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    Acute psychological effects of Coronavirus Disease 2019 outbreak among healthcare workers in China: a cross-sectional study. Wang Ying,Ma Simeng,Yang Can,Cai Zhongxiang,Hu Shaohua,Zhang Bin,Tang Shiming,Bai Hanping,Guo Xin,Wu Jiang,Du Hui,Kang Lijun,Tan Huawei,Li Ruiting,Yao Lihua,Wang Gaohua,Liu Zhongchun Translational psychiatry To study the acute psychological effects of Coronavirus Disease 2019 (COVID-19) outbreak among healthcare workers (HCWs) in China, a cross-sectional survey was conducted among HCWs during the early period of COVID-19 outbreak. The acute psychological effects including symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder (GAD-7) questionnaire, and the Impact of Event Scale-Revised (IES-R). The prevalence of depression, anxiety, and PTSD was estimated at 15.0%, 27.1%, and 9.8%, respectively. Having an intermediate technical title, working at the frontline, receiving insufficient training for protection, and lacking confidence in protection measures were significantly associated with increased risk for depression and anxiety. Being a nurse, having an intermediate technical title, working at the frontline, and lacking confidence in protection measures were risk factors for PTSD. Meanwhile, not worrying about infection was a protective factor for developing depression, anxiety, and PTSD. Psychological interventions should be implemented among HCWs during the COVID-19 outbreak to reduce acute psychological effects and prevent long-term psychological comorbidities. Meanwhile, HCWs should be well trained and well protected before their frontline exposure. 10.1038/s41398-020-01031-w
    When there is a will there is a way: The role of proactive personality in combating COVID-19. Yi-Feng Chen Nancy,Crant J Michael,Wang Nan,Kou Yu,Qin Yuhong,Yu Junhua,Sun Rongju The Journal of applied psychology The global COVID-19 pandemic has disrupted personal and work lives and created great uncertainty and stress, especially for frontline health care professionals like doctors and nurses who risk personal health while facing increased workloads and new COVID-related tasks. People can passively respond to this disruption, or they can be more active and choose to shape the conditions surrounding their work during the crisis. We designed a multiwave, multisource study examining whether a proactive orientation is a key resource for frontline health care professionals in the COVID-19 pandemic. Drawing from proactive and conservation of resources theories, we studied a sample of 408 doctors and nurses at a COVID-19 hospital in the locked-down area surrounding Wuhan City, China during the first wave of the virus. Our aim is to examine how personal agency contributes to health care professionals' performance and well-being when combating COVID-19. Proactive personality as a dispositional resource was associated with higher levels of perceived strengths use, a job-related motivational resource. This effect was jointly moderated by routine disruption and perceived organizational support. Proactive personality was indirectly associated with performance and two indicators of well-being (resilience and thriving) through perceived strengths use. More frequent physical exposure to the virus magnified the effects of perceived strengths use on an archival indicator of performance during the first wave of the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved). 10.1037/apl0000865
    Mental Health of Medical Staff During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis. Yan Haohao,Ding Yudan,Guo Wenbin Psychosomatic medicine OBJECTIVE:This study aimed to quantify the prevalence of the adverse mental health outcomes in medical staff working in the hospital settings during the coronavirus disease 2019 (COVID-19) pandemic and explore the relative distribution of anxiety and depressive symptoms. METHODS:PubMed, EMBASE, China National Knowledge Infrastructure, WANFANG DATA, and VIP Database for Chinese Technical Periodicals were searched for articles published from January 1, 2019, to April 19, 2020. The prevalence estimates of adverse mental health symptoms in medical staff were pooled using the random-effects model. RESULTS:A total of 35 articles and data of 25,343 medical staff were used in the final analysis. The pooled prevalence estimates in medical staff during the COVID-19 pandemic were as follows (ordered from high to low): fear-related symptoms, 67% (95% confidence interval [CI] = 61%-73%); high levels of perceived stress, 56% (95% CI = 32%-79%), anxiety symptoms, 41% (95% CI = 35%-47%); insomnia, 41% (95% CI = 33%-50%); posttraumatic stress disorder symptoms, 38% (95% CI = 34%-43%); depressive symptoms, 27% (95% CI = 20%-34%); and somatic symptoms, 16% (95% CI = 3%-36%). The subgroup analysis revealed that the prevalence estimates of fear-related symptoms were consistently high. CONCLUSIONS:Medical staff during the COVID-19 epidemic have a high prevalence of adverse mental health symptoms. Data-based strategies are needed to optimize mental health of medical staff and other health care professionals during times of high demand such as the COVID-19 and other epidemics.PROSPERO Registration: CRD42020182433. 10.1097/PSY.0000000000000922
    Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Lasalvia A,Bonetto C,Porru S,Carta A,Tardivo S,Bovo C,Ruggeri M,Amaddeo F Epidemiology and psychiatric sciences AIMS:Healthcare workers exposed to coronavirus 2019 (COVID-19) patients could be psychologically distressed. This study aims to assess the magnitude of psychological distress and associated factors among hospital staff during the COVID-19 pandemic in a large tertiary hospital located in north-east Italy. METHODS:All healthcare and administrative staff working in the Verona University Hospital (Veneto, Italy) during the COVID-19 pandemic were asked to complete a web-based survey from 21 April to 6 May 2020. Symptoms of post-traumatic distress, anxiety and depression were assessed, respectively, using the Impact of Event Scale (IES-R), the Self-rating Anxiety Scale (SAS) and the Patient Health Questionnaire (PHQ-9). Personal socio-demographic information and job characteristics were also collected, including gender, age, living condition, having pre-existing psychological problems, occupation, length of working experience, hospital unit (ICUs and sub-intensive COVID-19 units vs. non-COVID-19 units). A multivariable logistic regression analysis was performed to identify factors associated with each of the three mental health outcomes. RESULTS:A total of 2195 healthcare workers (36.9% of the overall hospital staff) participated in the study. Of the participants, 35.7% were nurses, 24.3% other healthcare staff, 16.4% residents, 13.9% physicians and 9.7% administrative staff. Nine per cent of healthcare staff worked in ICUs, 8% in sub-intensive COVID-19 units and 7.6% in other front-line services, while the remaining staff worked in hospital units not directly engaged with COVID-19 patients. Overall, 63.2% of participants reported COVID-related traumatic experiences at work and 53.8% (95% CI 51.0%-56.6%) showed symptoms of post-traumatic distress; moreover, 50.1% (95% CI 47.9%-52.3%) showed symptoms of clinically relevant anxiety and 26.6% (95% CI 24.7%-28.5%) symptoms of at least moderate depression. Multivariable logistic regressions showed that women, nurses, healthcare workers directly engaged with COVID-19 patients and those with pre-existing psychological problems were at increased risk of psychopathological consequences of the pandemic. CONCLUSIONS:The psychological impact of the COVID-19 pandemic on healthcare staff working in a highly burdened geographical of north-east Italy is relevant and to some extent greater than that reported in China. The study provides solid grounds to elaborate and implement interventions pertaining to psychology and occupational health. 10.1017/S2045796020001158
    Mental health issues and psychological risk factors among Paraguayan healthcare workers during the COVID-19 pandemic. Journal of mental health (Abingdon, England) BACKGROUND:There is an increasing concern regarding the mental health of healthcare workers during the COVID-19 pandemic. AIMS:This study aimed to assess the psychological impact of the COVID-19 exposure among Paraguayan healthcare workers. METHODS:A cross-sectional descriptive study has been carried out in five hospitals of Paraguay. Demographic and occupational exposure to COVID-19 were collected through a short questionnaire. Mental health status was assessed with the GAD-7, the PHQ-9, and the PCL-C. Logistic regression was used to determine psychological risk factors. RESULTS:432 participants were surveyed. 218 (50.46%) were physicians. The prevalence of symptoms of anxiety, depression and PTSD was 48.15, 41.90, and 5.79%, respectively. There were no significant differences in anxiety (128 [29.63%] vs. 80 [18.52%];  = 0.3303), depression (102 [23.61%] vs. 79 [18.29%];  = 0.6703), or PTSD (14 [3.24%] vs. 11 [2.55%];  = 0.8074) between frontline versus second-line workers. Main risk factors associated with psychological distress included work experience <5 years for depression and a COVID-19 positive diagnosis or having family/friends with a COVID-19 positive diagnosis for PTSD. CONCLUSIONS:Paraguayan healthcare workers reported high prevalence of anxiety, depression, and a low prevalence of PTSD. A positive diagnosis of COVID-19 and work experience <5 years are important psychological risk factors. 10.1080/09638237.2021.1979494
    Physician Satisfaction With Telemedicine During the COVID-19 Pandemic: The Mayo Clinic Florida Experience. Mayo Clinic proceedings. Innovations, quality & outcomes OBJECTIVE:To evaluate physician perceptions and attitudes toward telemedicine use at a tertiary care academic institution in northeast Florida during the coronavirus disease 2019 pandemic. PATIENTS AND METHODS:An anonymous 38-question cross-sectional survey was developed using Qualtrics survey software (Qualtrics) and e-mailed to all staff physicians from all specialty disciplines at Mayo Clinic in Florida. The survey was open from August 17, 2020, through September 1, 2020. Collected data included general demographic characteristics and employment information, attitude and experience with telemedicine use before and during the coronavirus disease 2019 pandemic, perception of patients' experience, and the effect of telemedicine on burnout. RESULTS:The survey was distributed to 529 eligible physicians at our institution, with 103 physicians responding (20%). The distribution of specialties was 22% primary care specialties, 41% other internal medicine subspecialties, and 18% surgical specialties. Collectively, 63% found comparable quality of care when provided virtually (vs in-person) whereas 80% perceived telemedicine as cost-effective. A total of 76% of physicians felt that telemedicine increased flexibility and control over patient care activities, with 36% reporting improved work-life balance and 30% reporting improved burnout symptoms. Overall, 42% preferred using telemedicine over in-person visits when possible. CONCLUSION:Physicians generally had positive attitudes regarding the adoption of telemedicine and perceived that the quality of health care delivery as generally comparable to in-person care. Future studies are needed to explore attitudes regarding telemedicine after the pandemic and how this virtual technology may be further used to improve physicians' professional and personal well-being. 10.1016/j.mayocpiqo.2021.06.006
    Use of telehealth for HIV care in Italy: Are doctors and patients on the same page? A cross-sectional study. Massaroni Valentina,Delle Donne Valentina,Ciccarelli Nicoletta,Ciccullo Arturo,Borghetti Alberto,Faliero Domenico,Visconti Elena,Tamburrini Enrica,Di Giambenedetto Simona International journal of medical informatics BACKGROUND:The COVID-19 pandemic has changed outpatient clinical practice, which has led to the need defining digital healthcare modalities to provide telehealth services. The aim of our study was to explore opinions about HIV management via telehealth in a representative, southern central Italian cohort of individuals with HIV (PLWH) and doctors involved in the treatment process. METHODS:We enrolled 80 PLWH who have never used telehealth tools and 60 doctors, who administered an anonymous self-report questionnaire to investigate their opinions about telehealth service use. RESULTS:Most of the doctors and patients indicated that they would use telehealth services; however, 88.3% of the doctors and 40% of the PLWH did not want to substitute personal visits with telehealth services. Unlike PLWH, physicians seemed to agree with most of the possible risks of telehealth, such as patients' isolation from the hospital system (71.7%), interaction difficulty (46.7%) and lower quality of patient assessment (63.3%). The doctors focused on the qualitative aspects of telehealth services reducing patients' exposure to stigma (61.7%), improving quality of patient care (41.7%), and improving privacy (58.3%). By contrast, patients focused on the quantitative aspects of telehealth services improving timely access to care (44%), time saving (63%) and improving interaction with doctor (43%). CONCLUSIONS:Both PLWH (especially older patients and those with longer experience of disease management) and doctors welcome the use of telehealth services but disagree using it to substitute medical consultation in person focusing on different possible benefits and risks of telehealth depending on the needs expressed. Thus, our results suggest the need to initiate and expand communication about telehealth between doctors and patients. 10.1016/j.ijmedinf.2021.104616
    Covid-19 and Increased Risk of Physician Suicide: A Call to Detoxify the U.S. Medical System. Kakarala Sophia E,Prigerson Holly G Frontiers in psychiatry Suicide among physicians is a longstanding problem, with risk factors exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. In this article, we explore suicidal thoughts and behaviors among physicians and risk factors created or intensified by the work environment, such as overwork and loss of autonomy. We discuss the ways in which the COVID-19 pandemic has made the medical work environment more stressful (e.g. greater exposure to traumatic experiences and employment insecurity) and, consequently, elevated physician suicide risk. We also review evidence that the medical system in the United States has not adequately protected physicians' mental health. Lack of confidentiality, stigma, cost, and time, as well as intrusive medical licensing applications, remain barriers to physicians seeking help. Work pressures imposed by insurance companies and financial incentives to increase revenue while cutting costs compound physicians' work stress. We conclude that system-wide changes to the practice of medicine and policies regarding healthcare delivery are needed to improve physicians' work environments, as is research addressing the impact of the interventions to reduce their suicidal risk. The proposed changes, and greater access to timely and confidential mental health services amid and in the aftermath of the pandemic, may prove promising approaches to reduce physicians' suicide risk. 10.3389/fpsyt.2022.791752
    Association of Social Network Use With Increased Anxiety Related to the COVID-19 Pandemic in Anesthesiology, Intensive Care, and Emergency Medicine Teams: Cross-Sectional Web-Based Survey Study. Clavier Thomas,Popoff Benjamin,Selim Jean,Beuzelin Marion,Roussel Melanie,Compere Vincent,Veber Benoit,Besnier Emmanuel JMIR mHealth and uHealth BACKGROUND:Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. OBJECTIVE:Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. METHODS:We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents' use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. RESULTS:We included 641 respondents in the final analysis; 553 (86.3%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19-related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (P=.02) and multivariate (P<.001) analyses, with an average anxiety increase of 10% in social network users. Anxiety was higher among health care workers using social networks to obtain information on COVID-19 than among those using other sources (median 6, IQR 5-8 vs median 6, IQR 4-7; P=.04). Social network users considered that they were less informed about COVID-19 than those who did not use social networks (median 8, IQR 7-9 vs median 7, IQR 6-8; P<.01). CONCLUSIONS:Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic. 10.2196/23153
    Anxiety Levels Among Physician Mothers During the COVID-19 Pandemic. Linos Elizabeth,Halley Meghan C,Sarkar Urmimala,Mangurian Christina,Sabry Hala,Olazo Kristan,Mathews Kusum S,Diamond Lisa,Goyal Monika K,Linos Eleni,Jagsi Reshma The American journal of psychiatry 10.1176/appi.ajp.2020.20071014
    Pediatric hematology/oncology healthcare professional emotional health during COVID-19. Schechter-Finkelstein Tal,Plenert Erin,La Rosa Jennifer,McLean Jennifer,Chiang K Y,Krueger Joerg,Hearne Erin,Sung Lillian Cancer medicine OBJECTIVES:Little is known about the impact of coronavirus disease 2019 (COVID-19) on healthcare professional emotional health in pediatric hematology/oncology. Primary objective was to describe anxiety, depression, positive affect, and perceived stress among pediatric hematology/oncology healthcare professionals following a COVID-19 outbreak. Secondary objectives were to compare these outcomes based on contact with a positive person, and to identify risk factors for worse outcomes. MATERIALS AND METHODS:We included 272 healthcare professionals working with pediatric hematology/oncology patients. We determined whether respondents had direct or indirect contact with a COVID-19-positive individual and then measured outcomes using the Patient-Reported Outcomes Measurement Information System (PROMIS) depression, anxiety, and positive affect measures, and the Perceived Stress Scale. RESULTS:Among eligible respondents, 205 agreed to participate (response rate 75%). Sixty-nine (33.7%) had contact with a COVID-19-positive person. PROMIS anxiety, depression, and positive affect scores were similar to the general United States population. Those who had contact with a COVID-19-positive individual did not have significantly different outcomes. In multiple regression, non-physicians had significantly increased anxiety (nurses: p = 0.013), depression (nurses: p = 0.002, pharmacists: p = 0.038, and other profession: p = 0.021), and perceived stress (nurses: p = 0.002 and other profession: p = 0.011) when compared to physicians. CONCLUSIONS:Pediatric hematology/oncology healthcare professionals had similar levels of anxiety, depression, and positive affect as the general population. Contact with a COVID-19-positive individual was not significantly associated with outcomes. Non-physician healthcare professionals had more anxiety, depression, and perceived stress when compared to physicians. These findings may help to develop programs to support healthcare professional resilience. 10.1002/cam4.4253
    People's Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study. Isautier Jennifer Mj,Copp Tessa,Ayre Julie,Cvejic Erin,Meyerowitz-Katz Gideon,Batcup Carys,Bonner Carissa,Dodd Rachael,Nickel Brooke,Pickles Kristen,Cornell Samuel,Dakin Thomas,McCaffery Kirsten J Journal of medical Internet research BACKGROUND:In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people's experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. OBJECTIVE:This study aimed to compare participants' perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. METHODS:A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. RESULTS:Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was "just as good as" or "better than" their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores (ie, individuals' willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants' telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. CONCLUSIONS:Based on our sample's responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic. 10.2196/24531
    Mental illness and suicide among physicians. Harvey Samuel B,Epstein Ronald M,Glozier Nicholas,Petrie Katherine,Strudwick Jessica,Gayed Aimee,Dean Kimberlie,Henderson Max Lancet (London, England) The COVID-19 pandemic has heightened interest in how physician mental health can be protected and optimised, but uncertainty and misinformation remain about some key issues. In this Review, we discuss the current literature, which shows that despite what might be inferred during training, physicians are not immune to mental illness, with between a quarter and a third reporting increased symptoms of mental ill health. Physicians, particularly female physicians, are at an increased risk of suicide. An emerging consensus exists that some aspects of physician training, working conditions, and organisational support are unacceptable. Changes in medical training and health systems, and the additional strain of working through a pandemic, might have amplified these problems. A new evidence-informed framework for how individual and organisational interventions can be used in an integrated manner in medical schools, in health-care settings, and by professional colleagues is proposed. New initiatives are required at each of these levels, with an urgent need for organisational-level interventions, to better protect the mental health and wellbeing of physicians. 10.1016/S0140-6736(21)01596-8
    Radiation Oncologist Perceptions of Telemedicine from Consultation to Treatment Planning: A Mixed-Methods Study. Zhang Helen,Cha Elaine E,Lynch Kathleen,Cahlon Oren,Gomez Daniel R,Shaverdian Narek,Gillespie Erin F International journal of radiation oncology, biology, physics PURPOSE:Telemedicine was rapidly implemented for initial consultations and radiation treatment planning in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we explore utilization of and physician perspectives on this approach in an attempt to identify patient populations that may benefit most from virtual care. METHODS AND MATERIALS:This is a mixed-methods study with a convergent design. Approximately 6 to 8 weeks after implementation of telemedicine, all radiation oncologists in a single academic radiation oncology department were invited to participate in either semistructured interviews with embedded survey questions or a concurrently administered survey only. Rapid qualitative analysis was used to identify common themes, and quantitative data was assessed using descriptive statistics and univariable analyses. RESULTS:At the apex of the pandemic, 92% of radiation oncology visits were conducted via telemedicine. In total, 51 of 61 radiation oncologists participated in the study (response rate 84%). Most (71%) reported no difference in ability to treat cancer appropriately via telemedicine, which was more common among specialized physicians (P = .01) but not those with higher visit volume or years of experience. Over half (55%) perceived no difference or even improvement in overall visit quality with telemedicine. Virtual visits were deemed acceptable for a median of 70% to 96% of patients, which varied by disease site. Need for physical examination, and availability of an acceptable proxy, factored into telemedicine acceptability. Most (88%) found telemedicine better than expected, but opinions were split on how telemedicine would affect physician burnout. Almost all (96%) foresaw a role for telemedicine beyond the pandemic and would opt for a median of 50% (interquartile range 20%-66%) of visits conducted via telemedicine. CONCLUSIONS:Among radiation oncologists in an academic setting, telemedicine was perceived to be highly appropriate and acceptable for most patients. Future studies should focus on identifying the 5% to 30% of patients whose care may be optimized with in-person visits, and if there is alignment with patient preferences. 10.1016/j.ijrobp.2020.07.007
    Virtual care: a 'Zoombie' apocalypse? Shachak Aviv,Alkureishi Maria Alcocer Journal of the American Medical Informatics Association : JAMIA In the wake of COVID-19, clinicians took to telehealth to continue providing services to their patients, mostly via telephone or videoconferencing technology. Telehealth has many promised and proven benefits including convenience to the patient, potentially less distraction from the electronic health record (EHR), saves in travel time and expenses, and lowering patients' wait time in the clinic. However, there could be some unintended negative consequences including increased clinician burnout due to screen fatigue, potential loss of information due to the limitations of the medium, difficulty discussing sensitive issues and impacts on patient-clinician relationship, empathy, and compassion. In this perspective, we discuss some of the positives and potential negatives of telehealth and highlight some considerations that could guide the choice of media. We submit that for telehealth to become a sustainable solution that is widely applied, it is important to take these issues into consideration in both research and implementation of telehealth solutions. 10.1093/jamia/ocaa185
    Impact of the intersection of anaesthesia and gender on burnout and mental health, illustrated by the COVID-19 pandemic. Lorello G R,Gautam M,Barned C,Peer M Anaesthesia Physician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender-related risk factors for and experiences of burnout and poor mental health remain under-researched and under-reported. This negatively impacts individual practitioners, the anaesthesia workforce and patients and carries significant financial implications. We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID-19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID-19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health. 10.1111/anae.15360
    Moral distress in frontline healthcare workers in the initial epicenter of the COVID-19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Norman Sonya B,Feingold Jordyn H,Kaye-Kauderer Halley,Kaplan Carly A,Hurtado Alicia,Kachadourian Lorig,Feder Adriana,Murrough James W,Charney Dennis,Southwick Steven M,Ripp Jonathan,Peccoralo Lauren,Pietrzak Robert H Depression and anxiety INTRODUCTION:Little is known about the relationship between moral distress and mental health problems. We examined moral distress in 2579 frontline healthcare workers (FHCWs) caring for coronavirus disease 2019 (COVID-19) patients during the height of the spring 2020 pandemic surge in New York City. The goals of the study were to identify common dimensions of COVID-19 moral distress; and to examine the relationship between moral distress, and positive screen for COVID-19-related posttraumatic stress disorder (PTSD) symptoms, burnout, and work and interpersonal functional difficulties. METHOD:Data were collected in spring 2020, through an anonymous survey delivered to a purposively-selected sample of 6026 FHCWs at Mount Sinai Hospital; 2579 endorsed treating COVID-19 patients and provided complete survey responses. Physicians, house staff, nurses, physician assistants, social workers, chaplains, and clinical dietitians comprised the sample. RESULTS:The majority of the sample (52.7%-87.8%) endorsed moral distress. Factor analyses revealed three dimensions of COVID-19 moral distress: negative impact on family, fear of infecting others, and work-related concerns. All three factors were significantly associated with severity and positive screen for COVID-19-related PTSD symptoms, burnout, and work and interpersonal difficulties. Relative importance analyses revealed that concerns about work competencies and personal relationships were most strongly related to all outcomes. CONCLUSION:Moral distress is prevalent in FHCWs and includes family-, infection-, and work-related concerns. Prevention and treatment efforts to address moral distress during the acute phase of potentially morally injurious events may help mitigate risk for PTSD, burnout, and functional difficulties. 10.1002/da.23205
    Physician Burnout and the Electronic Health Record Leading Up to and During the First Year of COVID-19: Systematic Review. Journal of medical Internet research BACKGROUND:Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. OBJECTIVE:The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. METHODS:No human participants were involved in this review; however, 100% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). RESULTS:The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one's schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. CONCLUSIONS:The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. TRIAL REGISTRATION:PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201820. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.2196/15490. 10.2196/36200
    Validation of the World Health Organization Well-Being Index (WHO-5) among medical educators in Hong Kong: a confirmatory factor analysis. Chan Linda,Liu Rebecca K W,Lam Tai Pong,Chen Julie Y,Tipoe George L,Ganotice Fraide A Medical education online BACKGROUND:The COVID-19 pandemic has exacerbated the pre-existing global crisis of physician burnout. Physician and particularly medical educator well-being, has come into focus as educators can influence their own and learners' well-being. Measuring this construct is one important step towards promoting well-being in the work and learning environments. The 5-item World Health Organization Well-Being Index (WHO-5) has been validated in different populations worldwide for assessing well-being. Yet, its psychometric acceptability remains unexplored among medical educators in Asia including Hong Kong (HK). This study evaluates the validity of the WHO-5 when used among HK medical educators. METHOD:Using data from 435 medical educators, we employed combined within-network (confirmatory factor analysis; CFA) and between-network approaches (correlation and regression) to scale validation. RESULTS:CFA results indicated that our data fit the a priori WHO-5 model, suggesting structural validity. Results of comparison of means indicated no gender differences, but there were significant differences when participants were compared by age and professional backgrounds. Resilience predicted well-being as measured by the WHO-5, suggesting construct criterion validity. CONCLUSIONS:Our findings extend the validity evidence for the WHO-5 to HK medical educators examined in this study. This enables their well-being to be assessed when evaluating the impact of future well-being programmes. 10.1080/10872981.2022.2044635
    The Effect of Nursing Students' Self-Efficacy on Patient-Centered Communication During the COVID-19 Pandemic: The Mediating Effect of Learning Burnout. Wang Jing,Zheng Qiuyue,Song Wei,Wei Ling Frontiers in psychiatry The 2019 coronavirus disease (COVID-19) outbreak has put the global health system under the spotlight. As part of the medical workforce, nurses play an important role in interacting with and caring for patients; hence, patient-centered communication (PCC) has been emphasized in nursing education. Thus, it is worth investigating how future nurses perceive PCC and PCC-related factors under the special circumstances of COVID-19. For this purpose, the present study analyzed the mechanisms underlying the association between self-efficacy and nurse-patient communication tendency through learning burnout among nursing students during the COVID-19 pandemic. The general self-efficacy questionnaire, college students' learning burnout scale, and doctor-patient communication tendency scale were used to survey 2,231 nursing students in higher vocational medical colleges at the onset of the COVID-19 pandemic. General self-efficacy can directly negatively correlate with the degree of nursing students' overall nurse-patient communication, including caring, sharing, and health promotion. Dejection from learning burnout partially mediated the relationships between self-efficacy and caring and between self-efficacy and sharing; it fully mediated the relationship between self-efficacy and health promotion. Reduced personal accomplishment partially mediated between self-efficacy and caring, while it fully mediated between self-efficacy and health promotion; however, it did not play a role in the sharing model. Self-efficacy influences nurse-patient communication through learning burnout. Specifically, dejection and reduced personal accomplishment-two aspects of learning burnout-may compromise nursing students' willingness to engage in PCC. Thus, the importance of PCC, especially during critical health situations such as pandemics, should be emphasized further in future nursing education. 10.3389/fpsyt.2021.787819
    Gender and occupational role differences in work-related post-traumatic stress symptoms, burnout and global functioning in emergency healthcare workers. Carmassi Claudia,Dell'Oste Valerio,Bertelloni Carlo Antonio,Pedrinelli Virginia,Barberi Filippo Maria,Malacarne Paolo,Dell'Osso Liliana Intensive & critical care nursing OBJECTIVES:To explore gender and occupational role impact on work-related Post-Traumatic Stress Symptoms, Post-Traumatic Stress Disorder, burnout and global functioning in a sample of emergency healthcare workers. DESIGN:A cross-sectional study. PARTICIPANTS/SETTING:126 healthcare workers of the Emergency Department, including Intensive Care Unit, Emergency Room and Emergency Medicine, of a major University Hospital in central Italy were recruited. MAIN OUTCOME MEASURES:Participants were assessed by means of the: Trauma and Loss Spectrum-Self Report (TALS-SR) to explore Post-Traumatic Stress Spectrum Symptoms, Professional Quality of Life (ProQOL) Scale to assess Compassion Satisfaction, Burnout and Compassion Fatigue and Work and Social Adjustment Scale (WSAS) to measure global functioning. RESULTS:The present findings showed females were more prone to develop Post-Traumatic Stress Symptoms, particularly re-experiencing (p = .010) and hyperarousal (p = .026) symptoms and medical doctors reporting higher Burnout (p < .001) and lower Compassion Satisfaction (p = .009) mean scores than nurses. Higher levels of functioning impairment emerged amongst medical doctors rather than nurses, in both social (p = .029) and private (p = .020) leisure activities. Linear correlations highlighted relationships between the TALS-SR, ProQOL and WSAS scores. Finally, medical doctor status was significantly associated with lower Compassion Satisfaction (p = .029) and higher Burnout (p = .015). CONCLUSION:Our results highlight high post-traumatic stress symptoms and burnout levels in emergency healthcare workers with a relevant impact of female gender and occupational role, supporting the need for preventive strategies, also in light of the current COVID-19 pandemic. 10.1016/j.iccn.2021.103154
    Clinician Wellness During the COVID-19 Pandemic: Extraordinary Times and Unusual Challenges for the Allergist/Immunologist. Bansal Priya,Bingemann Theresa A,Greenhawt Matthew,Mosnaim Giselle,Nanda Anil,Oppenheimer John,Sharma Hemant,Stukus David,Shaker Marcus The journal of allergy and clinical immunology. In practice The global spread of coronavirus disease 2019 (COVID-19) has caused sudden and dramatic societal changes. The allergy/immunology community has quickly responded by mobilizing practice adjustments and embracing new paradigms of care to protect patients and staff from severe acute respiratory syndrome coronavirus 2 exposure. Social distancing is key to slowing contagion but adds to complexity of care and increases isolation and anxiety. Uncertainty exists across a new COVID-19 reality, and clinician well-being may be an underappreciated priority. Wellness incorporates mental, physical, and spiritual health to protect against burnout, which impairs both coping and caregiving abilities. Understanding the stressors that COVID-19 is placing on clinicians can assist in recognizing what is needed to return to a point of wellness. Clinicians can leverage easily accessible tools, including the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation approach, wellness apps, mindfulness, and gratitude. Realizing early warning signs of anxiety, depression, substance abuse, and posttraumatic stress disorder is important to access safe and confidential resources. Implementing wellness strategies can improve flexibility, resilience, and outlook. Historical parallels demonstrate that perseverance is as inevitable as pandemics and that we need not navigate this unprecedented time alone. 10.1016/j.jaip.2020.04.001
    The Effect of COVID-19 on Interventional Pain Management Practices: A Physician Burnout Survey. Jha Sachin Sunny,Shah Shalini,Calderon Michael David,Soin Amol,Manchikanti Laxmaiah Pain physician BACKGROUND:Burnout has been a commonly discussed issue for the past ten years among physicians and other health care workers. A survey of interventional pain physicians published in 2016 reported high levels of emotional exhaustion, often considered the most taxing aspect of burnout. Job dissatisfaction appeared to be the leading agent in the development of burnout in pain medicine physicians in the United States. The COVID-19 pandemic has drastically affected the entire health care workforce and interventional pain management, with other surgical specialties, has been affected significantly. The COVID-19 pandemic has placed several physical and emotional stressors on interventional pain management physicians and this may lead to increased physician burnout. OBJECTIVE:To assess the presence of burnout specific to COVID-19 pandemic among practicing interventional pain physicians. METHODS:American Society of Interventional Pain Physicians (ASIPP) administered a 32 question survey to their members by contacting them via commercially available online marketing company platform. The survey was completed on www.constantcontact.com. RESULTS:Of 179 surveys sent, 100 responses were obtained. The data from the survey demonstrated that 98% of physician practices were affected by COVID and 91% of physicians felt it had a significant financial impact. Sixty seven percent of the physicians responded that in-house billing was responsible for their increased level of burnout, whereas 73% responded that electronic medical records (EMRs) were one of the causes. Overall, 78% were very concerned. Almost all respondents have been affected with a reduction in interventional procedures. 60% had a negative opinion about the future of their practice, whereas 66% were negative about the entire health care industry. LIMITATIONS:The survey included only a small number of member physicians. Consequently, it may not be generalized for other specialties or even pain medicine. However, it does represent the sentiment and present status of interventional pain management. CONCLUSION:The COVID-19 pandemic has put interventional pain practices throughout the United States under considerable financial and psychological stress. It is essential to quantify the extent of economic loss, offer strategies to actively manage provider practice/wellbeing, and minimize risk to personnel to keep patients safe.
    Experiences of Work-Family Conflict and Mental Health Symptoms by Gender Among Physician Parents During the COVID-19 Pandemic. Frank Elena,Zhao Zhuo,Fang Yu,Rotenstein Lisa S,Sen Srijan,Guille Constance JAMA network open Importance:The COVID-19 pandemic has placed increased strain on health care workers and disrupted childcare and schooling arrangements in unprecedented ways. As substantial gender inequalities existed in medicine before the pandemic, physician mothers may be at particular risk for adverse professional and psychological consequences. Objective:To assess gender differences in work-family factors and mental health among physician parents during the COVID-19 pandemic. Design, Setting, and Participants:This prospective cohort study included 276 US physicians enrolled in the Intern Health Study since their first year of residency training. Physicians who had participated in the primary study as interns during the 2007 to 2008 and 2008 to 2009 academic years and opted into a secondary longitudinal follow-up study were invited to complete an online survey in August 2018 and August 2020. Exposures:Work-family experience included 3 single-item questions and the Work and Family Conflict Scale, and mental health symptoms included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scale. Main Outcomes and Measures:The primary outcomes were work-to-family and family-to-work conflict and depressive symptoms and anxiety symptoms during August 2020. Depressive symptoms between 2018 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic) were compared by gender. Results:Among 215 physician parents who completed the August 2020 survey, 114 (53.0%) were female and the weighted mean (SD) age was 40.1 (3.57) years. Among physician parents, women were more likely to be responsible for childcare or schooling (24.6% [95% CI, 19.0%-30.2%] vs 0.8% [95% CI, 0.01%-2.1%]; P < .001) and household tasks (31.4% [95% CI, 25.4%-37.4%] vs 7.2% [95% CI, 3.5%-10.9%]; P < .001) during the pandemic compared with men. Women were also more likely than men to work primarily from home (40.9% [95% CI, 35.1%-46.8%] vs 22.0% [95% CI, 17.2%-26.8%]; P < .001) and reduce their work hours (19.4% [95% CI, 14.7%-24.1%] vs 9.4% [95% CI, 6.0%-12.8%]; P = .007). Women experienced greater work-to-family conflict (β = 2.79; 95% CI, 1.00 to 4.59; P = .03), family-to-work conflict (β = 3.09; 95% CI, 1.18-4.99; P = .02), and depressive (β = 1.76; 95% CI, 0.56-2.95; P = .046) and anxiety (β = 2.87; 95% CI, 1.49-4.26; P < .001) symptoms compared with men. We observed a difference between women and men in depressive symptoms during the COVID-19 pandemic (mean [SD] PHQ-9 score: 5.05 [6.64] vs 3.52 [5.75]; P = .009) that was not present before the pandemic (mean [SD] PHQ-9 score: 3.69 [5.26] vs 3.60 [6.30]; P = .86). Conclusions and Relevance:This study found significant gender disparities in work and family experiences and mental health symptoms among physician parents during the COVID-19 pandemic, which may translate to increased risk for suicide, medical errors, and lower quality of patient care for physician mothers. Institutional and public policy solutions are needed to mitigate the potential adverse consequences for women's careers and well-being. 10.1001/jamanetworkopen.2021.34315
    Covid-19 related oncologist's concerns about breast cancer treatment delays and physician well-being (the CROWN study). Yao Katharine A,Attai Deanna,Bleicher Richard,Kuchta Kristine,Moran Meena,Boughey Judy,Wilke Lee G,Dietz Jill R,Stevens Randy,Pesce Catherine,Kopkash Katherine,Kurtzman Scott,Sarantou Terry,Victorson David Breast cancer research and treatment PURPOSE:To examine how treatment delays brought on by the COVID-19 pandemic impacted the physical and emotional well-being of physicians treating these patients. METHODS:A cross-sectional survey of physician breast specialists was posted from April 23rd to June 11th, 2020 on membership list serves and social media platforms of the National Accreditation Program for Breast Centers and the American Society of Breast Surgeons. Physician well-being was measured using 6 COVID-19 burnout emotions and the 4-item PROMIS short form for anxiety and sleep disturbance. We examined associations between treatment delays and physician well-being, adjusting for demographic factors, COVID-19 testing and ten COVID-19 pandemic concerns. RESULTS:870 physicians completed the survey, 61% were surgeons. The mean age of physicians was 52 and 548 (63.9%) were female. 669 (79.4%) reported some delay in patient care as a result of the COVID-19 pandemic. 384 (44.1%) and 529 (60.8%) of physicians scored outside normal limits for anxiety and sleep disturbance, respectively. After adjusting for demographic factors and COVID-19 testing, mean anxiety and COVID-19 burnout scores were significantly higher among physicians whose patients experienced either delays in surgery, adjuvant chemotherapy, radiation, breast imaging or specialty consultation. A multivariable model adjusting for ten physician COVID-19 concerns and delays showed that "delays will impact my emotional well-being" was the strongest concern associated with anxiety, sleep disturbance and COVID-19 burnout factors. CONCLUSIONS:Breast cancer treatment delays during the initial surge of the COVID-19 pandemic in the United States were associated with a negative impact on physician emotional wellness. 10.1007/s10549-021-06101-1
    The inevitability of Covid-19 related distress among healthcare workers: Findings from a low caseload country under lockdown. Hawari Feras I,Obeidat Nour A,Dodin Yasmeen I,Albtoosh Asma S,Manasrah Rasha M,Alaqeel Ibrahim O,Mansour Asem H PloS one OBJECTIVES:To characterize psychological distress and factors associated with distress in healthcare practitioners working during a stringent lockdown in a country (Jordan) that had exhibited one of the lowest incidence rates of Covid-19 globally at the time of the survey. METHODS:A cross-sectional online survey sent to healthcare practitioners working in various hospitals and community pharmacies. Demographic, professional and psychological characteristics (distress using Kessler-6 questionnaire, anxiety, depression, burnout, sleep issues, exhaustion) were measured as were sources of fear. Descriptive and multivariable statistics were performed using level of distress as the outcome. RESULTS:We surveyed 937 practitioners (56.1% females). Approximately 68%, 14%, and 18% were nurses/technicians, physicians, and pharmacists (respectively). 32% suffered from high distress while 20% suffered from severe distress. Exhaustion, anxiety, depression, and sleep disturbances were reported (in past seven days) by approximately 34%, 34%, 19%, and 29% of subjects (respectively). Being older or male, a positive perception of communications with peers, and being satisfied at work, were significantly associated with lower distress. Conversely, suffering burnout; reporting sleep-related functional problems; exhaustion; being a pharmacist (relative to a physician); working in a cancer center; harboring fear about virus spreading; fear that the virus threatened life; fear of alienation from family/friends; and fear of workload increases, were significantly associated with higher distress. CONCLUSION:Despite low caseloads, Jordanian practitioners still experienced high levels of distress. Identified demographic, professional and psychological factors influencing distress should inform interventions to improve medical professionals' resilience and distress likelihood, regardless of the variable Covid-19 situation. 10.1371/journal.pone.0248741
    Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students. Yu Allison,Wilkes Michael,Iosif Ana-Maria,Rea Margaret,Fisher Alice,Fine Jeffrey,Perry Ross,Rice Elizabeth,Jandrey Karl,Griffin Erin,Sciolla Andres Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry OBJECTIVE:Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. METHODS:Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. RESULTS:Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were "extremely" or "very" concerned about family members getting infected (n = 71, 76% School of Medicine (SOM); n = 31, 76% School of Nursing (SON); n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM; n = 28, 68% SON; n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). CONCLUSIONS:Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises. 10.1007/s40596-021-01444-9
    Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak. Frontiers in psychiatry OBJECTIVE:The outbreak of the 2019 novel coronavirus disease (COVID-19) not only caused particularly large public health problems, but also caused great psychological distress, especially for medical staff. We aimed to investigate the prevalence rate of insomnia and to confirm the related social psychological factors among medical staff in hospitals during the COVID-19 outbreak. METHOD:Medical staff members in China were recruited, including frontline medical workers. The questionnaire, administered through the WeChat program, obtained demographic data and asked self-design questions related to the COVID-19 outbreak, insomnia/depressive/anxiety symptoms, and stress-related symptoms. We used a logistic regression analysis to examine the associations between sociodemographic factors and insomnia symptoms. RESULT:There were a total of 1,563 participants in our study. Five-hundred-and-sixty-four (36.1%) participants had insomnia symptoms according to the Insomnia Severity Index (ISI) (total score ≥ 8). A multiple binary logistic regression model revealed that insomnia symptoms were associated with an education level of high school or below (OR = 2.69, = 0.042, 95% CI = 1.0-7.0), being a doctor (OR = 0.44, = 0.007, 95% CI = 0.2-0.8), currently working in an isolation unit (OR = 1.71, = 0.038, 95% CI = 1.0-2.8), is worried about being infected (OR = 2.30, p < 0.001, 95% CI = 1.6-3.4), perceived lack of helpfulness in terms of psychological support from news or social media with regard to COVID-19 (OR = 2.10, = 0.001, 95% CI = 1.3-3.3), and having very strong uncertainty regarding effective disease control (OR = 3.30, = 0.013, 95% CI = 1.3-8.5). CONCLUSION:Our study found that more than one-third of the medical staff suffered insomnia symptoms during the COVID-19 outbreak. The related factors included education level, an isolation environment, psychological worries about the COVID-19 outbreak, and being a doctor. Interventions for insomnia among medical staff are needed considering the various sociopsychological factors at play in this situation. 10.3389/fpsyt.2020.00306
    Healthcare Worker Mental Health After the Initial Peak of the COVID-19 Pandemic: a US Medical Center Cross-Sectional Survey. Journal of general internal medicine BACKGROUND:There is a paucity of data on the mental health impact of the Coronavirus disease 2019 (COVID-19) pandemic on United States (US) healthcare workers (HCWs) after the first surge in the spring of 2020. OBJECTIVE:To determine the impact of the pandemic on HCWs, and the relationship between HCW mental health and demographics, occupational factors, and COVID-19 concerns. DESIGN:Cross-sectional survey in an urban medical center (September-November 2020) in Baltimore, MD, in the United States. PARTICIPANTS:A total of 605 HCWs (physicians, nurse practitioners, nurses, physician assistants, patient care technicians, respiratory therapists, social workers, mental health therapists, and case managers). MAIN MEASURES:Measures of mental health (Patient Health Questionnaire-2, Generalized Anxiety Disorder-7, PROMIS Sleep Disturbance 4a, Impact of Event Scale-Revised, Maslach Burnout Inventory-2 item, Connor-Davidson Resilience Scale-2 item), demographics, occupational factors, and COVID-19 related concerns. KEY RESULTS:Fifty-two percent of 1198 HCWs responded to the survey and 14.2% reported depression, 43.1% mild or higher anxiety, 31.6% sleep disturbance, 22.3% posttraumatic stress symptoms, 21.6% depersonalization, 46.0% emotional exhaustion, and 23.1% lower resilience. Relative to HCWs providing in-person care to COVID-19 infected patients none of their working days, those doing so all or most days were more likely to experience worse depression (adjusted odds ratio, 3.9; 95% CI, 1.3-11.7), anxiety (aOR, 3.0; 95% CI, 1.4-6.3), possible PTSD symptoms (aOR, 2.6; 95% CI, 1.1-5.8), and higher burnout (aOR, 2.6; 95% CI, 1.1-6.0). Worse mental health in several domains was associated with higher health fear (aORs ranged from 2.2 to 5.0), job stressors (aORs ranged from 1.9 to 4.0), perceived social stigma/avoidance (aORs ranged from 1.8 to 2.9), and workplace safety concerns (aORs ranged from 1.8 to 2.8). CONCLUSIONS:US HCWs experienced significant mental health symptoms eight months into the pandemic. More time spent providing in-person care to COVID-19-infected patients and greater COVID-19-related concerns were consistently associated with worse mental health. 10.1007/s11606-021-07251-0
    Effects of Persistent Exposure to COVID-19 on Mental Health Outcomes Among Trainees: a Longitudinal Survey Study. Goss Charles W,Duncan Jennifer G,Lou Sunny S,Holzer Katherine J,Evanoff Bradley A,Kannampallil Thomas Journal of general internal medicine BACKGROUND:The rapid spread of the coronavirus disease 2019 (COVID-19) has created considerable strain on the physical and mental health of healthcare workers around the world. The effects have been acute for physician trainees-a unique group functioning simultaneously as learners and care providers with limited autonomy. OBJECTIVE:To investigate the longitudinal effects of physician trainee exposure to patients being tested for COVID-19 on stress, anxiety, depression, and burnout using three surveys conducted during the early phase of the pandemic. DESIGN:Longitudinal survey study. PARTICIPANTS:All physician trainees (N = 1375) at an academic medical center. MAIN MEASURE:Assess the relationship between repeated exposure to patients being tested for COVID-19 and stress, anxiety, depression, and burnout. KEY RESULTS:Three hundred eighty-nine trainees completed the baseline survey (28.3%). Of these, 191 and 136 completed the ensuing surveys. Mean stress, anxiety, and burnout decreased by 21% (95% confidence interval (CI): - 28 to - 12%; P < 0.001), 25% (95% CI: - 36 to - 11%; P < 0.001), and 13% (95% CI: - 18 to - 7%; P < 0.001), respectively, per survey. However, for each survey time point, there was mean increase in stress, anxiety, and burnout per additional exposure: stress [24% (95% CI: + 12 to + 38%; P < 0.001)], anxiety [22% (95% CI: + 2 to + 46%; P = 0.026)], and burnout [18% (95% CI: + 10 to + 28%; P < 0.001)]. For depression, the association between exposure was strongest for the third survey, where mean depression scores increased by 33% per additional exposure (95% CI: + 18 to + 50%; P < 0.001). CONCLUSIONS:Training programs should adapt to address the detrimental effects of the "pileup" of distress associated with persistent exposure through adaptive programs that allow flexibility for time off and recovery. 10.1007/s11606-021-07350-y
    The Impact of COVID-19 on Interventional Pain Management Practices is Significant and Long-Lasting: An Interventional Pain Management Physician Survey. Manchikanti Laxmaiah,Pampati Vidyasagar,Jha Sachin Sunny,Sanapati Mahendra R,Soin Amol,Shah Shalini,Kaye Alan D,Hirsch Joshua A Pain physician BACKGROUND:As with many others in the house of medicine, the COVID-19 pandemic has adversely impacted the practice of interventional pain management. This in part relates to various  state health authority or medical board restrictions with reductions in patient volume for evaluations, follow-ups, and procedures. Of course, the pandemic continues to persist which is in turn leading to longer-lasting effects. Our previous survey was performed in March 2020. At that time, there was a national lockdown in the United States with COVID-19 disease qualifying as a pandemic by the World Health Organization (WHO). The pandemic caused by COVID-19 disease continues to have far-reaching implications on how we deliver routine care to patients and its effect on patient care, economic aspects, and health of interventional pain management providers. OBJECTIVE:To assess the current and expected future impact of the COVID-19 pandemic on interventional pain management practices in a physician survey. The study was performed based on performance in 2021 compared to the 2019 pre-COVID era. METHODS:The American Society of Interventional Pain Physicians (ASIPP) administered a 16-question survey to their members by contacting them via a commercially available online marketing company platform. The survey was completed on www.constantcontact.com. RESULTS:The results showed that 88% of the providers experienced a reduction in income and a similar number expect decreases over the next 12 months. A large proportion of respondents (73.3%) reported a reduction in revenue of 11%-25%. In contrast, another 21.5% reported a revenue decline of 26%-50%, and 29% reported 11%-25% increase in expenses. Overall, new patient volume decreased 11%-25% based on the response from almost 63%, whereas almost 9% reported a decline of 26%-50%. In contrast, established patient volume declined 1%-10% as reported by 64% of the respondents, compared to an 11%-25% decrease by a small proportion of 14%. All interventional procedures showed significant decreases across the board, with 69% of the respondents reporting a decline in-office procedures, 64% in ambulatory surgery center (ASC) procedures, and 57% in hospital outpatient department (HOPD) procedures, ranging from 11%-25%. LIMITATIONS:The survey included a relatively small number of member physicians which could introduce sampling error. Consequently, it may not be generalizable for other specialties or even to pain medicine. CONCLUSION:The COVID-19 pandemic has put interventional pain practices throughout the United States under considerable financial and psychological stress. This study seeks to quantify the extent of economic loss and other challenges resultant from the pandemic. Almost 99% reported a decrease in revenues in the last 12 months, with 86% reporting an expected reduction in the next 12 months and 49% reporting an increase in expenses. Declines have been reported in all sectors with new patients, office procedures, ASC, and HOPD procedures, except for established patient visits, which have shown minor declines compared to other domains. Understanding the issues facing interventional pain management physicians facilitates the development of strategies to actively manage provider practice/well-being, and to minimize risk to personnel to keep patients safe.
    Stress, anxiety, depression and burnout in frontline healthcare workers during two peaks of COVID-19 pandemic in Russia. Mosolova Ekaterina,Sosin Dmitry,Mosolov Sergey Psychiatry research PURPOSE:In this study we aimed to assess the range of psychopathological symptoms (anxiety, stress, depression, burnout) and risk factors in frontline HCWs during spring and autumn outbreaks of the new coronavirus infection in Russian Federation. METHODS:We conducted two independent, cross-sectional hospital-based online surveys. Data of 2195 HCWs were collected between May 19th and May 26th 2020 and between October 10th and October 17th 2020. Stress, anxiety, depression, burnout and perceived stress were assessed using the Russian versions of SAVE-9 and GAD-7, PHQ-9, MBI and PSS-10 scales. Logistic regression analysis was performed to determine the influence of different variables. RESULTS:The study revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7%,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The rate of anxiety was higher in October 2020 compared with May 2020. Revealed risk factors included: female gender, younger age, being a physician, working for over a week, living outside of Moscow or Saint Petersburg, being vaccinated against COVID-19. CONCLUSION:These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups and its increasing importance over time. 10.1016/j.psychres.2021.114226
    The short-term impact of COVID-19 pandemic on spine surgeons: a cross-sectional global study. Khattab Mohamed Fawzy,Kannan Tareq M A,Morsi Ahmed,Al-Sabbagh Qussay,Hadidi Fadi,Al-Sabbagh Mohammed Qussay,M Taha Muzahem,Bourghli Anouar,Obeid Ibrahim European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society PURPOSE:The outbreak of COVID-19 erupted in December 2019 in Wuhan, China. In a few weeks, it progressed rapidly into a global pandemic which resulted in an overwhelming burden on health care systems, medical resources and staff. Spine surgeons as health care providers are no exception. In this study, we try to highlight the impact of the crisis on spine surgeons in terms of knowledge, attitude, practice and socioeconomic burden. METHODS:This was global, multicentric cross-sectional study on 781 spine surgeons that utilized an Internet-based validated questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment, future perceptions, effect of this crisis on practice and psychological distress. Univariate and multivariate ordinal logistic regression analyses were used to evaluate the predictors for the degree of COVID-19 effect on practice. RESULTS:Overall, 20.2%, 52% and 27.8% of the participants were affected minimally, intermediately and hugely by COVID-19, respectively. Older ages (β = 0.33, 95% CI 0.11-0.56), orthopedic spine surgeons (β = 0.30, 95% CI 0.01-0.61) and those who work in the private sector (β = 0.05, 95% CI 0.19-0.61) were the most affected by COVID-19. Those who work in university hospitals (β = - 0.36, 95% CI 0.00 to - 0.71) were affected the least. The availability of N95 masks (47%) and disposable eye protectors or face shields (39.4%) was significantly associated with lower psychological stress (p = 0.01). Only 6.9%, 3.7% and 5% had mild, moderate and severe mental distress, respectively. CONCLUSION:While it is important to recognize the short-term impact of COVID-19 pandemic on the practice of spine surgery, predicting where we will be standing in 6-12 months remains difficult and unknown. The COVID-19 crisis will probably have an unexpected long-term impact on lives and economies. 10.1007/s00586-020-06517-1
    Depression, Suicidal Thoughts, and Burnout Among Physicians During the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study. Al-Humadi Samer,Bronson Brian,Muhlrad Samantha,Paulus Megan,Hong Houlin,Cáceda Ricardo Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry OBJECTIVES:Frontline workers have been a bulwark in the fight against COVID-19, while being subject to major unexpected stressors. These include conflicting news, evolving guidelines, perceived inadequate personal protective equipment, overflow of patients with rising death counts, absence of disaster training, and limitations in the implementation of social distancing. This study investigates the incidence and associated factors of depression, suicidal thoughts, and burnout among physicians during the COVID-19 pandemic. METHODS:In a cross-sectional survey-based study of resident, fellow, and attending physicians from a tertiary university hospital during the height of the COVID-19 pandemic in New York from April 24 to May 15, 2020, demographics and practice specialty, attending vs. resident/fellow status, call frequency, emotional exhaustion, depersonalization, and depression severity were examined. RESULTS:Two hundred twenty-five subjects completed the survey (response rate of 16.3%), with rates of 6.2% depression, 6.6% suicidal ideation, and 19.6% burnout. Depression, suicidal ideation, and burnout were all associated with history of prior depression/anxiety and frequency of on call. Suicidal ideation and burnout were also associated with younger age. There was no difference in rates of depression, suicidal ideation, or burnout between attending and resident physicians. Female physicians reported less work-life balance and more burnout. CONCLUSIONS:These findings highlight the importance of considering physician mental health during times of peak stress, such as natural or man-made disasters. The prominence of premorbid depression/anxiety as a relevant factor underscores the need to further understand physician mental health and provide early screening and treatment. 10.1007/s40596-021-01490-3
    The effects of the COVID-19 outbreak on physicians' psychological resilience levels. Arslan Hatice Nilden,Karabekiroglu Aytul,Terzi Ozlem,Dundar Cihad Postgraduate medicine BACKGROUND:Health-care workers exposed to coronavirus19 disease could be psychologically stressed. The objective of this study is to assess the anxiety, depression levels, and psychological resilience of physicians working during the Covid-19 outbreak and to evaluate the related factors that are associated with their psychological resilience. METHODS:The sample of this descriptive study was composed of medical doctors and dentists. The data were obtained online between April 13-23, 2020 through a survey prepared by the researchers. In addition, a questionnaire about the participants' sociodemographic characteristics, the Psychological Resilience Scale and Hospital Anxiety Depression Scale (HAD-A/HAD-D) was given. RESULTS:The average age of the 671 participants was 44.0 ± 9.0 years. Psychological resilience scores were significantly higher in those who had children, who had worked for 15 years or more, and who had received training about COVID-19 (p < 0.05). Depression scores were higher among women and in those who reported having a chronic disease, whose workload increased after the outbreak, and who had physical contact with COVID-positive patients. The anxiety scores were also higher among women and in those whose workload had increased and who had contact with COVID-positive patients (p < 0.05). The physicians with scores below the cutoff point on the HAD-D/HAD-A had significantly higher scores on the Psychological Resilience Scale (p < 0.05). DISCUSSION:Depression and anxiety levels were found to be significantly lower in physicians with greater psychological resilience. Psychological and social support of all health-care workers, especially physicians, is important in the struggle with the pandemic. It is thought that determining the variables related to psychological resilience in health-care workers will be a guide for psychosocial services. 10.1080/00325481.2021.1874166
    The COVID-19 reset: lessons from the pandemic on Burnout and the Practice of Surgery. Romanelli John,Gee Denise,Mellinger John D,Alseidi Adnan,Bittner James G,Auyang Edward,Asbun Horacio,Feldman Liane S, Surgical endoscopy BACKGROUND:Burnout among physicians is an increasing concern, and surgeons are not immune to this threat. The ongoing COVID-19 pandemic has caused dramatic changes to surgeon workflow, often leading to redeployment to other clinical areas, slowdown and shutdown of elective surgery practices, and an uncertain future of surgical practice in the post-pandemic setting. Paradoxically, for many surgeons who had to prepare for but not immediately care for a major surge, the crisis did allow for reflective opportunities and a resetting of priorities that could serve to mitigate chronic patterns contributory to Burnout. METHODS:SAGES Reimagining the Practice of Surgery task force convened a webinar to discuss lessons learned from the COVID pandemic that may address burnout. RESULTS:Burnout is multifactorial and may vary in cause among different generation/experience groups. Those that report burnout symptoms often complain of lacking purpose or meaning in their work. Although many mechanisms to address Burnout are from a defensive standpoint-including coping mechanisms, problem solving, and identification of a physician having wellness difficulties-offensive mechanisms such as pursuing purpose and meaning and finding joy in one's work can serve as reset points that promote thriving and fulfillment. Understanding what motivates physicians will help physician leaders to develop and sustain effective teams. Reinvigorating the surgical workforce around themes of meaning and joy in the service rendered via our surgical skills may diminish Burnout through generative and aspirational strategies, as opposed to merely reactive ones. Fostering an educational environment free of discriminatory or demeaning behavior may produce a new workforce conducive to enhanced and resilient wellbeing at the start of careers. CONCLUSION:Surgeon wellness and self-care must be considered an important factor in the future of all healthcare delivery systems, a need reaffirmed by the COVID-19 pandemic. 10.1007/s00464-020-08072-8
    Emergency physician stressors, concerns, and behavioral changes during COVID-19: A longitudinal study. Baumann Brigitte M,Cooper Richelle J,Medak Anthony J,Lim Stephen,Chinnock Brian,Frazier Remi,Roberts Brian W,Epel Elissa S,Rodriguez Robert M Academic emergency medicine : official journal of the Society for Academic Emergency Medicine OBJECTIVES:The objective was to provide a longitudinal assessment of anxiety levels and work and home concerns of U.S. emergency physicians during the COVID-19 pandemic. METHODS:We performed a longitudinal, cross-sectional email survey of clinically active emergency physicians (attending, fellow, and resident) at seven academic emergency departments. Follow-up surveys were sent 4 to 6 weeks after the initial survey and assessed the following: COVID-19 patient exposure, availability of COVID-19 testing, levels of home and workplace anxiety/stress, changes in behaviors, and performance on a primary care posttraumatic stress disorder screen (PC-PTSD-5). Logistic regression explored factors associated with a high PC-PTSD-5 scale score (≥3), indicating increased risk for PTSD. RESULTS:Of the 426 surveyed initial respondents, 262 (61.5%) completed the follow-up survey. While 97.3% (255/262) reported treating suspected COVID-19 patients, most physicians (162/262, 61.8%) had not received testing themselves. In follow-up, respondents were most concerned about the relaxing of social distancing leading to a second wave (median score = 6, IQR = 4-7). Physicians reported a consistently high ability to order COVID-19 tests for patients (median score = 6, IQR = 5-7) and access to personal protective equipment (median score = 6, IQR = 5-6). Women physicians were more likely to score ≥ 3 than men on the PC-PTSD-5 screener on the initial survey (43.3% vs. 22.5%; Δ 20.8%, 95% confidence interval [CI] = 9.3% to 31.5%), and despite decreases in overall proportions, this discrepancy remained in follow-up (34.7% vs. 16.8%; Δ 17.9%, 95% CI = 7.1% to 28.1%). In examining the relationship between demographics, living situations, and institution location on having a PC-PTSD-5 score ≥ 3, only female sex was associated with a PC-PTSD-5 score ≥ 3 (adjusted odds ratio = 2.48, 95% CI = 1.28 to 4.79). CONCLUSIONS:While exposure to suspected COVID-19 patients was nearly universal, stress levels in emergency physicians decreased with time. At both initial and follow-up assessments, women were more likely to test positive on the PC-PTSD-5 screener compared to men. 10.1111/acem.14219
    Academic Emergency Medicine Physicians' Anxiety Levels, Stressors, and Potential Stress Mitigation Measures During the Acceleration Phase of the COVID-19 Pandemic. Rodriguez Robert M,Medak Anthony J,Baumann Brigitte M,Lim Stephen,Chinnock Brian,Frazier Remi,Cooper Richelle J Academic emergency medicine : official journal of the Society for Academic Emergency Medicine OBJECTIVE:The objective was to assess anxiety and burnout levels, home life changes, and measures to relieve stress of U.S. academic emergency medicine (EM) physicians during the COVID-19 pandemic acceleration phase. METHODS:We sent a cross-sectional e-mail survey to all EM physicians at seven academic emergency departments. The survey incorporated items from validated stress scales and assessed perceptions and key elements in the following domains: numbers of suspected COVID-19 patients, availability of diagnostic testing, levels of home and workplace anxiety, severity of work burnout, identification of stressors, changes in home behaviors, and measures to decrease provider anxiety. RESULTS:A total of 426 (56.7%) EM physicians responded. On a scale of 1 to 7 (1 = not at all, 4 = somewhat, and 7 = extremely), the median (interquartile range) reported effect of the pandemic on both work and home stress levels was 5 (4-6). Reported levels of emotional exhaustion/burnout increased from a prepandemic median (IQR) of 3 (2-4) to since the pandemic started a median of 4 (3-6), with a difference in medians of 1.8 (95% confidence interval = 1.7 to 1.9). Most physicians (90.8%) reported changing their behavior toward family and friends, especially by decreasing signs of affection (76.8%). The most commonly cited measures cited to alleviate stress/anxiety were increasing personal protective equipment (PPE) availability, offering rapid COVID-19 testing at physician discretion, providing clearer communication about COVID-19 protocol changes, and assuring that physicians can take leave for care of family and self. CONCLUSIONS:During the acceleration phase, the COVID-19 pandemic has induced substantial workplace and home anxiety in academic EM physicians, and their exposure during work has had a major impact on their home lives. Measures cited to decrease stress include enhanced availability of PPE, rapid turnaround testing at provider discretion, and clear communication about COVID-19 protocol changes. 10.1111/acem.14065
    Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study. Denning Max,Goh Ee Teng,Tan Benjamin,Kanneganti Abhiram,Almonte Melanie,Scott Alasdair,Martin Guy,Clarke Jonathan,Sounderajah Viknesh,Markar Sheraz,Przybylowicz Jan,Chan Yiong Huak,Sia Ching-Hui,Chua Ying Xian,Sim Kang,Lim Lucas,Tan Lifeng,Tan Melanie,Sharma Vijay,Ooi Shirley,Winter Beatty Jasmine,Flott Kelsey,Mason Sam,Chidambaram Swathikan,Yalamanchili Seema,Zbikowska Gabriela,Fedorowski Jaroslaw,Dykowska Grazyna,Wells Mary,Purkayastha Sanjay,Kinross James PloS one The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49-2.95), nurse (OR 1.38; 95% CI 1.04-1.84), and 'other clinical' (OR 2.02; 95% CI 1.45-2.82); being redeployed (OR 1.27; 95% CI 1.02-1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98-2.99), anxiety (OR 4.87; 95% CI 3.92-6.06) and depression (OR 4.06; 95% CI 3.04-5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51-0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22-0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers. 10.1371/journal.pone.0238666
    Mental health among healthcare providers during coronavirus disease (COVID-19) outbreak in Saudi Arabia. AlAteeq Deemah A,Aljhani Sumayah,Althiyabi Ibrahim,Majzoub Safaa Journal of infection and public health BACKGROUND:The novel coronavirus (COVID-19) was recently declared a pandemic by the World Health Organization (WHO). The first confirmed case in Saudi Arabia was announced on March 2, 2020. Several psychiatric manifestations may appear during pandemics, especially among frontline healthcare providers. OBJECTIVES:This study sought to explore depression and anxiety levels among healthcare providers during the COVID-19 outbreak in Saudi Arabia. METHODS:This was a cross-sectional study of a convenience sample of 502 healthcare providers in the Ministry of Health. Depression and anxiety were assessed via the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) questionnaires, respectively. RESULTS:The respondents represented various healthcare occupations: administrators (28.49%), nurses (26.29%), physicians (22.11%), non-physician specialists (13.94%), technicians (6.77%), and pharmacists (2.30%). The majority of them were male (68.1%). More than half of them had depressive disorder (55.2%), which ranged from mild (24.9%), moderate (14.5%), and moderately severe (10%) to severe (5.8%). Half of the sample had generalized anxiety disorder (51.4%), which ranged from mild (25.1%) and moderate (11%) to severe (15.3%). Multivariate analysis showed that males were significantly less predicted to have anxiety (Beta=-0.22, P-value <0.04), 30-39 years age group were significantly more predicted to have depression and anxiety group (Beta=0.204, P-value <0.001 and beta=0.521, P-value <0.003 respectively), and nurses had significantly higher mean score of anxiety (Beta=0.445, P-value <0.026). CONCLUSIONS:This study revealed that depression and anxiety are prevailing conditions among healthcare providers. Although efforts were accelerated to support their psychological well-being, more attention should be paid to the mental health of female, 30-39 age group and nursing staff. Promoting healthcare service as a humanitarian and national duty may contribute to making it a more meaningful experience in addition to advocating for solidarity, altruism, and social inclusion. Longitudinal research studies need to be conducted to follow up on healthcare providers' mental health symptoms and develop evidence-based interventions. 10.1016/j.jiph.2020.08.013
    The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study. Social psychiatry and psychiatric epidemiology BACKGROUND:Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS:Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. RESULTS:As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS:This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings. 10.1007/s00127-021-02211-9
    Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective study. Teo Irene,Chay Junxing,Cheung Yin Bun,Sung Sharon C,Tewani Komal G,Yeo Li Fang,Yang Grace Meijuan,Pan Fang Ting,Ng Jin Ying,Abu Bakar Aloweni Fazila,Ang Hui Gek,Ayre Tracy Carol,Chai-Lim Crystal,Chen Robert Chun,Heng Ai Ling,Nadarajan Gayathri Devi,Ong Marcus Eng Hock,See Brian,Soh Chai Rick,Tan Boon Kiat Kenneth,Tan Bien Soo,Tay Kenny Xian Khing,Wijaya Limin,Tan Hiang Khoon PloS one AIM:The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. METHOD:A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale). RESULTS:The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout. CONCLUSIONS:Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs. 10.1371/journal.pone.0258866
    Estimating COVID-19 prevalence and infection control practices among US dentists. Estrich Cameron G,Mikkelsen Matthew,Morrissey Rachel,Geisinger Maria L,Ioannidou Effie,Vujicic Marko,Araujo Marcelo W B Journal of the American Dental Association (1939) BACKGROUND:Understanding the risks associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during oral health care delivery and assessing mitigation strategies for dental offices are critical to improving patient safety and access to oral health care. METHODS:The authors invited licensed US dentists practicing primarily in private practice or public health to participate in a web-based survey in June 2020. Dentists from every US state (n = 2,195) answered questions about COVID-19-associated symptoms, SARS-CoV-2 infection, mental and physical health conditions, and infection control procedures used in their primary dental practices. RESULTS:Most of the dentists (82.2%) were asymptomatic for 1 month before administration of the survey; 16.6% reported being tested for SARS-CoV-2; and 3.7%, 2.7%, and 0% tested positive via respiratory, blood, and salivary samples, respectively. Among those not tested, 0.3% received a probable COVID-19 diagnosis from a physician. In all, 20 of the 2,195 respondents had been infected with SARS-CoV-2; weighted according to age and location to approximate all US dentists, 0.9% (95% confidence interval, 0.5 to 1.5) had confirmed or probable COVID-19. Dentists reported symptoms of depression (8.6%) and anxiety (19.5%). Enhanced infection control procedures were implemented in 99.7% of dentists' primary practices, most commonly disinfection, COVID-19 screening, social distancing, and wearing face masks. Most practicing dentists (72.8%) used personal protective equipment according to interim guidance from the Centers for Disease Control and Prevention. CONCLUSIONS:COVID-19 prevalence and testing positivity rates were low among practicing US dentists. This indicates that the current infection control recommendations may be sufficient to prevent infection in dental settings. PRACTICAL IMPLICATIONS:Dentists have enhanced their infection control practices in response to COVID-19 and may benefit from greater availability of personal protective equipment. ClinicalTrials.gov: NCT04423770. 10.1016/j.adaj.2020.09.005
    Exposure to COVID-19 patients increases physician trainee stress and burnout. Kannampallil Thomas G,Goss Charles W,Evanoff Bradley A,Strickland Jaime R,McAlister Rebecca P,Duncan Jennifer PloS one The coronavirus disease 2019 (COVID-19) pandemic has put considerable physical and emotional strain on frontline healthcare workers. Among frontline healthcare workers, physician trainees represent a unique group-functioning simultaneously as both learners and caregivers and experiencing considerable challenges during the pandemic. However, we have a limited understanding regarding the emotional effects and vulnerability experienced by trainees during the pandemic. We investigated the effects of trainee exposure to patients being tested for COVID-19 on their depression, anxiety, stress, burnout and professional fulfillment. All physician trainees at an academic medical center (n = 1375) were invited to participate in an online survey. We compared the measures of depression, anxiety, stress, burnout and professional fulfillment among trainees who were exposed to patients being tested for COVID-19 and those that were not, using univariable and multivariable models. We also evaluated perceived life stressors such as childcare, home schooling, personal finances and work-family balance among both groups. 393 trainees completed the survey (29% response rate). Compared to the non-exposed group, the exposed group had a higher prevalence of stress (29.4% vs. 18.9%), and burnout (46.3% vs. 33.7%). The exposed group also experienced moderate to extremely high perceived stress regarding childcare and had a lower work-family balance. Multivariable models indicated that trainees who were exposed to COVID-19 patients reported significantly higher stress (10.96 [95% CI, 9.65 to 12.46] vs 8.44 [95% CI, 7.3 to 9.76]; P = 0.043) and were more likely to be burned out (1.31 [95% CI, 1.21 to1.41] vs 1.07 [95% CI, 0.96 to 1.19]; P = 0.002]. We also found that female trainees were more likely to be stressed (P = 0.043); while unmarried trainees were more likely to be depressed (P = 0.009), and marginally more likely to have anxiety (P = 0.051). To address these challenges, wellness programs should focus on sustaining current programs, develop new and targeted mental health resources that are widely accessible and devise strategies for creating awareness regarding these resources. 10.1371/journal.pone.0237301
    The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression. Salari Nader,Khazaie Habibolah,Hosseinian-Far Amin,Khaledi-Paveh Behnam,Kazeminia Mohsen,Mohammadi Masoud,Shohaimi Shamarina,Daneshkhah Alireza,Eskandari Soudabeh Human resources for health BACKGROUND:Stress, anxiety, and depression are some of the most important research and practice challenges for psychologists, psychiatrists, and behavioral scientists. Due to the importance of issue and the lack of general statistics on these disorders among the Hospital staff treating the COVID-19 patients, this study aims to systematically review and determine the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. METHODS:In this research work, the systematic review, meta-analysis and meta-regression approaches are used to approximate the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. The keywords of prevalence, anxiety, stress, depression, psychopathy, mental illness, mental disorder, doctor, physician, nurse, hospital staff, 2019-nCoV, COVID-19, SARS-CoV-2 and Coronaviruses were used for searching the SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases. The search process was conducted in December 2019 to June 2020. In order to amalgamate and analyze the reported results within the collected studies, the random effects model is used. The heterogeneity of the studies is assessed using the I index. Lastly, the data analysis is performed within the Comprehensive Meta-Analysis software. RESULTS:Of the 29 studies with a total sample size of 22,380, 21 papers have reported the prevalence of depression, 23 have reported the prevalence of anxiety, and 9 studies have reported the prevalence of stress. The prevalence of depression is 24.3% (18% CI 18.2-31.6%), the prevalence of anxiety is 25.8% (95% CI 20.5-31.9%), and the prevalence of stress is 45% (95% CI 24.3-67.5%) among the hospitals' Hospital staff caring for the COVID-19 patients. According to the results of meta-regression analysis, with increasing the sample size, the prevalence of depression and anxiety decreased, and this was statistically significant (P < 0.05), however, the prevalence of stress increased with increasing the sample size, yet this was not statistically significant (P = 0.829). CONCLUSION:The results of this study clearly demonstrate that the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients is high. Therefore, the health policy-makers should take measures to control and prevent mental disorders in the Hospital staff. 10.1186/s12960-020-00544-1
    Mental Health Consequences for Healthcare Workers During the COVID-19 Pandemic: A Scoping Review to Draw Lessons for LMICs. Moitra Modhurima,Rahman Muhammad,Collins Pamela Y,Gohar Fatima,Weaver Marcia,Kinuthia John,Rössler Wulf,Petersen Stefan,Unutzer Jurgen,Saxena Shekhar,Huang Keng Yen,Lai Joanna,Kumar Manasi Frontiers in psychiatry The COVID-19 pandemic has had a significant impact on the mental health of healthcare workers (HCWs) particularly in low and middle-income countries (LMICs). This scoping review provides a summary of current evidence on the mental health consequences of COVID on HCWs. A scoping review was conducted searching PubMed and Embase for articles relevant to mental health conditions among HCWs during COVID-19. Relevant articles were screened and extracted to summarize key outcomes and findings. A total of fifty-one studies were included in this review. Depressive symptoms, anxiety symptoms, psychological trauma, insomnia and sleep quality, workplace burnout and fatigue, and distress were the main outcomes reviewed. Most studies found a high number of symptoms endorsed for depression, anxiety, and other conditions. We found differences in symptoms by sex, age, and HCW role, with female, younger-aged, frontline workers, and non-physician workers being affected more than other subgroups. This review highlights the existing burden of mental health conditions reported by HCWs during COVID-19. It also demonstrates emerging disparities among affected HCW subgroups. This scoping review emphasizes the importance of generating high quality evidence and developing informed interventions for HCW mental health with a focus on LMICs. 10.3389/fpsyt.2021.602614
    Reported effects of the COVID-19 pandemic on the psychological status of emergency healthcare workers: A scoping review. Alanazi Tariq Noman M,McKenna Lisa,Buck Miranda,Alharbi Rayan Jafnan Australasian emergency care BACKGROUND:While literature on psychological consequences among frontline healthcare workers (HCWs) flourishes, understanding the psychological burden on this group is particularly crucial, as their exposure to COVID-19 makes them especially at high risk. We explored what is known about psychological effects of the COVID-19 pandemic on emergency HCWs. METHODS:We used a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. RESULTS:The search identified 5432 articles, from which a total of 21 were included in the final review. Anxiety, burnout, depression, inadequate sleep, post-traumatic stress disorder (PTSD) symptoms, distress/stress and secondary trauma, were all reportedly experienced by emergency HCWs. Anxiety, burnout, depression and stress levels were higher among physicians and nurses compared to others. Post-traumatic stress disorder symptoms were higher among reserve medics, while Red Cross volunteers developed similar reactions of psychological stress and secondary trauma to other healthcare workers. Male HCWs reported more post-traumatic stress disorder symptoms than females, while stress was higher among females than male HCWs. CONCLUSIONS:Emergency HCWs providing care during the COVID-19 pandemic are at risk from specific psychological impacts, including anxiety, burnout, depression, inadequate sleep, PTSD symptoms, psychological distress/stress and secondary trauma, and stress TWEETABLE ABSTRACT: Emergency healthcare workers are at direct risk of psychological impacts from the COVID-19 pandemic. 10.1016/j.auec.2021.10.002
    Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. Restauri Nicole,Sheridan Alison D Journal of the American College of Radiology : JACR The coronavirus disease 2019 (COVID 2019) pandemic has presented myriad challenges to an underprepared health care system. Health care providers are facing unprecedented acute workplace stress compounded by a high baseline rate of physician burnout. This article discusses the relationship between acute stress disorder, posttraumatic stress disorder, and burnout through a literature review focusing on the mental health impact on health care providers after prior epidemics and natural disasters. We offer both a framework for understanding the mental health impact of the COVID-19 epidemic on physicians while proposing a systems based model to respond to these challenges. 10.1016/j.jacr.2020.05.021
    Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control. Li Zhenyu,Ge Jingwu,Yang Meiling,Feng Jianping,Qiao Mei,Jiang Riyue,Bi Jiangjiang,Zhan Gaofeng,Xu Xiaolin,Wang Long,Zhou Qin,Zhou Chenliang,Pan Yinbing,Liu Shijiang,Zhang Haiwei,Yang Jianjun,Zhu Bin,Hu Yimin,Hashimoto Kenji,Jia Yan,Wang Haofei,Wang Rong,Liu Cunming,Yang Chun Brain, behavior, and immunity Since December 2019, more than 79,000 people have been diagnosed with infection of the Corona Virus Disease 2019 (COVID-19). A large number of medical staff was sent to Wuhan city and Hubei province to aid COVID-19 control. Psychological stress, especially vicarious traumatization caused by the COVID-19 pandemic, should not be ignored. To address this concern, the study employed a total of 214 general public and 526 nurses (i.e., 234 front-line nurses and 292 non-front-line nurses) to evaluate vicarious traumatization scores via a mobile app-based questionnaire. Front-line nurses are engaged in the process of providing care for patients with COVID-19. The results showed that the vicarious traumatization scores for front-line nurses including scores for physiological and psychological responses, were significantly lower than those of non-front-line nurses (P < 0.001). Interestingly, the vicarious traumatization scores of the general public were significantly higher than those of the front-line nurses (P < 0.001); however, no statistical difference was observed compared to the scores of non-front-line nurses (P > 0.05). Therefore, increased attention should be paid to the psychological problems of the medical staff, especially non-front-line nurses, and general public under the situation of the spread and control of COVID-19. Early strategies that aim to prevent and treat vicarious traumatization in medical staff and general public are extremely necessary. 10.1016/j.bbi.2020.03.007
    Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Kang Lijun,Ma Simeng,Chen Min,Yang Jun,Wang Ying,Li Ruiting,Yao Lihua,Bai Hanping,Cai Zhongxiang,Xiang Yang Bing,Hu Shaohua,Zhang Kerang,Wang Gaohua,Ma Ci,Liu Zhongchun Brain, behavior, and immunity 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. 10.1016/j.bbi.2020.03.028
    Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Walton Matthew,Murray Esther,Christian Michael D European heart journal. Acute cardiovascular care The COVID-19 pandemic is an unprecedented challenge for society. Supporting the mental health of medical staff and affiliated healthcare workers (staff) is a critical part of the public health response. This paper details the effects on staff and addresses some of the organisational, team and individual considerations for supporting staff (pragmatically) during this pandemic. Leaders at all levels of health care organisations will find this a valuable resource. 10.1177/2048872620922795
    Anxiety and depression symptoms of medical staff under COVID-19 epidemic in China. Liu Yuan,Chen Hongguang,Zhang Nan,Wang Xing,Fan Qinyi,Zhang Yuling,Huang Liping,Hu Bo,Li Mengqian Journal of affective disorders BACKGROUND:It is well known that unexpected pandemic has led to an increase in mental health problems among a variety of populations. METHODS:In this study, an online non-probability sample survey was used to anonymously investigate the anxiety and depression symptoms among medical staff under the COVID-19 outbreak. The questionnaire included Perceived Stress Scale-10 (PSS-10), Generalized Anxiety Disorder 7-Item Scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Factors associated with anxiety and depression symptoms were estimated by logistic regression analysis. RESULTS:A total of 1090 medical staff were investigated in this study. The estimated self-reported rates of anxiety symptoms, depression symptoms and both of the two were 13.3%, 18.4% and 23.9% respectively. Factors associated with self-reported anxiety symptoms include married status (OR=2.3, 95%CI: 1.2, 4.4), not living alone (OR=0.4, 95%CI: 0.2, 0.7), never confiding their troubles to others (OR=2.2, 95%CI: 1.4, 3.5) and higher stress (OR=14.4, 95%CI: 7.8, 26.4). Factors associated with self-reported depression symptoms include not living alone (OR=0.4, 95%CI: 0.3, 0.7), sometimes/often getting care from neighbours (OR=0.6, 95%CI: 0.4, 0.9), never confiding their troubles to others (OR=2.0, 95%CI: 1.3, 3.0) and higher stress (OR=9.7, 95%CI: 6.2, 15.2). LIMITATIONS:The study was a non-probability sample survey. Besides, scales used in this study can only identify mental health states. CONCLUSIONS:Under outbreak of COVID-19, self-reported rates of anxiety symptoms and depression symptoms were high in investigated medical staff. Psychological interventions for those at high risk with common mental problems should be integrated into the work plan to fight against the epidemic. 10.1016/j.jad.2020.09.004
    Factors Influencing Mental Health of Medical Workers During the COVID-19 Outbreak. Zhang Yan,Xie Simiao,Wang Pu,Wang Guixiang,Zhang Li,Cao Xiaochen,Wu Wenzhi,Bian Yueran,Huang Fei,Luo Na,Luo Mingyan,Xiao Qiang Frontiers in public health Since the outbreak of COVID-19, physical and psychological harm has been spreading across the global population alongside the spread of the virus. Currently, the novel coronavirus has spread to most countries in the world, and its impact on the public is also increasing. As a high-risk group in direct contact with the virus, medical workers should be monitored, and their mental health deserves extensive attention. The aim of this study was to explore the mental health of medical workers facing the novel coronavirus and the main factors affecting it. : The present cross-sectional study including 2,100 eligible individuals from 1,050 hospitals in China was conducted through the network platform powered by www.wjx.cn, a platform providing functions equivalent to Amazon Mechanical Turk. We used a self-designed questionnaire to collect demographic information and data on mental states, including gender, age (years), educational level, job rank, body and mind reaction, cognition of risk, and the judgment of the epidemic situation. Independent samples -tests and one-way (ANOVA) analysis were carried out to compare the differences in the mental reactions according to the demographic and psychological states of the participants. : There were 502 males (23.9%) and 1,598 females (76.1%). The participants reported feeling calm (39.1%), tense (63.0%), scared (31.4%), angry (18.8%), sad (49.0%), afraid (34.7%), optimistic (5.1%), impressed (65.0%), and confident (31.1%) during the epidemic. At the same time, the psychological stress responses of medical staff were significantly different according to the levels of exposure in their environments, duration and personal experience. : Prolonged exposure to the virus and intense work are detrimental to the mental health of medical care personnel. It is necessary to adjust work conditions and intensity according to workers' mental state flexibly and systematically. 10.3389/fpubh.2020.00491
    Symptoms of Anxiety, Depression, and Peritraumatic Dissociation in Critical Care Clinicians Managing Patients with COVID-19. A Cross-Sectional Study. Azoulay Elie,Cariou Alain,Bruneel Fabrice,Demoule Alexandre,Kouatchet Achille,Reuter Danielle,Souppart Virginie,Combes Alain,Klouche Kada,Argaud Laurent,Barbier François,Jourdain Mercé,Reignier Jean,Papazian Laurent,Guidet Bertrand,Géri Guillaume,Resche-Rigon Matthieu,Guisset Olivier,Labbé Vincent,Mégarbane Bruno,Van Der Meersch Guillaume,Guitton Christophe,Friedman Diane,Pochard Frédéric,Darmon Michael,Kentish-Barnes Nancy American journal of respiratory and critical care medicine Frontline healthcare providers (HCPs) during the coronavirus disease (COVID-19) pandemic are at high risk of mental morbidity. To assess the prevalence of symptoms of anxiety, depression, and peritraumatic dissociation in HCPs. This was a cross-sectional study in 21 ICUs in France between April 20, 2020, and May 21, 2020. The Hospital Anxiety and Depression Scale and the Peritraumatic Dissociative Experience Questionnaire were used. Factors independently associated with reported symptoms of mental health disorders were identified. The response rate was 67%, with 1,058 respondents (median age 33 yr; 71% women; 68% nursing staff). The prevalence of symptoms of anxiety, depression, and peritraumatic dissociation was 50.4%, 30.4%, and 32%, respectively, with the highest rates in nurses. By multivariable analysis, male sex was independently associated with lower prevalence of symptoms of anxiety, depression, and peritraumatic dissociation (odds ratio of 0.58 [95% confidence interval, 0.42-0.79], 0.57 [95% confidence interval, 0.39-0.82], and 0.49 [95% confidence interval, 0.34-0.72], respectively). HCPs working in non-university-affiliated hospitals and nursing assistants were at high risk of symptoms of anxiety and peritraumatic dissociation. Importantly, we identified the following six modifiable determinants of symptoms of mental health disorders: fear of being infected, inability to rest, inability to care for family, struggling with difficult emotions, regret about the restrictions in visitation policies, and witnessing hasty end-of-life decisions. HCPs experience high levels of psychological burden during the COVID-19 pandemic. Hospitals, ICU directors, and ICU staff must devise strategies to overcome the modifiable determinants of adverse mental illness symptoms. 10.1164/rccm.202006-2568OC
    Mental health problems and social supports in the COVID-19 healthcare workers: a Chinese explanatory study. Fang Xue-Hui,Wu Li,Lu Lun-Shan,Kan Xiao-Hong,Wang Hua,Xiong Yan-Jun,Ma Dong-Chun,Wu Guo-Cui BMC psychiatry BACKGROUND:Coronavirus disease 2019 (COVID-19) has spread rapidly in China and other overseas areas, which has aroused widespread concern. The sharp increase in the number of patients has led to great psychological pressure on health care workers. The purpose of this study was to understand their mental health status and needs, so as to provide a scientific basis for alleviating the psychological pressure of health care workers. METHODS:Using a cross-sectional study design, 540 health care workers were randomly selected from two designated tuberculosis medical institutions in Anhui Province. The basic situation, perceived social support, depression level, loneliness and COVID-19 related knowledge were collected and analyzed by questionnaire. RESULTS:A total of 511 valid questionnaires were finally retrieved. There were 139 people in epidemic prevention and control positions (27.20%). Depression level: People in isolation ward, fever clinic and pre-check triage were at the level of mild to moderate depression. Female was higher than male; nurse was higher than doctor; middle and junior job titles were higher than senior titles; junior college degree or below were higher than bachelor's degree, master's degree and above; isolation ward, fever clinic and pre-check triage were significantly higher than those of non-prevention and control positions (p < 0.05). Loneliness scores: Doctors were higher than that of medical technicians, and isolation ward, fever clinic and pre-check triage were higher than those of other medical departments (p < 0.05). Social support: Doctors were lower than that of medical technicians, and isolation ward, fever clinic and pre-check triage were significantly lower than those of other departments (p < 0.05). The score of social support was negatively correlated with depression and loneliness (p < 0.001), while depression was positively correlated with loneliness (p < 0.001). Health care workers most want to receive one-to-one psychological counseling (29.75%), and provide crisis management (24.07%). The awareness rate of health care workers on COVID-19's knowledge was relatively high. CONCLUSIONS:The psychological problems of health care workers, especially women, nurses with low educational background, low professional title, and staff in the epidemic prevention and control positions are relatively serious. 10.1186/s12888-020-02998-y
    Psychological Impact of the COVID-19 Pandemic on Chinese Health Care Workers: Cross-Sectional Survey Study. Ni Jie,Wang Fang,Liu Yihai,Wu Mingyue,Jiang Yan,Zhou Yujie,Sha Dujuan JMIR mental health BACKGROUND:The outbreak of COVID-19 has dominated headlines worldwide. The number of infections has continued to rise and had reached 30,000 worldwide at the time this paper was written. Because of the high risk of nosocomial transmission, medical health care workers may be experiencing substantial psychological stress. This descriptive study aimed to identify psychosocial effects on hospital staff associated with working in a hospital environment during the COVID-19 outbreak. OBJECTIVE:Our survey participants included 57 frontline clinicians working at Wuhan First Hospital and 157 medical students working at Jiangsu Provincial People's Hospital during the COVID-19 outbreak. The questionnaire we adopted included questions regarding the participants' personal well-being, sociodemographic characteristics, and psychological status. METHODS:57 frontline clinicians working in Wuhan First Hospital and 157 medical training students working in Jiangsu Provincial Peoples Hospital during this outbreak participated in our survey. The questionnaire we adopted included questions regarding the participants' personal well-being, sociodemographic characteristics and the psychological status. RESULTS:The COVID-19 outbreak had psychological impacts both on formal workers and medical students. The psychological effects included sleep disorders, anxiety, and depression. There was no significant difference between the group of formal workers and medical students (P=.85), and more than 50% (30/54, 56%, vs. 83/157, 52.9%) of the respondents reported pandemic-related mental disorders. CONCLUSIONS:Our study indicates that the high risk of SARS-CoV-2 exposure caused substantial psychological stress among health care workers. This finding emphasizes the need to promote psychological crisis intervention for medical personnel during this epidemic. 10.2196/23125
    Depressive State in the Emergency Department During COVID-19: A National Cross-Sectional Survey in China. Liu Shuang,Han Wei,Shen Chenyu,Zhu Changju,Wang Qiaofang,Liang Xianquan,He Xiangxi,Xie Qin,Wei Jie,Wu Miao,Zhao Xiaodong,Liu Hongsheng,Liu Danping,Guo Xiaowang,Nie Shinan,Cao Liping,Lu Linxin,Fang Yaqin,Lu Zhongqiu,Wu Yixu,Zhao Min,Han Jun,Zhang Xinchao,Chang Jie,Xu Shuogui,Ma Wenjie,Si Junli,Qi Suxia,Peng Peng,Chai Yage,Cao Yu,Jiang Yaowen,Yin Wen,Wang Yanjun,Zhan Hong,Huang Yingxiong,Deng Ying,Song Juanjuan,Yang Lishan,Wu Jiali,Ding Banghan,Zheng Danwen,Qian Chuanyun,Huang Rui,Lin Jiyan,Xu Zhihong,Zhang Guoxiu,Hu Yingying,Dou Qingli,Zhang Xiaoming,Tian Yingping,Yao Dongqi,Walline Joseph Harold,Zhu Huadong,Xu Jun,Li Yi,Yu Xuezhong Frontiers in psychiatry Chinese emergency department (ED) staff encountered significant mental stress while fighting the coronavirus disease 2019 (COVID-19) pandemic. We sought to investigate the prevalence and associated factors for depressive symptoms among ED staff (including physicians, nurses, allied health, and auxiliary ED staff). A cross-sectional national survey of ED staff who were on duty and participated in combating the COVID-19 pandemic was conducted March 1-15, 2020. A total of 6,588 emergency medical personnel from 1,060 hospitals responded to this survey. A majority of respondents scored above 10 points on the PHQ-9 standardized test, which is associated with depressive symptoms. Those aged 31-45, those working in the COVID-19 isolation unit, and those with relatives ≤ 16 or ≥70 years old at home all had statistically significant associations with scoring >10 points. Depressive symptoms among Chinese emergency medical staff were likely quite common during the response to the COVID-19 pandemic and reinforce the importance of targeted ED staff support during future outbreaks. 10.3389/fpsyt.2021.566990
    A cross-sectional study of the psychological status of 33,706 hospital workers at the late stage of the COVID-19 outbreak. Lixia Wang,Xiaoming Xu,Lei Shi,Su Hong,Wo Wang,Xin Fang,Jianmei Chen,Qi Zhang,Ming Ai,Li Kuang Journal of affective disorders BACKGROUND:Hospital workers have been under intense psychological pressure since the COVID-19 outbreak. We analyzed the psychological status of hospital staff in the late period of the COVID-19 to provide a basis for the construction of global health care after the COVID-19 outbreak. METHODS:We used online surveys to assess participants' self-reported symptoms at the late stage of the outbreak. This study collected data on sociodemographic characteristics, epidemic-related factors, psychological status (PHQ-9, GAD-7, and PHQ-15), psychological assistance needs, perceived stress and support, PTSD symptoms (PCL-C) and suicidal and self-injurious ideation (SSI). Participants were hospital workers in all positions from 46 hospitals. Chi-square tests to compare the scales and logistic regression analysis were used to identify risk factors for PTSD and SSI. RESULTS:Among the 33,706 participants, the prevalences of depression, anxiety, somatic symptoms, PTSD symptoms, and SSI were 35.8%, 24.4%, 49.7%, 5.0%, and 1.3%, respectively. Logistic regression analysis showed that work in a general ward, attention to the epidemic, high education, work in non-first-line departments, insufficient social support, and anxiety and somatization symptoms were influencing factors of PTSD (P<0.05). The independent risk factors for SSI were female gender; psychological assistance needs; contact with severe COVID-19 patients; high stress at work; single or divorced marital status; insufficient social support; and depression, anxiety or PTSD symptoms (P<0.05). LIMITATIONS:This cross-sectional study could not reveal causality, and voluntary participation may have led to selection bias. The longer longitudinal studies are needed to determine the long-term psychological impact. CONCLUSION:This COVID-19 pandemic had a sustained, strong psychological impact on hospital workers, and hospital workers with PTSD symptoms were a high-risk group for SSI in the later period of the epidemic. Continuous attention and positive psychological intervention are of great significance for specific populations. 10.1016/j.jad.2021.10.013
    Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada. Myran Daniel T,Cantor Nathan,Rhodes Emily,Pugliese Michael,Hensel Jennifer,Taljaard Monica,Talarico Robert,Garg Amit X,McArthur Eric,Liu Cheng-Wei,Jeyakumar Nivethika,Simon Christopher,McFadden Taylor,Gerin-Lajoie Caroline,Sood Manish M,Tanuseputro Peter JAMA network open Importance:Physicians self-report high levels of symptoms of anxiety and depression, and surveys suggest these symptoms have been exacerbated by the COVID-19 pandemic. However, it is not known whether pandemic-related stressors have led to increases in health care visits related to mental health or substance use among physicians. Objective:To evaluate the association between the COVID-19 pandemic and changes in outpatient health care visits by physicians related to mental health and substance use and explore differences across physician subgroups of interest. Design, Setting, and Participants:A population-based cohort study was conducted using health administrative data collected from the universal health system (Ontario Health Insurance Plan) of Ontario, Canada, from March 1, 2017, to March 10, 2021. Participants included 34 055 physicians, residents, and fellows who registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018 and were eligible for the Ontario Health Insurance Plan during the study period. Autoregressive integrated moving average models and generalized estimating equations were used in analyses. Exposures:The period during the COVID-19 pandemic (March 11, 2020, to March 10, 2021) compared with the period before the pandemic. Main Outcomes and Measures:The primary outcome was in-person, telemedicine, and virtual care outpatient visits to a psychiatrist or family medicine and general practice clinicians related to mental health and substance use. Results:In the 34 055 practicing physicians (mean [SD] age, 41.7 [10.0] years, 17 918 [52.6%] male), the annual crude number of visits per 1000 physicians increased by 27%, from 816.8 before the COVID-19 pandemic to 1037.5 during the pandemic (adjusted incident rate ratio per physician, 1.13; 95% CI, 1.07-1.19). The absolute proportion of physicians with 1 or more mental health and substance use visits within a year increased from 12.3% before to 13.4% during the pandemic (adjusted odds ratio, 1.08; 95% CI, 1.03-1.14). The relative increase was significantly greater in physicians without a prior mental health and substance use history (adjusted incident rate ratio, 1.72; 95% CI, 1.60-1.85) than in physicians with a prior mental health and substance use history. Conclusions and Relevance:In this study, the COVID-19 pandemic was associated with a substantial increase in mental health and substance use visits among physicians. Physician mental health may have worsened during the pandemic, highlighting a potential greater requirement for access to mental health services and system level change. 10.1001/jamanetworkopen.2021.43160
    A population-based survey of patients' experiences with teleconsultations in cancer care in Denmark during the COVID-19 pandemic. Acta oncologica (Stockholm, Sweden) BACKGROUND:During the COVID-19 pandemic, teleconsultations (TC) have been increasingly used in cancer care as an alternative to outpatient visits. We aimed to examine patient-related and cancer-specific characteristics associated with experiences with TC among patients with cancer during the COVID-19 pandemic. MATERIAL AND METHODS:This population-based survey included patients with breast, lung, gastrointestinal, urological, and gynaecological cancers with appointments in the outpatient clinics, Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Denmark in March and April 2020. Age- and sex-adjusted logistic regression analyses were used to study associations of sociodemographics, cancer and general health, anxiety, and health literacy with patients' experiences of TC in regards to being comfortable with TC, confident that the doctor could provide information or assess symptoms/side effects and the perceived outcome of TC. RESULTS:Of the 2119 patients with cancer receiving the electronic survey, 1160 (55%) participated. Two thirds of patients (68%) had consultations with a doctor changed to TC. Being male, aged 65-79 years, and having TC for test results were statistically significantly associated with more comfort, confidence, and perceived better outcome of TC. Having breast cancer, anxiety, low health literacy, or TC for a follow-up consultation were statistically significantly associated with less positive experiences with TC. Living alone, short education, disability pension, and comorbidity were statistically significantly associated with anxiety and low health literacy. CONCLUSIONS:Most patients reported positive experiences with TC, but in particular patients with anxiety and low health literacy, who were also the patients with fewest socioeconomic and health resources, felt less comfortable and confident with and were more likely to perceive the outcome negatively from this form of consultation. TC may be suitable for increasing integration into standard cancer care but it should be carefully planned to meet patients' different information needs in order not to increase social inequality in cancer. 10.1080/0284186X.2021.1956688
    Suddenly Becoming a "Virtual Doctor": Experiences of Psychiatrists Transitioning to Telemedicine During the COVID-19 Pandemic. Uscher-Pines Lori,Sousa Jessica,Raja Pushpa,Mehrotra Ateev,Barnett Michael L,Huskamp Haiden A Psychiatric services (Washington, D.C.) OBJECTIVE:In response to the COVID-19 pandemic, many psychiatrists have rapidly transitioned to telemedicine. This qualitative study sought to understand how this dramatic change in delivery has affected mental health care, including modes of telemedicine psychiatrists used, barriers encountered, and future plans. The aim was to inform the ongoing COVID-19 response and pass on lessons learned to psychiatrists who are starting to offer telemedicine. METHODS:From March 31 to April 9, 2020, semistructured interviews were conducted with 20 outpatient psychiatrists practicing in five U.S. states with significant early COVID-19 activity. Inductive and deductive approaches were used to develop interview summaries, and a matrix analysis was conducted to identify and refine themes. RESULTS:At the time of the interviews, all 20 psychiatrists had been using telemedicine for 2-4 weeks. Telemedicine encompassed video visits, phone visits, or both. Although many continued to prefer in-person care and planned to return to it after the pandemic, psychiatrists largely perceived the transition positively. However, several noted challenges affecting the quality of provider-patient interactions, such as decreased clinical data for assessment, diminished patient privacy, and increased distractions in the patient's home setting. Several psychiatrists noted that their disadvantaged patients lacked reliable access to a smartphone, computer, or the Internet. Participants identified several strategies that helped them improve telemedicine visit quality. CONCLUSIONS:The COVID-19 pandemic has driven a dramatic shift in how psychiatrists deliver care. Findings highlight that although psychiatrists expressed some concerns about the quality of these encounters, the transition has been largely positive for both patients and physicians. 10.1176/appi.ps.202000250
    Preliminary Report: US Physician Stress During the Early Days of the COVID-19 Pandemic. Linzer Mark,Stillman Martin,Brown Roger,Taylor Sam,Nankivil Nancy,Poplau Sara,Goelz Elizabeth,Sinsky Christine, Mayo Clinic proceedings. Innovations, quality & outcomes Objective:To assess the impact of the COVID-19 crisis on physician stress and mental health. Methods:The 10-item Coping With COVID survey assessed stress among 2373 physicians from April 4 to May 27, 2020. A stress summary score with 4 items (a single-item [overall] stress measure, fear of exposure, perceived anxiety/depression due to COVID, and work overload, each scored 1-4) ranged from 4 to 16. Hypothesized stress mitigators included enhanced purpose and feeling valued by one's organization. Multilevel linear regression tested associations of variables with overall stress and stress summary scores. Results:In 2373 physicians in 17 organizations (median response rate of 32%), mean stress summary score was 9.1 (SD 2.6). Stress was highest among women (stress summary score, 9.4 [SD 2.5] vs 8.7 [SD 2.6] in men; <.001), inpatient physicians (stress summary score, 9.4 [SD 2.8] vs 8.9 [SD 2.5] in outpatient physicians; <.001), early- and mid-career physicians (stress summary score, 9.5 [SD 2.6] vs 8.6 [SD 2.5] in late-career physicians; <.001), and physicians in critical care (stress summary score, 10.8), emergency departments (10.2), and hospital medicine (10.1). Increases in perceived anxiety/depression (regression coefficient, 0.30), workload (0.28), and fear (0.14) were associated with higher overall stress ( values <.001). Increases in feeling valued were associated with lower stress summary scores (regression coefficient, -0.67; <.001) and explained 11% of stress summary score variance at the physician level and 31% of variance at the organizational level. Conclusion:Mental health support, modulation of workload, and noting physicians' organizational value should be explored as means to reduce COVID-related stress. 10.1016/j.mayocpiqo.2021.01.005