Burnout, moral injury, and suicidal/self-harm ideation among healthcare professionals in Mainland China: Insights from an online survey during the COVID-19 pandemic.

OBJECTIVE: This survey aimed to explore the relationships between burnout, moral injury, and suicidal/self-harm ideation among Chinese health professionals to provide a reference for protecting their mental health. METHOD: Health professionals were surveyed online using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel, Patient Health Questionnaire-9, and the Moral Injury Symptoms Scale-Health Professional. RESULTS: In the analysis, 6146 eligible respondents were included in the study. The average participant age was 34.9 ± 8.5 years, and suicidal/self-harm ideation was detected in 2338 participants (38.0%). The prevalence of suicidal/self-harm ideation among those with severe burnout in the dimensions of emotional exhaustion, depersonalisation, and decreased personal accomplishment was significantly higher than those with mild burnout. The prevalence of suicidal/self-harm ideation among those with significant moral injury symptoms was higher than those without moral injury. Unconditional logistic regression analysis showed that those with moderate or severe emotional exhaustion, moderate or severe reduced sense of professional accomplishment and moderate or severe depersonalisation had increased risks of suicidal/self-harm ideation. CONCLUSIONS: Structural equation modelling demonstrated that burnout significantly mediated the relationship between moral injury and suicidal/self-harm ideation. The proportion of mediation (PM) by burnout was 43.0%. Burnout and moral injury were potential predictors of suicidal/self-harm ideation among health professionals. Both moral injury and burnout had positive and direct effects on suicidal/self-harm ideation, and burnout was a mediator in this relationship among Chinese health professionals. Therefore, to alleviate the moral injury and subsequent burnout of healthcare workers and enhance their mental qualities, active interventions should be developed in the future.

Host preference between symbiotic and aposymbiotic Aphis fabae, by the aphid parasitoid, Lysiphlebus ambiguus.

Few empirical studies have directly explored the association between Buchnera aphidicola (Enterobacteriales: Enterobacteriaceae), the primary endosymbiont of aphids, and the life history strategies of aphid parasitoids. A series of paired-choice experiments were conducted to explore the preference of the parasitoid Lysiphlebus ambiguus Halliday (Hymenoptera: Aphididae) for symbiotic and aposymbiotic Aphis fabae Scopoli (Hemiptera: Aphididae) and the suitability of these hosts for parasitoid development. When given a choice between symbiotic and aposymbiotic aphids of the same instar, the parasitoid significantly preferred symbiotic over aposymbiotic aphids only during the later instars (L(4) and adult). The suitability of aposymbiotic aphids for parasitoid development was equal to that of symbiotic aphids in terms of survivorship and sex ratio, but was significantly lower than that of symbiotic aphids for L(4) and adult instars in development rate and/or female adult size. When given a choice between similar-sized symbiotic L(2) and aposymbiotic L(4) aphids, the parasitoid preferred the former. No significant differences in preference or host suitability were demonstrated when the parasitoid was given a choice between different instars of aposymbiotic aphids. While parasitoid lifetime fecundity increased with aphid instar at the time of oviposition, there was no significant influence of previous development from symbiotic versus aposymbiotic aphids. These results suggest that while L. ambiguus can discriminate between symbiotic and aposymbiotic A. fabae during later instars and when the aphids are of a similar size, the primary endosymbiont is not needed for successful parasitoid development; and its absence only compromises parasitoid growth reared from later instar aposymbiotic host.

Effects of aposymbiotic and symbiotic aphids on parasitoid progeny development and adult oviposition behavior within aphid instars.

This study aims at exploring the potential relationship between aphidiine parasitoid development and the primary endosymbiont in aphids by focusing on specific aphid instars and the relative effects on parasitoid oviposition behavior and progeny development. Lysiphlebus ambiguus (Aphidiidae, Hymenoptera) is a solitary parasitoid of several species of aphids, including Aphis fabae. In this study, A. fabae was treated with antibiotic rifampicin to obtain aposymbiotic hosts and exposed to parasitism. L. ambiguus launched significantly more attacks on symbiotic L(2) (the second instar), aposymbiotic L(3) (the third instar) and L(4) (the forth instar) hosts than on the corresponding hosts at the same age. L. ambiguus also parasitized more L(1) aphids compared with adults irrespective of whether the aphid was asymbiotic or not. Pupa mortality rate of parasitoid progeny was significantly lower from aposymbiotic hosts than from the corresponding symbiotics at all stages. Female-biased parasitoid progeny was produced from aposymbiotic aphids without respect to host ages, but female progeny increased linearly with host ages at parasitism from symbiotic aphids. Body size of parasitoid progeny increased linearly with host instars at parasitism in symbiotic aphids but did not significantly change across host instars in aposymbiotic aphids. The offspring parasitoids turned out to be generally large in body size from attacking aposymbiotic aphids compared with the symbiotics. Development time of egg-to-adult of parasitoid progeny decreased with host instars in both symbiotic and aposymbiotic aphids but was generally much longer in aposymbiotic aphids than in symbiotic aphids. Our study suggests that age or body size of host aphids may not be the only cue exercised by L. ambiguus to evaluate host quality and that offspring parasitoids may be able to compensate for the nutrition stress associated with disruption of primary endosymbiotc bacteria in aposymbiotic aphids.