions and providing supports system to women healthcare workers are part of social protection are needed in battling the pandemic.
Healthcare workers (HCWs) in Ontario, Canada have faced unprecedented risks during the COVID-19 pandemic. They have been infected at an elevated rate compared to the general public. HCWs have argued for better protections with minimal success. A worldwide shortage of N95s and comparable respirators appears to have influenced guidelines for protection, which stand at odds with increasing scientific evidence. In-depth interviews were conducted with ten frontline HCWs about their concerns. They reported that the risk of contracting COVID-19 and infecting family members has created intense anxiety. This, in conjunction with understaffing and an increased workload, has resulted in exhaustion and burnout. HCWs feel abandoned by their governments, which failed to prepare for an inevitable epidemic, despite recommendations. The knowledge that they are at increased risk of infection due to lack of protection has resulted in anger, frustration, fear, and a sense of violation that may have long-lasting implications.
Sacrifié: Le personnel de la santé ontarien à l'époque de la COVID-19
Résumé
En Ontario, au Canada, le personnel de la santé a eu à faire face à des risques sans précédent durant la pandémie de COVID-19. On y a constaté un taux d'infection plus élevé chez les travailleuses et travailleurs de la santé (TTS) qu'au sein de la population en général. Les TTS ont revendiqué des moyens de protection améliorés, sans grand succès. Une pénurie mondiale de masques respirateurs de type N95 ou similaires semble avoir joué sur les directives en matière de protection, qui ne cadrent pas avec une accumulation de preuves scientifiques. Lors d'entretiens en profondeur, dix TTS de première ligne ont été invités à donner leur avis sur la situation. à les entendre, le risque de contracter la COVID-19 et d'infecter les membres de leur famille leur cause beaucoup d'anxiété. Associée à un manque de personnel et à une charge de travail accrue, cette anxiété se traduit par un épuisement physique et professionnel. Les TTS se sentent abandonnés par leurs gouvernements, qui ont manqué de se préparer à l'inévitabilité d'une épidémie, malgré ce qui leur avait été recommandé. Leur réalisation d'être exposés à un plus grand risque d'infection par manque d'équipement de protection s'est muée en colère, frustration et peur, et en un sentiment de violation de leurs droits dont on peut craindre qu'il subsiste fort longtemps.
Objectives:
To analyze healthcare workers experiences in dealing with the Coronavirus (COVID-19) pandemic. Methods: An anonymous open web-based survey study was conducted among healthcare workers from the March 2020 to April 2020. A total of 24 relevant questions were asked based on participants' characteristics, obligations, and preparedness in healthcare workers in the event of COVID-19 pandemic. Results: Approximately 1036 healthcare workers participated in this study with high response rate. Out of all the participants, 70% were women, 52% belonged to the 26-34 year age range, 50% were nurses, 33.7% were clinicians, 74.3% agreed to work overtime, 93.1% understand why they should stay past their shift end, 97.7% thought that preventing illness among healthcare workers and providing safety to family members, nearly 94% thought that personal protective equipment (PPE) for employees will enhance their willingness to report to work. Approximately 89.3% express a desire for incentives and financial support for family members. Conclusion: We recommend that providing PPE, reducing psychological stress, financial support and safety to family members of healthcare workers will increase the willingness to report to work.
Background/aim:
COVID-19 pandemic exposed physicians to extraordinary stress and made them vulnerable to various types of psychological illnesses. The aim of this study was to evaluate the impact that the COVID-19 pandemic had on the psychological well-being of physicians.
Materials and methods:
We performed a cross-sectional, survey-based study, targeting physicians in Saudi Arabia during the COVID-19 pandemic. The primary outcome was to assess the psychological impact that the pandemic had on physicians by using a questionnaire that was previously designed and used by Reynold's et al. to survey Canadians during the SARS outbreak in 2003. The questionnaire assessed respondents' understanding of the rationale for quarantine, quarantine behaviors (including difficulties and compliance), as well as socio-economic and psychological impacts through answers that are based on a Likert scale. We also assessed the possible risk factors for psychological disorders related to the pandemic.
Results:
The study included 529 physicians from various regions in Saudi Arabia. The enrolled physicians were practicing different specialties and branches in medicine. We classified them based on their workplace in relation to COVID-19 exposure to: COVID-19 designated center vs. non-COVID-19 designated centers. Furthermore, we subdivided the physicians who work in COVID-19 designated centers to those who work in high-risk areas such as ER, ICU and COVID-19 isolation wards and other areas as low-risk areas. The most common feelings reported by the physicians during the pandemic were: worry (357, 67.5%), isolation (301, 56.9%) and fear (263, 49.7%). According to logistic regression analysis, physicians older than age 60 were less likely to feel isolated (OR = 0.08, 95% CI = 0.01-0.96, P = 0.05), female physicians were more likely to experience fear (OR = 2.96, 95% CI = 1.20 - 7.27, P = 0.02) and worry (OR = 2.87,95% CI = 1.23 - 6.69, P = 0.02), while physicians with a previous exposure to similar traumatic events were less likely to experience fear (OR = 0.24, 0.10 - 0.64, P = 0.004) during the COVID-19 pandemic.
Conclusions:
The COVID-19 pandemic had a negative psychological effect on physicians in Saudi Arabia. Gender, age, and previous exposure to similar traumatic events were predictive of psychological reactions to the pandemic in this population.
This study aimed to assess the prevalence and variables related to perceived stress associated with the COVID-19 pandemic in a sample of Colombian adults using a designed online cross-sectional survey. Adults answered a version of the Perceived Stress Scale (PSS-10) modified for COVID-19 (PSS-10-C), with Cronbach alpha equal to 0.86. In total, 406 individuals aged between 19 and 88 years (M = 43.9; SD = 12.4) agreed to participate in the survey: 61.8% were females, 90.6% had a university degree, 44.1% were health professionals, and 45.7% considered public health policies for preventing the spread of the disease inconsistent with scientific recommendations. PSS-10-C scores ranged from 0 to 36 (M = 16.5; SD = 7.3); 58 individuals (14.3%) scored for high perceived stress (cut-off point = 25). The inconsistency between policies and scientific evidence was significantly related to high perception of stress associated with COVID-19 (OR = 2.36; 95%CI: 1.32-4.20), after adjusting for gender. We concluded that the study group presented the prevalence of perceived stress associated with COVID-19 at high levels, arising from the inconsistent strategies developed by health authorities in view of scientific recommendations. Further researches must address the psychosocial aspects of epidemics.
The aim of this study is an evaluation of the Italian dentists' knowledge regarding COVID-19 and their perception of the risks associated with COVID-19, their attitude in resuming their activities, and how they judge the institutional intervention on a health and economic basis.
Methods:
This research evaluated Italian dentists from 11 to 18 April 2020, using a questionnaire submitted via Google Forms (Alphabet, Mountain View, CA, USA). It consisted of different investigations about sociodemographic aspects, profession-related characteristics, knowledge about COVID-19 infection transmission modalities, symptoms, and attitude in treating potentially infected patients. Statistical analysis was performed using the Pearson chi2 test and Student t-test. The α-level was fixed at p = 0.05. All data were analyzed with STATA 16 (StataCorp LP, College Station, TX, USA).
Results:
1500 dentists (664 men and 836 women) completed the questionnaire. The majority of respondents declared having been trained in infection prevention procedures (64.3%) but not specifically to prevent the spread of COVID-19 (48.7%). A total of 57.2% declared that they were not trained sufficiently to restart working after lockdown, with a significantly higher prevalence (Pearson chi2 test, p < 0.001) among women (62.3%) than men (50.9%).
Conclusion:
Italian dentists were informed correctly on the mode of transmission but partially missed COVID-19 symptoms. Dentists considered the virus infection highly dangerous, and they were not confident in being able to work safely. The lack of precise operating guidelines creates uncertainties on infection control measures and appropriate personal protective equipment (PPE) use. The participants revealed apprehension for their health and the current and future economic situation of their practices.
Aim: COVID-19 pandemic affected most health care professionals and to the best of our knowledge, there has not been any studies on the gynecology and obstetrics department workers in the literature. In our study, we aim to investigate the psychological and social effects of the COVID-19 epidemic on the healthcare workers serving in the gynecology and obstetrics department and to help healthcare professionals improve their physical and mental health.Methods: This cross-sectional study was conducted among healthcare professionals working in obstetrics and gynecology clinics in Mardin province. It was carried out in Mardin State Hospital and Kızıltepe State Hospital, which are considered “Pandemic Hospitals”. All participants received Sociodemographic Data Form, Psychological Symptom Screening Test (SCL-90-R), Beck Anxiety Inventory and Short Psychiatric Rating Scale. These evaluation scales were applied to 13 doctors, 52 midwives and 38 nurses working in Gynecology and Obstetrics Clinics in total. They were compared in terms of occupation, gender, and age, as those under or equal to 29 (≤29) years and over 29 years (>29) of age. Twenty-nine was picked because it was the mean age of the group.Results: Although differences did not reach statistical significance, anxiety, hostility, and phobic anxiety were higher in participants over the age of 29 years (P=0.472, P=0.549, P=0.776, respectively). According to profession groups, only phobic anxiety scores were higher among doctors (P=0.373), and somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, paranoid ideation, psychoticism, eating and gastrointestinal symptoms (GIS) were higher in midwives (P=0.166, P=0.624, P=0.531, P=0.321, P=0.147, P=0.205, P=0.359, P=0.490, P=0.696, P=0.557, respectively). Conclusion: COVID-19 will undoubtedly have psychological consequences which may be permanent in healthcare professionals. Frontline employees will be at risk, especially in departments with emergency services. Actions are needed to alleviate the effects of COVID-19 on mental health by protecting and promoting the psychological well-being of healthcare workers during and after the outbreak.
Purpose:
To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India.
Methods:
An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training or practising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9).
Results:
In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in 101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses.
Conclusion:
A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.
Italy has been the first-hit European country to face the outbreak of coronavirus disease 2019 (COVID-19). Aim of this survey was to assess in depth the impact of the outbreak on healthcare workers (HCW). A 40-item online survey was disseminated via social media inviting Italian HCW, with questions exploring demographics, health status and work environment of respondents. A total of 527 were invited to take part in March 2020, of whom 74% (n = 388) responded to the survey. Of these, 235 (61%) were women. HCW were mostly physicians (74%), from high-prevalence regions (52%). 25% experienced typical symptoms during the last 14 days prior to survey completion, with only 45% of them being tested for COVID-19. Among the tested population, 18 (18%) resulted positive for COVID-19, with 33% being asymptomatic. Only 22% of HCW considered personal protective equipment adequate for quality and quantity. Females and respondents working in high-risk sectors were more likely to rate psychological support as useful (OR, 1.78 [CI 95% 1.14–2.78] P = 0.012, and 2.02 [1.12–3.65] P = 0.020, respectively) and workload as increased (mean increase, 0.38 [0.06–0.69] P = 0.018; and 0.54 [0.16–0.92] P = 0.005, respectively). The insights from this survey may help authorities in countries where COVID-19 epidemic has not yet broken out. Management strategies should be promptly undertaken in order to enhance safety and optimise resource allocation.
Background
A growing body of evidence suggests that in the face of life adversity, threats, or other major stressful events, resilience is more conducive to individual adaptation and growth.
Material/Methods
The Connor-Davidson Resilience Scale and the Chinese Perceived Stress Scale were used to evaluate the resilience and perceived stress of 600 medical staff members from the radiology departments in 32 public hospitals in Sichuan Province, China, respectively. Multiple linear regression was used to analyze factors related to resilience.
Results
The total resilience score was 65.76±17.26, wherein the toughness dimension score was 33.61±9.52, the strength dimension score was 21.25±5.50, and the optimism dimension score was 10.91±3.15. There was a significant negative correlation between perceived stress and resilience (r=−0.635, P<0.001). According to multivariate analysis, the total perceived stress score (β=−1.318, P<0.001), gender (β=−4.738, P<0.001), knowledge of COVID-19 (β=2.884, P=0.043), knowledge of COVID-19 protective measures (β=3.260, P=0.042), and availability of adequate protective materials (β=−1.268, P=0.039) were independent influencing factors for resilience.
Conclusions
The resilience level of the medical staff in the radiology departments during the outbreak of COVID-19 was generally low, particularly regarding toughness. More attention should be paid to resilience influence factors such as high perceived stress, female gender, lack of understanding of COVID-19 and protective measures, and lack of protective materials, and targeted interventions should be undertaken to improve the resilience level of the medical staff in the radiology departments during the outbreak of COVID-19.
The first case of 2019-nCoV pneumonia infection occurred in Wuhan, Hubei Province, South China Seafood Market in December 2019. As a group with a high probability of infection, health workers are faced with a certain degree of psychological challenges in the process of facing the epidemic. This study attempts to evaluate the impact of 2019-nCoV outbreak on the psychological state of Chinese health workers and to explore the influencing factors. During the period from 31 January 2020 to 4 February 2020, the 'Questionnaire Star' electronic questionnaire system was used to collect data. The 2019-nCoV impact questionnaire and The Impact of Event Scale (IES) were used to check the psychological status of health workers in China. A total of 442 valid data were collected in this study. Seventy-four (16.7%) male and 368 (83.3%) female individuals participated in this study. The average score of high arousal dimension was 5.15 (s.d. = 4.71), and the median score was 4.0 (IQR 2.0, 7.0). The average score of IES was 15.26 (s.d. = 11.23), and the median score was 13.5 (IQR 7.0, 21.0). Multiple regression analysis showed that there were critical statistical differences in high arousal scores among different gender groups (male 3.0 vs. female 5.0, P = 0.075). Whether being quarantined had significant statistical differences of IES scores (being quarantined 16.0 vs. not being quarantined 13.0, P = 0.021). The overall impact of the 2019-nCoV outbreak on health workers is at a mild level. Chinese health workers have good psychological coping ability in the face of public health emergencies.
Corona Virus Disease 2019 (COVID‐19) outbreak has attracted worldwide attention. The COVID‐19 outbreak is unique in its rapid transmission and results in heavy stress for the front‐line health care workers (HCWs). The current study aimed to exam posttraumatic stress symptoms (PTSS) of HCWs fighting for the COVID‐19 and to evaluate their sleep quality after one‐month stressful suffering. 377 HCWs working in different provinces of China participated in the survey between February 1st and 5th. The demographic information was collected firstly. Posttraumatic Stress Disorder Checklist for DSM‐5 (PCL‐5) and The Pittsburgh Sleep Quality Index (PSQI) were selected to measure PTSS and sleep quality. Results showed that one month after the outbreak, the prevalence of PTSS was 3.8% in HCWs. Female HCWs were more vulnerable to PTSS with hazard ratio of 2.136 (95% CI= 1.388‐3.286). HCWs with higher exposure level also significantly rated more hyper‐arousal symptoms (hazard ratio= 4.026, 95% CI= 1.233‐13.140). There was a significant difference of sleep quality between participants with and without PTSS (Z value= 6.014, p<0.001) and among different groups with various contact frequency (Chi‐square=7.307, p=0.026). Path analysis showed that there was a significant indirect effect from exposure level to PTSS through sleep quality (coefficient =1.750, 95% CI of Boostroop test = 0.543‐2.998). In summary, targeted interventions on sleep contribute to the mental recovery during the outbreak of COVID‐19. Understanding the mental health response after a public health emergency might help HCWs and communities prepare for a population's response to disaster.
Background
During February 2020, the coronavirus disease 2019 (COVID-19) epidemic in Hubei Province, China, was at its height, requiring isolation of the population. This study aimed to compare the emotional state, somatic responses, sleep quality, and behavior of people in Hubei Province with non-endemic provinces in China during two weeks in February 2020.
Material/Methods
Questionnaires were completed by 939 individuals (357 men; 582 women), including 33 from Hubei and 906 from non-endemic provinces. The Stress Response Questionnaire (SRQ) determined the emotional state, somatic responses, and behavior. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the duration of sleep and sleep quality.
Results
There were 939 study participants, aged 18–24 years (35.89%) and 25–39 years (35.57%); 65.92% were university students. During a two week period in February 2020, the emotional state and behavior of participants in Hubei improved, but the quality of sleep did not. Health workers and business people became increasingly anxious, but other professionals became less anxious. The data showed that most people in Hubei Province developed a more positive attitude regarding their risk of infection and the chances of surviving the COVID-19 epidemic.
Conclusions
During a two-week period, front-line health workers and people in Hubei Province became less anxious about the COVID-19 epidemic, but sleep quality did not improve. Despite public awareness, levels of anxiety exist that affect the quality of life during epidemics, including periods of population quarantine. Therefore, health education should be combined with psychological counseling for vulnerable individuals.
Objective:
We explored whether medical health workers had more psychosocial problems than nonmedical health workers during the COVID-19 outbreak.
Methods:
An online survey was run from February 19 to March 6, 2020; a total of 2,182 Chinese subjects participated. Mental health variables were assessed via the Insomnia Severity Index (ISI), the Symptom Check List-revised (SCL-90-R), and the Patient Health Questionnaire-4 (PHQ-4), which included a 2-item anxiety scale and a 2-item depression scale (PHQ-2).
Results:
Compared with nonmedical health workers (n = 1,255), medical health workers (n = 927) had a higher prevalence of insomnia (38.4 vs. 30.5%, p < 0.01), anxiety (13.0 vs. 8.5%, p < 0.01), depression (12.2 vs. 9.5%; p< 0.04), somatization (1.6 vs. 0.4%; p < 0.01), and obsessive-compulsive symptoms (5.3 vs. 2.2%; p < 0.01). They also had higher total scores of ISI, GAD-2, PHQ-2, and SCL-90-R obsessive-compulsive symptoms (p ≤ 0.01). Among medical health workers, having organic disease was an independent factor for insomnia, anxiety, depression, somatization, and obsessive-compulsive symptoms (p < 0.05 or 0.01). Living in rural areas, being female, and being at risk of contact with COVID-19 patients were the most common risk factors for insomnia, anxiety, obsessive-compulsive symptoms, and depression (p < 0.01 or 0.05). Among nonmedical health workers, having organic disease was a risk factor for insomnia, depression, and obsessive-compulsive symptoms (p < 0.01 or 0.05).
Conclusions:
During the COVID-19 outbreak, medical health workers had psychosocial problems and risk factors for developing them. They were in need of attention and recovery programs.
Importance
Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed.
Objective
To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China.
Design, Settings, and Participants
This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible.
Main Outcomes and Measures
The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale–Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes.
Results
A total of 1257 of 1830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers. A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]). Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers (eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale–Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001). Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P = .008). Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001).
Conclusions and Relevance
In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.
A scale designed to assess various aspects of the burnout syndrome was administered to a wide range of human services professionals. Three subscales emerged from the data analysis: emotional exhaustion, depersonalization, and personal accomplishment. Various psychometric analyses showed that the scale has both high reliability and validity as a measure of burnout. Since the publication of this article in 1981, more extensive research was done on the MBI, which resulted in some modifications of the original measure. The present article has been re-edited to reflect those modifications. However, it does not include other new additions (which are contained in the MBI Manual distributed by the publisher, Mind Garden).
Background
The emergency department is considered to be a high-risk area, as it is often the first stop for febrile patients who are subsequently diagnosed with coronavirus disease 2019. This study, which employed a cross-sectional design, aimed to assess the mental health of emergency department medical staff during the epidemic in China.
Methods
Demographic data and mental health measurements were collected by electronic questionnaires from February 28, 2020 to March 18, 2020.
Outcomes
A total of 14,825 doctors and nurses in 31 provinces of mainland China completed the survey. The prevalence rates of depressive symptoms and post-traumatic stress disorder (PTSD) were 25.2% and 9.1%, respectively. Men were more likely to have depressive symptoms and PTSD than women. Those who were middle aged, worked for fewer years, had longer daily work time, and had lower levels of social support were at a higher risk of developing depressive symptoms and PTSD. Working in the Hubei province was associated with a higher risk of depressive symptoms, while those working in the Hubei province but residing in another province had a lower risk of depressive symptoms and PTSD. Being a nurse was associated with a higher risk of PTSD.
Interpretation
The findings suggest that targeted psychological interventions to promote the mental health of medical staff with psychological problems need to be immediately implemented. Special attention should be paid to local medical staff in Hubei.
Background
During the COVID-19 pandemic general medical complications have received the most attention, whereas only few studies address the potential direct effect on mental health of SARS-CoV-2 and the neurotropic potential. Furthermore, the indirect effects of the pandemic on general mental health are of increasing concern, particularly since the SARS-CoV-1 epidemic (2002-2003) was associated with psychiatric complications.
Methods
We systematically searched the database Pubmed including studies measuring psychiatric symptoms or morbidities associated with COVID-19 among infected patients and among none infected groups the latter divided in psychiatric patients, health care workers and non-health care workers.
Results
A total of 43 studies were included. Out of these, only two studies evaluated patients with confirmed COVID-19 infection, whereas 41 evaluated the indirect effect of the pandemic (2 on patients with preexisting psychiatric disorders, 20 on medical health care workers, and 19 on the general public). 18 of the studies were case-control studies/compared to norm, while 25 of the studies had no control groups. The two studies investigating COVID-19 patients found a high level of post-traumatic stress symptoms (PTSS) (96.2%) and significantly higher level of depressive symptoms (p=0.016). Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. Studies investigating health care workers found increased depression/depressive symptoms, anxiety, psychological distress and poor sleep quality. Studies of the general public revealed lower psychological well-being and higher scores of anxiety and depression compared to before COVID-19, while no difference when comparing these symptoms in the initial phase of the outbreak to four weeks later. A variety of factors were associated with higher risk of psychiatric symptoms and/or low psychological well-being including female gender, poor-self-related health and relatives with COVID-19.
Conclusion
Research evaluating the direct neuropsychiatric consequences and the indirect effects on mental health is highly needed to improve treatment, mental health care planning and for preventive measures during potential subsequent pandemics.
Aim
To investigate anxiety, stress, and depression levels of physicians during the Covid-19 outbreak and explored associated factors in both clinical and general site.
Methods
An online survey is conducted to asses psychological responses of healthcare workers and related factors during Covid-19 outbreak. It is consisted of three subsections covering the following areas: 1) sociodemographic data 2) information on individuals` working condition 3) Depression Anxiety and Stress Scale-21 (DAS-21).
Results
Of all 442 participants, 286 (64.7%) had symptoms of depression, 224 (51.6%) anxiety, and 182 (41.2%) stress. Being female, young, and single, having less work experience, working in frontline were associated with higher scores, whereas having a child was associated with lower scores in each subscale. Factors found to be associated with higher DAS-21 total scores in frontline workers were as follows: increased weekly working hours, increased number of Covid-19 patients cared for, lower level of support from peers and supervisors, lower logistic support, and lower feelings of competence during Covid-19 related tasks.
Conclusions
Our findings highlight the factors which need to be taken into consideration to protect the mental wellbeing of doctors while fighting with a disaster that has major impacts on society worldwide.
Background
: Since the outbreak of 2019 new coronavirus (COVID-19) pneumonia, healthcare workers (HCW) have suffered psychological stress. The present study is to examine the prevalence of stress, anxiety and depression of HCW in China during the COVID-19 epidemic, and to determine the risk factors predicting psychological morbidities that can be used as psychological intervention targets.
Methods
: A cross-sectional survey was conducted to investigate the psychological levels of HCW in multiple centers in China. The prevalence of stress, anxiety and depression were determined by using Perceived Stress Scale (PSS-14) and Hospital Anxiety / Depression scale (HAD). Psychology related factors were evaluated and correlation between job title and contact history was analyzed.
Results
: We received 958 of effective responses, 73.6% of which were from Wuhan and 67.2% were female participants. 55.1% of respondents had psychological stress that is higher than that of HCW during SARS. 54.2% and 58% of participants had symptoms of anxiety and depression. Stress levels of HCW were different in job titles and years of work experience. Anxiety and depression levels were different between different gender, job titles, degrees of protective measures and levels of contact history. Gender, intermediate title, protective measures and contact history were the independent risk factors for anxiety. Protective measures and contact history were the independent risk factors for depression.
Conclusions
: The COVID-19 epidemic has induced stress levels for HCW, and high percentages of HCW have anxiety and depression. The situation of HCW is worrying and intervention service is urgent.
This study reports the physical health, mental health, anxiety, depression, distress, and job satisfaction of healthcare staff in Iran when the country faced its highest number of total active COVID-19 cases. In a sample of 304 healthcare staff (doctors, nurses, radiologists, technicians, etc.), we found a sizable portion reached the cutoff levels of disorders in anxiety (28.0%), depression (30.6%), and distress (20.1%). Age, gender, education, access to PPE (personal protective equipment), healthcare institutions (public vs. private), and individual status of COVID-19 infection each predicted some but not all the outcome variables of SF-12, PHQ-4, K6, and job satisfaction. The healthcare workers varied greatly in their access to PPE and in their status of COVID-19 infection: negative (69.7%), unsure (28.0%), and positive (2.3%). The predictors were also different from those identified in previous studies of healthcare staff during the COVID-19 crisis in China. This study helps to identify the healthcare staff in need to enable more targeted help as healthcare staff in many countries are facing peaks in their COVID-19 cases.
Background
Intimate partner violence (IPV) is defined as physical or sexual violence, emotional abuse and stalking. It is typically experienced by women but can also be experienced by men. During quarantine due to the COVID-19, home risks to become a very dangerous place for victims of domestic violence.
Method
Very recent studies focusing on abusive situations during COVID emergence were identified in PubMed/Medline, Scopus, Embase.
Results
During the COVID-19 outbreak people have encountered an invisible and dark enemy and an experience of impotence. Due to the feelings of frustration and agitation, aggression arises with possible transgenerational transmission of trauma and violence.
Conclusions
Especially during quarantine and COVID emergence around the world there is a need of programs aimed to prevent acts of domestic violence and to achieve accurate assessment of multiple domains of abuse (psychological, physical, sexual) provided by trained multidisciplinary staffs (including psychiatrists, psychologists, social and legal services).
Background
Coronavirus disease (COVID-19), an infection of the zoonotic coronavirus, is presenting a healthcare challenge around the globe. This study aims to assess the levels of disease knowledge and risk perception among pharmacists. We also recognize predictors of risk perception and perceived media roles. Methods This is a questionnaire-base cross-sectional study. The questionnaire was developed on a web-based platform and invitations were sent to pharmacists nationwide to participate in the study using social media applications. Results A total of 486 pharmacists participated in this study, where females were dominant (78.6%, n = 382). Most (40.4%, n = 198) pharmacists scored 4 out of 5 in basic disease knowledge, and more than half were able to recognize common methods of spread. Risk was highly perceived among participants, and was predicted by gender, living area, and having children (p < 0,05). Frequency of watching the media and sources of information also influenced both risk perception and perceived media roles. Conclusion Disease awareness among pharmacists, as well as risk perception must be considered for effective risk communication planning. The role of media in shaping perceptions should also be carefully studied to encourage compliance with government containment measures and engagement in preventive behaviors.
Introduction
The spread of novel corona virus (COVID-19) across the globe and the associated morbidity and mortality challenged the nations by several means. One such underrecognized and unaddressed area is the mental health issues medical staff develop during the pandemic.
Materials and methods
This review aimed to review the literature about mental health problems faced by health care workers (HCW) during the COVID-19 pandemic. Literature search was conducted in the following databases: PubMed, Google Scholar, Cochrane Library, Embase. All types of articles published in the last 4 months (January 2020-April 2020) which were relevant to the subject of the review were searched. A total of 23 articles were selected by initial screening and 6 articles were included in the final review.
Results
Review of all the 6 articles showed that current research focused on assessing several aspects of mental health affected in HCW due to COVID-19. Several sociodemographic variables like gender, profession, age, place of work, department of work and psychological variables like poor social support, self-efficacy were associated with increased stress, anxiety, depressive symptoms, insomnia in HCW. There is increasing evidence that suggests that COVID-19 can be an independent risk factor for stress in HCW.
Conclusion
Regular screening of medical personnel involved in treating, diagnosing patients with COVID-19 should be done for evaluating stress, depression and anxiety by using multidisciplinary Psychiatry teams.
Objective
Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers.
Methods
Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated.
Results
Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p=0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p=0.001), stress (OR 3.06, 95% CI 1.27-7.41, p=0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p=0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales.
Conclusions
Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.
Context
The epidemic of Coronavirus Disease 2019 (COVID-19) was first identified in Wuhan, China and has now spread worldwide. In the affected countries, physicians and nurses are under heavy workload conditions and are at high risk of infection.
Objectives
The aim of this study was to compare the frequency of burnout between physicians and nurses on the front line and those working in usual wards.
Methods
A survey with 49 questions total was administered to 220 medical staff members from the COVID-19 front lines and usual wards, with a ratio of 1:1. General information such as age, gender, marriage status, and the Maslach Burnout Inventory-Medical Personnel (MBI), were gathered and compared.
Results
The group working on the front lines had a lower frequency of burnout (13% versus 39%, P < .0001), and were less worried about being infected compared to the usual ward group.
Conclusion
Compared to medical staff working on their usual wards for uninfected patients, medical staff working on the COVID-19 front line had a lower frequency of burnout. These results suggest that in the face of the COVID-19 crisis, both front line and usual ward staff should be considered when policies and procedures to support the well-being of health care workers are devised.
The severe 2019 outbreak of novel coronavirus disease (COVID-19), which was first reported in Wuhan, would be expected to impact the mental health of local medical and nursing staff and thus lead them to seek help. However, those outcomes have yet to be established using epidemiological data. To explore the mental health status of medical and nursing staff and the efficacy, or lack thereof, of critically connecting psychological needs to receiving psychological care, we conducted a quantitative study. This is the first paper on the mental health of medical and nursing staff in Wuhan. Notably, among 994 medical and nursing staff working in Wuhan, 36.9% had subthreshold mental health disturbances (mean PHQ-9: 2.4), 34.4% had mild disturbances (mean PHQ-9: 5.4), 22.4% had moderate disturbances (mean PHQ-9: 9.0), and 6.2% had severe disturbance (mean PHQ-9: 15.1) in the immediate wake of the viral epidemic. The noted burden fell particularly heavily on young women. Of all participants, 36.3% had accessed psychological materials (such as books on mental health), 50.4% had accessed psychological resources available through media (such as online push messages on mental health self-help coping methods), and 17.5% had participated in counseling or psychotherapy. Trends in levels of psychological distress and factors such as exposure to infected people and psychological assistance were identified. Although staff accessed limited mental healthcare services, distressed staff nonetheless saw these services as important resources to alleviate acute mental health disturbances and improve their physical health perceptions. These findings emphasize the importance of being prepared to support frontline workers through mental health interventions at times of widespread crisis.
Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, is prevalent internationally. Rates of burnout symptoms that have been associated with adverse effects on patients, the health care workforce, costs, and physician health exceed 50% in studies of both physicians-in-training and practicing physicians. This problem represents a public health crisis with negative impacts on individual physicians, patients, and health care organizations and systems. Drivers of this epidemic are largely rooted within health care organizations and systems, and include excessive workloads, inefficient work processes, clerical burdens, work-home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures, and leadership culture. Individual physician-level factors also play a role, with higher rates of burnout commonly reported in female and younger physicians. Effective solutions align with these drivers. For example, organizational efforts such as locally-developed practice modifications and increased support for clinical work have demonstrated benefits in reducing burnout. Individually-focused solutions such as mindfulness-based stress reduction and small-group programs to promote community, connectedness, and meaning have also been shown to be effective. Regardless of the specific approach taken, the problem of physician burnout is best addressed when viewed as a shared responsibility of both health care systems and individual physicians. Although our understanding of physician burnout has advanced considerably in recent years, many gaps in our knowledge remain. Longitudinal studies of burnout's effects and the impact of interventions on both burnout and its effects are needed, as are studies of effective solutions implemented in combination. For medicine to fulfill its mission for patients and for public health, all stakeholders in health care delivery must work together to develop and implement effective remedies for physician burnout.
Importance
Depression is common among training physicians and may disproportionately affect women. The identification of modifiable risk factors is key to reducing this disease burden and its negative impact on patient care and physician career attrition.
Objective
To determine the presence and magnitude of a sex difference in depressive symptoms and work-family conflict among training physicians; and if work-family conflict impacts the sex difference in depressive symptoms among training physicians.
Design, Setting, and Participants
A prospective longitudinal cohort study of medical internship in the United States during the 2015 to 2016 academic year in which 3121 interns were recruited across all specialties from 44 medical institutions.
Main Outcomes and Measures
Prior to and during their internship year, participants reported the degree to which work responsibilities interfered with family life using the Work Family Conflict Scale and depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9).
Results
Mean (SD) participant age was 27.5 (2.7) years, and 1571 participants (49.7%) were women. Both men and women experienced a marked increase in depressive symptoms during their internship year, with the increase being statistically significantly greater for women (men: mean increase in PHQ-9, 2.50; 95% CI, 2.26-2.73 vs women: mean increase, 3.20; 95% CI, 2.97-3.43). When work-family conflict was accounted for, the sex disparity in the increase in depressive symptoms decreased by 36%.
Conclusions and Relevance
Our study demonstrates that depressive symptoms increase substantially during the internship year for men and women, but that this increase is greater for women. The study also identifies work-family conflict as an important potentially modifiable factor that is associated with elevated depressive symptoms in training physicians. Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians. Given that depression among physicians is associated with poor patient care and career attrition, efforts to alleviate depression among physicians has the potential to reduce the negative consequences associated with this disease.
To determine the point prevalence of alcohol abuse and dependence among practicing surgeons.
Cross-sectional study with data gathered through a 2010 survey.
The United States of America.
Members of the American College of Surgeons.
Alcohol abuse and dependence.
Of 25,073 surgeons sampled, 7197 (28.7%) completed the survey. Of these, 1112 (15.4%) had a score on the Alcohol Use Disorders Identification Test, version C, consistent with alcohol abuse or dependence. The point prevalence for alcohol abuse or dependence for male surgeons was 13.9% and for female surgeons was 25.6%. Surgeons reporting a major medical error in the previous 3 months were more likely to have alcohol abuse or dependence (odds ratio, 1.45; P < .001). Surgeons who were burned out (odds ratio, 1.25; P = .01) and depressed (odds ratio, 1.48; P < .001) were more likely to have alcohol abuse or dependence. The emotional exhaustion and depersonalization domains of burnout were strongly associated with alcohol abuse or dependence. Male sex, having children, and working for the Department of Veterans Affairs were associated with a lower likelihood of alcohol abuse or dependence.
Alcohol abuse and dependence is a significant problem in US surgeons. Organizational approaches for the early identification of problematic alcohol consumption followed by intervention and treatment where indicated should be strongly supported.
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