The interplay between acute post-traumatic stress, depressive and anxiety symptoms on healthcare workers functioning during the COVID-19 emergency: A multicenter study comparing regions with increasing pandemic incidence.

BACKGROUND: Healthcare workers (HCWs) deployed to the frontline during the COVID-19 pandemic are at risk for developing mental disorders, with a possible impact on their wellbeing and functioning. The present study aimed at investigating post-traumatic stress symptoms (PTSS), anxiety and depressive symptoms and their relationships with impairment in the functioning impairment among frontline HCWs from three Italian regions differently exposed to the first wave of the COVID-19 emergency: Tuscany (low), Emilia-Romagna (medium) and Lombardy (high). METHODS: 514 frontline HCWs were consecutively enrolled in hospital units devoted to the treatment of COVID-19 patients. They completed the IES-R, PHQ-9 and GAD-7 to assess PTSS, depressive and anxiety symptoms respectively, and the WSAS to investigate functioning impairment. RESULTS: A total of 23.5% of HCWs reported severe PTSS, 22.4% moderate-severe anxiety symptoms, 19.3% moderate-severe depressive symptoms and 22.8% impairment in global functioning. HCWs from the higher-exposure regions reported significantly higher scores in all instruments than those from lower-exposure regions. In a multiple linear regression model, PTSS, depressive and anxiety symptoms presented a significant positive association with the functioning impairment. Both PTSS and depression resulted to be independently related to functioning impairment. LIMITATIONS: The cross-sectional design and the use of self-report instruments. CONCLUSIONS: Depressive and PTSS appear to be the greatest contributors to functioning impairment in HCWs exposed to a massive stressful sanitary event as the COVID-19 pandemic. A more accurate assessment of work-related mental health outcomes in such population could help planning effective prevention strategies and therapeutic interventions.

Post-traumatic stress disorder, burnout and their impact on global functioning in Italian emergency healthcare workers.

BACKGROUND: Post-traumatic stress disorder (PTSD) and burnout are severe and frequent conditions among emergency healthcare workers exposed to repeated work-related traumatic experiences. The aim of the present study was to investigate PTSD, burnout and global functioning in a sample of emergency healthcare workers (HCWs) of a major university hospital in Italy, exploring possible correlations between the two constructs. METHODS: The study sample included 137 medical and nursing Emergency Room and Intensive Care Unit staff members of a major University Hospital in Italy (Pisa), all assessed by means of the Trauma and Loss Spectrum - Self Report (TALS-SR), for post-traumatic stress spectrum, the Professional Quality of Life Scale - Revision IV (ProQOL R-IV), for burnout related to work activities, and the Work and Social Adjustment Scale (WSAS), for global functioning. RESULTS: Forty-nine subjects reported a full (18, 14.3%) or partial (31, 24.6%) symptomatological DSM-5 PTSD. HCWs with PTSD reported significantly higher burnout scores and global functioning impairment compared to those without PTSD. Mean to good significant correlations emerged between the TALS-SR total and domains scores, the ProQOL subscales and the WSAS scores. CONCLUSIONS: This work, conducted before the COVID-19 pandemic, underlines a positive correlation between burnout and post-traumatic stress spectrum symptoms in emergency HCWs, showing the need for a deeper assessment of work-related post-traumatic stress symptoms in such population in order to improve the well-being and to prevent burnout.

PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic.

The COronaVIrus Disease-19 (COVID-19) pandemic has highlighted the critical need to focus on its impact on the mental health of Healthcare Workers (HCWs) involved in the response to this emergency. It has been consistently shown that a high proportion of HCWs is at greater risk for developing Posttraumatic Stress Disorder (PTSD) and Posttraumatic Stress Symptoms (PTSS). The present study systematic reviewed studies conducted in the context of the three major Coronavirus outbreaks of the last two decades to investigate risk and resilience factors for PTSD and PTSS in HCWs. Nineteen studies on the SARS 2003 outbreak, two on the MERS 2012 outbreak and three on the COVID-19 ongoing outbreak were included. Some variables were found to be of particular relevance as risk factors as well as resilience factors, including exposure level, working role, years of work experience, social and work support, job organization, quarantine, age, gender, marital status, and coping styles. It will be critical to account for these factors when planning effective intervention strategies, to enhance the resilience and reduce the risk of adverse mental health outcomes among HCWs facing the current COVID-19 pandemic.