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Mental Health of Health Care Workers in the COVID-19 Pandemic

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Occupational Safety and Health".

Deadline for manuscript submissions: closed (11 August 2023) | Viewed by 36041

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Dr. Serena Barello

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Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
Interests: patient engagement in healthcare; patient-centered medicine, communication and medical practice; assessments of patient and consumer activation; cancer and palliative care; mental health; patient education in chronic conditions; medical psychology, qualitative methods
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Dr. Anna Falcó-Pegueroles

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Faculty of Nursing, University of Barcelona, 08907 Barcelona, Spain
Interests: advance nursing practice; bioethics; nursing care; critical care nursing
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Dr. Loris Bonetti

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1. Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Via Violino, 11, 6928 Manno, Switzerland
2. Nursing Research Competence Centre, Department of Nursing, Ente Ospedaliero Cantonale (EOC), Viale Officina, 3, 6500 Bellinzona, Switzerland
Interests: geriatric care; bioethics; nursing profession; nutrition; patient engagement; critical care nursing; patient-nurse relationship; mental health; quantitative research; mixed-methods
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Special Issue Information

Dear Colleagues,

The outbreak of coronavirus disease 2019 (COVID-19) caused by the virus SARS-CoV-2 has become a public health emergency of major international concern and has placed extraordinary demands upon healthcare systems worldwide. This has caused an overload of work in every healthcare organization and increased healthcare professionals’ work-related stress, burnout, and poor mental health. In fact, healthcare professionals were forced to work long hard shifts, stay away from their loved ones for fear of infecting them, behave in ways that often challenged them, causing ethical conflicts, and to fear for their health because of potential contagion. This situation has increased psychological suffering in health professionals.

On the other hand, it is true that healthcare professionals have often found innovative coping strategies and ways of dealing with the dramatic situation, which have allowed them to mitigate the psychological impact of the pandemic.

This special issue intends to provide the scientific community with evidence on both the aspects of psychological suffering experienced by health professionals during the pandemic (with its correlates such as burnout, post-traumatic stress syndrome, and ethical conflicts), and the coping strategies, resilience and adjustment processes they experienced and enacted during the pandemic.

Knowing the sources of psychological distress but also how to cope with them, is expected to contribute towards the knowledge base in order to cope effectively with current and future health emergencies.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on mental health care and promotion in healthcare professionals. We encourage the submission of original research papers (both qualitative and quantitative), reviews, meta-analyses, and case studies that contribute new knowledge in this area. Interventional studies, trials, and epidemiological studies are also encouraged. The focus may include a specific population.

Dr. Serena Barello
Dr. Anna Falcó-Pegueroles
Dr. Bonetti Loris
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

SARS-CoV-2
anxiety
depression
burnout
coping
resilience
adjustment
ethical conflict
health professionals
post traumatic growth.

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Published Papers (10 papers)

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Research

14 pages, 952 KiB

Open AccessArticle

Long-Term Trajectory and Risk Factors of Healthcare Workers’ Mental Health during COVID-19 Pandemic: A 24 Month Longitudinal Cohort Study

by Alice Fattori, Anna Comotti, Sara Mazzaracca, Dario Consonni, Lorenzo Bordini, Elisa Colombo, Paolo Brambilla and Matteo Bonzini

Int. J. Environ. Res. Public Health 2023, 20(5), 4586; https://doi.org/10.3390/ijerph20054586 - 4 Mar 2023

Cited by 12 | Viewed by 2679

Abstract

Background: Research has shown the substantial impact of the COVID-19 pandemic on healthcare workers’ (HCWs) mental health, however, it mostly relies on data collected during the early stages of COVID-19. The aim of this study is to assess the long-term trajectory of HCWs’ mental health and the associated risk factors. Methods: a longitudinal cohort study was carried out in an Italian hospital. At Time 1 (July 2020–July 2021), 990 HCWs took part in the study and completed the General Health Questionnaire (GHQ-12), the Impact of Event Scale (IES-R), and the General Anxiety Disorder (GAD-7)questionnaire. McNemar’s test measured changes in symptoms’ trajectories, and random effects models evaluated risk factors associated with scores above the cut-off. Results: 310 HCWs participated to the follow-up evaluation (Time 2; July 2021–July 2022). At Time 2, scores above cut-offs were significantly lower (p < 0.001) than at Time 1 for all scales (23% vs. 48% for GHQ-12; 11% vs. 25% for IES-R; 15% vs. 23% for GAD-7). Risk factors for psychological impairment were being a nurse (IES-R: OR 4.72, 95% CI 1.71–13.0; GAD-7: OR 2.82, 95% CI 1.44–7.17), a health assistant (IES-R: OR 6.76, 95% CI 1.30–35.1), or having had an infected family member (GHQ-12: OR 1.95, 95% CI 1.01–3.83). Compared to Time 1, gender and experience in COVID-19 units lost significance with psychological symptoms. Conclusions: data over more than 24 months from the pandemic onset showed improvement of HCWs’ mental health; our findings suggested the need to tailor and prioritize preventive actions towards healthcare workforce. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

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14 pages, 830 KiB

Open AccessArticle

Mediating Effect of Challenges on Demographics and Coping Strategies of Indian Healthcare Workers during COVID-19

by Anahita Ali and Santosh Kumar

Int. J. Environ. Res. Public Health 2023, 20(5), 4474; https://doi.org/10.3390/ijerph20054474 - 2 Mar 2023

Cited by 1 | Viewed by 1624

Abstract

Healthcare workers (HCWs) including doctors, nurses and allied workers struggled to cope up with the stressful situation as the COVID-19 pandemic unsettled healthcare systems, including India’s. Many factors (commonly called as stressors) acted as major sources of stress and resulted in poor mental health of HCWs. Therefore, this study predicted and explained the mediating effect of challenges on demographic characteristics and coping strategies of HCWs. Data from a cross-sectional study was collected from the district hospital of Rajasthan, India, during the period of August 2022–October 2022. HCW’s experience level, shift type and distance of greenspaces from their accommodation were significantly correlated with the challenges they faced at work, specifically societal challenges. Thus, HCWs were more inclined to adopt a meaning-focused coping strategy to retain good mental health during the pandemic. Therefore, these findings call for interventions requiring a layered response, comprising strategies and actions that are structural. At the organizational level, these actions may provide supportive workplace environments. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

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13 pages, 730 KiB

Open AccessArticle

Indian Healthcare Workers’ Issues, Challenges, and Coping Strategies during the COVID-19 Pandemic: A Cross-Sectional Study

by Anahita Ali and Santosh Kumar

Int. J. Environ. Res. Public Health 2023, 20(4), 3661; https://doi.org/10.3390/ijerph20043661 - 18 Feb 2023

Cited by 7 | Viewed by 3306

Abstract

India faced the maximum number of mortalities and morbidities during the second wave of COVID-19. Healthcare workers (HCWs) worked in high-pressure and stressful environments. Therefore, this study aimed to assess the common issues, challenges, and coping strategies of HCWs, as well as the statistical association between demographical characteristics and coping strategies. A cross-sectional study was conducted with 759 HCWs, involving simple, random sampling in Rajasthan, India, between August 2022 and October 2022. Participants responded to a self-administered questionnaire that included a Brief–COPE inventory. The statistical association between commonly adopted coping strategies and demographic characteristics was tested using the chi-square test and Fisher’s exact test. A total of 669 (88%) respondents agreed that they faced issues during the COVID-19 pandemic: 721 (95%) participants experienced challenges at the personal level, 716 (94%) at the organizational level, and 557 (74%) at the societal level. Problem-focused coping strategies were frequently adopted by the participants. Gender, marital status, education, hours of work per day, and residential area were significantly associated with a problem-focused coping strategy (p < 0.05). The findings of this study reported a limited use of coping strategies by the participants during the public health crisis, despite facing issues and challenges at work. These findings highlight the need to assist HCWs in developing coping mechanisms to maintain good mental health at work. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

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20 pages, 442 KiB

Open AccessArticle

Predictors of Post-Traumatic Growth in a Sample of United Kingdom Mental and Community Healthcare Workers during the COVID-19 Pandemic

by Kirsten Barnicot, Rose McCabe, Angeliki Bogosian, Renos Papadopoulos, Mike Crawford, Peter Aitken, Tanja Christensen, Jonathan Wilson, Bonnie Teague, Ravi Rana, Donna Willis, Ryan Barclay, Amy Chung and Frank Rohricht

Int. J. Environ. Res. Public Health 2023, 20(4), 3539; https://doi.org/10.3390/ijerph20043539 - 17 Feb 2023

Cited by 6 | Viewed by 3284

Abstract

Experiences of adversity can generate positive psychological effects alongside negative impacts. Little research to date has evaluated predictors of post-traumatic growth in mental or community healthcare workers during the COVID-19 pandemic. Following a survey of 854 community and mental healthcare staff in the United Kingdom in July to September 2020, multiple linear regression was used to determine the association between hypothesised risk and protective factors (personal, organisational and environmental variables) and total scores on the Post-traumatic Growth Inventory–Short Version. Positive self-reflection activities, black and minority ethnic status, developing new healthcare knowledge and skills, connecting with friends and family, feeling supported by senior management, feeling supported by the UK people, and anxiety about the personal and work-related consequences of COVID-19 each significantly independently predicted greater post-traumatic growth. Working in a clinical role and in mental healthcare or community physical healthcare predicted lower post-traumatic growth. Our research supports the value of taking an organisational growth-focused approach to occupational health during times of adversity, by supporting staff to embrace opportunities for personal growth. Valuing staff’s cultural and religious identity and encouraging self-reflective activities, such as mindfulness and meditation, may help to promote post-traumatic growth. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

15 pages, 658 KiB

Open AccessArticle

A Qualitative Approach to Understanding Canadian Healthcare Workers’ Use of Coping Strategies during the COVID-19 Pandemic

by Mauda Karram, Andrea M. D'Alessandro-Lowe, Kimberly Ritchie, Andrea Brown, Yuanxin Xue, Mina Pichtikova, Maxwell Altman, Isaac Beech, Heather Millman, Fardous Hosseiny, Sara Rodrigues, Alexandra Heber, Charlene O'Connor, Hugo Schielke, Ann Malain, Ruth A. Lanius, Randi E. McCabe and Margaret C. McKinnon

Int. J. Environ. Res. Public Health 2023, 20(3), 2551; https://doi.org/10.3390/ijerph20032551 - 31 Jan 2023

Cited by 4 | Viewed by 3606

Abstract

Throughout the COVID-19 pandemic, healthcare workers (HCWs) have been exposed to highly stressful situations, including increased workloads and exposure to mortality, thus posing a risk for adverse psychological outcomes, including acute stress, moral injury, and depression or anxiety symptoms. Although several reports have sought to identify the types of coping strategies used by HCWs over the course of the pandemic (e.g., physical activity, religion/spirituality, meditation, and alcohol), it remains unclear which factors may influence HCWs’ choice of these coping strategies. Accordingly, using a qualitative approach, the purpose of the present study was to gain a deeper understanding of the factors influencing HCWs’ choice of coping strategies during the COVID-19 pandemic in Canada. Fifty-one HCWs participated in virtual, semi-structured interviews between February and June 2021. Interview transcripts were analysed through an inductive thematic approach, yielding two primary themes. First, HCWs described an ongoing shift in their approach to coping depending on their mental “bandwidth”, ranging from “quick fix” to more “intentional effort” strategies to engage in proactive strategies to improve mental health. Second, many HCWs identified various barriers to desired coping strategies during the pandemic, including the preponderance of pandemic- and other circumstantial-related barriers. The findings from this study offer a unique understanding of the factors influencing HCWs’ choice of coping strategies under novel and increased stress. This knowledge will be central to developing appropriate forms of support and resources to equip HCWs throughout and after the pandemic period, and in mitigating the potential adverse mental health impacts of this period of prolonged stress and potential trauma. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

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19 pages, 613 KiB

Open AccessArticle

Occupational Burnout in Healthcare Workers, Stress and Other Symptoms of Work Overload during the COVID-19 Pandemic in Poland

by Zbigniew Izdebski, Alicja Kozakiewicz, Maciej Białorudzki, Joanna Dec-Pietrowska and Joanna Mazur

Int. J. Environ. Res. Public Health 2023, 20(3), 2428; https://doi.org/10.3390/ijerph20032428 - 30 Jan 2023

Cited by 30 | Viewed by 7533

Abstract

This study explored the level and selected determinants of burnout among five groups of healthcare workers (physicians, nurses, paramedics, other medical and nonmedical staff) working during the COVID-19 pandemic in Poland. This cross-sectional study was conducted from February to April 2022, with the use of a self-administered mostly online survey. The BAT-12 scale was used to measure burnout, and the PSS-4 scale was used to measure stress. The sample was limited to 2196 individuals who worked with patients during the COVID-19 pandemic. A series of multivariate logistic regression models with three to nine predictors was estimated. The prevalence of burnout ranged from 27.7% in other nonmedical staff to 36.5% in nurses. Adjusting for age and gender, both physicians (p = 0.011) and nurses (p < 0.001) were at higher risk of burnout. In the final model, elevated stress most likely increased the risk of burnout (OR = 3.88; 95%CI <3.13–3.81>; p < 0,001). Other significant predictors of burnout included traumatic work-related experience (OR =1.91, p < 0.001), mobbing (OR = 1.83, p < 0.001) and higher workload than before the pandemic (OR = 1.41, p = 0.002). Only 7% of the respondents decided to use various forms of psychological support during the pandemic. The presented research can contribute to the effective planning and implementation of measures in the face of crisis when the workload continues to increase. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

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15 pages, 539 KiB

Open AccessArticle

Moral Distress of Intensive Care Nurses: A Phenomenological Qualitative Study Two Years after the First Wave of the COVID-19 Pandemic

by Debora Rosa, Loris Bonetti, Giulia Villa, Sara Allieri, Riccardo Baldrighi, Rolando Francesco Elisei, Paola Ripa, Noemi Giannetta, Carla Amigoni and Duilio Fiorenzo Manara

Int. J. Environ. Res. Public Health 2022, 19(22), 15057; https://doi.org/10.3390/ijerph192215057 - 16 Nov 2022

Cited by 7 | Viewed by 2607

Abstract

Background: The COVID-19 pandemic has imposed great pressure on healthcare facilities, exposing healthcare professionals to various challenges that may result in the onset of moral distress, a condition of psychological distress caused by the inability to act as it would be most morally appropriate. The purpose of this research was to investigate the experience lived by nurses who worked in an intensive care unit during the COVID-19 pandemic. Methods: This is a phenomenological study using interpretative phenomenological analysis. Sixteen nurses who worked in the COVID-19 Intensive Care Unit of Northern Italian Hospitals from January to April 2022 were selected through purposive sampling. Data on experiences, thoughts, and symptoms were collected through semi-structured interviews with in-person and remote modalities. Results: Five themes and fourteen subthemes emerged from the study. The themes are: (1) pride, isolation, and fear; (2) teamwork and organisation; (3) moral/ethical aspect; (4) true heroes; and (5) dignity. Conclusions: This study highlights the impact of the COVID-19 pandemic on intensive care unit nurses. It has emerged that the risk of moral distress is high among healthcare workers in the front line of the fight against the virus. This condition should be avoided and managed through early psychological interventions, sharing of experiences, and a good organization that supports decision-making and professional well-being. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

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9 pages, 551 KiB

Open AccessArticle

Recurrent SARS-CoV-2 Serology Testing and Pandemic Anxiety: A Study of Pediatric Healthcare Workers

by Natasha Li, Sarah R. Martin, Theodore W. Heyming, Chloe Knudsen-Robbins, Terence Sanger and Zeev N. Kain

Int. J. Environ. Res. Public Health 2022, 19(15), 9562; https://doi.org/10.3390/ijerph19159562 - 3 Aug 2022

Viewed by 1565

Abstract

Background: Limited access to SARS-CoV-2 testing has been identified as a potential source of anxiety among healthcare workers (HCWs), but the impact of repeated testing on pandemic-related anxiety in pediatric HCWs has not been examined. We sought to understand the impact of repeated SARS-CoV-2 antibody testing on pediatric HCWs’ COVID-19 anxiety. Methods: This longitudinal cohort study was conducted between April and July 2020. Participants, 362 pediatric HCWs, underwent rapid SARS-CoV-2 antibody testing either every 96 h or weekly and were asked to rate their COVID-19 anxiety on a visual analog scale. Changes in self-reported anxiety from the study baseline were calculated for each testing day response. Bivariate analyses, repeated measures, and logistic regression analyses were performed to examine demographics associated with changes in anxiety. Results: Baseline COVID-19 anxiety was significantly higher in HCWs with less than 10 years of experience (Z = −2.63, p = 0.009), in females compared to males (Z = −3.66 p < 0.001), and in nurses compared to other HCWs (F (3,302) = 6.04, p = 0.003). After excluding participants who received a positive test result, repeated measures analyses indicated that anxiety decreased over time (F (5,835) = 3.14, p = 0.008). Of the HCWs who reported decreased anxiety, 57 (29.8%) had a clinically meaningful decrease (≥30%) and Emergency Department (ED) HCWs were 1.97 times more likely to report a clinically meaningful decrease in anxiety (X² (1) = 5.05, p = 0.025). Conclusions: The results suggest that repeated SARS-CoV-2 antibody serology testing is associated with decreased COVID-19 anxiety in HCWs. Routine screening for the disease may be a helpful strategy in attenuating pandemic-related anxiety in pediatric HCWs. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

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13 pages, 369 KiB

Open AccessArticle

Treating Anti-Vax Patients, a New Occupational Stressor—Data from the 4th Wave of the Prospective Study of Intensivists and COVID-19 (PSIC)

by Nicola Magnavita, Paolo Maurizio Soave and Massimo Antonelli

Int. J. Environ. Res. Public Health 2022, 19(10), 5889; https://doi.org/10.3390/ijerph19105889 - 12 May 2022

Cited by 17 | Viewed by 2393

Abstract

The Prospective Study of Intensivists and COVID-19 (PSIC) is a longitudinal study that besides investigating a cohort of intensivists from one of the two COVID-19 hub hospitals in Central Italy since the beginning of the pandemic (first wave, April 2020), has conducted a new survey at each successive wave. In addition to the variables investigated in previous surveys (job changes due to the pandemic, justice of safety procedures, job stress, sleep quality, satisfaction, happiness, anxiety, depression, burnout, and intention to quit), the latest fourth wave (December 2021) study has evaluated discomfort in caring for anti-vax patients. A multivariate logistic regression model confirmed that high levels of occupational stress (distressed 75.8%) were associated with isolation, monotony, lack of time for meditation, and poor relationships with anti-vaccination patients. Compared to the first phase, there was a reduction in levels of insomnia and anxiety, but the percentage of intensivists manifesting symptoms of depression remained high (58.9%). The study underlined the efficacy of organizational interventions and psychological support. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

18 pages, 416 KiB

Open AccessArticle

Mental Well-Being and Job Satisfaction of Hospital Physicians during COVID-19: Relationships with Efficacy Beliefs, Organizational Support, and Organizational Non-Technical Skills

by Vincenza Capone, Roberta Borrelli, Leda Marino and Giovanni Schettino

Int. J. Environ. Res. Public Health 2022, 19(6), 3734; https://doi.org/10.3390/ijerph19063734 - 21 Mar 2022

Cited by 35 | Viewed by 5977

Abstract

The COVID-19 outbreak has led worldwide governments to take preventive measures to contain the spread of the virus and its extraordinary demands upon healthcare workers. Consequently, healthcare workers have been under high pressures, putting them at risk of developing adverse outcomes. The present study aims to investigate the psychological and organizational factors that contributed to physicians’ well-being during the pandemic. A total of 78 Italian physicians participated in the study. They completed a self-report questionnaire measuring efficacy beliefs, orientation towards patient engagement, job satisfaction, non-technical skills, organizational support, sense of belonging to the hospital, job satisfaction, and mental well-being. Physicians’ sense of belonging to their hospital, efficacy beliefs about their organizations and communication with patients, as well as non-technical skills related to communication and risk awareness were positively associated with job satisfaction. In addition, the latter and sense of belonging to own hospital were positively associated with mental well-being. These findings may guide policymakers and healthcare organizations managers to consider the potential psychosocial factors related to physicians’ well-being and the required preventive measures that can help in enhancing their human and organizational resources to cope with stressful situations such as the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Mental Health of Health Care Workers in the COVID-19 Pandemic)

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