Mental health symptoms in Australian general practitioners during the COVID-19 pandemic.

BACKGROUND: General practitioners (GPs) play a central role during the COVID-19 pandemic, and yet awareness of their mental health is limited. METHODS: A nationwide online survey of self-identified frontline healthcare workers was conducted between 27 August and 23 October 2020. Participants were recruited through health and professional organisations, colleges, universities, government contacts, and media. A subset of the findings on GPs and hospital medical staff (HMS) was used for this study. RESULTS: Of 9518 responses, there were 389 (4%) GPs and 1966 (21%) HMS. Compared with HMS, GPs received significantly less training on personal protective equipment usage or care for COVID-19 patients, and less support or communication within their workplace. GPs were significantly more concerned about household income, disease transmission to family and being blamed by colleagues if they became infected, all of which were associated with worse psychological outcomes. Significantly more GPs reported burnout, and experienced moderate-to-severe emotional exhaustion than HMS. Both groups used similar coping strategies, except fewer GPs than HMS used digital health applications or increased alcohol consumption. Less than 25% of either group sought professional help. CONCLUSIONS: GPs are vital in our healthcare systems, yet face unique workplace challenges and mental health stressors during the pandemic. Targeted workplace and psychological support is essential to protect wellbeing among the primary care workforce.

SINFONIA study protocol: a phase II/III randomised controlled trial examining benefits of guided online group singing in people with chronic obstructive pulmonary disease and interstitial lung disease and their carers.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and interstital lung disease (ILD) are incurable conditions characterised by airflow limitation, persisting respiratory symptoms, and progressive respiratory failure. People living with COPD or ILD often suffer from chronic and severe breathlessness, with limited treatment options and low engagement rates with current therapies. Group singing represents a potential community-based therapy to improve quality of life for patients with COPD or ILD and breathlessness. METHODS: This protocol papers describes SINFONIA, a parallel, double-arm, randomised, blinded-analysis, mixed-methods phase II/III trial of guided, online group singing that will be conducted over 24 months. Adults with confirmed COPD or ILD, on stable treatment for at least four weeks at time of recruitment, with a modified Medical Research Council (mMRC) dyspnoea score of two or greater, who are capable and willing to give consent, and not currently participating in pulmonary rehabilitation will be eligible to participate. Carers may optionally enrol in the trial. Data will be collected on quality of life, anxiety and depression, breathlessness, mastery of breathing, exercise tolerance, loneliness, healthcare utilisation, and carer quality of life (optional). Participants will be randomised 1:1 to intervention or control arms with intervention arm attending one 90 min, guided, online, group singing session per week for 12 weeks and control arm continuing routine care. Phase II of the trial aims to determine the feasibility and acceptability of guided, online group singing and will collect preliminary data on effectiveness. Phase III aims to determine whether guided, online group singing has an effect on quality of life with the primary outcome being a between arm difference in quality of life (36-item Short Form Survey) measured at 12 weeks. DISCUSSION: SINFONIA is the first study is the first of its kind in Australia and to our knowledge, the first to deliver the singing intervention program entirely online. Determining the feasibility, acceptability, and effectiveness of guided, online group singing is an important step towards improving low-cost, low-risk, community-based therapeutic options for patients living with COPD or ILD and breathlessness. TRIAL REGISTRATION: Phase II- ACTRN12621001274864 , registered 20th September 2021; Phase III- ACTRN12621001280897 , registered 22nd September 2021.

Cross-sectional survey of COVID-19-related impacts on mental health of nurses: occupational disruption, organisational preparedness, psychological harm, and moral distress.

Background: The COVID-19 pandemic has presented unprecedented levels of prolonged strain on healthcare systems and healthcare workers (HCWs) globally, with nurses at the forefront.Objectives: To describe types and prevalence of occupational disruptions and exposure to COVID-19, and their impacts on mental health, moral distress, coping strategies, and help-seeking behaviours of Australian nurses.Design: A cross-sectional online anonymous survey distributed amongst Australian HCWs between 27 August and 23 October 2020.Methods: Data was collected on demographics, workplace disruption, personal relationships, and mental health. Predictors of mental health impacts and coping strategies were identified through multivariate regression analyses.Results: 7845 complete responses were returned, of which 3082 (39.3%) were from nurses and 4763 (60.7%) were from all other professions ('other HCWs'). Occupational disruption was common, with nurses specifically reporting additional paid hours (p < 0.001). Nurses were exposed to, and infected with, COVID-19 more frequently than other HCWs (p < 0.001) and were more likely to report concerns around stigmatisation from the broader community (p < 0.001). Symptoms of mental illness (anxiety, depression, PTSD and burnout) were significantly more prevalent in nurses than other HCWs, despite both groups scoring high on resilience. Common predictors of mental health symptoms included exposure to COVID-19 and worsening of personal relationships. Nurses reported a variety of coping strategies and were more likely than other HCWs to increase alcohol consumption. Engagement with formal support services was low for both groups. Personal and professional predictors for coping strategy use were identified.Conclusions: Urgent action is needed to address staff shortages and burnout which have been exacerbated by COVID-19. Initiatives that recognise the importance of nursing staff and incentivise current and future nurses to join and remain in the workforce are essential.

Differences in psychosocial distress among rural and metropolitan health care workers during the COVID-19 pandemic.

OBJECTIVE: The Australian COVID-19 Frontline Healthcare Workers study examined the prevalence and severity of mental health symptoms during the second wave of the COVID-19 pandemic. This substudy examined the differences in psychological well-being between rural and metropolitan health care workers (HCWs). DESIGN: A nationwide survey conducted between August and October 2020. SETTING AND PARTICIPANTS: Australian HCWs were recruited through multiple strategies. MAIN OUTCOME MEASURES: Demographics, mental health outcomes (anxiety, depression, post-traumatic stress disorder [PTSD] and burnout). RESULTS: Complete responses were included from 7846 participants, with 1473 (18.8%) in regional or remote ('rural') areas and 81.2% in metropolitan areas. Rural participants were older, more likely to work in allied health, nursing or in health administration, and had worked longer in their profession than metropolitan participants. Levels of resilience were similar (p = 0.132), but there was significantly higher prevalence of pre-COVID-19 pandemic mental illness in the rural workforce (p < 0.001). There were high levels of current mental health issues: moderate-severe PTSD (rural 38.0%; metropolitan 41.0% p = 0.031); high depersonalisation (rural 18.1%; metropolitan 20.7% p = 0.047); and high emotional exhaustion (rural 46.5%; metropolitan 43.3% p = 0.002). Among rural participants, mental health symptoms were associated with younger age, worry about being blamed if they contracted COVID-19, fear of transmitting COVID-19 to their family, experiencing worsening relationships and working in primary care or allied health. CONCLUSION: Despite having low COVID-19 case numbers in rural Australian health services compared with metropolitan counterparts over the course of 2020, there were widespread mental health impacts on the workforce. Rural health services need specific and flexible training, education, work policies and practices that support psychological well-being now in preparedness for ongoing or future crises.

Thoughts of suicide or self-harm among Australian healthcare workers during the COVID-19 pandemic.

OBJECTIVE: To identify the prevalence and predictors of (a) thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic and (b) help-seeking among those healthcare workers with thoughts of suicide or self-harm. METHOD: Analysis of data from the Australian COVID-19 Frontline Healthcare Workers Study, an online survey of healthcare workers conducted during the second wave of the COVID-19 pandemic in Australia. Outcomes of interest were thoughts of suicide or self-harm as measured through the Patient Health Questionnaire for depression and help-seeking behaviours. RESULTS: Overall, 819 (10.5%) of 7795 healthcare workers reported thoughts of suicide or self-harm over a 2-week period. Healthcare workers with these thoughts experienced higher rates of depression, anxiety, post-traumatic stress disorder and burnout than their peers. In multivariable models, the odds of suicide or self-harm thoughts were higher among workers who had friends or family infected with COVID-19 (odds ratio = 1.24, 95% confidence interval = [1.06, 1.47]), were living alone (odds ratio = 1.32, 95% confidence interval = [1.06, 1.64]), younger (⩽30 years cf. >50 years; odds ratio = 1.70, 95% confidence interval = 1.36-2.13), male (odds ratio = 1.81, 95% confidence interval = [1.49, 2.20]), had increased alcohol use (odds ratio = 1.58, 95% confidence interval = [1.35, 1.86]), poor physical health (odds ratio = 1.62, 95% confidence interval = [1.36, 1.92]), increased income worries (odds ratio = 1.81, 95% confidence interval = [1.54, 2.12]) or prior mental illness (odds ratio = 3.27, 95% confidence interval = [2.80, 3.82]). Having dependent children was protective (odds ratio = 0.75, 95% confidence interval = [0.61, 0.92]). Fewer than half (388/819) of the healthcare workers who reported thoughts of suicide or self-harm sought professional support. Healthcare workers with thoughts of suicide or self-harm were more likely to seek support if they were younger (⩽30 years cf. >50 years; odds ratio = 1.78, 95% confidence interval = [1.13, 2.82]) or had prior mental health concerns (odds ratio = 4.47, 95% confidence interval = [3.25, 6.14]). CONCLUSION: One in 10 Australian healthcare workers reported thoughts of suicide or self-harm during the pandemic, with certain groups being more vulnerable. Most healthcare workers with thoughts of suicide or self-harm did not seek professional help. Strong and sustained action to protect the safety of healthcare workers, and provide meaningful support, is urgently needed.

Differential Impacts of the COVID-19 Pandemic on Mental Health Symptoms and Working Conditions for Senior and Junior Doctors in Australian Hospitals.

OBJECTIVE: This study investigated severity, prevalence, and predictors of workplace disruption and mental health symptoms in Australian junior and senior hospital medical staff during the COVID-19 pandemic. METHODS: A cross-sectional survey collected data on demographics, workplace disruption, personal relationships, and mental health. RESULTS: One thousand twenty-one (62.1%) senior and 745 (37.9%) junior medical staff, located primarily in Victoria, completed the survey. Work disruptions were common but varied by seniority, withjunior staff more frequently exposed to COVID- 19 (P < 0.001). Symptoms of anxiety, depression, post-traumatic stress disorder and burnout were common but significantly higher in junior doctors (P  = 0.011 to < 0.001). Common predictors for experiencing mental health symptoms were identified, including prior mental health diagnoses and worsening personal relationships. CONCLUSIONS: COVID-19 has had significant but varied impacts on junior and senior doctors, with junior doctors particularly susceptible to harm to mental health. Interventions to safeguard hospital medical staff and prevent attrition of this important workforce are urgently needed.

Mental Health Symptoms and Workplace Challenges among Australian Paramedics during the COVID-19 Pandemic.

BACKGROUND: Paramedics are vital to the health system response to the COVID-19 pandemic; however, the pressures on this workforce have been intense and challenging. This study reports on mental health symptoms and the working environment among Australian paramedics during the COVID-19 pandemic and explores their experiences of work and wellbeing during this time. METHODS: An anonymous, online survey of frontline healthcare workers examined work environment, psychological wellbeing, and contained four open-ended qualitative items. Using a mixed method approach, quantitative data were analysed descriptively and qualitative data were analysed using content analysis. RESULTS: This paper reports findings from 95 paramedics who provided complete quantitative data and 85 paramedics who provided free-text responses to at least one qualitative item. Objectively measured mental health symptoms were common among paramedics, and almost two thirds of paramedics self-reported experiencing burnout. Qualitative analysis highlighted key issues of safety and risk in the workplace, uncertainty and upheaval at work and at home, and lack of crisis preparedness. Qualitative analysis revealed four themes; 'the pervasiveness of COVID-19 disruptions across all life domains'; 'the challenges of widespread disruption at work'; 'risk, uncertainty and feeling unsafe at work', and 'the challenges of pandemic (un)preparedness across the health system'. CONCLUSIONS: The COVID-19 pandemic resulted in considerable occupational disruption for paramedics and was associated with significant negative impacts on mental health. Findings emphasise the need for more adaptive working conditions, mental health support for paramedics, and enhanced crisis preparedness across the health system for future crises.

Differences in Coping Strategies and Help-Seeking Behaviours among Australian Junior and Senior Doctors during the COVID-19 Pandemic.

BACKGROUND: Throughout the COVID-19 pandemic, hospital medical staff (HMS) have faced significant personal, workplace, and financial disruption. Many have experienced psychosocial burden, exceeding already concerning baseline levels. This study examines the types and predictors of coping strategies and help-seeking behaviours utilised by Australian junior and senior HMS during the first year of the pandemic. METHODS: A cross-sectional online survey of Australian frontline healthcare workers was conducted between 27 August and 23 October 2020. Data collected included demographics, personal and workplace disruptions, self-reported and validated mental health symptoms, coping strategies, and help-seeking. RESULTS: The 9518 participants included 1966 hospital medical staff (62.1% senior, 37.9% junior). Both groups experienced a high burden of anxiety, depression, post-traumatic stress disorder, and burnout. Coping strategies varied by seniority, with maintaining exercise the most common strategy for both groups. Adverse mental health was associated with increased alcohol consumption. Engagement with professional support, although more frequent among junior staff, was uncommon in both groups. CONCLUSIONS: Junior and senior staff utilised different coping and help-seeking behaviours. Despite recognition of symptoms, very few HMS engaged formal support. The varied predictors of coping and help-seeking identified may inform targeted interventions to support these cohorts in current and future crises.

Occupational Disruptions during the COVID-19 Pandemic and Their Association with Healthcare Workers' Mental Health.

BACKGROUND: The COVID-19 crisis has caused prolonged and extreme demands on healthcare services. This study investigates the types and prevalence of occupational disruptions, and associated symptoms of mental illness, among Australian frontline healthcare workers during the COVID-19 pandemic. METHODS: A national cross-sectional online survey was conducted between 27 August and 23 October 2020. Frontline healthcare workers were invited to participate via dissemination from major health organisations, professional associations or colleges, universities, government contacts, and national media. Data were collected on demographics, home and work situations, and validated scales of anxiety, depression, PTSD, and burnout. RESULTS: Complete responses were received from 7846 healthcare workers (82.4%). Most respondents were female (80.9%) and resided in the Australian state of Victoria (85.2%). Changes to working conditions were common, with 48.5% reporting altered paid or unpaid hours, and many redeployed (16.8%) or changing work roles (27.3%). Nearly a third (30.8%) had experienced a reduction in household income during the pandemic. Symptoms of mental illness were common, being present in 62.1% of participants. Many respondents felt well supported by their workplaces (68.3%) and believed that workplace communication was timely and useful (74.4%). Participants who felt well supported by their organisation had approximately half the risk of experiencing moderate to severe anxiety, depression, burnout, and PTSD. Half (50.4%) of respondents indicated a need for additional training in using personal protective equipment and/or caring for patients with COVID-19. CONCLUSIONS: Occupational disruptions during the COVID-19 pandemic occurred commonly in health organisations and were associated with worse mental health outcomes in the Australian health workforce. Feeling well supported was associated with significantly fewer adverse mental health outcomes. Crisis preparedness focusing on the provision of timely and useful communication and support is essential in current and future crises.

Coping strategies adopted by Australian frontline health workers to address psychological distress during the COVID-19 pandemic.

OBJECTIVES: The Australian COVID-19 Frontline Healthcare Workers Study investigated coping strategies and help-seeking behaviours, and their relationship to mental health symptoms experienced by Australian healthcare workers (HCWs) during the COVID-19 pandemic. METHODS: Australian HCWs were invited to participate a nationwide, voluntary, anonymous, single time-point, online survey between 27th August and 23rd October 2020. Complete responses on demographics, home and work situation, and measures of health and psychological wellbeing were received from 7846 participants. RESULTS: The most commonly reported adaptive coping strategies were maintaining exercise (44.9%) and social connections (31.7%). Over a quarter of HCWs (26.3%) reported increased alcohol use which was associated with a history of poor mental health and worse personal relationships. Few used psychological wellbeing apps or sought professional help; those who did were more likely to be suffering from moderate to severe symptoms of mental illness. People living in Victoria, in regional areas, and those with children at home were significantly less likely to report adaptive coping strategies. CONCLUSIONS: Personal, social, and workplace predictors of coping strategies and help-seeking behaviour during the pandemic were identified. Use of maladaptive coping strategies and low rates of professional help-seeking indicate an urgent need to understand the effectiveness of, and the barriers and enablers of accessing, different coping strategies.

Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic.

BACKGROUND: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. METHODS: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations, or colleges, universities, government contacts, and national media. RESULTS: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%), or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with increased risk of anxiety, depression, post-traumatic stress disorder, and burnout. Conversely, feeling appreciated by the community protected against these risks in healthcare workers. CONCLUSIONS: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.