Anxiety, Depression and Post-Traumatic Stress Disorder in Physicians Compared to Nurses during the COVID-19 Pandemic: An Observational, Cross Sectional, Multicentric Study

(1) Background: The coronavirus pandemic has highlighted the precarious health situation of our country, thanks to the grueling workloads caused by understaffing and fear of contracting COVID-19. By considering this critical situation, frontline healthcare professionals who have been directly involved in the diagnosis, treatment, and care of SARS-CoV-2 patients are now at risk of developing psychological distress and other mental health symptoms, accomplices of the fear of contracting the COVID-19 and the exhausting workloads. (2) Methods: An observational, cross-sectional, multicenter study was conducted by administering an online questionnaire to all Italian physicians and nurses who worked during the COVID-19 pandemic. The questionnaire consists of socio-demographic characteristics, an assessment of anxiety levels with the State-Trait Anxiety Inventory (STAI), which also assessed trait and state anxiety, the Beck Depression Inventory (BDI) to evaluate the condition of depressive severity, and, finally, the Impact of Event Scale–Revised (IES–R), which was administered in order to quantify the post-traumatic stress disorder (PTSD) among the participants. (3) Results: A total of 770 Italian healthcare workers were enrolled in this study. Of these, 95 (12.30%) were physicians and 675 (87.70%) were nurses. By considering PTSD, anxiety, and depression levels between the physicians and nurses recruited, a significant difference was reported in the STAI-1 assessment, as both physicians and nurses reported slight and moderate levels (p = 0.033). (4) Conclusions: Physicians and nurses, who have been subjected to physical impoverishment, with the infinite physical forces spent to support the pace of work at the limits of the possible, but above all mental capacity, with the anxiety of having to face an unknown enemy, such as COVID-19. This has resulted in a significant increase in anxiety, depression, post-traumatic symptoms, and sleep disturbances, with possible repercussions not only on the quality of life of the physicians and nurses but also on the quality of assistance provided.

Exploring Internet Addiction in Italian Nurses during the COVID-19 Outbreak

(1) Background: Nomophobia is considered a digital and virtual contemporary society disorder and refers to discomfort, anxiety, nervousness, or distress caused by being out of contact with a cell phone or computer. The present study had a twofold objective: to evaluate the expert use of the Internet among Italian nurses by correlating it with socio-demographic characteristics, such as: sex, years of work experience, professional role, and level of nursing education;and to assess a possible increase in the levels of nomophobia among Italian nurses during COVID-19 compared to the pre-pandemic period. (2) Methods: An observational, cross-sectional, multicenter study was conducted from April to September 2020, such as during the First Wave of the COVID-19 outbreak. (3) Results: A total of 502 nurses were enrolled in the present study. Significantly differences were reported in the IAT (Internet Addiction Test) levels according to socio-demographic characteristics since males reported significantly higher IAT levels than females (p < 0.001). Nurses who worked more than 6 years reported significantly higher IAT levels (p = 0.031) than their younger colleagues. More nursing managers and coordinators reported significantly higher IAT levels than registered nurses (p < 0.001). This trend was repeated by considering the nursing educational level, as nurses who recorded more years of nursing educational level reported significantly higher IAT levels than the others (p = 0.003). Additionally, significant differences were reported according to all the socio-demographic characteristics considered and IAT subdimensions, namely: Salience, Excessive Use, Neglect Work, Anticipation, and Lack of Control. (4) Conclusions: The study revealed higher levels of Internet addiction in men than in women during the COVID-19 pandemic period, as well as a significant correlation between nomophobia, years of work experience, and the role of nursing coordinator/manager.

The satisfaction level perceived by Italians during the first phase of the Covid-19 pandemic phase.

Aim of the work.  To survey the degree of satisfaction of the Italian population in reference to the health care provided throughout the national territory in the period of emergency COVID-19. METHODS: Observational, cross sectional, multicenter study conducted during the first phase of the pandemic (May-June 2020) involving the national population (n=889) subjects, through an online survey. RESULTS: 889 people participated in the study. Among the perceptions regarding the level of satisfaction with the care received during the first pandemic wave, significant differences were found in the level of satisfaction with the health care received in general (p=.049), the degree of satisfaction toward the health care to people admitted to the hospital (p=. 046), to the treatment received for the COVID-19 test (p=.002), to the difficulty of contacting the general practitioner (.032), to the treatment received by their own health care company (p=.006), to the treatment received by the toll-free number (p<.001) and the 1500 number (p<.001) and the treatment received for one's own relative (p<.001). The greatest difficulty for all detected was finding surgical masks to protect themselves from infection. CONCLUSIONS: The COVID-19 pandemic seems not to have created new problems, rather it has shown - in a violent way - many of the challenges that have been looming for some time in the health services (and not only the Italian one) and, for these reasons, it is necessary to start from what has been learned in the last few months and draw new guidelines for the future.

Healthcare workers perceptions in the difficult moment of the end of life and coping strategies adopted during the COVID-19 pandemic: an Italian pilot study.

BACKGROUND AND AIM OF THE WORK: In a society that tries so hard to forget and make people forget that death exists, death has never been so close to man in his daily life as during this pandemic. Health care professionals have therefore all too often had to  deal with the death of the people they care for and with related issues such as, for example, the dignity of death, the humanization of death and care for the dying. The aim of the study is to highlight the perceptions of physicians, nurses and health and social workers in the difficult moment of the end of life, also analyzing which coping strategies were implemented by them. METHODS: All Italian healthcare workers were enrolled in this survey. The questionnaire was administered in an online version. Physicians, nurses and support staff (social and health workers) were contacted through social networks. RESULTS: A total of 512 healthcare workers were enrolled in this survey. No statistical significant differences were recorded among the COPE-NVI- 25 sub dimensions according to sex, profession and to different wards. Additionally, by considering the COPE-NVI-25 sub dimensions according to years of work experience, a statistical significant difference was reported in the Transcendent Orientation sub dimension (p=.047), as healthcare workers with 11-20 years of work experience recorded higher levels than the other two groups. By considering differences in the COPE-NVI-25 sub dimensions according to religion, significant differences were recorded in the transcendent orientation (p=.032), in the positive attitude (p=.030), in the social support (p=.035). CONCLUSIONS: From the evidence in the literature, the quality of end-of-life care performance has a positive correlation with awareness of a good death and attitudes towards end-of-life care.

The psychological impact of the Coronavirus emergency on physicians and nurses: an Italian observational study.

BACKGROUND: The Coronavirus has put a strain on the response capacity of health systems and there are various psychological effects on health workers. AIM OF THE STUDY: To investigate the psychological impact of the coronavirus emergency on physicians and nurses. MATERIALS AND METHODS: A study was conducted on a sample of nurses and physicians (n=770), who were asked to fill in a questionnaire investigating physical and psychological problems. It also included the IES (Impact Event Scale), STAI (State Trait Anxiety Inventory) scale and BDI (Beck Depression Inventory). RESULTS: 87.7% of the sample was represented by nurses (n=675), 12.3% (n=95) by physicians. 52.3% (n=403) of the participants believed that they had not received good training on the correct use of Personal Protective Equipment. 18.2% (n=140) declared that they had experienced a moment in which they had had to choose among the patients whom to treat for an essential therapy. Among the psychological symptoms, stress (76.2%; n=587), anxiety (59.4%; n=457) and depression (11.8%) prevailed and only 3.9% of the healthcare personnel sought help from a psychologist. The total score of the IES-R scale was 3.47. A significant association emerged between exposure and the risk of contagion (p-value = 0.003), stress was more present among nurses than among physicians (77.5% vs. 67.4%; p = 0.003). Among physical symptoms, headache (52.2%; n=402) and pressure injuries (24.8% n= 191) prevailed. CONCLUSIONS: The results of the study show that mental health monitoring of health workers, who are at risk of developing major psychological disorders, is a priority.

Targeting the gut-lung microbiota axis by means of a high-fibre diet and probiotics may have anti-inflammatory effects in COVID-19 infection.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 is a 2019 novel coronavirus, which only in the European area has led to more than 300,000 cases with at least 21,000 deaths. This manuscript aims to speculate that the manipulation of the microbial patterns through the use of probiotics and dietary fibers consumption may contribute to reduce inflammation and strengthen the immune system response in COVID-19 infection. The reviews of this paper are available via the supplemental material section.