Protective factors against depressive symptoms among Brazilian healthcare workers during the initial stages of the COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: This study aims to assess the prevalence of depressive symptoms among healthcare workers and possible factors associated with this outcome (resilience, spirituality, social support, quality of life, among other individual variables). Our hypothesis is that some of these factors can have a protective effect on depressive symptoms. DESIGN: Web-based cross-sectional survey. SETTING: Participants were recruited online from 16 April to 23 April 2020. PARTICIPANTS: 1043 healthcare workers, predominantly Brazilians, aged 18 years or older. PRIMARY AND SECONDARY OUTCOME MEASURES: Depression was the primary outcome, measured using the Patient Health Questionnaire-9 (PHQ-9). Possible protective factors were measured in the following ways: social support was assessed by the modified Medical Outcomes Study Social Support Survey (mMOS-SS); spirituality, religiousness and personal beliefs (SRPB) were evaluated using the 9-item SRPB module of the brief WHO Quality of Life instrument (WHOQoL-SRPB-bref); quality of life was assessed using the brief EUROHIS instrument for Quality of Life (EUROHIS-QoL 8-item); resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC 10). RESULTS: 23% met the criteria for depression according to the PHQ-9 scale. Quality of life (B=-3.87 (-4.30 to -3.43), ß=-0.37, p<0.001), social support (B=-0.32 (-0.59 to -0.05), ß=-0.04, p=0.022), resilience (B=-0.19 (-0.23 to -0.15), ß=-0.20, p<0.001), SRPB (B=-0.03 (-0.05 to -0.02), ß=-0.01, p<0.001) and physical exercise (B=-0.95 (-1.40 to -0.51), ß=-0.08, p<0.001) demonstrated protective effects against depression. CONCLUSION: Healthcare workers have a high risk of developing depressive symptoms during the COVID-19 pandemic, especially those working in the front line. However, there are factors that seem to work as protective mechanisms against depression, notably perceived quality of life.

Distress and resilience of healthcare professionals during the COVID-19 pandemic (DARVID): study protocol for a mixed-methods research project.

INTRODUCTION: The unprecedented COVID-19 pandemic has exposed healthcare professionals (HCPs) to exceptional situations that can lead to increased anxiety (ie, infection anxiety and perceived vulnerability), traumatic stress and depression. We will investigate the development of these psychological disturbances in HCPs at the treatment front line and second line during the COVID-19 pandemic over a 12-month period in different countries. Additionally, we will explore whether personal resilience factors and a work-related sense of coherence influence the development of mental health problems in HCPs. METHODS AND ANALYSIS: We plan to carry out a sequential qualitative-quantitative mixed-methods design study. The quantitative phase consists of a longitudinal online survey based on six validated questionnaires, to be completed at three points in time. A qualitative analysis will follow at the end of the pandemic to comprise at least nine semistructured interviews. The a priori sample size for the survey will be a minimum of 160 participants, which we will extend to 400, to compensate for dropout. Recruitment into the study will be through personal invitations and the 'snowballing' sampling technique. Hierarchical linear regression combined with qualitative data analysis, will facilitate greater understanding of any associations between resilience and mental health issues in HCPs during pandemics. ETHICS AND DISSEMINATION: The study participants will provide electronic informed consent. All recorded data will be stored on a secured research server at the study site, which will only be accessible to the investigators. The Bern Cantonal Ethics Committee has waiv ed the need for ethical approval (Req-2020-00355, 1 April 2020). There are no ethical, legal or security issues regarding the data collection, processing, storage and dissemination in this project. TRIAL REGISTRATION NUMBER: ISRCTN13694948.