The mental health of Brazilian healthcare professionals during the COVID-19 pandemic: a longitudinal study

Objective: To compare the distress level among Brazilian healthcare professionals during the coronavirus disease 2019 (COVID-19) pandemic and estimate risks by sex, age, and occupation. Methods: In a longitudinal cohort design, a nationally distributed online survey was used to collect data from 10,490 active healthcare professionals who worked during the pandemic. Participants were mostly female, aged 18 to 82 years; 13 different health professions and all states of Brazil were represented. Results: The most frequent professions were psychology, dentistry, and nursing. The Brief Symptom Inventory (BSI) score suggested an increased distress perception among health professionals. Females showed poorer mental health than males, but the absolute rise in Global Severity Index (GSI) score was larger in males than in females. Younger adults reported more symptoms of psychological distress than older adults. The most impacted age group was between 30-39 years. Nurse technicians presented the highest risk of distress. Conclusion: Health professionals are essential to overcoming the pandemic; thus, their mental health status should be monitored, and features associated with increased distress should be identified. Our findings suggest distress risk should be stratified by occupation, age, and sex. Health professionals showed an increased distress perception. Women, individuals between the ages of 30 and 39, nursing personnel, and physicians were more likely to report distress compared with other health professionals.

Psychometric properties of the Brief Symptom Inventory support the hypothesis of a general psychopathological factor

Abstract Introduction The existence of a general factor related to psychiatric symptoms is supported by studies using a variety of methods in both clinical and non-clinical samples. Objectives This study aims to evaluate the replicability of the internal structure of the Brief Symptom Inventory in a large Brazilian sample. Methods Participants were 6,427 Brazilian subjects (81% female). Mean age was 42.1 years (standard deviation [SD] = 13.6, Min = 13, Max = 80). All participants completed the online version of the Brief Symptom Inventory. This scale presents a general score (GSI) and nine specific clusters of symptoms (depression, anxiety, phobic anxiety, interpersonal sensibility, psychoticism, paranoid ideation, obsessive-compulsive behavior, hostility, and somatization symptoms). Results Confirmatory factor analysis was performed to assess the factor structure of the BSI. The results showed that the best-fitting model was a bifactor solution and the general factor was the main dimension explaining most of the reliable variability in the data. Conclusion The findings suggest that the BSI's internal structure was replicated in a non-clinical sample and that the general factor is the most reliable score. However, it is necessary to better understand the meaning of the general factor scores in a non-clinical sample to increase interpretability of scores.

Changes in Work and Occupational Behavior in a Brazilian Sample During the COVID-19 Pandemic: A Longitudinal Study

The COVID-19 pandemic led to changes in occupational behaviors, affecting millions of workers. This study aimed to assess changes in various perceptions about work at the beginning of the pandemic in Brazil, and six months later. 702 individuals of both sexes (566 females, 80.62%), aged between 16 and 75 years (M=41.8; SD=13.5), residents in 24 different states of Brazil (most from the Southeast region, 59.26%) participated in this research and answered an online survey about their work experience during the pandemic at two different timepoints. The questionnaire included questions about increased/decreased productivity, fear of contamination by COVID-19 at work, need for going out to work, performing voluntary work, waiting for the return of their work/study activities, previous/current experience working-from-home, use of video conference programs, performing voluntary work to fight COVID-19, job loss and incidence of health problems that prevented the participant from carrying out daily/work/study activities. The results indicated that workers experienced new ways of performing their activities, changed their perceptions about their productivity, how/where they worked, and how they felt about their routine, although the majority of variables remained stable between timepoints.(AU)

A pandemia da COVID-19 resultou em mudanças nos comportamentos ocupacionais, afetando milhões de trabalhadores. Este estudo teve como objetivo avaliar as mudanças em diferentes percepções sobre o trabalho no início da pandemia no Brasil e seis meses depois. 702 indivíduos de ambos os sexos (566 sexo feminino, 80,62%), com idade entre 16 e 75 anos (M = 41,8; DP = 13,5), residentes em 24 diferentes estados do Brasil (maioria da região Sudeste, 59,26%) participaram e responderam a uma pesquisa online sobre sua experiência de trabalho durante a pandemia em dois momentos diferentes. O questionário incluía questões sobre aumento/diminuição da produtividade, medo de contaminação pelo COVID-19 no trabalho, necessidade de sair para trabalhar, realização de trabalho voluntário, espera pelo retorno de suas atividades de trabalho/estudo, experiência anterior/atual de trabalho remoto, utilização de programas de videoconferência, realização de trabalho voluntário de combate ao COVID-19, perda de emprego e incidência de problemas de saúde que o impediram de realizar atividades cotidianas/laborais/de estudo. Os resultados indicaram que os trabalhadores vivenciaram novas formas de realizar suas atividades, mudaram suas percepções sobre sua produtividade, como/onde trabalhavam e como se sentiam em relação ao seu cotidiano, apesar da maioria das variáveis se manterem estáveis entre os dois momentos.(AU)

La pandemia del COVID-19 resultó en cambios en los comportamientos ocupacionales, afectando millones de trabajadores. Este estudio tiene como objetivo evaluar los cambios en diferentes percepciones sobre el trabajo en el inicio de la pandemia en Brasil e seis meses después. 702 individuos de ambos sexos (566 mujeres, 80,62%), con edades entre los 16 y 75 años (M=41,8; DP=13,5) 702 individuos de ambos sexos (566 mujeres, 80,62%), con edades entre 16 y 75 años (M = 41,8; DT = 13,5), residentes en 24 estados diferentes de Brasil (la mayoría de la región Sudeste, 59,26%) participaron en esta investigación y respondieron a cuestiones sobre su experiencia de trabajo durante la pandemia en dos momentos distintos. El cuestionario on-line incluía preguntas sobre aumento/disminución de la productividad, miedo a la contaminación por COVID-19 en el trabajo, necesidad de salir a trabajar, realizar trabajo voluntario, esperar el regreso de sus actividades laborales/de estudio, experiencia previa/actual trabajando home office, uso de programas de videoconferencia, realización de trabajo voluntario para combatir COVID-19, pérdida de empleo e incidencia de problemas de salud que impedían al participante realizar actividades diarias/laborales/de estudio. Los resultados indicaron que los trabajadores vivenciaron nuevas formas de realizar sus actividades, cambiaron sus percepciones sobre su productividad, como/donde trabajaban y como se sentían en relación a su cotidiano, aunque la mayoría de las variables se mantuvieron estables entre los dos momentos.(AU)

Preditores de sofrimento psicológico e prevalência de transtornos mentais autodeclarados em profissionais de saúde e na população em geral durante a pandemia de Covid-19 no Brasil / Predictors of psychological distress and prevalence of self-reported mental disorders in health care professionals and in the general population during the Covid-19 pandemic in Brazil

O fardo dos transtornos mentais pode aumentar durante a pandemia de Covid-19. Por isso, é estratégico caracterizar a saúde mental da população. Analisamos dados coletados pela Internet de 164.881 profissionais de saúde e 5.635 participantes da população geral. O Índice de Gravidade Global (GSI) do Inventário Breve de Sintomas, diagnóstico autodeclarado de transtornos mentais, características sociodemográficas, estado de saúde física, história de contato com a Covid-19, percepções e preocupações e medidas preventivas adotadas foram comparados entre as amostras. Análises de regressão múltipla foram usadas para investigação de fatores associados ao GSI. O distresse psicológico foi classificado como alto ou muito alto em 13,4% dos profissionais de saúde e em 31,4% dos participantes da população geral. A prevalência de transtornos mentais ao longo da vida foi 36% para profissionais de saúde e 44,7% para a população geral, sendo os mais frequentes transtornos depressivos e ansiedade generalizada. Entre os profissionais de saúde, ser do sexo feminino e mais jovem foi associado à maior distresse psicológico. Para a população geral foram preditores de distresse a classe econômica e um domicílio com mais pessoas. Foram significativamente associados ao GSI sintomas de Covid-19, sentir-se menos produtivo no trabalho, medo de transmitir o vírus para a família, medo de dificuldades financeiras e sentir que os relacionamentos em casa pioraram. A prevalência de transtornos mentais atinge parte relevante da população brasileira. Fatores sociodemográficos, aspectos familiares e instabilidade financeira devem ser considerados no entendimento do distresse psicológico durante a pandemia.(AU)

BACKGROUND: The burden of mental disorders is likely to increase during the Covid-19 pandemic. Knowing the rate of psychological distress and mental disorders, its severity, and factors associated with psychological distress is strategical. METHOD: We analyzed online cross-sectional data from 164,881 health professionals and from 5,635 participants from the general population in Brazil. The Global Severity Index (GSI) from the Brief Symptom Inventory, self-reported diagnosis of mental disorders, sociodemographic characteristics, and factors related to Covid-19, such as physical health status, diagnosis and contact history, perceptions and concerns, and precautionary measures were compared between samples. Multiple regression analysis was used to investigate factors related to GSI scores. RESULTS: Psychological distress was high or very high in 13.4% of health professionals and in 31.4% of the general population. Health professionals reported a lower rate of current or previous history of mental disorders (36%) than participants from the general population (44.7%). Age (younger) and gender (female) predicted higher psychological distress for health professionals and economic class (lower) and household size (more members) for the general population. People with higher GSI scores reported to have experienced more physical symptoms associated with Covid-19, feeling less productive at work, being afraid of transmitting the coronavirus to the family, fear of financial difficulties, and feeling that home relations were worse during the pandemic outbreak. CONCLUSIONS: Psychological distress at the first wave of Covid-19 was associated with sociodemographic features and an anxious perception of physical symptoms, virus transmission to loved ones, disruption of family relations, and financial situation.(AU)

INTRODUCCIÓN: Es probable que la carga de los trastornos mentales aumente durante la pandemia de Covid-19. Conocer la tasa de malestar psicológico y de los trastornos mentales, su gravedad y los factores asociados al malestar psicológico es estratégico. MÉTODO: Se analizaron datos transversales en línea de 164.881 profesionales de la salud y 5.635 participantes de la población general de Brasil. Se compararon entre las muestras el Índice de Gravedad Global (GSI) del Inventario Breve de Síntomas, el diagnóstico auto declarado de trastornos mentales, las características sociodemográficas y los factores relacionados con la Covid-19. Se utilizó un análisis de regresión múltiple para investigar los factores relacionados con las puntuaciones del GSI. RESULTADOS: El malestar psicológico era alto o muy alto en 13,4% de los profesionales de la salud y en 31,4% de la población general. Los profesionales de la salud declararon tasa de 36% de trastornos mentales y la población general de 44,7%. La edad (más joven) y el sexo (femenino) predijeron un mayor malestar psicológico para los profesionales de la salud y la clase económica (más baja) y el tamaño de la familia (más miembros) para la población general. Las personas con puntuaciones más altas en el GSI declararon haber experimentado más síntomas físicos asociados a la Covid-19, sentirse menos productivos en el trabajo, tener miedo de transmitir el coronavirus a la familia, temer dificultades económicas y sentir que las relaciones domésticas empeoraron. CONCLUSIONES: La angustia psicológica se asoció a las características sociodemográficas y a la percepción ansiosa de los síntomas físicos, la transmisión del virus a los seres queridos, la perturbación de las relaciones familiares y la situación económica.(AU)

Defense mechanisms and quality of life of medical students according to graduation phase

Abstract Objectives To compare health-related quality of life (QoL) of medical students in initial and final phases of the program, and to evaluate the association between ego defense mechanisms and specific health-related QoL domains within each group. Methods This was an observational, cross-sectional study. Quality of life was assessed according to the World Health Organization Quality of Life instrument - Abbreviated Version (WHOQOL-Bref); anxiety and depression symptoms were evaluated using the Hospital Anxiety and Depression Scale (HADS); defense mechanisms were assessed using the Defense Style Questionnaire (DSQ-40) Results A total of 139 medical students were evaluated. Students in the initial semesters of the program (1st and 3rd) presented more depressive symptoms and worse quality of life in the psychological domain of WHOQOL-Bref when compared to those in the final semesters (8th and 12th). In a later analysis, conducted to identify the variables associated with the psychological domain of the WHOQOL-Bref for each group, both depressive symptoms and defense mechanisms were independently associated with the outcome for medical students in the beginning and in the end of the graduation program. Conclusions Students in the initial phases of medical school may need more specific attention from educational managers. Understanding the role of ego defense mechanisms in the quality of life of medical students may help identify effective psychopedagogical interventions for this population. In addition, the results reinforce the impact of depressive symptoms on quality of life, an association already well evidenced in the literature.

Trends in the prescription of clozapine in a psychiatric hospital: a 5-year observational study / Tendência na prescrição de clozapina em um hospital psiquiátrico: estudo observacional de 5 anos

Abstract Introduction Clozapine is a well-recognized effective treatment for some patients with treatment-resistant schizophrenia (TRS). Although it has potential benefits and approximately 30% of patients have a clinical indication for clozapine use, prescription rates are low. Objective To evaluate clozapine prescription trends over a 5-year period in a tertiary psychiatric hospital. Methods In this observational study, data prospectively collected by the Medical and Statistical File Service (Serviço de Arquivo Médico e Estatístico) and the Pharmacy Division of Instituto de Psiquiatria de Santa Catarina between January 2010 and December 2014 were summarized and analyzed by investigators blinded to data collection. The number of 100 mg clozapine pills dispensed by the Pharmacy Division to the inpatient units was the outcome and considered a proxy measure of clozapine prescriptions. The number of occupied inpatient unit beds and the number of patients admitted with F20-F29 (ICD-10) diagnoses during the study period were considered to be possible confounders. Results A multiple linear regression model showed that time in months was independently associated with an increase in the number of clozapine pills dispensed by the Pharmacy Division (β coefficient = 15.82; 95% confidence interval 10.88-20.75). Conclusion Clozapine prescriptions were found to have increased during the 5-year period studied, a trend that is opposite to reports from several other countries.

Resumo Introdução Clozapina é um medicamento reconhecidamente eficaz para alguns pacientes com esquizofrenia refratária ao tratamento. Apesar dos seus potenciais benefícios e de sua indicação clínica para aproximadamente 30% dos pacientes, a frequência de prescrição de clozapina é baixa. Objetivos Avaliar a tendência na prescrição de clozapina durante um período de 5 anos em um hospital psiquiátrico. Métodos Neste estudo observacional, dados coletados prospectivamente pelo Serviço de Arquivo Médico e Estatístico e pela Divisão de Farmácia (DF) do Instituto de Psiquiatria de Santa Catarina foram analisados por pesquisadores cegos para a coleta de dados. O número de comprimidos de clozapina 100 mg dispensados pela DF às enfermarias foi considerado a variável dependente e a medida de prescrição de clozapina. Número de leitos de internação ocupados e número de pacientes admitidos com diagnósticos F20-F29 (CID-10) durante o período de estudo foram considerados possíveis confundidores. Resultados Após análise com modelo de regressão linear múltipla, tempo em meses foi independentemente associado com aumento do número de comprimidos de clozapina 100 mg dispensados pela DF (coeficiente β = 15,82; intervalo de confiança de 95% 10,88-20,75). Conclusão Houve um aumento na prescrição de clozapina durante o período de 5 anos estudado, uma tendência oposta à relatada em vários outros países.

Variables associated with health-related quality of life in a Brazilian sample of patients from a tertiary outpatient clinic for depression and anxiety disorders / Variáveis associadas à qualidade de vida em uma amostra de pacientes de um serviço ambulatorial terciário para transtornos de ansiedade e depressão

Introduction: Health-related quality of life (HRQOL) assessment tools have been broadly used in the medical context. These tools are used to measure the subjective impact of the disease on patients. The objective of this study was to evaluate the variables associated with HRQOL in a Brazilian sample of patients followed up in a tertiary outpatient clinic for depression and anxiety disorders. Method: Cross-sectional study. Independent variables were those included in a sociodemographic questionnaire and the Hospital Anxiety and Depression Scale (HADS) scores. Dependent variables were those included in the short version of the World Health Organization Quality of Life (WHOQOL-BREF) and the scores for its subdomains (overall quality of life and general health, physical health, psychological health, social relationships, and environment). A multiple linear regression analysis was used to find the variables independently associated with each outcome. Results: Seventy-five adult patients were evaluated. After multiple linear regression analysis, the HADS scores were associated with all outcomes, except social relationships (p = 0.08). Female gender was associated with poor total scores, as well as psychological health and environment. Unemployment was associated with poor physical health. Conclusion: Identifying the factors associated with HRQOL and recognizing that depression and anxiety are major factors are essential to improve the care of patients.

Introdução: Instrumentos para avaliar qualidade de vida relacionada à saúde têm sido amplamente utilizados no contexto médico, visando mensurar o impacto da doença de uma perspectiva subjetiva e relevante ao paciente. O objetivo desse estudo foi identificar variáveis associadas à qualidade de vida em uma amostra de pacientes acompanhados em um ambulatório terciário para transtornos de ansiedade e depressão. Métodos: Estudo transversal. As variáveis independentes incluíram dados de um questionário sociodemográfico e pontuação na Escala Hospitalar de Ansiedade e Depressão (HADS). Variáveis dependentes: pontuação total na escala breve de qualidade de vida da Organização Mundial de Saúde (WHOQOL-Bref) e cada um de seus subdomínios (geral, físico, psicológico, social e ambiental). Regressão linear múltipla foi aplicada para identificar as variáveis preditoras associadas de forma independente a cada uma das variáveis dependentes. Resultados: Setenta e cinco pacientes adultos foram avaliados. Após análise de regressão linear múltipla, pontuação na HADS esteve associada com todos os desfechos analisados, exceto para o subdomínio social (p = 0,08). Sexo feminino esteve negativamente associado com a pontuação total da WHOQOL-Bref e com os subdomínios psicológico e ambiental. Desemprego esteve associado com o subdomínio físico. Conclusão: A identificação de fatores associados à qualidade de vida relacionada à saúde e o reconhecimento de que a depressão e a ansiedade são variáveis fundamentais são essenciais para uma melhor assistência aos pacientes.

Cognitive performance of long-term institutionalized elderly patients with schizophrenia: a case control study / Desempenho cognitivo em pacientes idosos com esquizofrenia: um estudo caso-controle

Cognitive impairment is inherent to the ageing process. Several studies suggest that patients with late-life schizophrenia have more marked cognitive impairment. Objective: The aim of this study was to compare the cognitive performance of elderly institutionalized patients with schizophrenia and institutionalized elderly control patients without neurological or psychiatric diseases, matched for age, educational level and institutionalization time. Methods: The Cambridge Examination for Mental Disorders of the Elderly (CAMCOG) was used to test 10 institutionalized elderly patients with schizophrenia. Results were compared with those of 10 institutionalized control patients with history of Hansens disease. Results: Patients with schizophrenia showed a worse performance in terms of total CAMCOG score and on its subtests of orientation, language, abstraction, and memory. Patients with schizophrenia also disclosed a non-significant trend toward lower scores on the MMSE and on calculus. Conclusion: Findings demonstrated that schizophrenia was associated to worse cognitive impairment in long-term institutionalized elderly patients compared with institutionalized patients without neurological or psychiatric diseases.

Prejuízo cognitivo é inerente ao processo de senescência. Estudos tem sugerido que pacientes idosos com esquizofrenia apresentam esse prejuízo de maneira mais acentuada. Objetivo: O objetivo deste estudo foi comparar o desempenho cognitivo de pacientes idosos com esquizofrenia, institucionalizados, com indivíduos idosos, institucionalizados, sem doenças neurológicas ou psiquiátricas, pareados pela idade, escolaridade e tempo de institucionalização. Métodos: Cambridge Examination for Mental Disorders of the Elderly (CAMCOG) foi aplicado em 10 pacientes, institucionalizados, com esquizofrenia, cujo desempenho cognitivo foi comparado ao de 10 indivíduos, institucionalizados, com história de doença de Hansen. Resultados: Pacientes com esquizofrenia apresentaram um pior desempenho na pontuação total do CAMCOG e em seus subitens orientação, linguagem, abstração e memória. Pacientes com esquizofrenia também apresentaram uma tendência, não significativa, para menor pontuação no MEEM e cálculo. Conclusão: Nossos achados demonstram que a esquizofrenia está associada a piora do comprometimento cognitivo em pacientes idosos com institucionalização de longa permanência comparados a pacientes institucionalizados sem doenças neurológicas ou psiquiátricas.