Stressors faced by healthcare professionals and coping strategies during the early stage of the COVID-19 pandemic in Germany.

BACKGROUND: The COVID-19 pandemic has exerted great pressure on national health systems, which have aimed to ensure comprehensive healthcare at all times. Healthcare professionals working with COVID-19 patients are on the frontline and thereby confronted with enormous demands. Although early reports exist on the psychological impact of the pandemic on frontline medical staff working in Asia, little is known about its impact on healthcare professionals in other countries and across various work sectors. The present cross-sectional, online survey sought to investigate common work stressors among healthcare professionals, their psychological stress as well as coping resources during the pandemic. METHODS: A sample of 575 healthcare professionals (57% male) in three different sectors (hospital, prehospital emergency care, and outpatient service) reported their experiences concerning work and private stressors, psychological stress, and coping strategies between April 17, 2020 and June 5, 2020. To capture pandemic-specific answers, most of the items were adapted or newly developed. Exploratory factor analyses (EFA) were conducted to detect underlying latent factors relating to COVID-specific work stressors. In a next step, the effects of these latent stressors across various work sectors on psychological stress (perceived stress, fatigue, and mood) were examined by means of structural equation models (SEM). To add lived experience to the findings, responses to open-ended questions about healthcare professionals' stressors, effective crisis measures and prevention, and individual coping strategies were coded inductively, and emergent themes were identified. RESULTS: The EFA revealed that the examined work stressors can be grouped into four latent factors: "fear of transmission", "interference of workload with private life", "uncertainty/lack of knowledge", and "concerns about the team". The SEM results showed that "interference of workload with private life" represented the pivotal predictor of psychological stress. "Concerns about the team" had stress-reducing effects. The latent stressors had an equal effect on psychological stress across work sectors. On average, psychological stress levels were moderate, yet differed significantly between sectors (all p < .001); the outpatient group experienced reduced calmness and more stress than the other two sectors, while the prehospital group reported lower fatigue than the other two sectors. The prehospital group reported significantly higher concerns about the team than the hospital group (p < .001). In their reports, healthcare professionals highlighted regulations such as social distancing and the use of compulsory masks, training, experience and knowledge exchange, and social support as effective coping strategies during the pandemic. The hospital group mainly mentioned organizational measures such as visiting bans as effective crisis measures, whereas the prehospital sector most frequently named governmental measures such as contact restrictions. CONCLUSION: The study demonstrated the need for sector-specific crisis measures to effectively address the specific work stressors faced by the outpatient sector in particular. The results on pandemic-specific work stressors reveal that healthcare professionals might benefit from coping strategies that facilitate the utilization of social support. At the workplace, team commitment and knowledge exchange might buffer against adverse psychological stress responses. Schedules during pandemics should give healthcare workers the opportunity to interact with families and friends in ways that facilitate social support outside work. Future studies should investigate cross-sector stressors using a longitudinal design to identify both sector- and time-specific measures. Ultimately, an international comparison of stressors and measures in different sectors of healthcare systems is desirable.

Direct and Stress-Buffering Effects of COVID-19-Related Changes in Exercise Activity on the Well-Being of German Sport Students.

Maintaining or initiating exercise activity in the COVID-19 pandemic may act as a buffer against the observed stress-related deterioration in well-being, with emotion regulation (ER) discussed as a possible moderator. Therefore, the present study investigated the interaction between stress, exercise activity (EA), and ER on mood. In an online survey, 366 German sports science students (56% women, Mage = 23.04, SD = 2.87) reported their stress levels (general and COVID-19-specific), mood (energy, valence, calmness), EA before and during the pandemic, and use of ER strategies in spring 2020. Pandemic-related change in EA was calculated as residual change. Due to gender differences in mental health and EA, the main and interaction effects were tested in twelve hierarchical regression analyses, separately for men and women. Overall, EA significantly decreased during the pandemic and was positively associated with energy in both men and women. ER was positively associated with women's energy, but negatively with all three mood dimensions in men. Only one three-way interaction appeared significant: in the case of high stress, low levels of EA and high use of ER were associated with the greatest deteriorations in energy in men. Our findings suggest that EA may buffer deteriorations in energy in men with high stress and difficulties in ER.

The impact of the COVID-19 pandemic on European police officers: Stress, demands, and coping resources.

PURPOSE: Facing the COVID-19 pandemic, police officers are confronted with various novel challenges, which might place additional strain on officers. This mixed-method study investigated officers' strain over a three-month-period after the lockdown. METHODS: In an online survey, 2567 police officers (77% male) from Austria, Germany, Switzerland, the Netherlands, and Spain participated at three measurement points per country in spring, 2020. Three-level growth curve models assessed changes in strain and its relation to stressor appraisal, emotion regulation, and preparedness through training. To add context to the findings, free response answers about officers' main tasks, stressors, and crisis measures were coded inductively. RESULTS: On average, officers seemed to tolerate the pandemic with slight decreases in strain over time. Despite substantial variance between countries, 66% of the variance occurred between individuals. Sex, work experience, stressor appraisal, emotion regulation, and preparedness significantly predicted strain. Risk of infection and deficient communication emerged as main stressors. Officers' reports allowed to derive implications for governmental, organizational, and individual coping strategies during pandemics. CONCLUSION: Preparing for a pandemic requires three primary paths: 1) enacting unambiguous laws and increasing public compliance through media communication, 2) being logistically prepared, and 3) improving stress regulation skills in police training.

Acute and Chronic Stress in Daily Police Service: A Three-Week N-of-1 Study.

On duty, police officers are exposed to a variety of acute, threatening stress situations and organizational demands. In line with the allostatic load model, the resulting acute and chronic stress might have tremendous consequences for police officers' work performance and psychological and physical health. To date, limited research has been conducted into the underlying biological, dynamic mechanisms of stress in police service. Therefore, this ecological momentary assessment study examined the associations of stress, mood and biological stress markers of a 28-year-old male police officer in a N-of-1 study over three weeks (90 data points). Four times a day (directly after waking up, 30 minutes later, 6 hours later, before going to bed), he answered questions about the perceived stress and mood using a smartphone application. With each data entry, he collected saliva samples for the later assessment of salivary cortisol (sCort) and alpha-amylase (sAA). In addition, data was collected after six police incidents during duty. sCort and sAA were not related to perceived stress in daily life and did not increase in police incidents. Regarding mood measures, deterioration of calmness, but not valence and energy was associated with perceived stress. The results suggest continued police service to constitute a major chronic stressor resulting in an inability to mount a proper response to further acute stress. As an indicator of allostatic load, psychological and biological hyporesponsivity in moments of stress may have negative consequences for police officers' health and behavior in critical situations that require optimal performance. Prospectively, this research design may also become relevant when evaluating the efficacy of individualized stress management interventions in police training.

Wrist-Worn Wearables for Monitoring Heart Rate and Energy Expenditure While Sitting or Performing Light-to-Vigorous Physical Activity: Validation Study.

BACKGROUND: Physical activity reduces the incidences of noncommunicable diseases, obesity, and mortality, but an inactive lifestyle is becoming increasingly common. Innovative approaches to monitor and promote physical activity are warranted. While individual monitoring of physical activity aids in the design of effective interventions to enhance physical activity, a basic prerequisite is that the monitoring devices exhibit high validity. OBJECTIVE: Our goal was to assess the validity of monitoring heart rate (HR) and energy expenditure (EE) while sitting or performing light-to-vigorous physical activity with 4 popular wrist-worn wearables (Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa). METHODS: While wearing the 4 different wearables, 25 individuals performed 5 minutes each of sitting, walking, and running at different velocities (ie, 1.1 m/s, 1.9 m/s, 2.7 m/s, 3.6 m/s, and 4.1 m/s), as well as intermittent sprints. HR and EE were compared to common criterion measures: Polar-H7 chest belt for HR and indirect calorimetry for EE. RESULTS: While monitoring HR at different exercise intensities, the standardized typical errors of the estimates were 0.09-0.62, 0.13-0.88, 0.62-1.24, and 0.47-1.94 for the Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, respectively. Depending on exercise intensity, the corresponding coefficients of variation were 0.9%-4.3%, 2.2%-6.7%, 2.9%-9.2%, and 4.1%-19.1%, respectively, for the 4 wearables. While monitoring EE at different exercise intensities, the standardized typical errors of the estimates were 0.34-1.84, 0.32-1.33, 0.46-4.86, and 0.41-1.65 for the Apple Watch Series 4, Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, respectively. Depending on exercise intensity, the corresponding coefficients of variation were 13.5%-27.1%, 16.3%-28.0%, 15.9%-34.5%, and 8.0%-32.3%, respectively. CONCLUSIONS: The Apple Watch Series 4 provides the highest validity (ie, smallest error rates) when measuring HR while sitting or performing light-to-vigorous physical activity, followed by the Polar Vantage V, Garmin Fenix 5, and Fitbit Versa, in that order. The Apple Watch Series 4 and Polar Vantage V are suitable for valid HR measurements at the intensities tested, but HR data provided by the Garmin Fenix 5 and Fitbit Versa should be interpreted with caution due to higher error rates at certain intensities. None of the 4 wrist-worn wearables should be employed to monitor EE at the intensities and durations tested.

Heidelberg Risk Sport-Specific Stress Test: A Paradigm to Investigate the Risk Sport-Specific Psycho-Physiological Arousal.

In risk sports with medium to high risks of injury (e.g., surfing, free solo climbing, wingsuit flying), athletes frequently find themselves in unexpected and threatening situations. Elevated psycho-physiological stress responses to these situations might have tremendous consequences for their performance as well as for their long-term health. To gain a better understanding of the psycho-physiological response to such events, innovative, externally valid and standardized stress induction protocols are needed. Therefore, the aim of this paper is to introduce and evaluate a risk sport-specific stress protocol, i.e., the Heidelberg Risk Sport-Specific Stress Test (HRSST), which utilizes fear of falling as the stressful event. Climbing novices were asked to climb up a 12 m high wall. Then, participants were requested to "jump into the rope", leading to a secured fall of about 3 m. This imposed physical danger assumed to elicit psycho-physiological responses. Self-reported state anxiety, salivary cortisol, and heart rate/heart rate variability were measured before, during, and after the HRSST. Results of four independent studies that investigated the psycho-physiological response to the HRSST in 214 participants were analyzed, leading to conclusions about the stressor's effectiveness. Results showed that self-reported state anxiety consistently increased after the HRSST in all four experiments (moderate to large effects). The results of the physiological indicators were inconclusive. Salivary cortisol significantly increased after the HRSST in one of four experiments (small effect sizes). Although heart rate significantly increased during the "jump in the rope" in experiment 1, heart rate variability significantly decreased after the HRSST in only one of three experiments (small effect sizes). Findings suggest that the HRSST is a valid method to induce risk sport-specific emotional stress, but effects on physiological stress markers were rather minor. To sum up, in case of appropriate sports climbing facilities, the HRSST appears to be a cost-efficient and promising stress induction protocol: It offers the possibility to investigate risk sport-specific stress responses and their underlying mechanisms in climbing novices. These findings may also find application in professions in which individuals are exposed to risky situations, such as police officers, medical first responders, firefighters and military personnel.

Mindful Sensation Seeking: An Examination of the Protective Influence of Selected Personality Traits on Risk Sport-Specific Stress.

Stress often has a negative influence on sports performance. Stress-induced decreases in performance can be especially disastrous for risk sports athletes, who often put their life at risk when practicing their sport. Therefore, it is of great importance to identify protective factors in stressful situations in risk sports. On average, risk sports athletes score extremely high on the personality trait sensation seeking. At the same time, theoretical considerations about dispositional mindfulness suggest that mindful athletes can handle stress more effectively. The main goal of this experiment is to examine the influence of sensation seeking and mindfulness on the stress response to a risk sport-specific stressor. To induce stress, 88 male students completed the Heidelberg Risk Sport-Specific Stress Test (HRSST) which utilizes fear of falling as the stressful event during a climbing exercise. Psychological (anxiety) and physiological (cortisol) responses were measured at multiple time points before and after the HRSST to determine the severity of the stress response. In reaction to the stressor, a significant increase in self-reported state anxiety, but no significant increase in cortisol were observed. The mindfulness subscale external observation correlated positively with anxiety in the climbing wall, sensation seeking and the anxiety scales after the jump correlated negatively and sensation seeking predicted anxiety subscales after the jump in hierarchical regression analyses. However, mindfulness did not predict anxiety measures. Neither sensation seeking nor mindfulness correlated significantly with cortisol levels. The results suggest that high sensation seekers perceive a risk sport-specific stressor as less stressful. The missing physiological response might be explained by the Cross-Stressor-Adaptation-Hypothesis and particularities of the sample. Good internal observers might be especially aware of their need of stimulation and new experiences, which in turn might explain the higher experience-seeking scores. Future studies should further examine the role of mindfulness in stressful situations and the interaction of its subscales with sensation seeking. The current experiment offers new possibilities for adjoining research fields at the interface between sports sciences, psychology and medicine: The findings can be transferred to high risk professions such as police officers, firefighters and military forces (e.g., for selection processes or for interventions).

Effects of Coping-Related Traits and Psychophysiological Stress Responses on Police Recruits' Shooting Behavior in Reality-Based Scenarios.

Police officers are often required to perform under high-stress circumstances, in which optimal task performance is crucial for their and the bystanders' physical integrity. However, stress responses, particularly anxiety and increased cortisol levels, shift attention from goal-directed to stimulus-driven control, leaving police officers with poor shooting performance under stress. Cardiac vagal activity and coping-related traits (i.e., self-control, sensation seeking) might help individuals to maintain performance under stress. So far, only few studies have integrated coping-related traits, psychophysiological stress markers and occupationally meaningful measures of behavior to investigate police officers' work performance under stress. Therefore, the present study investigated 19 police recruits (M age = 22.84, SD = 3.30) undergoing a reality-based shooting scenario in two experimental conditions in a within-design: low stress (LS) against a non-threatening mannequin, and high stress (HS), involving physical threat by an opponent. Psychological (i.e., anxiety, mental effort) and physiological stress responses (i.e., salivary cortisol, alpha-amylase, cardiac vagal activity) as well as shooting accuracy were repeatedly assessed. It was hypothesized that under stress, police recruits would demonstrate elevated psychophysiological stress responses and impaired shooting performance. Elevated psychophysiological stress responses would negatively influence shooting performance, whereas self-control, sensation seeking and cardiac vagal activity would positively influence shooting performance. While recruits reported significantly higher anxiety and mental effort in the HS scenario, both scenarios elicited comparable physiological responses. Overall, shooting accuracy was low and did not significantly decrease in the HS scenario. Shooting performance was predicted by self-control in the LS scenario and by post-task cardiac vagal activity in the HS scenario. While increased anxiety hints at a successful stress manipulation, physiological responses suggest similar stress levels for both scenarios, diminishing potential behavioral differences between the scenarios. Performance efficiency decreased under stress, as indicated by increasing mental effort. Findings on self-control suggest that suppressing negative stress responses might lead to impaired goal-directed attention, resulting in performance decrements. For police research and training, high-realism scenarios afford an opportunity to investigate and experience psychophysiological stress responses.

Cortisol and behavioral reaction of low and high sensation seekers differ in responding to a sport-specific stressor.

BACKGROUND/OBJECTIVES: Sensation seeking is closely related to practicing high-risk sports. This domain offers individuals an opportunity to achieve an increased level of arousal. Moreover, stress reactivity implies interindividual differences in the capacity to respond to a stressor. The purpose of this study was to examine whether high sensation seekers (HSS) compared to low sensation seekers (LSS) experience lower levels of stress on a physiological and psychological basis. Stress was induced in a sport-specific experimental paradigm with a climbing task through a jump into the rope. METHODS: Two extreme groups (n = 28 male athletes) were examined in a mixed-factorial design (between: HSS vs. LSS; within: repeated measurements of several variables related to stress reactivity - cortisol, heart rate, anxiety). RESULTS: In response to the stressor HSS compared to LSS released a significantly lower amount of cortisol and needed less time for the climbing task. Heart rate and anxiety were not significant. CONCLUSIONS: Individuals seem to react physiologically differently to a sport-specific stressor, depending on their level of sensation seeking. HSS seem to be less strained, and seem to perform better. These findings might be relevant not only for the evaluation of (sport-) psychological interventions but also for other contexts (e.g., special forces).