Longitudinal assessment and determinants of short-term and longer-term psychological distress in a sample of healthcare workers during the COVID-19 pandemic in Quebec, Canada.

Introduction: Previous research has demonstrated the negative impact of the COVID-19 pandemic emergency on the wellbeing of healthcare workers. However, few research contributions reported a longitudinal evaluation of psychological distress and examined determinants of its duration and course over time. The present study aims to explore the impact of the pandemic emergency on HCWs mental health by adopting a longitudinal design and assessing mental health as combination of overlapping clinical symptoms (post-traumatic stress disorder, depression and anxiety). Methods: Data were collected weekly through a mobile application during and after the first wave of COVID-19 in the province of Quebec, Canada, in 2020. Analysis was conducted on a final sample of 382 participants. Participants were grouped into "resilient" (RES) if they did not manifest clinical-level psychological distress during monitoring, "short-term distress" (STD) if distress exceeded the clinical threshold for 1-3 weeks, and longer-term distress (LTD) if it occurred for four or more weeks, even if not consecutively. Descriptive statistics for all variables were computed for each subgroup (RES, STD and LTD), and pairwise comparisons between each group for every descriptive variable were made using chi square statistics for categorical variables and t-test for continuous variables. Predictors of distress groups (STD and LTD vs RES) were assessed running multinomial hierarchical logistic regression models. Results: In our sample, almost two third (59.4%) HCWs did not manifest moderate or severe distress during the monitoring time. Short-term distress, mostly post-traumatic symptoms that lasted for less than 4 weeks, were the most common distress response, affecting almost one third of participants. Longer psychological distress occurred only in a smaller percentage (12.6%) of cases, as a combination of severe posttraumatic, depressive and anxiety symptoms. Perceived occupational stress was the most significant risk factor; moreover individual, peritraumatic work and family risk and protective factors, were likely to significantly affect the stress response. Discussion: Results tend to provide a more complex and resiliency-oriented representation of psychological distress compared to previous cross-sectional studies, but are in line with stress response studies. Findings allow us to better describe the profiles of distress response in STD and LTD groups. Participants that manifest short term distress experience acute stress reaction in which the interplay between personal, family and professional life events is associated with the stress response. Conversely, longer term distress response in HCWs presents a more complex mental health condition with an higher level of impairment and support needs compared to participants with short-term distress.

Evolution of burnout and psychological distress in healthcare workers during the COVID-19 pandemic: a 1-year observational study.

BACKGROUND: Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psychiatry; 2021) remained associated when assessed several months later. METHODS: We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multivariable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equivalent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective factors at both time points. RESULTS: Prevalence of burnout and anxiety were similar at three and 12 months (52% vs. 51%, p = 0.66; 23% vs. 23%, p = 0.91), while PTSD (23% vs. 11%, p < 0.0001) and depression (11% vs. 6%, p = 0.001) decreased significantly over time. Higher resilience was associated with a lower probability of all outcomes at both time points. Perceived organizational support remained significantly associated with a reduced risk of burnout at 12 months. Social support emerged as a protective factor against burnout at 12 months and persisted over time for studied PTSD, anxiety, and depression. CONCLUSIONS: Healthcare workers' occupational and mental health stabilized or improved between three and 12 months after the pandemic onset. The predominant protective factors against burnout remained resilience and perceived organizational support. For PTSD, anxiety and depression, resilience and social support were important factors over time.

Trainee Therapists' Perceptions of a Blended Intervention to Promote Resilience after a Natural Disaster: A Qualitative Case Study.

BACKGROUND: Natural disasters happen in an increased frequency, and telemental health interventions could offer easily accessible help to reduce mental health symptoms experienced by survivors. However, there are very few programs offered to natural disaster survivors, and no research exists on therapists' experiences with providing blended interventions for natural disaster survivors. AIMS: Our qualitative case study aims to describe psychologists' experiences with an online, therapist-assisted blended intervention for survivors of the Fort McMurray wildfires in Alberta, Canada. METHOD: The RESILIENT intervention was developed in the frames of a randomized controlled trial to promote resilience after the Fort McMurray wildfires by providing survivors free access to a 12-module, therapist-assisted intervention, aiming to improve post-traumatic stress, insomnia, and depression symptoms. A focus group design was used to collect data from the therapists, and emerging common themes were identified by thematic analysis. RESULTS: Therapists felt they could build strong alliances and communicate emotions and empathy effectively, although the lack of nonverbal cues posed some challenges. The intervention, according to participating therapists, was less suitable for participants in high-stress situations and in case of discrepancy between client expectations and the intervention content. Moreover, the therapists perceived specific interventions as easy-to-use or as more challenging based on their complexity and on the therapist support needed for executing them. Client engagement in the program emerged as an underlying theme that had fundamental impact on alliance, communication, and ultimately, treatment efficiency. Therapist training and supervision was perceived as crucial for the success of the program delivery. CONCLUSIONS: Our findings provided several implications for the optimalization of blended interventions for natural disaster survivors from our therapists' perspective.

Assessment of Psychological Distress in Health Care Workers During the First two Waves of COVID-19: A Follow-up of a Canadian Longitudinal Study.

Background: Health care workers (HCW) exposed to COVID-19 risk experiencing psychological distress. Little is known regarding longitudinal perspectives and evolutions of psychological distress within this population. The objective of this study is to extend the results of our previous study to the pandemic's second wave. Method: This prospective cohort study was conducted from May 8, 2020, to January 24, 2021, and includes 787 HCW. Symptoms of anxiety and depression were assessed using the Generalised Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics illustrated the evolution of psychological distress indicators, whereas latent class analysis helped identify trajectories. Results: The results showed that a lower proportion of HCW exceeded the clinical threshold during the second wave (36,5% vs. 31,1%). As in the first wave, most of our sample fell onto the resilient trajectory (67.22%). We adapted the name of the remaining trajectories to better suit their evolution: rapid recovery (15.76%), slow recovery (9.66%), and delayed (7.37%). Conclusion: Approximately two-thirds of the HCW did not manifest significant distress. For those who did, the distress was transient. We observed a trend of positive adaptability among HCW, considering that the proportion of HCW experiencing psychological distress exceeding clinical threshold remained lower than during the first wave. Our data highlight the dynamic nature of psychological distress. To be able to detect psychological distress as it arises, HCW should use self-monitoring as an essential tool. This vigilance would allow institutions to offer timely support and resources for those experiencing psychological distress.

Factors Associated With Burnout, Post-traumatic Stress and Anxio-Depressive Symptoms in Healthcare Workers 3 Months Into the COVID-19 Pandemic: An Observational Study.

Objective: This study examined how best to identify modifiable protective and risk factors for burnout in healthcare workers in the face of the COVID-19 pandemic. Individual, occupational, organizational and social factors were investigated. The study also assessed the impact of these factors on post-traumatic stress disorder (PTSD), anxiety, and depression. Methods: Healthcare workers in the Quebec (Canada) healthcare system were recruited between May 21 to June 5, 2020. Participants answered an electronic survey 3 months after the COVID-19 epidemic outbreak began in Canada. Using the Maslach Burnout Inventory, PTSD Checklist for DSM-5, and Hospital Anxiety and Depression Scale, we studied the prevalence of burnout, PTSD, anxiety and depression in this cohort. Multivariable logistic or linear regression models including resilience, social and organizational support, workload and access to mental health help, simulation techniques and protective personal equipment (PPE) as well as perception of PPE security were conducted for each outcome. Results: In mid-June 2020, 467 participants completed the survey. We found that half (51.8%) of the respondents experienced burnout characterized by emotional exhaustion and/or depersonalization at least once a week. In total, 158 healthcare workers (35.6%) displayed severe symptoms of at least one of the mental health disorders (24.3% PTSD, 23.3% anxiety, 10.6% depression). Resilience (OR = 0.69, 95% CI: [0.55-0.87]; p = 0.002) and perceived organizational support (OR = 0.75, 95% CI: [0.61-0.93]; p = 0.009) were significantly associated with burnout and other outcomes. Social support satisfaction, perception of PPE security, work type and environment, mental health antecedents and reassignment were associated with PTSD and/or anxiety and/or depression, but not burnout. Conclusion: Future studies should address primarily resilience and perceived organizational support to promote mental health and prevent burnout, PTSD, anxiety and depression.

Assessment of Psychological Distress in Health-care Workers during and after the First Wave of COVID-19: A Canadian Longitudinal Study: Évaluation de la Détresse Psychologique Chez Les Travailleurs de la Santé Durant et Après la Première Vague de la COVID-19: une étude longitudinale canadienne.

OBJECTIVES: Health-care workers (HCW) exposed to COVID-19 are at risk of experiencing psychological distress. Although several cross-sectional studies have been carried out, a longitudinal perspective is needed to better understand the evolution of psychological distress indicators within this population. The objectives of this study were to assess the evolution of psychological distress and to identify psychological distress trajectories of Canadian HCW during and after the first wave of COVID-19. METHOD: This prospective cohort study was conducted from May 8 to September 4, 2020, and includes a volunteer sample of 373 HCW. Symptoms of post-traumatic disorder, anxiety, and depression were assessed using the Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders fifth edition (PCL-5), the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9. Descriptive statistics were used to illustrate the evolution of psychological distress indicators, whereas latent class analysis was carried out to identify trajectories. RESULTS: During and after the first wave of COVID-19, the rates of clinical mental health symptoms among our sample varied between 6.2% and 22.2% for post-traumatic stress, 10.1% and 29.9% for depression, and 7.3% and 26.9% for anxiety. Finally, 4 trajectories were identified: recovered (18.77%), resilient (65.95%), subchronic (7.24%), and delayed (8.04%). CONCLUSION: The longitudinal nature of our study and the scarcity of our data are unique among existing studies on psychological distress of HCW in COVID-19 context and allow us to contextualize prior transversal data on the topic. Although our data illustrated an optimistic picture in showing that the majority of HCW follow a resilience trajectory, it is still important to focus our attention on those who present psychological distress. Implementing preventive mental health interventions in our health-care institutions that may prevent chronic distress is imperative. Further studies need to be done to identify predictors that may help to characterize these trajectories.

Group therapy via videoconferencing for individuals with early psychosis: A pilot study.

AIM: The COVID-19 pandemic has introduced many mental health professionals to therapy via videoconferencing. Mostly individual teletherapy has been offered and studied, although group therapy is often offered in clinics. In fact, little is known regarding group therapy's acceptability, feasibility, and potential impact when offered via videoconferencing. METHODS: This pilot study offered group cognitive-behavioural therapy for psychosis via videoconferencing to 14 individuals with early psychosis either living in remote areas or confined during the pandemic. RESULTS: The rate of consenting to the study (79%) and actual participation rates were acceptable (18.5 sessions out of 24). Although some technological obstacles were encountered, solutions offered allowed the videoconferencing group to be considered feasible for most participants and therapists. Prepost results on symptoms and self-esteem were comparable to those of other studies using the same group treatment but in-person. Alliance scores seemed similar as well. CONCLUSIONS: More studies are warranted on the efficacy of group therapy via videoconferencing. This pilot study does offer promising results, suggesting that a wider range of people with early psychosis can be reached and benefit from the advantages of receiving an evidence-based group intervention.