ABSTRACT
Background: The COVID-19 Pandemic had a significant negative impact on the mental health of healthcare workers (HCWs). Evidence-based interventions that could be used to mitigate this impact are lacking in the literature. This review aims to evaluate psychological interventions used for employees following previous disasters and assess the transferability of these interventions to a healthcare setting during the COVID-19 pandemic. Methods: Intervention information from a previously published systematic review of the literature published up to 2015 was extracted, and an additional search of studies published from 2015–2020 was conducted. Studies were assessed for transferability using a checklist derived from the PIET-T process model. Results: Interventions from eighteen studies were assessed for transferability (including three studies identified in an updated literature search). Interventions established as most transferable included resilience training, meditation/mindfulness interventions, and cognitive behavioural therapy. Psychological debriefing was transferable but as it is contrary to current recommendations is not deemed appropriate for adoption. Conclusions: Several existing interventions have the potential to be utilised within the COVID-19 context/ pandemic. More research needs to be undertaken in this area to assess these interventions upon transfer. © Journal of Public Health and Emergency. All rights reserved.
ABSTRACT
Since the emergence of the COVID-19 pandemic, there has been increased interest in identifying ways of protecting the mental well-being of healthcare workers (HCWs). Much of this has been directed towards promoting and enhancing the resilience of those deemed as frontline workers. Based on a review of the extant literature, this paper seeks to problematise aspects of how 'frontline work' and 'resilience' are currently conceptualised. Firstly, frontline work is arbitrarily defined and often narrowly focused on acute, hospital-based settings, leading to the needs of HCWs in other sectors of the healthcare system being overlooked. Secondly, dominant narratives are often underpinned by a reductionist understanding of the concept of resilience, whereby solutions are built around addressing the perceived deficiencies of (frontline) HCWs rather than the structural antecedents of distress. The paper concludes by considering what interventions are appropriate to minimise the risk of burnout across all sectors of the healthcare system in a post-pandemic environment.
ABSTRACT
Purpose: The need to evaluate SARS-CoV-2 immune responses is an important clinical research focus. Detecting neutralizing antibodies is one measure of immune response, but the ability to evaluate CD4 and CD8 T cell responses specific to SARSCoV-2 is also an important measure of immune status. The role these two arms of the immune system play in protection is currently unknown. Methods: We developed a whole blood flow cytometry assay that detects functional CD4 and CD8 responses to stimulation by peptide antigen pools encompassing the spike (S1-receptor binding domain (RBD) and S2) and nucleocapsid (N) proteins to address this need. Activated T cells were defined as CD4 or CD8 T cells coexpressing the CD69 activation marker with IFN-γ, TNF-α or IL-2. Polyfunctional T cells, expressing multiple cytokines, were also identified. This assay was validated using whole blood from SARS-CoV-2 recovered volunteers and apparently normal donors who self-reported as uninfected by SARS-CoV-2. Results: The range in responses varied by donor and was not correlated with the reported severity of their disease. A positive response was defined as a 3-fold increase in the number of activated T cells over the unstimulated control. Of the 32 SARS-CoV-2 recovered donors tested, 25 responded to two or three of the peptide pools and five did not respond to any SARS-CoV-2 peptides. Responses ranged from 0.03% up to 1.23% of the CD4 or CD8 population. The responding T cells were predominantly CD4, but when CD8 T cells responded they tended to recognize the nucleocapsid peptides most strongly. Data from one individual with a robust response are shown below. For uninfected donors, five of 21 showed a low, but detectable response to stimulation with at least one peptide pool. These responses could be attributed to an asymptomatic infection, or to cross-reactive T cells specific to one of the seasonal respiratory coronaviruses. Conclusions: In summary, we developed a sensitive assay to detect SARS-CoV-2 spike-and nucleocapsid-specific T cell responses in whole blood samples. This assay will be valuable in monitoring SARS-CoV-2 T cell response and duration in infected individuals. Measuring the T cell responses to SARS-CoV-2 vaccinated individuals is currently under investigation. (Table Presented).
ABSTRACT
Study Objective: The COVID-19 pandemic has placed an unprecedented psychological burden on emergency medicine (EM) providers who have experienced anxiety, depression, isolation, burnout, and poor self-care. ACEP along with 44 medical organizations issued a statement in support of clinician health in the post-pandemic period calling for the removal of barriers to mental health care and using non-clinical mental health support, specifically peer support, to foster resilience and recovery. While physicians prefer to seek support from colleagues, formal peer support interventions are not well studied. The objectives of the study were to determine feasibility, receptivity, and effect of physician peer support groups on symptoms of acute distress, anxiety, depression, and burnout. Methods: A quasi-experimental design was used to determine pre-post intervention changes in anxiety and depression (primary outcomes) using the Patient Health Questionnaire (PHQ-4);provider burnout using the Maslach Burnout Inventory;and distress symptoms (fatigue, trouble sleeping, nervousness, feeling down, anger, helplessness, guilt, difficulty concentrating) using the SPADE Symptom Screener and PROMIS measure. The Participant-rated Global Impression of Change was used to monitor whether feeling better at the end of each session compared to the beginning. Receptivity was assessed using a net promoter score question. The study population was emergency physicians serving 10 academic and community hospitals who self-identified as having any mental health challenge during the pandemic. Three groups of 8 providers were recruited via departmental email listservs to participate in eight 1-hour virtual, peer support group sessions via Zoom Health. The visit structure was based on the National Alliance of Mental Illness (NAMI) peer support model and adapted for use in the clinician population. Three physicians were trained to cofacilitate with a NAMI support group leader. Data were collected using the Zoom polling function. Change analysis was conducted using dependent t-tests in SPSS. A sample size of 16 clinicians was needed to provide 80% power for two-sided tests at an alpha of 0.05 to detect a large effect size of 1.0 (3-point absolute change) for the PHQ-4. Results: Of the 24 participating physicians, the majority were faculty physicians, white, female, and in practice 5 years or less. Average attendance was 6.5 sessions with 83% of physicians reaching the attendance goal of 6 out of 8 sessions. On average, participants reported feeling better at the end compared to the beginning of each session. Eighty six percent of physicians reported they would recommend peer support groups to a friend or colleague. Positive effect sizes showed improvement in 8 of 11 distress symptoms, and marginal significance (p<.10) for guilt and anxiety. Conclusions: High levels of attendance, feeling better at the end of sessions, and willingness to recommend peer support groups to friends or colleagues demonstrate high physician receptivity to peer support and feasibility of implementation. Positive effect sizes show promising signs of improvement in the majority of anxiety, depression, distress, and burn out symptoms in this pilot study. Attention is needed to tailor strategies to male providers who may be hesitant to participate. Further research of this model with a larger samples and more robust design is planned. [Formula presented]