ABSTRACT
Background: COVID-19 has had a significant impact on the wellbeing of healthcare workers, with quantitative studies identifying increased stress, anxiety, depression, insomnia, and PTSD in a wide range of settings. Limited qualitative data so far has offered in-depth details concerning what underlies these challenges, but none provide comprehensive comparison across different healthcare systems. Objective: To explore qualitative findings relating to healthcare worker distress from two different countries to understand the nuanced similarities and differences with respect to the sources and impact of distress relating to COVID-19. Method: A comparative interpretive thematic analysis was carried out between two qualitative data sets examining healthcare workers’ experiences of distress during the COVID-19 pandemic. Data from Canada and the UK were collected in parallel and analyzed in an iterative, collaborative process. Results: A number of sources of distress cut across both study settings including concerns about safety and patient care, challenges at home or in one’s personal life, communication issues, work environment, media and public perception, and government responses to the pandemic. These sit on a spectrum from individual to institutional sources and were mutually reinforcing. Our analysis also suggested that common mechanisms such as exacerbations in uncertainty, hypervigilance, and moral injury underpinned these sources, which contributed to how they were experienced as distressing. Conclusion: This is the first international collaboration utilising qualitative data to examine this pressing issue. Despite differences in the political, social, health service, and pandemic-related context, the sources and mechanisms of distress experienced by healthcare workers in Canada and the UK were remarkably similar. HIGHLIGHTS This international comparative qualitative study explores how mechanisms that lead to distress are shared across different geographies and cultures, even as the local context shapes the sources of distress themselves.
ABSTRACT
Background: COVID-19 has had a significant impact on the wellbeing of healthcare workers, with quantitative studies identifying increased stress, anxiety, depression, insomnia, and PTSD in a wide range of settings. Limited qualitative data so far has offered in-depth details concerning what underlies these challenges, but none provide comprehensive comparison across different healthcare systems. Objective: To explore qualitative findings relating to healthcare worker distress from two different countries to understand the nuanced similarities and differences with respect to the sources and impact of distress relating to COVID-19. Method: A comparative interpretive thematic analysis was carried out between two qualitative data sets examining healthcare workers' experiences of distress during the COVID-19 pandemic. Data from Canada and the UK were collected in parallel and analyzed in an iterative, collaborative process. Results: A number of sources of distress cut across both study settings including concerns about safety and patient care, challenges at home or in one's personal life, communication issues, work environment, media and public perception, and government responses to the pandemic. These sit on a spectrum from individual to institutional sources and were mutually reinforcing. Our analysis also suggested that common mechanisms such as exacerbations in uncertainty, hypervigilance, and moral injury underpinned these sources, which contributed to how they were experienced as distressing. Conclusion: This is the first international collaboration utilising qualitative data to examine this pressing issue. Despite differences in the political, social, health service, and pandemic-related context, the sources and mechanisms of distress experienced by healthcare workers in Canada and the UK were remarkably similar. HIGHLIGHTS This international comparative qualitative study explores how mechanisms that lead to distress are shared across different geographies and cultures, even as the local context shapes the sources of distress themselves.
Antecedentes: La COVID-19 ha tenido un impacto significativo en el bienestar de los trabajadores de la salud, con estudios cuantitativos que identifican un aumento del estrés, la ansiedad, la depresión, el insomnio, y el TEPT en una amplia variedad de entornos. Hasta ahora, los datos cualitativos son limitados y han ofrecido un profundo detalle sobre lo que subyace a estos desafíos, pero ninguno proporciona una comparación exhaustiva entre los diferentes sistemas de atención de salud.Objetivo: Explorar los hallazgos cualitativos relacionados con la angustia de los trabajadores de la salud de dos países diferentes para comprender las sutiles similitudes y diferencias con respecto a las fuentes y el impacto de la angustia relacionada con la COVID-19.Método: Se llevó a cabo un análisis temático interpretativo comparativo entre dos conjuntos de datos cualitativos que examinaron las experiencias de angustia de los trabajadores de la salud durante la pandemia de la COVID-19. Los datos de Canadá y el Reino Unido se recopilaron en paralelo y se analizaron en un proceso colaborativo iterativo.Resultados: Una serie de fuentes de angustia atraviesan ambos entornos de estudio, incluidas las preocupaciones sobre la seguridad y el cuidado del paciente, los desafíos en el hogar o en la vida personal, los problemas de comunicación, el entorno laboral, la percepción pública y de los medios de comunicación, y las respuestas gubernamentales a la pandemia. Estos se ubican en un espectro desde fuentes individuales hasta institucionales y se reforzaron mutuamente. Nuestro análisis también sugirió que mecanismos comunes como las exacerbaciones de la incertidumbre, la hipervigilancia, y el daño moral sustentaban estas fuentes, lo que contribuyó a que se experimentaran como angustiosas.Conclusión: Esta es la primera colaboración internacional que utiliza datos cualitativos para examinar este apremiante problema. A pesar de las diferencias en el contexto político, social, de servicios de salud y relacionado con la pandemia, las fuentes y los mecanismos de angustia experimentados por los trabajadores de la salud en Canadá y el Reino Unido fueron notablemente similares.
Subject(s)
COVID-19 , Health Personnel , Humans , Pandemics , Qualitative Research , United Kingdom/epidemiologyABSTRACT
ObjectivesCOVID-19 has altered standard thresholds for identifying anxiety and depression. A brief questionnaire to determine when individuals are at a tipping point for severe anxiety or depression would greatly help decisions about when to seek assessment or treatment.DesignData were collected as part of the Frontline-COVID Study, a cross-sectional national online survey with good coverage of health and social care settings. New questionnaire items reflecting when coping was actually breaking down were compared with standard measures of severe anxiety and depression. Data were collected between 27 May and 23 July 2020.SettingThe majority of participants worked in hospitals (53%), in nursing or care homes (15%), or in other community settings (30%).ParticipantsOf 1194 qualifying respondents, 1038 completed the six tipping point items. Respondents included nurses, midwives, doctors, care workers, healthcare assistants, allied healthcare professionals and other non-medical staff. Over 90% were white and female.Main outcome measuresThreshold for severe anxiety according to the Generalised Anxiety Disorder Scale-7 or moderately severe depression according to the Patient Health Questionnaire-9.ResultsAnswering yes to one of two simple questions (‘Over the last week have you been often feeling panicky or on the point of losing control of your emotions?’, ‘Over the last week have you felt complete hopelessness about the future?’) demonstrated very high sensitivity (0.95, 95% CI 0.92 to 0.97) and negative predictive value (0.97, 95% CI 0.95 to 0.98). Answering yes to both questions yielded high specificity (0.90, 95% CI 0.87 to 0.92) and positive predictive value (0.72, 95% CI 0.67 to 0.77). Results were replicated in two random subsamples and were consistent across different genders, ethnic backgrounds, and health or social care settings.ConclusionsAnswering two simple yes/no questions can provide simple and immediate guidance to assist with decisions about whether to seek further assessment or treatment.
ABSTRACT
Health care workers worldwide are at an increased risk of a range of adverse mental health outcomes, including posttraumatic stress disorder (PTSD), following the unprecedented demand placed upon them during the COVID-19 pandemic. Psychosocial interventions offered to mitigate these risks should be based on the best available evidence; however, limited information regarding the comparative effectiveness of interventions is available. We undertook a systematic review of psychosocial interventions delivered to health care workers before, during, and after disasters. Eight databases were searched, including the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, EMBASE, and PsycINFO. Our primary outcomes were changes in symptoms of PTSD, anxiety, depression, and sleep. We calculated effect sizes, where unreported, and reliable change indices to appraise intervention effectiveness. The study was registered with PROSPERO (CRD42020182774). In total, 12,198 papers were screened, 14 of which were included in the present review. Interventions based on evidence-based protocols, including individual and group-based cognitive behavioral therapy (CBT) for PTSD, anxiety, and depression were found to lead to reliable changes in PTSD and anxiety symptoms. Single-session debriefing and psychological first aid workshops showed limited efficacy. There is limited evidence on psychosocial interventions for health care workers faced with disasters, with the strongest evidence base for CBT-based approaches. Future research should include controlled evaluations of interventions and aim to target identified risk factors.
Subject(s)
COVID-19 , Disasters , Stress Disorders, Post-Traumatic , Health Personnel , Humans , Outcome Assessment, Health Care , Pandemics , Psychosocial Intervention , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapyABSTRACT
Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams. HIGHLIGHTS We anticipate that up to 30% of survivors of severe COVID will develop PTSD, yet PTSD is frequently undetected in primary and secondary care settings. There is, therefore, a clear case for establishing systematic screening and ensuring timely access to treatment.
ABSTRACT
Based on research from previous pandemics, studies of critical care survivors, and emerging COVID-19 data, we estimate that up to 30% of survivors of severe COVID will develop PTSD. PTSD is frequently undetected across primary and secondary care settings and the psychological needs of survivors may be overshadowed by a focus on physical recovery. Delayed PTSD diagnosis is associated with poor outcomes. There is a clear case for survivors of severe COVID to be systematically screened for PTSD, and those that develop PTSD should receive timely access to evidence-based treatment for PTSD and other mental health problems by multidisciplinary teams.
Basados en la investigación de pandemias previas, los estudios de los sobrevivientes a cuidados críticos, y los datos emergentes de COVID-19, estimamos que hasta un 30% de los sobrevivientes del COVID grave desarrollarán TEPT. El TEPT es frecuentemente subdetectado en los servicios de salud primarios y secundarios y las necesidades psicológicas de los sobrevivientes puede verse eclipsadas por un enfoque en la recuperación física. El diagnóstico tardío de TEPT se asocia con pobres resultados. Existe un caso claro para que los sobrevivientes del COVID grave sean evaluados sistemáticamente para detectar el TEPT, y aquellos que desarrollan un TEPT deben tener acceso oportuno a tratamientos basados en la evidencia para el TEPT y para otros problemas de salud mental por equipos multidisciplinarios.
Subject(s)
COVID-19/psychology , Stress Disorders, Post-Traumatic/epidemiology , Survivors/psychology , COVID-19/epidemiology , Humans , Mass Screening , Pandemics , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychologySubject(s)
Betacoronavirus , Coronavirus Infections , Health Personnel/psychology , Occupational Diseases , Occupational Health Services/methods , Pandemics , Pneumonia, Viral , Stress, Psychological , COVID-19 , Humans , Occupational Diseases/prevention & control , Occupational Diseases/therapy , Resilience, Psychological , SARS-CoV-2 , Stress, Psychological/prevention & control , Stress, Psychological/therapy , United KingdomABSTRACT
Religious leaders are at risk of psychological trauma and moral injury during the COVID-19 pandemic. This article highlights potentially traumatic or morally injurious experiences for religious leaders and provides evidence-based recommendations for mitigating their impact. (PsycInfo Database Record (c) 2020 APA, all rights reserved).