Moral Distress in Hospitals During the First Wave of the COVID-19 Pandemic: A Web-Based Survey Among 3,293 Healthcare Workers Within the German Network University Medicine

Objective: The present study aimed to investigate the correlation between moral distress and mental health symptoms, socio-demographic, occupational, and COVID-19-related variables, and to determine differences in healthcare workers’ (HCW) moral distress during the first wave of the COVID-19 pandemic.Method: Data from 3,293 HCW from a web-based survey conducted between the 20th of April and the 5th of July 2020 were analyzed. We focused on moral distress (Moral Distress Thermometer, MDT), depressive symptoms (Patient Health Questionnaire-2, PHQ-2), anxiety symptoms (Generalized Anxiety Disorder-2, GAD-2), and increased general distress of nurses, physicians, medical-technical assistants (MTA), psychologists/psychotherapists, and pastoral counselors working in German hospitals.Results: The strongest correlations for moral distress were found with depressive symptoms, anxiety symptoms, occupancy rate at current work section, and contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nurses and MTA experienced significantly higher moral distress than physicians, psychologists/psychotherapists, and pastoral counselors. The average level of moral distress reported by nurses from all work areas was similar to levels which before the pandemic were only experienced by nurses in intensive or critical care units.Conclusion: Results indicate that moral distress is a relevant phenomenon among HCW in hospitals during the COVID-19 pandemic, regardless of whether they work at the frontline or not and requires urgent attention.

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Resilience Moderates Negative Outcome from Stress during the COVID-19 Pandemic: A Moderated-Mediation Approach

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186461 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6461 ◽

Cited By ~ 4

Author(s):

Audun Havnen ◽

Frederick Anyan ◽

Odin Hjemdal ◽

Stian Solem ◽

Maja Gurigard Riksfjord ◽

...

Keyword(s):

Depressive Symptoms ◽

Indirect Effect ◽

Moderated Mediation ◽

Anxiety Symptoms ◽

Stress Exposure ◽

Mediation Analyses ◽

Symptoms Of Depression ◽

Moderated Mediation Model ◽

Treatment And Prevention ◽

Patient Health

Resilience refers to an individual’s healthy coping abilities when encountering adverse life events. The COVID-19 pandemic represents a situation with a high amount of stress exposure, which in turn may be associated with negative emotional outcome like depressive symptoms. The current study investigated if resilience moderated the effect of stress on symptoms of depression and if anxiety symptoms mediated this association. An adult sample of community controls completed the Perceived stress scale 14 (PSS-14), the Resilience scale for adults (RSA), the Patient health questionnaire 9 (PHQ-9) and the Generalized anxiety disorder 7 (GAD-7). Independent samples t-test, correlation analyses and moderated mediation analyses were conducted. The results showed that resilience moderated the relations between stress and anxiety symptoms (β = −0.131, p < 0.001) as well as between stress and depressive symptoms (β = −0.068, p < 0.05). In support of a moderated mediation model, resilience moderated the indirect effect of stress on depressive symptom, as confirmed by the index of moderated mediation (IMM = −0.036, p < 0.001; [95% BCa: −0.055, −0.020]). The high resilience subgroup was less affected than the low resilience subgroup by the effect of stress exposure symptoms of depression, mediated by anxiety. The study shows that stress exposure is associated with symptoms of depression, and anxiety mediates this association. Level of resilience differentiates the direct and indirect effect of stress on depression. Knowledge about the effect of stress in response to a pandemic is important for developing treatment and prevention strategies for stress, depression and health-related anxiety.

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Reliability and construct validity of the modified Finnish version of the 9-item Patient Health Questionnaire, and its’ content validity within biopsychosocial frame among female healthcare workers with sub-acute or recurrent LBP

10.21203/rs.2.18120/v1 ◽

2019 ◽

Author(s):

Jaana Helena Suni ◽

Tarja Virkkunen ◽

Pauliina Husu ◽

Kari Tokola ◽

Jari Parkkari ◽

...

Keyword(s):

Depressive Symptoms ◽

Construct Validity ◽

Internal Consistency ◽

Content Validity ◽

Healthcare Workers ◽

Bodily Pain ◽

Patient Health Questionnaire ◽

Health Questionnaire ◽

Increased Risk ◽

Patient Health

Abstract Background: Healthcare workers have increased risk for chronic low back pain (LBP) leading to reduced workability. Depression, a highly prevalent, costly and disabling condition, is commonly seen in patients with sub-acute LBP. This study investigated the psychometric properties and content-validity of a modified 9-item Patient Health Questionnaire (PHQ-9-mFIN) in female healthcare workers with sub-acute LBP. Methods: Reliability (internal consistency, test-retest repeatability) was assessed with standard methods. Construct validity of the PHQ-9-mFIN was assessed as level of depression (PHQ-9-mFIN: 0-4 none, 5-9 mild, ≥10 at least moderate) against RAND-36 Health Survey, a valid measure of health-related quality of life (HRQoL). Content validity was determined as the strength of the association between the levels of PHQ-9-mFIN and the selected biopsychosocial factors. Results: The internal consistency of the PHQ-9-mFIN was high (Cronbach’s α=0.82) and the test-retest repeatability scores (n=65) fair: Pearson’s correlation 0.76, Kappa-value 0.42 for the diagnostic criterion (i.e. scores 0-9 vs. 10-27). Construct validity (Spearman correlation) against the Physical and Mental component items and their summary scales of the RAND 36 were much higher for the Mental (range -0.43 to -0.70 and -0.68) than for the Physical (range -0.06 to -0.41 and -0.24), respectively. There was a clear stepwise association (p<0.001) between the levels of depressive symptoms and General health (physical component, range 59.1 to 78.8). The associations with all items of the Mental components were strong and graded (p<0.001). All participants had low scores for Bodily pain regardless of the level of depressive symptoms. There was a strong association (p≤0.003) between levels of PHQ-9-mFIN and multisite pain, lumbar exertion and recovery after work days, neuromuscular fitness in Modified push-ups, workability, and fear of pain related to work. Conclusions: The PHQ-9-mFIN showed adequate reliability, and excellent construct and content validity among female healthcare workers with recurrent LBP and physically strenuous work. Trial registration: NCT01465698

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Depressive symptoms are associated with cigarette smoking among tuberculosis patients in Botswana

10.1101/2021.09.14.21263357 ◽

2021 ◽

Author(s):

Alexandria Jones-Patten ◽

Qiao Wang ◽

Keneilwe Molebatsi ◽

Thomas E. Novotny ◽

Kamran Siddiqi ◽

...

Keyword(s):

Depressive Symptoms ◽

Cigarette Smoking ◽

Statistical Significance ◽

Median Number ◽

Cross Sectional Study ◽

Anxiety Symptoms ◽

Depression And Anxiety ◽

Cross Sectional ◽

Health Clinics ◽

Patient Health

AbstractBackgroundResearchers have increasingly recognized the adverse effects of smoking on tuberculosis (TB) outcomes. Smoking may be a maladaptive coping mechanism for depression and anxiety among TB patients; however, this association has not yet been investigated.Design/MethodsWe conducted a cross-sectional study among newly diagnosed TB patients between January and December 2019 in Gaborone, Botswana, and evaluated factors associated with cigarette smoking. Using the Patient Health Questionnaire-9 and the Zung Self-Rating Anxiety scale, we collected depression and anxiety scores, respectively; scores of ≥10 indicate depression and scores of ≥36 indicate anxiety. We performed Poisson regression analyses with robust variance to examine whether depression and anxiety were associated with smoking.ResultsOne hundred and eighty participants with TB were enrolled from primary health clinics. Among all enrollees, depression was reported in 46 (27.1%) participants, while anxiety was reported in 60 (44.4%) participants. Overall, 45 (25.0%) participants reported current smoking, and the median number of cigarettes per day was 10. Depressive symptoms were associated with a higher prevalence of smoking (aPR: 1.82; 95% CI = 1.11, 3.01) after adjusting for sex, HIV status, food insecurity, anxiety, and income. The association between anxiety symptoms and cigarette smoking did not reach statistical significance (aPR 1.26; 95% CI: 0.78-2.05).ConclusionsWe found the association between depressive symptoms and smoking among TB patients in Botswana to be significant and the association between anxiety symptoms and cigarette smoking insignificant. Future studies should further investigate these associations when addressing TB care.

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Brief Web-Based Intervention for Depression: Randomized Controlled Trial on Behavioral Activation (Preprint)

10.2196/preprints.15312 ◽

2019 ◽

Author(s):

Lena Jelinek ◽

Sönke Arlt ◽

Steffen Moritz ◽

Johanna Schröder ◽

Stefan Westermann ◽

...

Keyword(s):

Depressive Symptoms ◽

Active Control ◽

Behavioral Activation ◽

Dysfunctional Attitudes ◽

Patient Health Questionnaire ◽

Control Group ◽

Health Questionnaire ◽

Web Based ◽

Treatment Of Depression ◽

Patient Health

BACKGROUND Web-based interventions have been shown to be effective for the treatment of depression. However, interventions are often complex and include a variety of elements, making it difficult to identify the most effective component(s). OBJECTIVE The aim of this pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated intervention for depression (internet-based behavioral activation [iBA]) to a nonoverlapping active control intervention and a nonactive control group. METHODS We assessed 104 people with at least mild depressive symptoms (Patient Health Questionnaire-9, >4) via the internet at baseline (t0) and 2 weeks (t1) and 4 weeks (t2) later. After the t0 assessment, participants were randomly allocated to one of three groups: (1) iBA (n=37), (2) active control using a brief internet-based mindfulness intervention (iMBI, n=32), or (3) care as usual (CAU, n=35). The primary outcome was improvement in depressive symptoms, as measured using the Patient Health Questionnaire-9. Secondary parameters included changes in activity, dysfunctional attitudes, and quality of life RESULTS While groups did not differ regarding the change in depression from t0 to t1 (ηp2=.007, P=.746) or t0 to t2 (ηp2=.008, P=.735), iBA was associated with a larger decrease in dysfunctional attitudes from t0 to t2 in comparison to CAU (ηp2=.053, P=.04) and a larger increase in activity from t0 to t1 than the pooled control groups (ηp2=.060, P=.02). A change in depression from t0 to t2 was mediated by a change in activity from t0 to t1. At t1, 22% (6/27) of the participants in the iBA group and 12% (3/25) of the participants in the iMBI group indicated that they did not use the intervention. CONCLUSIONS Although we did not find support for the short-term efficacy of the single-module iBA regarding depression, long-term effects are still conceivable, potentially initiated by changes in secondary outcomes. Future studies should use a longer intervention and follow-up interval. CLINICALTRIAL DKRS (#DRKS00011562)

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Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 epidemic in China: a web-based cross-sectional survey

10.21203/rs.3.rs-17172/v1 ◽

2020 ◽

Cited By ~ 7

Author(s):

Yeen Huang ◽

Ning Zhao

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Sleep Quality ◽

Healthcare Workers ◽

Influence Factors ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Web Based

Abstract Background China has been severely affected by COVID-19 (Corona Virus Disease 2019) since December, 2019. This study aimed to assess the population mental health burden during the epidemic, and to explore the potential influence factors. Methods Using a web-based cross-sectional survey, we collected data from 7,236 self-selected volunteers assessed with demographic information, COVID-19 related knowledge, Generalized Anxiety Disorder-7 (GAD-7), Center for Epidemiology Scale for Depression (CES-D), and Pittsburgh Sleep Quality Index (PSQI). Logistic regressions were used to identify influence factors associated with mental health problem. Results Of the total sample analyzed, the overall prevalence of GAD, depressive symptoms, and sleep quality were 35.1%, 20.1%, and 18.2%, respectively. Young people reported a higher prevalence of GAD and depressive symptoms than older people ( P <0.001). Compared with other occupational group, healthcare workers have the highest rate of poor sleep quality ( P <0.001). Multivariate logistic regression showed that age (< 35 years) and times to focus on the COVID-19 (≥ 3 hours per day) were associated with GAD, and healthcare workers were associated with poor sleep quality. Conclusions Our study identified a major mental health burden of the public during COVID-19 epidemic in China. Young people, people who spent too much time on the epidemic, and healthcare workers were at high risk for mental illness. Continuous surveillance and monitoring of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide.

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Anxiety and depressive symptoms in college students during the late stage of the COVID-19 outbreak: a network approach

Translational Psychiatry ◽

10.1038/s41398-021-01738-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Wei Bai ◽

Hong Cai ◽

Shou Liu ◽

Xu Chen ◽

Sha Sha ◽

...

Keyword(s):

College Students ◽

Depressive Symptoms ◽

Late Stage ◽

Mental Health Problems ◽

Anxiety Symptoms ◽

Network Stability ◽

Novel Approach ◽

Patient Health ◽

Symptom Level ◽

Stability And Accuracy

AbstractMental health problems are common in college students even in the late stage of the coronavirus disease 2019 (COVID-19) outbreak. Network analysis is a novel approach to explore interactions of mental disorders at the symptom level. The aim of this study was to elucidate characteristics of depressive and anxiety symptoms network in college students in the late stage of the COVID-19 outbreak. A total of 3062 college students were included. The seven-item Generalized Anxiety Disorder Scale (GAD-7) and nine-item Patient Health Questionnaire (PHQ-9) were used to measure anxiety and depressive symptoms, respectively. Central symptoms and bridge symptoms were identified based on centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. The strongest direct relation was between anxiety symptoms “Nervousness” and “Uncontrollable worry”. “Fatigue” has the highest node strength in the anxiety and depression network, followed by “Excessive worry”, “Trouble relaxing”, and “Uncontrollable worry”. “Motor” showed the highest bridge strength, followed by “Feeling afraid” and “Restlessness”. The whole network was robust in both stability and accuracy tests. Central symptoms “Fatigue”, “Excessive worry”, “Trouble relaxing” and “Uncontrollable worry”, and critical bridge symptoms “Motor”, “Feeling afraid” and “Restlessness” were highlighted in this study. Targeting interventions to these symptoms may be important to effectively alleviate the overall level of anxiety and depressive symptoms in college students.

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Youth StepCare: A pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice.

10.21203/rs.2.11673/v2 ◽

2019 ◽

Author(s):

Belinda Parker ◽

Melinda Rose Achilles ◽

Mirjana Subotic-Kerry ◽

Bridianne O'Dea

Keyword(s):

Mental Illness ◽

General Practice ◽

Anxiety Symptoms ◽

Self Report ◽

Depression And Anxiety ◽

Web Based ◽

Practice Staff ◽

Factors Affecting ◽

Patient Health ◽

General Practices

Abstract Background: General Practitioners (GPs) are ideally placed to identify and manage emerging mental illness in young people, however, many report low levels of confidence in doing so. A web-based universal screening service delivered via a mobile tablet, Youth StepCare, was developed to assist GPs in identifying depression and anxiety symptoms in youth patients. The service also provided evidence-based treatment recommendations and fortnightly monitoring of symptoms. The current study assessed the feasibility and acceptability of delivering the Youth StepCare service in Australian general practices. Methods: A 12-week uncontrolled trial was undertaken between August 2018 and January 2019 in two general practices in NSW, Australia. The service was offered to all youth patients aged 14-17 years who visited their participating GP during the screening period alongside their parent or guardian. Youth patients reported the presence of depressive and anxiety symptoms using the self-report Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Questionnaire-7. New cases were defined as those who were experiencing symptoms and were not currently visiting their GP, nor had previously sought help for mental health issues. Feasibility and acceptability of the service among GPs and practice staff was assessed using a battery of questionnaires. Results: Five GPs and 6 practice staff participated in the trial. A total of 46 youth patients were approached and 28 consented to participate. Of these, 19 completed the screener (67.9%). Nine reported symptoms of anxiety or depression, two of which were new cases (22.2%). GPs and practice staff were satisfied with the service, reporting that there was a need for the service, and that they would use it again. Conclusions: The Youth StepCare service appears to be a useful tool for identifying youth with unidentified symptoms of mental illness that can be easily embedded into general practice. Further research would benefit from exploring the factors affecting initial GP uptake and a larger trial is required to determine the efficacy of the service on young people’s symptom reduction.

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Brief Web-Based Intervention for Depression: Randomized Controlled Trial on Behavioral Activation

Journal of Medical Internet Research ◽

10.2196/15312 ◽

2020 ◽

Vol 22 (3) ◽

pp. e15312

Author(s):

Lena Jelinek ◽

Sönke Arlt ◽

Steffen Moritz ◽

Johanna Schröder ◽

Stefan Westermann ◽

...

Keyword(s):

Depressive Symptoms ◽

Active Control ◽

Behavioral Activation ◽

Dysfunctional Attitudes ◽

Patient Health Questionnaire ◽

Control Group ◽

Health Questionnaire ◽

Web Based ◽

Treatment Of Depression ◽

Patient Health

Background Web-based interventions have been shown to be effective for the treatment of depression. However, interventions are often complex and include a variety of elements, making it difficult to identify the most effective component(s). Objective The aim of this pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated intervention for depression (internet-based behavioral activation [iBA]) to a nonoverlapping active control intervention and a nonactive control group. Methods We assessed 104 people with at least mild depressive symptoms (Patient Health Questionnaire-9, >4) via the internet at baseline (t0) and 2 weeks (t1) and 4 weeks (t2) later. After the t0 assessment, participants were randomly allocated to one of three groups: (1) iBA (n=37), (2) active control using a brief internet-based mindfulness intervention (iMBI, n=32), or (3) care as usual (CAU, n=35). The primary outcome was improvement in depressive symptoms, as measured using the Patient Health Questionnaire-9. Secondary parameters included changes in activity, dysfunctional attitudes, and quality of life Results While groups did not differ regarding the change in depression from t0 to t1 (ηp2=.007, P=.746) or t0 to t2 (ηp2=.008, P=.735), iBA was associated with a larger decrease in dysfunctional attitudes from t0 to t2 in comparison to CAU (ηp2=.053, P=.04) and a larger increase in activity from t0 to t1 than the pooled control groups (ηp2=.060, P=.02). A change in depression from t0 to t2 was mediated by a change in activity from t0 to t1. At t1, 22% (6/27) of the participants in the iBA group and 12% (3/25) of the participants in the iMBI group indicated that they did not use the intervention. Conclusions Although we did not find support for the short-term efficacy of the single-module iBA regarding depression, long-term effects are still conceivable, potentially initiated by changes in secondary outcomes. Future studies should use a longer intervention and follow-up interval. Trial Registration DKRS (#DRKS00011562)

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Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 epidemic in China: a web-based cross-sectional survey

10.1101/2020.02.19.20025395 ◽

2020 ◽

Cited By ~ 32

Author(s):

Yeen Huang ◽

Ning Zhao

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Sleep Quality ◽

Healthcare Workers ◽

Influence Factors ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Web Based

AbstractBackgroundChina has been severely affected by COVID-19 (Corona Virus Disease 2019) since December, 2019. This study aimed to assess the population mental health burden during the epidemic, and to explore the potential influence factors.MethodsUsing a web-based cross-sectional survey, we collected data from 7,236 self-selected volunteers assessed with demographic information, COVID-19 related knowledge, Generalized Anxiety Disorder-7 (GAD-7), Center for Epidemiology Scale for Depression (CES-D), and Pittsburgh Sleep Quality Index (PSQI). Logistic regressions were used to identify influence factors associated with mental health problem.ResultsOf the total sample analyzed, the overall prevalence of GAD, depressive symptoms, and sleep quality were 35.1%, 20.1%, and 18.2%, respectively. Young people reported a higher prevalence of GAD and depressive symptoms than older people (P<0.001). Compared with other occupational group, healthcare workers have the highest rate of poor sleep quality (P<0.001). Multivariate logistic regression showed that age (< 35 years) and times to focus on the COVID-19 (≥ 3 hours per day) were associated with GAD, and healthcare workers were associated with poor sleep quality.ConclusionsOur study identified a major mental health burden of the public during COVID-19 epidemic in China. Young people, people who spent too much time on the epidemic, and healthcare workers were at high risk for mental illness. Continuous surveillance and monitoring of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide.

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Generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown. Specific predictors and differences in symptoms severity

10.31234/osf.io/42m87 ◽

2020 ◽

Author(s):

Małgorzata Gambin ◽

Marcin Sekowski ◽

Małgorzata Woźniak-Prus ◽

Anna Wnuk ◽

Tomasz Oleksy ◽

...

Keyword(s):

Depressive Symptoms ◽

Emotional Distress ◽

Age Groups ◽

Anxiety Symptoms ◽

Therapeutic Interventions ◽

Generalized Anxiety ◽

Polish Population ◽

Younger Age ◽

Patient Health ◽

Household Members

Background. Previous studies carried out in different countries indicated that young adults experience higher levels of depressive and anxiety symptoms than older age groups during the COVID-19 pandemic. However, little is known about which epidemic-related difficulties and factors may contribute to these forms of emotional distress in various age groups. Purpose. The aim of the current study was to investigate: (i) differences in levels of depressive and generalized anxiety symptoms, as well as perceived difficulties related to pandemic across four age groups in the Polish population; (ii) which factors and difficulties related to pandemic are predictors of generalized anxiety and depressive symptoms in various age groups during the COVID-19 lockdown. Method. A total of 1115 participants (aged 18-85) took part in the study. The group was a representative sample of the Polish population in terms of sex, age, and place of residence. Participants completed online: The Patient Health Questionnaire-9, The Generalized Anxiety Disorder-7, Scale of Perceived Health and Life Risk of COVID-19, Social Support Sale, Scale of Epidemic-Related Difficulties. Results. Younger age groups (18-29 and 30-44) experienced higher levels of depressive and generalized anxiety symptoms than older adults (45-59 and 60-85 years). Difficulties in relationships and at home were amongst the strongest predictors of depressive and generalized anxiety symptoms in all age groups. Fear and uncertainty related to the spread of the virus were one of the most important predictors of emotional distress in all the groups apart from the adults between 18-29 years, whereas difficulties related to external restrictions were one of the most significant predictors of depressive and anxiety symptoms only in the youngest group. Conclusions. Our results indicate that the youngest adults and those experiencing difficulties in relationships among household members were the most vulnerable to depressive and generalized anxiety symptoms during the COVID-19 lockdown. Thus, it is important to plan preventive and therapeutic interventions to support these at-risk individuals in dealing with the challenges related to the COVID-19 pandemic.

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