Case study: Developing a strategy combining human and empirical interventions to support the resilience of healthcare workers exposed to a pandemic in an academic hospital.

The COVID-19 pandemic has put healthcare workers under important psychological pressure. Concerns have been raised regarding the mental health and psychological status of healthcare workers and have underlined the need for institutions to develop long-term interventions to support their resilience. The current case study presents the way a large university hospital in Brussels, Belgium, has evolved to deal with this health crisis and support its workers. Initiatives were multiple and complementary, as it was decided to combine different forms of clinical interventions that were developed by psychologists, psychiatrists, and human resources, to an empirical approach including a large survey that permitted to reach a much larger audience (the results of the study have been published previously). We describe the initially proposed measures of psychological support, including the creation of a telephone hotline, the presence of psychologists among teams of dedicated COVID-19 units, discussion groups, and individualized follow-ups, and their consequences on healthcare workers. Second, we address how these initial measures of support were modified to tailor in the best way possible the needs of healthcare workers, using a research action project that used a survey to measure and address the psychological distress of healthcare workers. We explain how, through different objectives (screening of distress, adaptation of initial measures based on reported needs, active reinforcement of individual and collective resilience, reminder of availability of help, and normalization of distress), a research action project can be a form of support and is an effective way for an institution to show its pre-occupation for the mental health of its teams. The current case study highlights how an institution can provide support and the importance of the use of a combined strategy to limit the consequences of a major health crisis on the mental health of its healthcare workers. Improving the resilience of healthcare workers both in the short and long term is of the essence to maintain optimal care of patients.

Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support Estados psicopatológicos entre los trabajadores de la salud congoleños durante la primera ola de la pandemia de COVID-19: vínculos con la regulación emocional y el apoyo social 在第一波 COVID-19 疫情期间刚果健康工作者的精神病状态：与情绪调节和社会支持的联系

Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women;131 men;mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = 0.24 (0.12–0.98)], hostility toward health workers [OR = 3.21 (1.23–4.21)], putting into perspective [OR = 0.91 (0.43–0.98)], self-blame [OR = 1.44 (1.11–2.39)], catastrophizing [OR = 1.85 (1.01–4.28)], blaming others [OR = 1.77 (1.04–3.32)], emotional support [OR = 0.83 (0.49–0.98)], instrumental support [OR = 0.74 (0.28–0.94)], and informational support [OR = 0.73 (0.43–0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54–3.78)], self-blame [OR = 1.57 (1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support [OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers’ wellbeing. HIGHLIGHTS Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits. Acute stress disorder and depression were negatively associated with adaptive emotion regulation and social support;and positively with maladaptive emotion regulation. Intervention aiming to support health workers in pandemics should target emotion regulation and social support.

Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support.

Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = 0.24 (0.12-0.98)], hostility toward health workers [OR = 3.21 (1.23-4.21)], putting into perspective [OR = 0.91 (0.43-0.98)], self-blame [OR = 1.44 (1.11-2.39)], catastrophizing [OR = 1.85 (1.01-4.28)], blaming others [OR = 1.77 (1.04-3.32)], emotional support [OR = 0.83 (0.49-0.98)], instrumental support [OR = 0.74 (0.28-0.94)], and informational support [OR = 0.73 (0.43-0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54-3.78)], self-blame [OR = 1.57 (1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support [OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers' wellbeing. HIGHLIGHTS: Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits.Acute stress disorder and depression were negatively associated with adaptive emotion regulation and social support; and positively with maladaptive emotion regulation.Intervention aiming to support health workers in pandemics should target emotion regulation and social support.

Antecedentes: La pandemia de COVID-19 es un factor estresante sin precedentes para los trabajadores de atención médica de primera línea, que aumenta notablemente las tasas de trastorno por estrés agudo y depresión. La regulación de las emociones y el apoyo social podrían ser factores protectores importantes contra tales estados psicopatológicos, pero su papel no ha sido explorado fuera de los contextos occidentales.Objetivo: Evaluar la asociación entre la regulación de las emociones, el apoyo social, el trastorno de estrés agudo y la depresión entre los trabajadores de la salud que confrontaron directamente la primera ola de la pandemia de COVID-19 en el este de la República Democrática del Congo.Método: Un estudio transversal evaluó el trastorno de estrés agudo, la depresión, estrategias de regulación emocional adaptativas (es decir, aceptación, refocalización positiva, …) y desadaptativas (es decir, autoculpabilización, rumiación, catastrofización, …), apoyo social (niveles instrumental, emocional, e informacional), así como situaciones y sentimientos autoinformados relacionados con el COVID-19, en una población de 252 trabajadores de salud de primera línea (121 mujeres; 131 hombres; edad media: 39 ± 11 años) en el Hospital General de Referencia de Bukavu. También exploramos las relaciones entre estas variables mediante regresión logística bivariada y multivariada.Resultados: Cuarenta por ciento de los participantes presentó síntomas de depresión y el dieciséis por ciento presentó trastorno de estrés agudo. En regresión logística bivariada, estos resultados psiquiátricos se asociaron con la disponibilidad de un kit de protección COVID-19 [OR = 0.24 (0.12­0.98)], hostilidad hacia los trabajadores de la salud [OR = 3.21 (1.23­4.21)], postura en perspectiva [ OR = 0.91 (0.43­0.98)], autoculpabilización [OR = 1.44 (1.11­2.39)], catastrofización [OR = 1.85 (1.01­4.28)], heteroculpabilización [OR = 1.77 (1.04­3.32)], apoyo emocional [OR = 0.83 (0.49­0.98)], apoyo instrumental [OR = 0.74 (0.28­0.94)] y apoyo informativo [OR = 0.73 (0.43­0.98)]. En la regresión logística multivariada, hostilidad [OR = 2.21 (1.54­3.78)], autoculpabilización [OR = 1.57 (1.02­2.11)], rumiación [OR = 1.49 (1.11­3.13)] y apoyo emocional [OR = 0.94 (0.65­0.98)] permanecieron significativamente asociados con los resultados psiquiátricos.Conclusión: La depresión y el trastorno de estrés agudo fueron muy frecuentes entre los trabajadores de la salud congoleños durante la primera ola de la pandemia sanitaria de COVID-19. La hostilidad, la autoculpabilización, la rumiación y el apoyo social se asociaron con depresión y/o trastorno de estrés agudo y deberían ser el objetivo de las intervenciones destinadas a apoyar el bienestar de los trabajadores de la salud.

Psychological distress among hospital caregivers during and after the first wave of COVID-19: Individual factors involved in the severity of symptoms expression.

Coronavirus disease 2019 has spread rapidly over the globe and has put an unprecedent psychological pressure on health care workers (HCWs). The present study aimed at quantifying the psychological consequences of the COVID-19 pandemic on HCWs during and after the first wave and identify sociodemographic, situational, and psychological risk/protective factors for symptoms severity. An online survey was sent by e-mail to all nurses and physicians employed by a teaching hospital in Brussels, Belgium. 542 (20,62%) completed the survey. 47%, 55%, 32% and 52% of participants reported posttraumatic stress, anxiety, depression and insomnia symptoms, respectively, during the peak. Two to three months later, posttraumatic symptoms emerged de novo in 54% of HCWs. It persisted in 89% of those presenting severe symptoms initially. Neuroticism was the strongest predictor of posttraumatic stress, anxiety, and insomnia. Work overload was the strongest predictor of depression and second predictor of posttraumatic stress, anxiety, and insomnia. Other significant predictors included being a nurse, the number of past traumatic experiences, avoidant coping style, and expressive suppression of emotions.