Sleep Quality between Nurses and the General Population during the COVID-19 Pandemic in Portugal: What Are the Differences?

Although several studies have described the impact of the COVID-19 pandemic, particularly on sleep quality, there are few studies that, in the same time period and using the same assessment tools, compare sleep quality and mental health status between nurses and the general population. Thus, the aim of this study was to (a) examine whether there were differences between nurses and the general population regarding sleep quality and mental health status during the COVID-19 pandemic and (b) identify which factors may explain sleep quality during the COVID-19 pandemic. To do that, we carried out a cross-sectional study in Portugal. Data were collected using an online survey platform during the first COVID-19 wave, from April to August 2020. Nurses presented poorer sleep quality than the general population, as well as higher anxiety levels. Irritability and worries about the future were two of the factors that might explain those differences. Thus, we can conclude that irritability and worries about the future are dimensions of anxiety that were associated with poor sleep quality during the COVID-19 pandemic. Thus, it would be important to adopt regular anxiety and sleep assessments, particularly for nurses, and to implement strategies to reduce this problem.

Workplace Wellbeing and Quality of Life Perceived by Portuguese Nurses during the COVID-19 Pandemic: The Role of Protective Factors and Stressors.

During the COVID-19 pandemic, nurses were exposed to many stressors, which may have been associated with some mental health problems. However, most of the studies carried out on nurses' quality of life and workplace wellbeing during the COVID-19 pandemic took a pathogenic approach. Given that current scientific knowledge in this field presented too many gaps to properly inform preventive and therapeutic action, the aim of this study was to explore whether protective factors (resilience, perceived social support, and professional identification) and stressors (perceived stress and psychosocial risks in the workplace) influenced the quality of life and workplace wellbeing perceived by Portuguese nurses during the COVID-19 pandemic. Data for this cross-sectional study was collected through online self-administered questionnaires. Linear regression models were used to analyze the relationships between variables. Results showed that perceived stress, resilience and job satisfaction were associated with quality of life and workplace wellbeing among Portuguese nurses. The study's findings could serve to inform health policy and should draw the attention of nursing managers to the needs and difficulties reported by nurses, to the importance of providing them with emotional support, and to the relevance of promoting a good work environment.

Positive Mental Health in University Students and Its Relations with Psychological Vulnerability, Mental Health Literacy, and Sociodemographic Characteristics: A Descriptive Correlational Study.

This study aimed to evaluate positive mental health (PMH) and its relation with sociodemographic characteristics, mental health literacy, and the psychological vulnerability scale (PVS) in Portuguese university students aged 17 to 62. A descriptive correlational study was carried out. An online survey was conducted to evaluate demographic variables, and several questionnaires were applied to evaluate positive mental health, psychological vulnerability, and mental health literacy. The data was collected from 1 November 2019 to 1 September 2020. Overall, 3405 students participated in the study. The results show that 67.8% of students revealed a high level of PMH, 31.6% presented a medium level of PMH, and 0.6% had a low level of PMH. Male students reported higher personal satisfaction (t (3170) = -2.39, p = 0.017) and autonomy (t (3170) = -3.33, p = 0.001) in PMH compared to female students. Students without a scholarship scored higher (t (3127) = -2.04, p = 0.42) in PMH than students who held a scholarship. Students who were not displaced from their home reported higher (t (3170) = -1.99, p = 0.047) self-control in PMH than those displaced from their home. University students with higher PMH results had lower PVS results and higher literacy results. The findings of this study will contribute to identifying students' PMH intervention needs.

Patient-Centered Care for People with Depression and Anxiety: An Integrative Review Protocol.

Introduction: Depression and anxiety are mental diseases found worldwide, with the tendency to worsen in the current pandemic period. These illnesses contribute the most to the world's rate of years lived with disability. We aim to identify and synthesize indicators for the care process of the person with depression and/or anxiety disorders, based on patient-centered care, going through the stages of diagnostic assessment, care planning, and intervention. Methods and analysis: An integrative literature review will be conducted, and the research carried out on the following databases: MEDLINE, PsycINFO, Scopus, and Psychology and Behavioral Sciences Collection, CINAHL, Web of Science, TrialRegistry, and MedicLatina. The research strategy contains the following terms MesH or similar: "patient-centered care," "depression," and "anxiety." Two independent revisers will perform the inclusion and exclusion criteria analysis, the quality analysis of the data, and its extraction for synthesis. Disagreements will be resolved by a third revisor. All studies related to diagnostic assessment, care planning, or intervention strategies will be included as long as they focus on care focused on people with depression and anxiety, regardless of the context. Given the plurality of the eligible studies, we used the narrative synthesis method for the analysis of the diagnostic assessment, the care and intervention planning, and the facilitators and barriers. PROSPERO registration number: CRD42021235405.

Impact of COVID-19 outbreak on nurses' mental health: A prospective cohort study.

OBJECTIVES: To evaluate variations in nurses' sleep quality and symptoms of depression, anxiety and stress during the COVID-19 outbreak, and to evaluate whether the presence of potential risk factors influenced these symptoms over time. METHODS: This prospective cohort study surveyed nurses three times - surveying personal factors, working conditions, family dynamics, and attitude towards COVID-19 - between March 31 and May 4, 2020. Nurses' mental health was assessed through Depression Anxiety Stress Scales - short version (DASS-21); their sleep quality was assessed through a 5-point Likert scale question. RESULTS: Nurses' sleep quality and symptoms of depression, anxiety and stress presented a positive variation over the COVID-19 outbreak. The only factors which are directly related to the COVID-19 outbreak and that were associated with the positive variation in nurses' symptoms of depression, anxiety and stress were the fear to infect others and the fear to be infected (higher fear of being infected or to infect someone corresponded to increased symptoms of depression, anxiety and stress). CONCLUSIONS: Although the COVID-19 outbreak seems to have had an immediate impact on nurses' mental health, a psychological adaptation phenomenon was also observed. Future research should focus on assessing nurses' symptoms of depression, anxiety and stress, after the COVID-19 pandemic, in order to compare and contrast the findings with the results of our study.

Sleep and Awakening Quality during COVID-19 Confinement: Complexity and Relevance for Health and Behavior.

OBJECTIVE: The aim of this study was to evaluate sleep and awakening quality (SQ and AQ) during COVID-19 in a large and diversified population in order to identify significant associations and risks in terms of demography, health and health-related behaviors, sleep variables, mental health, and attitudes. METHODS/RESULTS: Online surveys were used for data collection, received from 5479 individuals from the general population, sleep disorder patients, and COVID-involved (medical doctors (MDs) and nurses) and COVID-affected professionals (teachers, psychologists, and dentists). SQ and AQ were worse in adults, females, and high-education subjects. Feeling worse, having economic problems, depression, anxiety, irritability, and a high Calamity Experience Check List (CECL) score during COVID were significantly associated with poor SQ and AQ. Shorter sleep duration, increased latency, poor nutrition, low physical activity, increased mobile and social network use, more negative and less positive attitudes and behaviors were associated with poor AQ. CONCLUSIONS: The SQ logistic regression showed gender, morbidities, CECL, and awakenings as relevant, whereas, for AQ, relevant variables further included age and physical activity. Aiming to have a high stress compliance, each individual should sleep well, have important control of their mood, practice positive behaviors while dismissing negative behaviors and attitudes, practice exercise, have adequate nutrition, and beware of technologies and dependences.

Portuguese Nurses' Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak.

The COVID-19 pandemic has contributed to mental health problems worldwide. Nurses are particularly prone to stress because they directly care for individuals with suspected or confirmed cases of COVID-19. The aims of this study were (a) to explore the association between the mental health promotion strategies used by nurses during the COVID-19 outbreak and their symptoms of depression, anxiety, and stress; (b) to compare the symptoms of depression, anxiety, and stress of mental health nurses to those of non-mental health nurses; and (c) to compare the frequency of use of mental health strategies of mental health nurses to those of non-mental health nurses. A cross-sectional study was conducted with a sample of 821 nurses. Univariate and multivariate regression models were developed to identify potential protective factors of depression, anxiety, and stress. The chi-square test was also used to compare the use of strategies among mental health and non-mental health nurses. Portuguese nurses demonstrated high symptoms of depressive symptoms, stress, and anxiety. Healthy eating, physical activity, rest between shifts, maintaining social contacts, verbalizing feelings/emotions, and spending less time searching for information about COVID-19 were associated with better mental health. Mental health nurses had less depression, anxiety, and stress, and used more strategies to promote mental health than other nurses. We consider it important to promote nurses' mental health literacy by encouraging them to develop skills and strategies aimed at improving their resilience and ability to deal with difficult situations while caring for the population.

Nurses' Mental Health During the Covid-19 Outbreak: A Cross-Sectional Study.

OBJECTIVE: To describe nurses' mental health status during the Covid-19 outbreak and to explore the factors that might accentuate the negative consequences on their mental health. METHODS: We conducted an online survey to evaluate demographic variables, working conditions, family dynamics, and mental health variables in nurses working in healthcare settings, in Portugal, during the Covid-19 outbreak. RESULTS: Portuguese nurses presented higher depression, anxiety and stress levels, when compared to the Portuguese general population, during the outbreak. Overall, nurses who did not consider the quantity and quality of personal protective equipment as adequate presented significantly higher levels of depression, anxiety, and stress. CONCLUSIONS: Our results suggest that nurses' mental health status seems to be particularly affected by the Covid-19 outbreak and that some modifiable elements might accentuate the impacts on their mental health.

The use of mental health promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: A prospective cohort study.

OBJECTIVES: To evaluate and compare nurses' depression, anxiety and stress symptoms at the beginning of the COVID-19 pandemic and after six months; to evaluate and compare the frequency of use of mental health promotion strategies during the same period; and to identify the relationship between the frequency of use of mental health promotion strategies, during the same period, with nurses' depression, anxiety and stress symptoms. METHODS: Data collection was carried out in two moments: at baseline and after six months. An online questionnaire was applied to nurses to assess the frequency of use of some mental health promotion strategies and their depression, anxiety, and stress symptoms (through the Depression Anxiety Stress Scales - short version (DASS-21)). RESULTS: The anxiety and stress symptoms significantly decreased over time. The physical activity increased, and a decrease was observed in the remote social contacts after six months. The stress, anxiety and depression scores were significantly lower in nurses who frequently or always used all strategies compared to participants who never or rarely used them, except for one strategy (rejecting information about COVID-19 from unreliable sources). CONCLUSIONS: Mental health promotion strategies, such as physical activity, relaxation activity, recreational activity, healthy diet, adequate water intake, breaks between work shifts, maintenance of remote social contacts, and verbalization of feelings/emotions, are crucial to reduce nurses' stress, anxiety and depression symptoms during the COVID-19 outbreak.