A service evaluation of phased- and stepped-care psychological support for health and social care workers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has disproportionally affected the mental health of health and social care workers (HSCWs), with many experiencing symptoms of depression, anxiety and post-traumatic stress disorder. Psychological interventions have been offered via mental health services and in-house psychology teams, but their effectiveness in this context is not well documented. AIMS: To evaluate a stepped-care psychological support pathway for HSCWs from Homerton Healthcare Foundation Trust in London, which offered psychological first aid, evidence-based psychological therapies and group-based well-being workshops. METHOD: The service evaluation used a pre-post approach to assess depression, anxiety, functional impairment and post-traumatic stress disorder symptom change for those who attended sessions of psychological first aid, low- or high-intensity cognitive-behavioural therapy or a combination of these. In addition, the acceptability of the psychological first aid sessions and well-being workshops was explored via feedback data. RESULTS: Across all interventions, statistically significant reductions of depression (d = 1.33), anxiety (d = 1.37) and functional impairment (d = 0.93) were observed, and these reductions were equivalent between the interventions, as well as the demographic and occupational differences between the HSCWs (ethnicity, staff group and redeployment status). HSCWs were highly satisfied with the psychological first aid and well-being workshops. CONCLUSIONS: The evaluation supports the utility of evidence-based interventions delivered as part of a stepped-care pathway for HSCWs with common mental health problems in the context of the COVID-19 pandemic. Given the novel integration of psychological first aid within the stepped-care model as a step one intervention, replication and further testing in larger-scale studies is warranted.

Trauma history predicts depression and posttraumatic stress symptoms better than a psychiatric diagnosis: Comparing wartime, routine time, and early COVID-19 in Israel.

Individuals with a psychiatric diagnosis and those with a history of trauma are at high risk for depression and posttraumatic stress symptoms (PTSS) following exposure to new traumatic events. Nevertheless, research is scarce on how having both a psychiatric diagnosis and a trauma history affect reactions to new traumatic events, and how different trauma types may affect individuals with a psychiatric diagnosis. We thus examined whether different stressful contexts (War and COVID-19) affected individuals with and without a psychiatric diagnosis differentially and whether results might be explained by prior trauma exposure. In the same cohort, we assessed depression and PTSS during wartime (2014), routine time (2016), and during the COVID-19 pandemic (2020) in a sample with (n = 89) and without (n = 104) a self-reported psychiatric diagnosis. This cohort was recruited during the 2014 Israel-Gaza War using social media, snowballing and outreach to mental health rehabilitation centres. We used a linear mixed modelling approach on data from the entire sample, as well as on the two study groups separately. We found that trauma history predicted PTSS and depression whereas a history of psychiatric diagnosis did not. Regarding trauma types, we found that individuals in the psychiatric diagnosis group relative to themselves had more symptoms during COVID-19 compared to war and routine time, while those without diagnosis had more PTSS and depression symptoms during wartime compared to routine time and COVID-19. In conclusion, a traumatic past may have an important influence on reactions to different types of traumatic events. Distinct traumatic events may affect individuals with or without a psychiatric diagnosis differentially.

Perceived stress during COVID-19: Community resilience three years before the pandemic as a protective factor.

Research indicates that stress increased across the globe after the outbreak of the COVID-19 pandemic. Community resilience has been suggested as a central protective factor for stress related to disasters and emergency crises. This study examined the contribution of community resilience reported three years prior to the onset of the COVID-19 pandemic, together with related worries and personal risk factors, to perceived stress among Israeli adults following the first wave of COVID-19 in Israel. We performed a two-period 3-year longitudinal study (Period 1 [P1]: July-September 2017; Period 2: [P2] May-June 2020). The final sample included 578 participants. Participants completed a community resilience self-report questionnaire during P1 as well as measures regarding perceived stress and COVID-19 worries during P2. Using linear hierarchical regression, we tested the additional explanatory effect of community resilience and found it to be negatively associated with perceived stress. While health-related worries were not significantly associated with perceived stress, worries related to the functioning of governmental and health institutions regarding the COVID-19 pandemic were significantly associated with perceived stress. Additionally, being single, living in a smaller residence and income reduction during the pandemic predicted higher perceived stress. The current study highlights the potential buffering role of community resilience in protecting against COVID-19 stress. Assessing community resilience may help identify vulnerable groups, and focusing on community building may be an effective strategy to mitigate stress in future disasters.

Perceived stress during COVID-19: Community resilience three years before the pandemic as a protective factor

Research indicates that stress increased across the globe after the outbreak of the COVID-19 pandemic. Community resilience has been suggested as a central protective factor for stress related to disasters and emergency crises. This study examined the contribution of community resilience reported three years prior to the onset of the COVID-19 pandemic, together with related worries and personal risk factors, to perceived stress among Israeli adults following the first wave of COVID-19 in Israel. We performed a two-period 3-year longitudinal study (Period 1 [P1]: July–September 2017;Period 2: [P2] May–June 2020). The final sample included 578 participants. Participants completed a community resilience self-report questionnaire during P1 as well as measures regarding perceived stress and COVID-19 worries during P2. Using linear hierarchical regression, we tested the additional explanatory effect of community resilience and found it to be negatively associated with perceived stress. While health-related worries were not significantly associated with perceived stress, worries related to the functioning of governmental and health institutions regarding the COVID-19 pandemic were significantly associated with perceived stress. Additionally, being single, living in a smaller residence and income reduction during the pandemic predicted higher perceived stress. The current study highlights the potential buffering role of community resilience in protecting against COVID-19 stress. Assessing community resilience may help identify vulnerable groups, and focusing on community building may be an effective strategy to mitigate stress in future disasters.

Shared sources and mechanisms of healthcare worker distress in COVID-19: a comparative qualitative study in Canada and the UK Fuentes y mecanismos compartidos de la angustia de los trabajadores de la salud en COVID-19: Un estudio cualitativo comparativo de Canadá y el Reino Unido COVID-19 中医护人员痛苦的共享来源和机制：一项加拿大和英国的定性比较研究

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.

Shared sources and mechanisms of healthcare worker distress in COVID-19: a comparative qualitative study in Canada and the UK.

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.

What symptoms best predict severe distress in an online survey of UK health and social care staff facing COVID-19: development of the two-item Tipping Point Index

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.

Experiences and views of frontline healthcare workers' family members in the UK during the COVID-19 pandemic: a qualitative study.

Background: The COVID-19 pandemic has had a well-documented negative impact on the mental health and wellbeing of frontline healthcare workers (HCWs). Whilst no research has to date been carried out to explore the challenges experienced by the families of HCWs, some previous research has been conducted with military families, demonstrating that family members of deployed military personnel may also be affected seriously and negatively. Objectives: This study aimed to explore the experiences, views, and mental health impact on frontline HCWs' families during the COVID-19 pandemic in the UK and what support the families of frontline HCWs may need. Method: Close family members and friends of HCWs were interviewed. Transcripts were analysed in line with the principles of reflexive thematic analysis. Results: We completed fourteen interviews with three siblings, one mother, one friend, and nine spouses of HCWs. Family members were highly motivated to support healthcare workers and felt an intense sense of pride in their work. However, they also experienced increased domestic responsibilities and emotional burden due to anxiety about their loved ones' work. The fact that sacrifices made by family members were not noticed by society, the anxiety they felt about their family's physical health, the impact of hearing about traumatic experiences, and the failure of healthcare organisations to meet the needs of the HCWs all negatively affected the family members. Conclusions: We have an ethical responsibility to attend to the experiences and needs of the families of healthcare professionals. This study emphasises the experiences and needs of family members of healthcare professionals, which have hitherto been missing from the literature. Further research is needed to hear from more parents, siblings and friends, partners in same sex relationships, as well as children of HCWs, to explore the variety of family members and supporters' experiences more fully. HIGHLIGHTS: • COVID19 has impacted families of HCWs as well as workers themselves. They have experienced more anxiety, increased practical burden, significant physical health risks and been exposed vicariously to workers' traumatic experiences. We must ensure HCW families are better supported.

Antecedentes: La pandemia de COVID-19 ha tenido un impacto negativo bien documentado en la salud mental y bienestar de los trabajadores de la salud de la primera línea (HCWs por sus siglas en ingles). Mientras que hasta la fecha no se han llevado a cabo investigaciones que exploren los desafíos experimentados por las familias de los HCWs, algunas investigaciones previas fueron realizadas con familias de militares, demostrando que los miembros de la familia del personal militar desplegado también pueden ser afectados seria y negativamente.Objetivos: Este estudio apuntó a explorar las experiencias, puntos de vista, y el impacto en la salud mental de las familias de los HCWs de la primera línea durante la pandemia de COVID-19 en el Reino Unido y qué apoyo estas familias podrían necesitar.Método: Completamos catorce entrevistas con tres hermanos, una madre, un amigo y nueve esposas de HCWs. Los familiares estaban altamente motivados en apoyar a los trabajadores de la salud y sintieron un intenso sentido de orgullo por su trabajo. Sin embargo, también experimentaron un aumento en las responsabilidades domésticas y en la carga emocional debido a la ansiedad sobre el trabajo de sus seres queridos. El hecho de que el sacrificio hecho por los familiares no fuera notado por la sociedad, la ansiedad que sintieron sobre la salud física de su familia, el impacto de escuchar sobre experiencias traumáticas y la falla de las organizaciones de salud en conocer las necesidades de los HCWs, todo ello afectó negativamente a los familiares.Conclusiones: Tenemos una responsabilidad ética de abordar las experiencias y necesidades de los familiares de los profesionales de la salud. Este estudio enfatiza las experiencias y necesidades de los familiares de los profesionales de la salud, que hasta ahora no han aparecido en la literatura. Se necesita mayor investigación para escuchar a más padres, hermanos y amigos, parejas en relaciones del mismo sexo, así como de hijos de HCWs, para explorar de forma más completa la variedad de las experiencias de las familias y personas de apoyo.

Anticipating PTSD in severe COVID survivors: the case for screen-and-treat Anticipando el TEPT en los sobrevivientes de COVID severo: El caso para detección y tratamiento 预测重症 COVID 幸存者的 PTSD: 筛查和治疗的案例

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.

Anticipating PTSD in severe COVID survivors: the case for screen-and-treat.

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.

Risk factors for depression and anxiety during COVID-19 in Israel: A two-wave study before and during the pandemic.

Research indicates that mental health problems increased across the globe after the outbreak of the COVID-19 pandemic. However, there is a need for research examining specific risk factors for mental health problems, while accounting for symptoms before the pandemic. This study examined risk factors for depression and anxiety symptoms among Israeli adults following the first wave of the COVID-19 pandemic in Israel, above and beyond depression and anxiety symptoms reported 3 years before the pandemic. We performed a two-wave 3-year longitudinal study (W1 July-September 2017; W2 May-June 2020). The final sample included 578 participants who completed anxiety and depression self-report questionnaires at both waves. The W2 assessment additionally included being considered high-risk for COVID-19, and measures regarding loneliness, perceived stress, and COVID-19 worries. Both anxiety and depression symptoms were significantly higher at W2 during the pandemic. Worries related to COVID-19, perceived stress, loneliness, and prior mental health symptoms predicted depression and anxiety in W2. Additionally, being younger was associated with W2 anxiety. The current study highlights risk factors for psychological distress in light of the COVID-19 pandemic. Attention of clinicians and policy makers should be given to the important role of loneliness when screening and treating people during this pandemic.

Understanding the mental health impacts of COVID-19 through a trauma lens.

This special issue of the European Journal of Psychotraumatology (EJPT) presents the first studies published by EJPT on COVID-19. We present 26 qualitative and quantitative studies assessing the prevalence of trauma-related symptoms and psychopathology within specific vulnerable populations such as health-care workers, students, children, and managers, or more broadly at a country level with a diverse set of outcomes including post-traumatic stress, moral injury, grief and post-traumatic growth. Intervention studies focus on whether telehealth delivery of mental health therapy in the pandemic environment was useful and effective. It is clear that the pandemic has brought with it a rise in trauma exposure and consequently impacted on trauma-related mental health. While for many individuals, COVID-19-related events met criteria for a DSM-5 Criterion A event, challenges remain in disentangling trauma exposure from stress, anxiety, and other phenomena. It is important to determine the contexts in which a trauma lens makes a useful contribution to understanding the mental health impacts of COVID-19 and the ways in which this may facilitate recovery. The papers included in this Special Issue provide an important and much-needed evidence-based foundation for developing trauma-informed understanding and responses to the pandemic.

Este número especial de la Revista Europea de Psicotraumatología(European Journal of Psychotraumatology­EJPT) presenta los primeros estudios publicados por EJPT sobre COVID-19. Presentamos 26 estudios cualitativos y cuantitativos que evalúan la prevalencia de los síntomas y la psicopatología relacionados con el trauma en poblaciones vulnerables específicas, como trabajadores de la salud, estudiantes, niños y niñas, administradores o, en general, a nivel de país con un conjunto diverso de resultados que incluyen el estrés postraumático, el daño moral, el dolour, y el crecimiento postraumático. Los estudios de intervenciones se centran en si la prestación de telesalud de terapia de salud mental en el entorno pandémico fue útil y eficaz.Está claro que la pandemia ha traído consigo un aumento en la exposición al trauma y, en consecuencia, ha tenido un impacto en la salud mental relacionada con el trauma. Si bien para muchas personas los eventos relacionados con el COVID-19 cumplieron los criterios para un evento del Criterio A del DSM-5, persisten los desafíos para desenredar la exposición al trauma del estrés, la ansiedad, y otros fenómenos. Es importante determinar los contextos en los que un lente de trauma hace una contribución útil para comprender los impactos de COVID-19 en la salud mental y las formas en que esto puede facilitar la recuperación. Los artículos incluidos en este Número Especial brindan una base importante y muy necesaria, basada en la evidencia, para desarrollar una comprensión y respuestas a la pandemia informadas sobre el trauma.

Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis.

BACKGROUND: Healthcare workers across the world have risen to the demands of treating COVID-19 patients, potentially at significant cost to their own health and wellbeing. There has been increasing recognition of the potential mental health impact of COVID-19 on frontline workers and calls to provide psychosocial support for them. However, little attention has so far been paid to understanding the impact of working on a pandemic from healthcare workers' own perspectives or what their views are about support. METHODS: We searched key healthcare databases (Medline, PsychINFO and PubMed) from inception to September 28, 2020. We also reviewed relevant grey literature, screened pre-print servers and hand searched reference lists of key texts for all published accounts of healthcare workers' experiences of working on the frontline and views about support during COVID-19 and previous pandemics/epidemics. We conducted a meta-synthesis of all qualitative results to synthesise findings and develop an overarching set of themes and sub-themes which captured the experiences and views of frontline healthcare workers across the studies. RESULTS: This review identified 46 qualitative studies which explored healthcare workers' experiences and views from pandemics or epidemics including and prior to COVID-19. Meta-synthesis derived eight key themes which largely transcended temporal and geographical boundaries. Participants across all the studies were deeply concerned about their own and/or others' physical safety. This was greatest in the early phases of pandemics and exacerbated by inadequate Personal Protective Equipment (PPE), insufficient resources, and inconsistent information. Workers struggled with high workloads and long shifts and desired adequate rest and recovery. Many experienced stigma. Healthcare workers' relationships with families, colleagues, organisations, media and the wider public were complicated and could be experienced concomitantly as sources of support but also sources of stress. CONCLUSIONS: The experiences of healthcare workers during the COVID-19 pandemic are not unprecedented; the themes that arose from previous pandemics and epidemics were remarkably resonant with what we are hearing about the impact of COVID-19 globally today. We have an opportunity to learn from the lessons of previous crises, mitigate the negative mental health impact of COVID-19 and support the longer-term wellbeing of the healthcare workforce worldwide.

What support do frontline workers want? A qualitative study of health and social care workers' experiences and views of psychosocial support during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has placed a significant burden on the mental health and wellbeing of frontline health and social care workers. The need to support frontline staff has been recognised. However, there is to date little research specifically on how best to support the mental health needs of frontline workers, and none on their own experiences and views about what might be most helpful. AIMS: We set out to redress this research gap by qualitatively exploring UK frontline health and social care workers' own experiences and views of psychosocial support during the pandemic. METHOD: Frontline health and social care workers were recruited purposively through social media and by snowball sampling via healthcare colleagues. Workers who volunteered to take part in the study were interviewed remotely following a semi-structured interview guide. Transcripts of the interviews were analysed by the research team following the principles of Reflexive Thematic Analysis. RESULTS: We conducted 25 interviews with frontline workers from a variety of professional groups working in health and social care settings across the UK. Themes derived from our analysis showed that workers' experiences and views about psychosocial support were complex. Peer support was many workers' first line of support but could also be experienced as a burden. Workers were ambivalent about support shown by organisations, media and the public. Whilst workers valued psychological support services, there were many disparities in provision and barriers to access. CONCLUSIONS: The results of this study show that frontline health and social care workers are likely to need a flexible system of support including peer, organisational and professional support. More research is needed to fully unpack the structural, systemic and individual barriers to accessing psychosocial support. Greater collaboration, consultation and co-production of support services and their evaluation is warranted.

Experiences of mental health professionals supporting front-line health and social care workers during COVID-19: qualitative study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is having a well-documented impact on the mental health of front-line health and social care workers (HSCWs). However, little attention has been paid to the experiences of, and impact on, the mental health professionals who were rapidly tasked with supporting them. AIMS: We set out to redress this gap by qualitatively exploring UK mental health professionals' experiences, views and needs while working to support the well-being of front-line HSCWs during the COVID-19 pandemic. METHOD: Mental health professionals working in roles supporting front-line HSCWs were recruited purposively and interviewed remotely. Transcripts of the interviews were analysed by the research team following the principles of reflexive thematic analysis. RESULTS: We completed interviews with 28 mental health professionals from varied professional backgrounds, career stages and settings across the UK. Mental health professionals were motivated and driven to develop new clinical pathways to support HSCWs they perceived as colleagues and many experienced professional growth. However, this also came at some costs, as they took on additional responsibilities and increased workloads, were anxious and uncertain about how best to support this workforce and tended to neglect their own health and well-being. Many were professionally isolated and were affected vicariously by the traumas and moral injuries that healthcare workers talked about in sessions. CONCLUSIONS: This research highlights the urgent need to consider the mental well-being, training and support of mental health professionals who are supporting front-line workers.

Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19.

Background: Studies have shown that working in frontline healthcare roles during epidemics and pandemics was associated with PTSD, depression, anxiety, and other mental health disorders. Objectives: The objectives of this study were to identify demographic, work-related and other predictors for clinically significant PTSD, depression, and anxiety during the COVID-19 pandemic in UK frontline health and social care workers (HSCWs), and to compare rates of distress across different groups of HCSWs working in different roles and settings. Methods: A convenience sample (n = 1194) of frontline UK HCSWs completed an online survey during the first wave of the pandemic (27 May - 23 July 2020). Participants worked in UK hospitals, nursing or care homes and other community settings. PTSD was assessed using the International Trauma Questionnaire (ITQ); Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9); Anxiety was assessed using the Generalized Anxiety Disorder Scale (GAD-7). Results: Nearly 58% of respondents met the threshold for a clinically significant disorder (PTSD = 22%; anxiety = 47%; depression = 47%), and symptom levels were high across occupational groups and settings. Logistic regression analyses found that participants who were concerned about infecting others, who could not talk with their managers if there were not coping, who reported feeling stigmatized and who had not had reliable access to personal protective equipment (PPE) were more likely to meet criteria for a clinically significant mental disorder. Being redeployed during the pandemic, and having had COVID were associated with higher odds for PTSD. Higher household income was associated with reduced odds for a mental disorder. Conclusions: This study identified predictors of clinically significant distress during COVID-19 and highlights the need for reliable access to PPE and further investigation of barriers to communication between managers and staff.

Antecedentes: Los estudios han mostrado que el trabajo en roles de primera línea de salud durante epidemias y pandemias se asoció a TEPT, depresión, ansiedad y otros trastornos de salud mental.Objetivos: Los objetivos de este estudio fueron identificar predictores demográficos, predictores relacionados al trabajo y otros, para TEPT, depresión y ansiedad clínicamente significativos durante la pandemia por COVID-19 en la primera línea de trabajadores sociales y de la salud (HSCWs), y comparar las tasas de afectación entre los diferentes grupos de HSCWs trabajando en diferentes roles y contextos.Métodos: Una muestra por conveniencia (n=1194) de la primera línea de HSCWs en Reino Unido completó un cuestionario en línea durante la primera ola de la pandemia (27 de mayo ­ 23 de julio de 2020). Los participantes trabajaban en hospitales del Reino Unido, centros asistenciales u otros contextos clínicos comunitarios. Se evaluó TEPT usando el Cuestionario Internacional de Trauma (ITQ); la depresión fue evaluada usando el Cuestionario sobre la salud del paciente 9 (PHQ-9); la ansiedad fue evaluada usando la Escala sobre Trastorno Ansioso (GAD-7).Resultados: Cerca del 58% de los participantes cumplieron el umbral para algún trastorno clínicamente significativo (TEPT = 22%; ansiedad = 47%; depresión = 47%), y los niveles de síntomas fueron altos entre los grupos y contextos ocupacionales. Los análisis de regresión logística encontraron que los participantes que estaban preocupados respecto a contagiar a otros; quienes no pudieron hablar con sus administradores cuando no se estaban adaptando a la situación; quienes reportaron sentirse estigmatizados y quienes no tuvieron acceso a elementos de protección personal (EPP) confiables, tuvieron mayor probabilidad de cumplir los criterios para un trastorno mental clínicamente significativo. Ser redistribuido a otras funciones durante la pandemia, y haber tenido COVID se asociaron a mayores probabilidades de desarrollar TEPT. Un mayor ingreso familiar se asoció con menores probabilidades de desarrollar un trastorno mental.Conclusiones: Este estudio identificó predictores para afectación clínicamente significativa durante la pandemia por COVID-19 y resalta la necesidad de un acceso confiable a EPP y de mayor investigación sobre las barreras de comunicación entre los administradores y los equipos de trabajo.

The associations between media use, peritraumatic distress, anxiety and resilience during the COVID-19 pandemic.

This study examined the relationship between media use, experiences of media use as having a negative and/or positive impact on coping, peritraumatic distress, anxiety symptoms and resilience during the COVID-19 pandemic. A convenience sample of 902 Israeli adults (mean age = 46.21) completed measures of peritraumatic distress, anxiety symptoms and resilience, and reported on their media use experiences one month following the initial outbreak of the disease in Israel (April 2020). After controlling for COVID-19 related events and demographic covariates, experiencing media use as having a negative impact on coping was related to higher levels of peritraumatic distress and anxiety symptoms and lower levels of resilience. In contrast, experiencing media as having a positive impact was not related to peritraumatic distress, anxiety symptoms or resilience. The findings suggest that those reporting that media use had a negative impact on coping are at greater risk of experiencing higher levels of peritraumatic distress and anxiety symptoms as well as lower resilience. In addition, traditional media use was related to higher resiliency. Developing understanding of how media could be used to optimally support emergency responses is crucial in order to minimize psychopathology. Unified, clear, trustworthy and informative messaging has a special importance during a mass public health crisis. Further research will contribute to guidance of potential risk and resilience aspects of media use during emergencies.

Psychological trauma and moral injury in religious leaders during COVID-19.

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).