Depression, Anxiety, and Stress Among Healthcare Workers During the COVID-19 Outbreak and Relationships With Expressive Flexibility and Context Sensitivity

This study aimed at investigating depression, anxiety, and stress symptoms among healthcare workers and examine the role of expressive flexibility and context sensitivity as key components of resilience in understanding reported symptoms. We hypothesized a significant and different contribution of resilience components in explaining depression, anxiety, and stress. A total sample of 218 Italian healthcare workers participated in this study through an online survey during the lockdown, consequently to the COVID-19. The Depression Anxiety Stress Scales-21 (DASS-21) was used to measure depression, anxiety, and stress; the Flexible Regulation of Emotional Expression (FREE) scale was used to measure the ability to enhance and suppress emotional expression; the Context Sensitivity Index (CSI) was used to measure the ability to accurately perceive contextual cues and determine cue absence. Demographic and work-related data were also collected. DASS-21 cut-off scores were used to verify the mental status among the respondents. Correlational analyses examined relationships between DASS-21, FREE, and CSI, followed by three regression analyses with depression, anxiety, and stress as dependent variables, controlling for age, gender, and work experience. Enhancement and suppression abilities, cue presence, and cue absence served as independent variables. The results showed a prevalence of moderate to extremely severe symptoms of 8% for depression, 9.8% for anxiety, and 8.9% for stress. Results of correlational analysis highlighted that enhance ability was inversely associated with depression and stress. Suppression ability was inversely associated with depression, anxiety, and stress. The ability to perceive contextual cues was inversely associated with depression and anxiety. The regression analysis showed that the ability to enhance emotional expression was statistically significant to explain depression among healthcare workers. In predicting anxiety, age, and the ability to accurately perceive contextual cues and determine cue absence made substantial contributions as predictors. In the last regression model, age, work experience, and the ability to suppress emotional expression were significant predictors of stress. This study’s findings can help understand the specific contributions of enhancement and suppression abilities and sensitivity to stressor context cues in predicting depression, anxiety, and stress among healthcare workers. Psychological interventions to prevent burnout should consider these relationships.

Download Full-text

The Context Sensitivity Index (CSI): Measuring the Ability to Identify the Presence and Absence of Stressor Context Cues

Assessment ◽

10.1177/1073191118820131 ◽

2018 ◽

Vol 27 (2) ◽

pp. 261-273 ◽

Cited By ~ 1

Author(s):

George A. Bonanno ◽

Fiona Maccallum ◽

Matteo Malgaroli ◽

Wai Kai Hou

Keyword(s):

Self Regulation ◽

Context Sensitivity ◽

Sensitivity Index ◽

Contextual Cues ◽

Sufficient Knowledge ◽

Crucial Component ◽

Questionnaire Measure ◽

Presence And Absence ◽

Using Data ◽

Context Cues

The ability to accurately perceive cues to contextual demands across different situations has been identified as a crucial component of successful self-regulation. However, previous attempts to measure context sensitivity have suffered from serious methodological limitations, most notably the possibility that respondents may not possess sufficient knowledge of their own abilities, the confounding of perception of context with response to context, the use of only one or two contextual variations, and the failure to consider the abilities to both accurately detect contextual cues and accurately determine cue absence. This article reports a new, easy-to-administer scenario-based questionnaire measure, the Context Sensitivity Index (CSI), that addressed each of these limitations. The 20-item CSI was iteratively developed and normed using data from five studies to create separate indices to capture sensitivity to the presence of contextual cues (Cue Presence index) and to the relative absence of cues (Cue Absence index). We validated these indices against measures of flexibility, psychopathology, and other scales. Results are discussed in terms of the CSI’s implications, limitations, and future applications.

Download Full-text

COVID-19 Vaccination Did Not Change the Personal Protective Behaviors of Healthcare Workers in China

Frontiers in Public Health ◽

10.3389/fpubh.2021.777426 ◽

2021 ◽

Vol 9 ◽

Author(s):

Nan Zhang ◽

Hao Lei ◽

Li Li ◽

Tianyi Jin ◽

Xiyue Liu ◽

...

Keyword(s):

Higher Education ◽

Work Experience ◽

Healthcare Workers ◽

Online Survey ◽

Negative Impact ◽

Education Level ◽

Protective Behaviors ◽

Negative Effects ◽

Before And After ◽

Personal Protective Behaviors

Personal protective behaviors of healthcare workers (HCWs) and dynamic changes in them are known to play a major role in the hospital transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, 1,499 HCWs in Chinese hospitals completed an online survey about their knowledge on SARS-CoV-2 transmission and their personal protective behaviors before and after coronavirus disease 2019 (COVID-19) vaccination. Of all the respondents, 89% were vaccinated at the time of the survey and 96% believed that the vaccine was effective or highly effective. Further, 88% of the vaccinated HCWs expressed that they would get revaccinated if the vaccination failed. Compared with HCWs with a lower education level, those with a higher education level had less fear of being infected with SARS-CoV-2 and reported a lower negative impact of the pandemic on how they treated patients. Physicians and nurses were willing to believe that short-range airborne and long-range fomite are possible transmission routes. HCWs with a higher education level had a better knowledge of COVID-19 but worse personal protective behaviors. The fact that HCWs with a longer work experience had worse personal protective behaviors showed that HCWs gradually relax their personal protective behaviors over time. Moreover, vaccination reduced the negative effects of the COVID-19 pandemic on how the HCWs treated patients. Importantly, the survey revealed that after vaccination, HCWs in China did not relax their personal protective behaviors, and it may bring a low potential risk for following waves of variant virus (e.g., delta).

Download Full-text

Predictors of COVID-19 vaccine hesitancy among Egyptian healthcare workers: a cross-sectional study

BMC Infectious Diseases ◽

10.1186/s12879-021-06392-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rehab H. El-Sokkary ◽

Omnia S. El Seifi ◽

Hebatallah M. Hassan ◽

Eman M. Mortada ◽

Maiada K. Hashem ◽

...

Keyword(s):

Work Experience ◽

Healthcare Workers ◽

Online Survey ◽

Initial Step ◽

Cross Sectional Study ◽

Vaccine Hesitancy ◽

Sectional Study ◽

Cross Sectional ◽

Attitudes And Practices ◽

To Receive

Abstract Background Coronavirus disease 2019 (COVID-19) vaccination has raised concerns about vaccine hesitancy in general and COVID-19 vaccine hesitancy in particular. Understanding the factors driving the uncertainty regarding vaccination against COVID-19 is crucial. Methods This cross-sectional study was designed to identify the perceptions and attitudes of healthcare workers (HCWs) towards COVID-19 vaccines and determine the predictive factors that affect their willingness to receive the COVID-19 vaccine. An online survey was distributed among HCWs to collect data assessing demographic and general characteristics of the participants and vaccine-related characteristics, including source of information about the vaccine. In addition to items assessing the perception of COVID-19, there were items on COVID-19 vaccines and attitude towards vaccination in general and towards COVID-19 vaccines in particular. Results The participants were classified according to their willingness to take the COVID-19 vaccine as follows: hesitant (41.9%), refusing (32.1%), and willing (26%). Statistically significant differences were observed among the three groups for the perception of COVID-19 vaccines, attitude towards vaccination in general, and COVID-19 vaccines in particular (p < 0.01). Conclusions Although the participants adequately perceived COVID-19 severity, prevention, and COVID-19 vaccine safety, they were widely hesitant or refused to be vaccinated. A multidimensional approach is required to increase the vaccine acceptability rate. Higher income and increased years of work experience are positive predictors of willingness to receive a vaccine. Thus, further studies addressing the scope of COVID-19 vaccine hesitancy are warranted as an initial step to build trust in COVID-19 vaccination efforts with continuous monitoring of attitudes and practices of HCWs towards COVID-19 vaccines in the future.

Download Full-text

Psychological impact of repeated epidemic exposure on healthcare workers: findings from an online survey of a healthcare workforce exposed to both SARS (severe acute respiratory syndrome) and COVID-19

BMJ Open ◽

10.1136/bmjopen-2021-051895 ◽

2021 ◽

Vol 11 (11) ◽

pp. e051895

Author(s):

Lai Gwen Chan ◽

Pei Lin Lynnette Tan ◽

Kang Sim ◽

Ming Yee Tan ◽

Kah Hong Goh ◽

...

Keyword(s):

Work Experience ◽

Healthcare Workers ◽

Online Survey ◽

Minority Groups ◽

Prior Experience ◽

Tertiary Care ◽

Well Being ◽

Racial Minority ◽

Foreign Born ◽

The Impact

ObjectiveTo measure the psychological well-being of healthcare workers (HCWs) during this COVID-19 pandemic and examine the experiences of the subgroup of participants who were also HCWs during the 2003 SARS epidemic.DesignAnonymous online survey adapted from a similar study conducted during the SARS epidemic, disseminated from July 2020 to August 2020.SettingNine healthcare institutions across Singapore ranging from primary care, community care, tertiary care and specialised referral centres.ParticipantsEmployees working in the participating healthcare institutions.ResultsOf 3828 survey returns, 3616 had at least one completed item on the questionnaire. Majority were female (74.7%), nurses (51.7%), foreign-born (53.2%) and not working in the tertiary care setting (52.1%). The median score on the Impact of Events Scale (IES) was 15 (IQR 23) and 28.2% of the sample scored in the moderate/severe range. 22.7% of the participants were also HCWs during SARS and more than half of them felt safer and better equipped in the current pandemic. 25.2% of SARS HCWs and 25.9% of non-SARS HCWs had moderate/severe IES scores (p=0.904). After adjusting for age, marital status, parity and length of work experience, racial minority groups and living apart from family were independent predictors of high IES regardless of prior SARS epidemic experience. Daily exposure to confirmed or suspect COVID-19 cases increased the odds of high IES for non-SARS HCWs only.Conclusions and relevanceOverall, while 28% of HCWs in our study suffered from significant trauma-related psychological symptoms regardless of prior experience with the SARS epidemic, those with prior experience reported feeling safer and better equipped, finding the workload easier to manage, as well as having more confidence in their healthcare leaders. We recommend for more trauma-informed support strategies for our HCWs especially those from racial minority groups, who are foreign-born and isolated from their families.

Download Full-text

Healthcare Workers’ Perspectives on the Upcoming COVID-19 Vaccine in Terms of Their Exposure to the Influenza Vaccine in Riyadh, Saudi Arabia: A Cross-Sectional Study

Vaccines ◽

10.3390/vaccines9050465 ◽

2021 ◽

Vol 9 (5) ◽

pp. 465

Author(s):

Leena R. Baghdadi ◽

Shatha G. Alghaihb ◽

Alanoud A. Abuhaimed ◽

Dania M. Alkelabi ◽

Rawan S. Alqahtani

Keyword(s):

Saudi Arabia ◽

Influenza Vaccine ◽

Work Experience ◽

Healthcare Workers ◽

Seasonal Influenza ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Seasonal Influenza Vaccine ◽

History Of

In 2019, a novel severe acute respiratory syndrome (SARS-CoV-2 (COVID-19)) caused a global pandemic. There was an urgent need to develop a vaccine against COVID-19 to reduce its spread and economic burden. The main objective of this study was to understand the attitudes and concerns of healthcare workers (HCWs) towards the upcoming COVID-19 vaccine, whether their decision was influenced by their history of taking the seasonal influenza vaccine, and factors that influence the acceptance of the upcoming COVID-19 vaccine. This was a cross-sectional study conducted in Riyadh, Saudi Arabia. We selected and surveyed 356 HCWs via an electronic self-administered questionnaire. A total of 61.16% of HCWs were willing to receive the COVID-19 vaccine, and 55.9% of them had received the seasonal influenza vaccine in the preceding year (2019–2020). The strongest predictors for taking the COVID-19 vaccine were the HCWs’ belief that the COVID-19 vaccine would be safe, needed even for healthy people, that all HCWs should be vaccinated against COVID-19, and that HCWs will have time to take the vaccine. Being female, being middle aged, having <5 years of work experience, having no fear of injections, and being a non-smoker were predictive factors for taking the upcoming COVID-19 vaccine. No associations were found between the intention to take the COVID-19 vaccine and a history of taking the seasonal influenza vaccine.

Download Full-text

Compassion fatigue of funeral directors during and after the first wave of COVID-19

Journal of Public Health ◽

10.1093/pubmed/fdab030 ◽

2021 ◽

Author(s):

Roel Van Overmeire ◽

Rose-Lima Van Keer ◽

Marie Cocquyt ◽

Johan Bilsen

Keyword(s):

Compassion Fatigue ◽

Work Experience ◽

Online Survey ◽

Secondary Trauma ◽

Compassion Satisfaction ◽

Funeral Directors ◽

Quality Of Life Scale ◽

Life Scale ◽

And Gender

Abstract Background Compassion fatigue has not been studied among funeral directors. Yet, funeral directors have been exposed to the same risks for compassion fatigue as other caregivers during the coronavirus disease 2019 (COVID-19) pandemic. Methods An online survey was spread two times to 287 employees of funeral home DELA, in Belgium. Once during the height of the first wave of COVID-19 in Belgium, and a second time at the end of the first wave. The professional quality of life-scale 5 (PROQOL-5) was used to measure compassion fatigue, which includes burnout, compassion satisfaction and secondary trauma. Non-parametric tests were performed. Results In total, 104 participants answered the first survey, and 107 the second. Burnout increases from survey 1 to survey 2 (P < 0.001), while compassion satisfaction (P = 0.011) and secondary trauma decrease (P < 0.001). In survey 1, only age (P = 0.007) and gender (P = 0.040) were found to be significantly associated with secondary trauma. In survey 2, having more work experience is associated with having a higher burnout (P = 0.008) and secondary trauma (P = 0.001) score. Neither for burnout (P < 0.001), nor for secondary trauma (P < 0.001) are there any respondents in the highest category. Conclusions Although overall funeral directors do not have acute problems with compassion fatigue, burnout scores increase significantly after the first wave.

Download Full-text

P87 Paradigms about the COVID-19 pandemic: knowledge, attitudes and practices from medical students

BJS Open ◽

10.1093/bjsopen/zrab032.086 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Eddy Lincango-Naranjo ◽

Paola Solis-Pazmino ◽

Eddy Lincango-Naranjo

Keyword(s):

Medical Students ◽

Healthcare Workers ◽

Online Survey ◽

National Curriculum ◽

Negative Attitude ◽

Front Line ◽

Macroeconomic Factors ◽

Attitudes And Practices ◽

And Behavior ◽

Knowledge Attitudes And Practices

Abstract Introduction As new coronavirus has spread globally, economic instability in healthcare systems has been significant. This reality is especially accentuated in Ecuador where, the shortage of healthcare workers combined with cultural and macroeconomic factors have led it to face the most aggressive outbreak in Latin America. In this context, the participation of medical students on the front line is indispensable. Appropriate training on COVID-19 is an urgent need that universities and health systems must guarantee. We aimed to describe the knowledge, attitudes and practices in Ecuadorian final year medical students in order to identify the knowledge gaps, perceptions and behavior patterns which could guide the desig3n of better medical education curricula regarding COVID-19. Methods This descriptive 33-item online survey conducted between April 6 to April 20 sent by email and by Facebook and WhatsApp. Results 309 students responded to the survey. 88% scored high (≥ 70% correct) for knowledge of the disease. The majority of students were pessimistic about possible government actions, which is reflected in the negative attitude towards the control of COVID19 in Ecuador and volunteering during the outbreak (77%, and 58% of the students, respectively). Moreover, 91% of students said they did not have adequate protective equipment or training in their health facilities. Conclusions Ecuador has a capable upcoming workforce that could benefit from an opportunity to strengthen, improve and advance their training in preparation for COVID-19. Creating a national curriculum may be one of the most effective ways for all students to be trained, while simultaneously focusing on the students’ most pressing concerns.

Download Full-text

Application of Psychometric Approach for ASD Evaluation in Russian 3–4-Year-Olds

Mathematics ◽

10.3390/math9141608 ◽

2021 ◽

Vol 9 (14) ◽

pp. 1608

Author(s):

Andrey Nasledov ◽

Sergey Miroshnikov ◽

Liubov Tkacheva ◽

Kirill Miroshnik ◽

Meriam Uld Semeta

Keyword(s):

Autistic Spectrum Disorder ◽

Online Survey ◽

Total Sample ◽

Compact Set ◽

Healthy Controls ◽

Screening System ◽

Children With Asd ◽

Discriminant Analyses ◽

Biological Problem ◽

Choice Tasks

Background: Autistic spectrum disorder (ASD) is a significant socio-biological problem due to its wide prevalence and negative outcomes. In the current study, we aimed to develop an autism scale for early and accurate differentiation of 3- to 4-year-olds at risk for ASD since there is no systematic monitoring of young children in Russia yet. Methods: The total sample (N = 324) included 116 children with ASD, 131 children without ASD (healthy controls), and 77 children with developmental delay (DD). An online survey of specialists working with children was conducted based on a specially designed autism questionnaire consisting of 85 multiple-choice tasks distributed across 12 domains. Initially, each child was assessed by 434 items using a dichotomous scale (0 = no, 1 = yes). Factor and discriminant analyses were performed to identify a compact set of subscales that most accurately and with sufficient reliability predicted whether a child belongs to the ASD group. Results: As a result, four subscales were obtained: Sensorics, Emotions, Hyperactivity, and Communication. The high discriminability of the subscales in distinguishing the ASD group from the non-ASD group was revealed (accuracy 85.5–87.0%). Overall, the obtained subscales meet psychometric requirements and allow for creating an online screening system for wide application.

Download Full-text

The impact of COVID-19 on the care of people living with noncommunicable diseases in low- and middle-income countries: an online survey of physicians and pharmacists in nine countries

Primary Health Care Research & Development ◽

10.1017/s146342362100030x ◽

2021 ◽

Vol 22 ◽

Author(s):

Chris Bullen ◽

Jessica McCormack ◽

Amanda Calder ◽

Varsha Parag ◽

Kannan Subramaniam ◽

...

Keyword(s):

Public Health ◽

Healthcare Workers ◽

Online Survey ◽

World Health ◽

Noncommunicable Diseases ◽

Middle Income ◽

Middle Income Countries ◽

Health Measures ◽

The Impact ◽

Low And Middle Income

Abstract Background: The global COVID-19 pandemic has disrupted healthcare worldwide. In low- and middle-income countries (LMICs), where people may have limited access to affordable quality care, the COVID-19 pandemic has the potential to have a particularly adverse impact on the health and healthcare of individuals with noncommunicable diseases (NCDs). A World Health Organization survey found that disruption of delivery of healthcare for NCDs was more significant in LMICs than in high-income countries. However, the study did not elicit insights into the day-to-day impacts of COVID-19 on healthcare by front-line healthcare workers (FLHCWs). Aim: To gain insights directly from FLHCWs working in countries with a high NCD burden, and thereby identify opportunities to improve the provision of healthcare during the current pandemic and in future healthcare emergencies. Methods: We recruited selected frontline healthcare workers (general practitioners, pharmacists, and other medical specialists) from nine countries to complete an online survey (n = 1347). Survey questions focused on the impact of COVID-19 pandemic on clinical practice and NCDs; barriers to clinical care during the pandemic; and innovative responses to the many challenges presented by the pandemic. Findings: The majority of FLHCWs responding to our survey reported that their care of patients had been impacted both adversely and positively by the public health measures imposed. Most FLHCs (95%) reported a deterioration in the mental health of their patients. Conclusions: Continuity of care for NCDs as part of pandemic preparedness is needed so that chronic conditions are not exacerbated by public health measures and the direct impacts of the pandemic.

Download Full-text

Stress, Burnout, and Resilience among Healthcare Workers during the COVID-19 Emergency: The Role of Defense Mechanisms

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105258 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5258

Author(s):

Mariagrazia Di Giuseppe ◽

Gianni Nepa ◽

Tracy A. Prout ◽

Fabrizio Albertini ◽

Stefano Marcelli ◽

...

Keyword(s):

Healthcare Workers ◽

Defense Mechanisms ◽

Online Survey ◽

Healthcare Professionals ◽

Well Being ◽

Personal Accomplishment ◽

Traumatic Experience ◽

Psychological Resources ◽

Defensive Functioning ◽

The Impact

The experience of working on the frontlines of the COVID-19 healthcare crisis has presented a cumulative traumatic experience that affects healthcare professionals’ well-being. Psychological resources such as resilience and adaptive defense mechanisms are essential in protecting individuals from severe stress and burnout. During September 2020, 233 healthcare workers responded to an online survey to test the impact of demographic variables, COVID-19 exposure, and psychological resources in determining stress and burnout during the COVID-19 emergency. Frontline workers reported higher scores for stress, emotional exhaustion, and depersonalization (p < 0.001) as compared to colleagues working in units not directly serving patients with COVID-19. Mature defensive functioning was associated with resilience and personal accomplishment (r = 0.320; p < 0.001), while neurotic and immature defenses were related to perceived stress and burnout. Stress and burnout were predicted by lower age, female gender, greater exposure to COVID-19, lower resilience, and immature defensive functioning among healthcare professionals (R2 = 463; p < 0.001). Working on the frontlines of the COVID-19 pandemic appears to provoke greater stress and burnout. On the other hand, resilience and adaptive defense mechanisms predicted better adjustment. Future reaction plans should promote effective programs offering support for healthcare workers who provide direct care to patients with COVID-19.

Download Full-text