ABSTRACT
Background: The General Health Questionnaire (GHQ) is a widely used tool in clinical and research settings due to its brevity and easy administration. Researchers often adopt a dichotomous measurement method, considering a total score above or below a certain threshold, leading to an extreme simplification of the gathered data and, therefore, the loss of clinical details. In a multistep evaluation study aimed at assessing health care workers' mental health during the COVID-19 pandemic, GHQ-12 proved to be the most effective tool to detect psychological distress compared to other scales. These results deepened the understanding of GHQ-12 properties through a statistical study focusing on items' properties and characteristics. Methods: GHQ-12 responses were analyzed using Item Response Theory (IRT), a suitable method for scale assessment. Instead of considering the single overall score, in which each item accounts equally, it focuses on individual items' characteristics. Moreover, IRT models were applied combined with the latent class (LC) analysis, aiming to determine subgroups of individuals according to their level of psychological distress. Results: GHQ-12 was administered to 990 healthcare workers, and responses were scored using the binary method (0-0-1-1). We applied the two-parameter logistic (2-PL) model, finding that the items showed different ways of responses and features. The latent class analysis classified subjects into three sub-groups according to their responses to GHQ-12 only: 47% of individuals with general well-being, 38% expressing signs of discomfort without severity, and 15% of subjects with a high level of impairment. This result almost reproduces the subjects' classification obtained after administering the six questionnaires of the study protocol. Conclusions: Accurate statistical techniques and a deep understanding of the latent factors underlying the GHQ-12 resulted in more effective usage of such a psychometric questionnaire - i.e., a more refined gathering of data and significant time and resource efficiency. We underlined the need to maximize the extraction of data from questionnaires and the necessity of them being less lengthy and repetitive.
ABSTRACT
Introduction: Covid-19 pandemic is a severe challenge for healthcare workers (HCW) mental health. Several studies reported frequent adverse psychological outcomes in HCW. To identify risk factors of psychological impairment (PsI), we systematically examine workers in a University Hospital in Milan (Italy), using psychometric scales in the context of the occupational health surveillance. Methods: We enrolled 990 HCW (Jul20-Jul21), whose psychological wellbeing was screened by a 1st level questionnaire collecting individual/occupational data, personal/familiar/occupational Covid exposure, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R), anxiety (GAD-7). HCW showing PsI (i.e. > cut-off in at least one among GAD-7, IES-r, GHQ-12) have been further investigated by a 2nd level questionnaire (psycho-diagnostic) composed by PHQ-9, DES-II and SCL-90. Results: 316 workers (32%) showed sign of PsI at the 1st screening. Women, nurses, younger workers, subjects working in Covid area and having an infected family member showed significantly higher PsI risk. PsI prevalence was strongly associated to the pandemic time trends but sensibly decreased after Jan 21, when HCW received vaccination. Only a proportion of subjects with PsI, presented clinically relevant symptoms (2nd level screening). Those symptoms weren’t associated to working in Covid area, with Covid infection in family, with pandemic waves or workers’ vaccination. Conclusions: To evaluate psychological wellbeing of HCW constitutes a unique condition to detect occupational, and non-occupational risk factors for PsI in high stress contexts.
ABSTRACT
BACKGROUND: The COVID-19 pandemic is currently a severe challenge for healthcare workers, with a considerable impact on their mental health. In order to focus preventive and rehabilitation measures it's fundamental to identify risk factors of such psychological impairment. We designed an observational longitudinal study to systematically examine the psychological wellbeing of all employees in a large University Hospital in Italy, using validated psychometric scales in the context of the occupational physician's health surveillance, in collaboration with Psychiatric Unit. METHODS: The study started after ethical approval in August 2020. For each worker, the psychological wellbeing is screened in two steps. The first level questionnaire collects sociodemographic characteristics, personal and occupational COVID-19 exposure, worries and concerns about COVID-19, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R) and anxiety (GAD-7). Workers who score above the cut-off in at least one scale are further investigated by the second level questionnaire composed by PHQ-9, DES-II and SCL-90. If second level shows psychological impairments, we offer individual specialist treatment (third level). We plan to follow-up all subjects to monitor symptoms and possible chronicization; we aim to investigate potential risk factors through univariate analysis and multivariate logistic regressions. RESULTS: Preliminary results refer to a sample of 550 workers who completed the multi-step evaluation from August to December 2020, before vaccination campaign started. The participation rate was 90%. At first level screening, 39% of the subjects expressed general psychological discomfort (GHQ-12), 22% post-traumatic stress symptoms (IES-R), and 21% symptoms of anxiety (GAD-7). Women, nurses, younger workers, subjects with COVID-19 working exposure and with an infected family member showed significantly higher psychological impairment compared to colleagues. After the second level screening, 12% and 7% of all workers showed, respectively, depressive and dissociative symptoms; scorings were significantly associated with gender and occupational role. We are currently extending sample size and evaluating subjects over a period of further 12 months. CONCLUSIONS: The possibility to perform a systematic follow-up of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for psychological impairment in situations of prolonged stress, as well as variables associated with symptoms chronicization.