Resilience in alcohol use disorder: associations with negative and positive emotionality, quality of life, and disorder severity

In previous work looking at individuals exposed to childhood trauma, we have found that decreased neuroticism, impulsivity, and trait anxiety, and increased conscientiousness are associated with a decreased risk of alcohol use disorder (AUD), suggesting these characteristics contribute to a relative resilience to alcohol misuse. In the current study we confirm and expand on these findings using the Connor-Davidson Resilience Scale (CD-RISC), which assesses resilience based on individual characteristics and coping mechanisms as well as social relationships. We analyzed CD-RISC data from two NIAAA protocols: 1) the Natural History Protocol (NHP) (n = 245;156 with AUD, 89 without AUD);2) the COVID-19 Pandemic Impact on Alcohol Protocol (C19PIA) (n = 280;77 with AUD, 203 without AUD). Participants ranged from non-drinking healthy volunteers to heavy drinkers. In addition to the CD-RISC, assessments included the Structured Clinical Interview for DSM-5 disorders, and questionnaires related to problematic alcohol use, positive and negative affect, personality, perceived stress, and quality of life (i.e., physical health, psychological health, social relationships, and environment). Data analysis was conducted using general linear models, and analyses were run separately for the two independent samples due to differences in data collection methodology. For the C19PIA protocol sample, analyses were conducted on measures collected both pre-pandemic and during the pandemic. In both the NHP and C19PIA samples, CD-RISC score was negatively associated with neuroticism, negative affect, and perceived stress, and positively associated with extraversion, conscientiousness, positive affect, and all four quality of life measures. In the C19PIA sample, these results were consistent for analyses of both pre-pandemic and pandemic-associated measures. CD-RISC score was lower in individuals with AUD compared to those without AUD. In the NHP sample, which was enriched for individuals with AUD, greater resilience was associated with decreased AUD severity, and decreased anxiety and depression symptoms, among those diagnosed with AUD. A similar association between resilience and decreased AUD severity was observed in the C19PIA sample before the pandemic. Resilience was also associated with a reduction in impaired control over drinking in the C19PIA sample, both before and during the pandemic. The current findings highlight resilience as a key construct associated with multiple factors at the individual, social, and environmental levels. Of note, the same resilience-associated factors were observed both before and during the COVID 19 pandemic, with the latter representing a major stressor for many individuals. The finding that greater resilience is associated with decreased disorder severity and reduced depression and anxiety symptoms among those with AUD highlights the potential of resilience-oriented approaches to treatment. These approaches, often promoted for trauma-exposed individuals, could also prove beneficial for alcohol use disorder.Copyright © 2023

Mediating role of resilience in relationship between occupational stress and depression of staff of centers for disease control and prevention.

[Background] Since the outbreak of the COVID-19 epidemic, staff of the centers for disease control and prevention (CDC) have been burdened with heavy epidemic prevention control, and excessive occupational stress can cause depression and other psychological problems. [Objective] To explore the status of occupational stress, resilience, and depression of CDC staff and potential relationships between them. [Methods] From December 2020 to April 2021, a survey was conducted at provincial and municipal levels, and the stratified cluster sampling method was used at county (district) level to select a total of 3 514 samples. Their occupational stress, resilience, and depression status were evaluated using the Chinese Effort-Reward Imbalance Scale (ERI), the Chinese Connor-Davidson Resilience Scale (CD-RISC), and the Patient Health Questionnaire (PHQ-9). Independent sample t test, analysis of variance, chi2 test, Pearson correlation analysis, and mediation test (structural equation model) were conducted. [Results] The positive rate of occupational stress was 34.29% in the CDC staff, the resilience score was 66.28+/-15.32, and the positive rate of depression was 48.58%. Significant differences were found in the positive rates of occupational stress among different groups of gender, age, education background, marital status, administrative duty, weekly exercise frequency, chronic disease prevalence, and participation in epidemic control (P < 0.05);in the resilience scores among different groups of gender, age, administrative duty, weekly exercise frequency, chronic disease prevalence, and participation in epidemic control (P < 0.05);in the positive rates of depression among different groups of gender, age, educational background, personal monthly income, weekly exercise frequency, chronic disease prevalence, and participation in epidemic control (P < 0.05). Occupational stress was negatively correlated with resilience (r=-0.165, P < 0.01). Resilience was negatively correlated with depression (r=-0.383, P < 0.01). Occupational stress was positively correlated with depression (r=0.343, P < 0.01). The structural equation embracing a partial mediating effect of resilience on the relationship occupational stress and depression was established, and the partial mediating effect was 0.039, accounting for 10.46% of the total effect. [Conclusion] High positive rates of occupational stress, reduced resilience, and depression are shown among CDC staff in the context of the COVID-19 epidemic, and resilience partially mediates the effect of occupational stress on depression. The study findings suggest that improving resilience may reduce occupational stress and depression in CDC staff.Copyright © 2022, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.

The Effect of Social Capital on the Mental Health of the University Students During the COVID-19 Pandemic With the Mediation of the Resilience Variable

Background: This research was conducted to evaluate the effect of social capital on thstudent's mental health with the mediation of resilience during the COVID-19 pandemi Materials and Methods: The research is based on the objective criterion in the applied research group and the data collection method criterion in the survey research group. The statistical population includes the students of the state universities of Tehran and Islamic Azad University Science and Research Branch. The sample size was estimated to be 427 people using SPSS SamplePower software. The share of each university was determined by proportional stratified sampling, and then the samples from each stratum were selected by a simple random method. SPSS and AMOS software was used to analyze the data. Results: To investigate the hypotheses, we used the 1-sample t-test, the Pearson correlation, multiple regression analysis, and the structural equation model. According to research, social capital has a significant effect on the resilience and mental health of students, considering that the indirect effect of social capital (through resilience) on mental health has also become significant;therefore resilience variable has a mediating role between social capital and mental health variables. The age variable has a positive and significant relationship with all three variables of social capital, resilience, and mental health, so the variables above increase with age. Conclusion: Considering the importance of social capital, society members can improve their resilience by developing communication networks and being aware of critical conditions to suffer the least psychological and social damage in this pandemic. © 2022, Negah Institute for Scientific Communication. All rights reserved.

To Compare The Coping Strategies, Emotional Reactions, Burnout And Resilience In Doctors Caring And Not Caring For Covid19 Patients

Background: Rapid transmission of novel coronavirus (COVID-19) causing severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) occurred all across the world in few months causing a pandemic. Frontline medical staff as a result of heavy workload, insufficient protective equipment, a lack of information of the pathogen, and direct contact with patients faced the fear of getting infected themselves and their family. Anxiety, stress, and other negative emotions have led to a series of psychological crises in them. Aim(s): To compare the coping strategies, emotional reactions, burnout and resilience in doctors caring and not caring for COVID19 patients. Materials And Methods: Total 304 Doctors in tertiary care hospitals out of which 163 were caring and 141 were not caring for COVID19 patients participated in our study. Both groups were assessing and compared using The Fear of COVID-19 Scale, the coronavirus anxiety scale (CAS), Patient Health Questionnaire-2 (PHQ-2), Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief COPE, Connor-Davidson Resilience Scale abbreviated, Abbreviated Maslach Burnout Inventory, Two-Item Conjoint Screen (TICS) Results: All participants those who did COVID duty and those who did not do it showed high level of resilience though on comparison no significant different was found between two groups. Those who did not do COVID duty were scored higher in emotion focused coping strategies whereas who did not do COVID duty scored higher in avoidant coping strategies. Abbreviated version of Maslach Burnout Inventory indicated a great personal accomplishment, less depersonalization and low emotional exhaustion in all the participants irrespective of their duty status. Conclusion(s): On comparing those who did COVID duties against those who haven't, it was found that those who did not do COVID duty used more emotion-focused ways to cope and those who were doing COVID duties were using harmful avoidant coping to manage their daily chores. All the doctors participating in study showed high resilience irrespective of whether they did COVID duty or not.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Psychometric evaluation of the Connor-Davidson Resilience Scale among Iranian population.

BACKGROUND: The resilience construct is considered a personal trait composed of multiple aspects. Connor-Davidson Resilience Scale is a standard tool composed of five factors and 25 items. This study aimed to determine the psychometric properties of this scale. METHODS: In this cross-sectional study, after the scale translation, the factorial structural validity was assessed via the confirmatory factor analysis with 70 180 samples. Internal consistency, composite reliability, convergent validity were assessed by calculating Cronbach's alpha, composite reliability, maximum reliability, and Average Variance Extracted. The discriminant validity was assessed using Heterotrait-monotrait ratio of correlations matrix and also, measure invariance was evaluated. RESULTS: The original five-factor model had good model fit indices but due to low factor loading of item 2 and 20, the model was modified. The Cronbach's alpha and composite reliability for four factors were above 0.7 (except for factor 5). The convergent validity for all five factors were achieved. Between factors 1 with 2 and 4, 2 with 3 and 4 discriminant validity was not established (correlations > 0.9) and the results suggested that there might be a second-order latent construct behind these factors. Therefore, a second-order assessment was performed. The results of the second-order latent construct assessment showed a good goodness-of fit and strong measurement invariance for both men and women. CONCLUSION: The 23-item version of Connor-Davidson Resilience Scale is a reliable and valid scale to measure resilience as a complex construct in the Iran context.

Quality of life and intrinsic capacity in patients with post-acute COVID-19 syndrome is in relation to frailty and resilience phenotypes

Background. The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC). Methods. This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: 'fit/resilient', 'fit/non-resilient', 'frail/resilient' and 'frail/non-resilient'. Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions. Results. 232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Table 1 shows demographic, anthropometric and clinical characteristics, comorbidities and patient-reported outcomes according to four frailty-resilience phenotypes. With regards to study outcomes, Figure 1 depicts in radar graphs, mean scores of each domain of SF-36 (1A), EQ-5D5L (1B) and IC (1C). Figures shows polygon areas for each frailty/resilience phenotypes. Progressive increase of mean scores of each domain are plotted in the vertices of polygons, from the lowest (near the center) in frail and non-resilient, to highest (towards periphery) in fit and resilient. Multivariate logistic analyses were used to identify predictors of the total scores of SF-36 (Figure 2A), EQ-5D5L (Figure 2B) and IC (Figure 2C). Conclusion. Resilience is complementary to frailty in the identification of clinical phenotypes with different impact on wellness and QoL. Frailty and resilience should be evaluated in hospitalized COVID-19 patients to identify vulnerable individuals to prioritize urgent health interventions in people with PACS. Funding. This study is supported by a Gilead Sciences Inc. unrestricted grant.

Effect of Online Balint Group and Pharmacotherapy on COVID-19 Anxiety in Iranian Healthcare Workers: A Randomized Controlled Trial

Background: Anxiety persists following coronavirus disease 2019 (COVID-19) and has caused dysfunction. Objective(s): We compared the effect of the online Balint group and pharmacotherapy on COVID-19-induced anxiety in Iranian health-care workers (HCWs). Method(s): In the current clinical trial in the north of Iran in 2021, the participants were randomly assigned to two groups, including the Balint group (eight 60-minute online sessions) and the pharmacotherapy group (sertraline), following a phone screening pro-cedure by a psychiatrist. The groups filled out two questionnaires, namely the Connor-Davidson Resilience Scale and Corona Disease Anxiety Scale, at baseline and after the intervention (fourth week). Result(s): Forty-five HCWs were assessed. There was a significant difference in total anxiety score and also in sub-component in each group (P <= 0.001). No significant differences were observed regarding the effectiveness of both interventions in anxiety (P = 0.52);however, the pharmacotherapy interventions significantly affected the resilience and related subscales (P <= 0.05). The domain of spiritual influences significantly increased in the pharmacotherapy group (P = 0.031). Conclusion(s): Balint group and pharmacotherapy can improve COVID-19-induced anxiety and boost resilience in HCWs. Copyright © 2022, Author(s).

The Relationship between Anxiety, Resilience, and Posttraumatic Growth of the Medical Students in COVID-19 Pandemic in Iran

Background: Medical students serve as frontline individuals to COVD-19 patients, and their mental health affects the quality and safety of the provided services. Objective(s): The present study aimed to identify the relationship between anxiety, resilience, and posttraumatic growth of medical interns during COVID-19 pandemic. Method(s): This descriptive-correlational study was conducted in Kerman and Isfahan, Iran, from June to September 2020. The socio-demographic questionnaire, Beck Anxiety Inventory (BAI), Connor-Davidson Resilience Scale (CD-RIS), and Posttraumatic Growth Inventory (PTGI) were completed by 235 medical students. Pearson correlation test and descriptive statistics were used to analyze the data. Result(s): The mean and standard deviation scores of anxiety, resilience, and posttraumatic growth were 10.49, 1.08, and 50.60, as well as 13.39, 65.70, and 15.90, respectively. The results showed no significant relationship between anxiety and resilience (r = 0.16 and P = 0.057). A positive and significant correlation was observed between resilience and posttraumatic growth (r = 0.42 and P = 0.000). Furthermore, a significant negative correlation was found between anxiety and posttraumatic growth scores (r =-0.20 and P = 0.002). Conclusion(s): In sum, the more resilient and less anxious a person was, the greater his/her posttraumatic growth became. Therefore, it was recommended that appropriate psychological interventions be designed and implemented to improve the mental health of medical interns. Copyright © 2022, Author(s).

Psychological resilience and anxiety in response to COVID-19

Introduction: In Romania, the first case of COVID-19 was detected on 26 February 2020 and the number of cases has been rising afterward. Objective(s): The goal of this study was to assess anxiety and resilience regarding the COVID-19 pandemic and to analyse possible protective measures and risk factors. Method(s): This is a cross-sectional study and data were collected March and April 2021. Participants filled in the Zung Self-Rating Anxiety Scale and the Connor-Davidson Resilience Scale. Result(s): The sample consisted of 440 participants who presented to the general practitioner (female-65.7%) and the most representative age group was 35-64 years old;18.4% of the participants stated that they were infected;56.6% reported that they do not know anyone in their entourage who was infected/ has died of COVID- 19 (group A), 32.9% knowing people with an infection in their close social environment (group B) and 10.5% had close people who died (group C). Almost half of the respondents (49,3%) scored above the cut-off point of the anxiety index (mild 38.6%, moderate 9.9%, severe 0.8%). As we expected, there is a strong negative correlation between anxiety levels and resilience (Pearson Correlation=-.551, p<0.01). If groups A and B had similarities regarding anxiety levels (44.97 and 44.23), those knowing someone who died of COVID-19 (group C) had a higher anxiety level (47.81%) (p<0.05). Conclusion(s): The recent COVID-19 pandemic has caused an understandable surge in anxiety among the general population. Low level of resilience is predictive of the phenomenon of having high anxiety in the face of the death of others.

Resilience And Coping: The Chicken and The Egg Paradox

Introduction: Since the outbreak of the 2019 coronavirus, healthcare workers found themselves on the front lines of an unprecedented battle. Being characterized by adversity, this experience represents a fertile ground for the study of resilience. Objective(s): Our study aims to clarify the phenomenon of resilience through its influence on perceived stress level and its connection with coping strategies. Method(s): A cross-sectional study was conducted involving 254 healthcare professionals in the region of Sousse during the pandemic. In addition to socio-demographic and professional characteristics, Resilience, perceived stress, and coping strategies were assessed using the Connor-Davidson Resilience Scale (CD-RISC), the PSS10 scale, and the Brief Cope questionnaire, respectively. Result(s): The overall mean [+/-standard deviation (SD)] age of the participants was 32.9 +/- 8.76 years with a sex ratio (M / F) of 0.51. The assessment of resilience among participants revealed a mean score of 64.99 +/- 14.72. The majority of participants evinced a score> 50 (82.68%) and 39.76% had a score >70. Our results revealed that, on the one hand, problem-focused coping strategies were positive predictors of resilience (p<10-3), accounting for 3.6% of its variance. On the other hand, coping strategies (problemfocused strategies and avoidance strategies) are also an integral part of the process by which resilience significantly influences the level of perceived stress (mediating factor). Conclusion(s): Despite its complexity, the relationship between resilience and coping strategies is undeniable and it is a part of an important line of intervention opening the way to better identifications and care.

Psychological first aid intervention: rescue from psychological distress and improving the pre-licensure nursing students' resilience amidst COVID-19 crisis and beyond.

Background: The public health emergencies such as the COVID-19 pandemic resulted in mental and psychological ramifications on the healthcare professionals. The pre-licensure nursing students found themselves not only fighting against the baneful virus but also weak ego resilience. At this point, enriching the pre-licensure nursing students with psychological first aid (PFA) could help them to recover from the feeling of psychological distress and improve their resilience capacity to encounter any upcoming outbreaks. Methods: A quasi-experimental two groups, a pre-post-test study was used in which sixty-four pre-licensure nursing students completed a baseline survey which revealed high levels of psychological distress and low resilience capacity due to the COVID-19 crisis. The study group engaged in the Psychological First- aid Intervention (PFA) at the end of the clinical practicum course period, while the comparison group received routine psychological support. Results: A significant reduction in the psychological distress levels among students in the PFA group (FET=7.83, P = 0. 001). Likewise, significant improvements in the students' resilience capacity level immediately after the intervention (FET=3.34, P = 0.019) and during the two-month follow-up (FET=12.94, P = 0. 001). The implementation of PFA enhanced the pre-licensure nursing students' psychological health status and resilience capacity levels after their clinical training amid the ambiance of the COVID-19 crisis. Conclusion: The PFA effectively fostered the pre-licensure nursing students' recovery from the COVID-19 related- psychological distress and improve their resilience capacity. The application of RAPID model is recommended to reduce stress and prevent burnout among novice and future nurses who show signs of psychological exhaustion.

Resilience, Quality of life, and Wellbeing in intensive care survivors of Covid-19 critical illness

Introduction: The negative impact of Post-Intensive Care Syndrome on the quality of life of critical illness survivors has previously been well characterised.1 Survivors of Covid-19 critical illness are a relatively new cohort in terms of younger age and less prior comorbidity.2 The healthrelated quality of life, psychological problems, resilience, or wellbeing of survivors of Covid-19 critical illness have not been fully explored. Objectives: To characterise the resilience, wellbeing, selfefficacy, and quality of life of ICU-survivors, who were admitted with Covid-19, 6-9 months post-hospital discharge. To explore any potential associations with baseline characteristics. Methods: This was a prospective follow-up study of ICUsurvivor patients who were admitted with Covid-19 and discharged alive from the Royal Infirmary Edinburgh or St John's Hospital, Scotland. Eligible patients were identified by 2 specialist research nurses from the medical records and were contacted via telephone for consent. Paper copies of the questionnaire pack were posted to patients who consented. Demographic characteristics were captured from WardWatcher IT system (age, sex, length of ICU stay). 2 investigators telephoned participants to complete the questionnaires. Outcomes measured were: resilience, using the 10-item Connor-Davidson Resilience Scale (CDRISC), self-efficacy, using the General Self-Efficacy (GSE) Scale, overall health state, using The EuroQol EQ5D-5L Health Questionnaire, and Wellbeing, using 6 10-point visual analogue scales. Statistical analysis was conducted using R-Studio. Associations were tested with Fisher's exact test for categorical variables, and Kruskal-Wallis for continuous variables. Statistical significance was accepted at p<=0.05. Results: Of the 52 eligible patients consented to be contacted, 40 (76.9%) completed the questionnaires. 59.6% (31/52) were male;median age was 59.0 (IQR:53.0-66.2), and participants spent median 6.3 (IQR: 4.1-11.0;) days in ICU. Questionnaires were completed median 202 days (IQR:187.5-224.0) from hospital discharge. The median total CDRISC score was 34.5 (IQR: 30.8-38.0), which has previously been defined as normal resilience (27-37/40)3. 12.5% (5/40) and 32.5% (13/40) reported low (<27/40) and high (>=38/40) resilience respectively.3 The median total GSE score was 34.0 (IQR: 30.0-38.0) (international mean: 29.554). For overall health state (EQ5D-5L), the median overall health score was 80.0% (IQR:75.0-81.2), with the results in each domain as follows: Mobility: 27% (11/40) reported moderate or worse problems (with the remainder reporting no problems);Self-care: 10% (4/40) reported moderate or worse problems;Usual activities: 17% (7/40) reported moderate or worse problems;Pain: 17.5% (7/40) reported moderate or worse problems;Anxiety or depression: 17.5% (7/40) reported moderate or worse problems. For the wellbeing measures, participants rated 'Overall satisfaction with life as a whole' median 8/10 (IQR: 7-9), and 'I have a sense of direction and purpose in life' median 8/10 (IQR:7-9.5). Resilience, self-efficacy, health-related quality of life, and wellbeing were not significantly associated with age, length of ICU-stay, or time between discharge and questionnaire completion. Conclusion: Overall, ICU-survivors of Covid-19 critical illness reported normal resilience, and high levels of selfefficacy and wellbeing at 6-9 months post-hospital discharge. Many ICU-survivors experienced problems affecting their overall health state, such as with mobility and pain. Future studies are indicated to investigate how to best support ICU-survivors in their recovery.

Impact of a Yogic Breathing Technique on the Well-Being of Healthcare Professionals During the COVID-19 Pandemic

BACKGROUND: The COVID-19 pandemic created unprecedented challenges for healthcare providers (HCPs), resulting in stress-related disorders, insomnia, and burnout. Sudarshan Kriya Yoga (SKY), a mind-body intervention, was explored as a tool to positively impact the wellbeing of HCPs during the pandemic. METHODS: A pilot study with a single-arm pre-/post-assessment follow-up design was conducted. SKY was taught to participants in a 4-day online workshop between the months of April and June, 2020. Outcomes related to depression, anxiety, resilience, life satisfaction, and quality of sleep were measured using the following scales: Depression, Anxiety & Stress Scale, Connor- Davidson Resilience Scale, Satisfaction With Life Scale, and Pittsburgh Sleep Quality Index. RESULTS: Ninety-two patients completed the pre-/post- and 40-day assessments. A significant reduction was noted in the outcomes of stress, anxiety, depression, resilience, life satisfaction, and quality of sleep immediately after the program (P < .001). At 40 days of practice, significant improvements in resilience (P = .015) and life satisfaction (P < .001) were noted. CONCLUSIONS: SKY demonstrated a positive impact on the well-being of HCPs, even during the dire stresses of the pandemic, with improvements observed in both physical and mental health parameters. A significant, immediate reduction in stress, anxiety, and depression was noted. In addition, sustained improvements in quality of sleep, satisfaction with life, and resilience were experienced among those who practiced SKY. Interventions like SKY may serve as prudent low-cost, high-impact, easy-to-implement options for lowering stress and burnout among physicians.

The need for attention to mental health of nursing staff during COVID-19 pandemic as their basic human right

Purpose This purpose of this study was to investigate the role of nurses' resilience as an indicator of their mental health on sick leave absenteeism during the COVID-19 pandemic. Design/methodology/approach This descriptive-analytical study was conducted in 2020 to identify the predictors of absenteeism among 260 nurses working in two training hospitals delivering specialized services in the treatment of COVID-19 patients. Data was collected through the use of standard questionnaires including demographic information, nurses' resilience, intention for job turnover and absenteeism from the workplace. To predict sick leave absenteeism, regression analyses were implemented. Findings Study results revealed that the most influencing features for predicting the probability of taking sick leave among nurses were marital status, tenacity, age, work experience and optimism. Logistic regression also depicted that nurses who had less faith in God or less self-control were more likely to take sick leave. Practical implications The resilience of nurses working in the COVID-19 pandemic was relatively low, which needs careful consideration to apply for organizational support. Main challenge that most of the health systems face include an inadequate supply of nurses which consequently lead to reduced efficiency, poor quality of care and decreased job performance. Thus, hospital managers need to put appropriate managerial interventions into practice, such as building a pleasant and healthy work environment, to improve nurses' resilience in response to heavy workloads and stressful conditions. Originality/value To the best of the authors' knowledge, this is the first study to examine such a relationship, thus contributing findings will provide a clear contribution to nursing management and decision-making processes. Resilience is an important factor for nurses who constantly face challenging situations in a multifaceted health-care system.

Resiliency and its Relationship with Secondary Traumatic Stress among Nursing Staff during COVID-19 Pandemic

Background: Nurses are front-line health-care workers for patients with severe Coronavirus disease (COVID-19) symptoms. The aim of this study was to determine the resiliency of nurses and its relationship with secondary traumatic stress (STS) in pandemic conditions. Methods: This cross-sectional study was performed on 233 nurses working in a medical center providing services to patients with COVID-19 in southeast Iran from May to August 2020. Data were collected using demographic questionnaire, Connor-Davidson Resilience Scale (CD-RISC) and The Secondary Traumatic Stress Scale (STSS). Pearson correlation coefficient was used to determine the relationship between variables and data were analyzed through SPSS22. Results: The mean STS score of nurses was 40.82 ± 11.7. The results showed a significant relationship between STS score and Job satisfaction. The mean score of resilience was 60.91± 17.1 in nurses. The resiliency score showed significant difference based on work experience and exposure to COVID-19 disease. The results of correlation test showed that the overall stress score was significantly related to all aspects of resilience except trust (p < 0.05). Also, based on the multiple regression model, positive acceptance (one of the dimensions of resilience) and exposure to COVID-19 disease were the predictors of STS. Conclusion: The results showed that there is a significant and inverse relationship between resiliency score and STS. Therefore, according to the present conditions, it is recommended to design programs to improve resilience and reduce stress of nurses during COVID-19 pandemic.

Feasibility of virtual stress management and resiliency training (SMART) for oncology fellows during the COVID-19 pandemic

Background: Stress Management and Resiliency Training (SMART) is a validated resilience training program designed to reduce stress, improve emotional resilience, and decrease burnout. The prevalence of burnout among practicing oncologists is as high as 40%, but unknown among oncology trainees. We implemented a virtual format of the SMART program to the Hematology/Oncology fellowship at Mayo Clinic to assess the feasibility of such a delivery, measure baseline rates of burnout in this group, and to investigate if a virtual method of delivery is as effective as in-person delivery as described in the literature. Methods: The SMART project was a mixed-methods, prospective, single arm clinical trial. Hematology/Oncology Fellows at Mayo Clinic were invited to participate. Four one-hour training sessions were conducted virtually. Fellows were given access to SMART online video modules and a book which supported the content covered during virtual training, a companion resilience mobile app, and a paperback mindfulness journal. Stress, burnout, and emotional resilience were measured at baseline and three months post-intervention using the Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), and Connor-Davidson Resilience Scale (CD-RISC2). Changes in mean scores on the PSS, MBI, and CD-RISC2 were assessed using the Wilcoxon signed-rank test. Program feedback and feasibility data were obtained during a virtual focus group. Audio transcripts from the focus group were codified for thematic analysis and verified by intercoder triangulation. A 6-month assessment will be due in March 2022. Results: 26 of 50 fellows invited participated in our study. At baseline, 24% of participants had measurable burnout and 92% had moderate to high stress. At 3-months, the number of participants with moderate to high stress decreased to 71%, while rates of burnout remained unchanged. The PSS demonstrated a decrease in mean stress (-10.9%, p = 0.005), while the MBI demonstrated decreased emotional exhaustion (MBI-EE -6.01%, p = 0.04), an improved sense of personal achievement (MBI-PA 28.1%, p < 0.001), but slightly worse feelings of depersonalization (MBI-DP 16.46%, p = 0.05). The CD-RISC2 suggested no change in global emotional resilience (-0.71%, p = 0.82). Thematic analysis of the focus group data revealed that participants overwhelmingly found the program beneficial (83% of all responses), 20% indicated improved stress, and 15% indicated improved work performance. Conclusions: Oncology fellows in this study had lower rates of burnout compared to practicing oncologists. Virtual implementation of the SMART program is feasible and resulted in improvements in stress and prevented worsened burnout. Outcomes were comparable to previously published studies conducted in-person. Focus group participants found the training beneficial, reported lower stress, and improved work performance.

Analysis of stress predictors during confinement by COVID-19 in Spain

Introduction. Confinement has had a great emotional impact on the population, especially in terms of stress. Fac-tors such as the presence of previous mental or physical ill-ness, resilience or emotional intelligence may influence the occurrence or increase of stress. The aim was to assess pre-dictors of stress by comparing two statistical methodologies (one linear and one non-linear). Method. 802 Spaniards (65.50% women) who completed the questionnaires autonomously after signing the informed consent form participated. Stress (PSPP), COVID-19 threat perception (BIPQ-5), resilience (CD-RISC-10) and emotional intelligence (TMMS-24) were assessed. Descriptive statistics, hierarchical regression (HRM) and fuzzy set comparative qualitative analysis (fsQCA) were conducted. Results. Data obtained by HRM showed that the presence of previous mental illness, low resilience and emotional clari-ty, high emotional alertness and COVID-19 threat perception predicted 51% of the variance in stress. On the other hand, the results of the QCA showed that different combinations of these variables explained 71% of high stress and 56% of low stress. Pointing out how the presence of previous men-tal illness, high resilience, high emotional clarity and repair, low emotional alertness and low COVID-19 threat perception play a key role in explaining stress. Conclusions. These aspects will help to promote personal resources to buffer stress in confinement situations.

IMPLEMENTING VIRTUAL CARE PLANNING WITH RESIDENT/FAMILY: A CANADIAN COVID LONG-TERM CARE EXPERIENCE

Background COVID-19 imposed extreme constraints on Canadian long-term care (LTC) homes, leading to intense isolation for residents, restricted family visits, and staff shortages. Consequently, these challenges negatively impacted the mental and physical health of residents, family, and interdisciplinary workforce in LTC homes. Objectives 1. To describe how two LTC homes addressed promising practices - Presence of family, People in the workforce, and Future COVID-19 and non-COVID-19 care with implementation science. 2. To understand the enablers, barriers and outcomes to the implementation of an innovative re-engineered intervention - P.I.E.C.E.S.™ (PIECES), designed to include families virtually for team-based resident care planning, and empower Registered Practical Nurses (RPNs) to build resilience and wellbeing. Methods An interdisciplinary team (residents and family, nurses, and academic researchers), guided by the Consolidated Framework for Implementation Research, employed a mixedmethod design to investigate implementation processes, determinants, and outcomes. Interviews with residents/families and staff focus groups provided insight into enablers and challenges. Pre- and post-intervention results of the Connor Davidson Resilience Scale, Resilience at Work, and Assessment of Interprofessional Team Collaboration Scale informed understandings of personal, professional and organizational resilience outcomes. Results Findings highlighted how implementation of virtual PIECES helped sustain enhanced person-centered care through more comprehensive, collaborative, efficient and effective teams, leading to better outcomes for residents. Moreover, results suggested improved resilience, wellbeing, and communication between LTC home staff and family. New learnings improved preparedness for future outbreaks. Providing a plan for adapting, embedding, and sustaining the intervention based on implementation science will accelerate the spread of highquality actionable research evidence. Conclusions This is the first study to explore implementation processes of a virtually delivered PIECES intervention with meaningful engagement of multiple stakeholders (residents, family, RPNs). Findings provide evidence supporting important healthcare improvements, future spread of virtual interventions, and practice and policy changes for the LTC home sector.

The North Italian Longitudinal Study Assessing the Mental Health Effects of SARS-CoV-2 Pandemic Health Care Workers-Part II: Structural Validity of Scales Assessing Mental Health.

It is unclear if the factor structure of the questionnaires that were employed by studies addressing the impact of COVID-19 on the mental health of Healthcare Workers (HCW) did not change due to the pandemic. The aim of this study is to assess the factor structure and longitudinal measurement invariance of the Maslach Burnout Inventory (MBI) and the factor structure of the General Health Questionnare-12 (GHQ-12), PTSD Checklist for DSM-5-Short Form (PCL-5-SF), Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Post-Traumatic Growth Inventory-Short Form (PTGI-SF). Out of n = 805 HCWs from a University hospital who responded to a pre-COVID-19 survey, n = 431 were re-assessed after the COVID-19 outbreak. A Confirmatory Factor Analysis (CFA) on the MBI showed adequate fit and good internal consistency only after removal of items 2, 6, 12 and 16. The assumptions of configural and metric longitudinal invariance were met, whereas scalar longitudinal invariance did not hold. CFAs and exploratory bifactor analyses performed using data from the second wave confirmed that the GHQ-12, the PCL-5-SF, the PTGI-SF and the CD-RISC-10 were unidimensional. In conclusion, we found support for a refined version of the MBI. The comparison of mean MBI values in HCWs before and after the pandemic should be interpreted with caution.

CANCER PATIENTS' EXPERIENCE OF CANCER CARE DURING THE COVID-19 PANDEMIC IN THE FRENCHSPEAKING PART OF SWITZERLAND: A MIXED-METHOD STUDY

Introduction Literature on the impact of COVID-19 on cancer patients pointed towards an increase in uncertainty, anxiety, fear and distress. Our aim was to analyze cancer patient-reported experiences through a qualitative approach to identify their potential concerns, needs and resources during the pandemic and to evaluate their levels of distress and resilience. Methods Semi-structured telephone interviews were conducted after the second wave, March to July 2021, with cancer patients from three hospitals in the French-speaking part of Switzerland. Transcripts were analyzed using an iterative thematic analysis approach. Quantitative data included measurement of distress and resilience by the NCCN distress thermometer and the 2-item Connor-Davidson Resilience Scale. Results Patients with lung, breast, colon cancer or melanoma were included (n=35). Mean distress score was 2 (SD=2.1) and mean resilience score was 6.7 (SD=1.3). Thematic analysis highlighted five themes evoking changes in life, concerns, cancer care, resources and vaccination. Conclusions Cancer patients from the French-speaking part of Switzerland reported relatively low distress and high resilience. Nevertheless, interviews revealed COVID-related elements having an influence on patients' lives and trajectory of care. These results allow for a better understanding of the cancer patients' experiences during the COVID-19 pandemic in Switzerland and provide suggestions for better support.