Effects of COVID-19 stress, proximity, and adverse childhood experiences on healthcare workers' mental health.

Past research has shown that healthcare workers (HCWs) experience high levels of psychological distress during epidemics and pandemics, resulting in cascading effects that have led to chronically understaffed hospitals and healthcare centers. Due to the nature of their responsibilities and workplace stress, HCWs are among vulnerable groups especially during global health crises. During COVID-19 many healthcare workers reported greater symptoms of anxiety, depression, and COVID-19 related worries. Furthermore, adverse childhood experiences increase vulnerability for psychological conditions, especially during pandemics. This study sets out to (1) investigate the moderating effects of adverse childhood experiences on healthcare workers' COVID-19 related stressors and depression/anxiety symptoms, and (2) investigate the moderating effects of adverse childhood experiences on proximity to the COVID-19 virus and depression/anxiety symptoms. Participants included 438 employed HCWs recruited from academic medical centers and smaller healthcare agencies in northcentral Florida between October to December 2020. Mean age of participants was 38.23 (SD = 11.5) with most of the HCWs being white (72.1%), non-Hispanic (86.8%) and female (82%). Healthcare workers completed several online questionnaires, including the Adverse Childhood Experiences scale, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, a COVID-19 specific worries scale, and a Social Proximity to COVID-19 scale. Healthcare workers experiencing specific COVID-19 worries reported experiencing anxiety and depressive symptoms. A significant positive interaction was seen between childhood adverse experiences globally and COVID-19 worries on anxiety symptoms. A significant positive interaction was observed between childhood maltreatment specifically and COVID-19 worries on depressive symptoms. Additionally, a positive interaction effect was seen between childhood adverse experiences and COVID-19 social proximity for both depression symptoms and anxiety symptoms. Findings from the present study indicate that adverse childhood experiences strengthen the relationship between COVID-19 worry/proximity and negative psychological symptoms. Vulnerable populations such as individuals who have experienced ACEs could benefit from targeted and specific interventions to cope with the collective trauma experienced globally due to COVID-19. As COVID-19 becomes endemic, hospital leadership and authorities should continue addressing COVID-19 worries and HCWs' psychological symptoms through mental health support and organizational interventions.

Protective and risk factors associated with substance use coping among healthcare workers during the COVID-19 pandemic.

Background: Healthcare workers (HCWs) experienced high levels of stress and mental health consequences associated with the COVID-19 pandemic, which may have contributed to unhealthy coping behaviors, such as substance use coping (SUC). This study aimed to understand the extent of and predictors of SUC. Methods: The sample consisted of 263 HCWs in North Central Florida. Univariable and multivariable logistic regression analyses investigated whether moral injury and other work risk factors, protective factors, and clinically relevant symptoms (i.e., work exhaustion, interpersonal disengagement, depression, anxiety, and/or PTSD) were associated with likelihood of SUC. Results: Clinically relevant levels of interpersonal disengagement and anxiety increased the likelihood of SUC. Mediational analyses found that interpersonal disengagement and anxiety explained 54.3% of the relationship between Self Moral Injury and SUC and explained 80.4% of the relationship between professional fulfillment and SUC. Conclusion: Healthcare supervisors should be aware that providers who are experiencing moral injury and less professional fulfillment may be experiencing significant interpersonal disengagement and anxiety, which could lead to SUC. Future studies should examine the effects of implementing targeted prevention and treatment interventions, along with longitudinal outcomes related to SUC behaviors.

Predictors of professional burnout and fulfilment in a longitudinal analysis on nurses and healthcare workers in the COVID-19 pandemic.

AIMS AND OBJECTIVES: (1) To investigate the vulnerability of nurses to experiencing professional burnout and low fulfilment across 5 months of the COVID-19 pandemic. (2) To identify modifiable variables in hospital leadership and individual vulnerabilities that may mitigate these effects. BACKGROUND: Nurses were at increased risk for burnout and low fulfilment prior to the COVID-19 pandemic. Hospital leadership factors such as organisational structure and open communication and consideration of employee opinions are known to have positive impacts on work attitudes. Personal risk factors for burnout include symptoms of depression and anxiety. METHODS: Healthcare workers (n = 406 at baseline, n = 234 longitudinal), including doctors (n = 102), nurses (n = 94), technicians (n = 90) and non-clinical administrative staff (n = 120), completed 5 online questionnaires, once per month, for 5 months. Participants completed self-report questionnaires on professional fulfilment and burnout, perceptions of healthcare leadership, and symptoms of anxiety and depression. Participants were recruited from various healthcare settings in the southeastern United States. The STROBE checklist was used to report the present study. RESULTS: Both at baseline and across the 5 months, nurses working during the COVID-19 pandemic reported increased burnout and decreased fulfilment relative to doctors. For all participants, burnout remained largely steady and fulfilment decreased slightly. The strongest predictors of both burnout and fulfilment were organisational structure and depressive symptoms. Leadership consideration and anxiety symptoms had smaller, yet significant, relationships to burnout and fulfilment in longitudinal analyses. CONCLUSIONS: Burnout and reduced fulfilment remain a problem for healthcare workers, especially nurses. Leadership styles and employee symptoms of depression and anxiety are appropriate targets for intervention. RELEVANCE TO CLINICAL PRACTICE: Leadership wishing to reduce burnout and increase fulfilment among employees should increase levels of organisational support and consideration and expand supports to employees seeking treatment for depression and anxiety.

Increased Autonomic Reactivity and Mental Health Difficulties in COVID-19 Survivors: Implications for Medical Providers.

Background: Because there is a relationship between mental health (MH) and medical adversity and autonomic dysregulation, we hypothesized that individuals infected with COVID-19 would report greater current autonomic reactivity and more MH difficulties (emotional distress, mindfulness difficulties, and posttraumatic stress). We also hypothesized that individuals diagnosed with COVID-19 who are experiencing difficulties related to their prior adversity and those providing medical care to COVID-19 patients would be more negatively impacted due to their increased stress and infection rates. Method: US participants (N = 1,638; 61% female; Age M = 46.80) completed online self-report measures of prior adversity, current autonomic reactivity and current MH difficulties, and COVID-19 diagnosis history. Participants diagnosed with COVID-19 (n = 98) were more likely to be younger and providing medical care to COVID-19 patients. Results: Individuals diagnosed with COVID-19 reported increased current autonomic reactivity, being more negatively impacted by their prior MH/medical adversities, and currently experiencing more MH difficulties with an increased likelihood of clinically-significant PTSD and depression (p < 0.01 - p < 0.001). Current autonomic reactivity mediated 58.9% to 85.2% of the relationship between prior adversity and current MH difficulties; and COVID-19 diagnosis moderated and enhanced the effect of prior adversity on current autonomic reactivity (p < 0.01). Being a medical provider was associated with increased current autonomic reactivity (p < 0.01), while moderating and enhancing the relationship between current autonomic reactivity and emotional distress and posttraumatic stress symptoms (p < 0.05). Combining COVID-19 diagnosis with being a medical provider increased likelihood of clinically-significant PTSD and depression (p < 0.01). Conclusion: Individuals diagnosed with COVID-19, particularly medical providers, have increased current autonomic reactivity that is associated with their prior adversities and current MH difficulties.

Childhood Maltreatment Influences Autonomic Regulation and Mental Health in College Students.

Childhood maltreatment history may influence autonomic reactivity and recovery to stressors. Hypothetically, the maltreatment history may contribute to a retuned autonomic nervous system that is reflected in a novel metric, vagal efficiency (VE), designed to assess the functional efficiency of vagal cardioinhibitory pathways on heart rate. We explored whether VE mediates the well-documented relationship between maltreatment history and psychiatric symptoms. We also investigated the relationship between measures of autonomic regulation in response to the physical and emotional challenges and psychiatric symptoms. Participants (n = 167) completed self-report measures of psychiatric symptoms and had continuous beat-to-beat heart rate monitored before, during, and after physical and emotional stressors. Participants with maltreatment histories exhibited lower VE, which mediated the association of maltreatment history and the psychiatric symptoms of anxiety and depression. Consistent with prior literature, there were significant associations between maltreatment history and autonomic reactivity (i.e., heart rate and respiratory sinus arrhythmia) during emotional and physical challenges; however, when VE was entered as a covariate these associations were no longer statistically significant. Blunted VE may reflect a neural pathway through which maltreatment retunes autonomic regulation and provides a neurophysiological platform that increases mental health risk.

Morally Distressing Experiences, Moral Injury, and Burnout in Florida Healthcare Providers during the COVID-19 Pandemic.

Because healthcare providers may be experiencing moral injury (MI), we inquired about their healthcare morally distressing experiences (HMDEs), MI perpetrated by self (Self MI) or others (Others MI), and burnout during the COVID-19 pandemic. Participants were 265 healthcare providers in North Central Florida (81.9% female, Mage = 37.62) recruited via flyers and emailed brochures that completed online surveys monthly for four months. Logistic regression analyses investigated whether MI was associated with specific HMDEs, risk factors (demographic characteristics, prior mental/medical health adversity, COVID-19 protection concern, health worry, and work impact), protective factors (personal resilience and leadership support), and psychiatric symptomatology (depression, anxiety, and PTSD). Linear regression analyses explored how Self/Others MI, psychiatric symptomatology, and the risk/protective factors related to burnout. We found consistently high rates of MI and burnout, and that both Self and Others MI were associated with specific HMDEs, COVID-19 work impact, COVID-19 protection concern, and leadership support. Others MI was also related to prior adversity, nurse role, COVID-19 health worry, and COVID-19 diagnosis. Predictors of burnout included Self MI, depression symptoms, COVID-19 work impact, and leadership support. Hospital administrators/supervisors should recognize the importance of supporting the HCPs they supervise, particularly those at greatest risk of MI and burnout.

Relationship of childhood maltreatment, exercise, and emotion regulation to self-esteem, PTSD, and depression symptoms among college students.

OBJECTIVE: Because physical exercise improves psychological functioning, it may be beneficial to college students with maltreatment histories. Thus, we tested the hypotheses that cumulative maltreatment would negatively affect psychological functioning, physical exercise would positively affect psychological functioning, and emotion regulation difficulties would negatively contribute to the prediction of psychological functioning. Participants: Participants were 90 undergraduate students (71.1% female, 65.6% white). Methods: Participants completed questionnaires regarding their maltreatment and physical exercise history, emotion regulation difficulties, and psychological functioning. Results: Cumulative maltreatment was negatively correlated with self-esteem and positively correlated with PTSD/depression and frequent exercise was negatively correlated with PTSD/depression. Emotion regulation difficulties impacted the relationships between maltreatment history and psychological functioning, and accounted for much of the variability in psychological functioning. Cumulative maltreatment and exercise impacted different domains of emotion regulation which in turn uniquely affect psychological functioning. Conclusions: Therapeutic interventions should aim to improve these specific emotion regulation abilities.

Adversity History Predicts Self-Reported Autonomic Reactivity and Mental Health in US Residents During the COVID-19 Pandemic.

Background: The spread of the COVID-19 virus presents an unprecedented event that rapidly introduced widespread life threat, economic destabilization, and social isolation. The human nervous system is tuned to detect safety and danger, integrating body and brain responses via the autonomic nervous system. Shifts in brain-body states toward danger responses can compromise mental health. For those who have experienced prior potentially traumatic events, the autonomic threat response system may be sensitive to new dangers and these threat responses may mediate the association between prior adversity and current mental health. Method: The present study collected survey data from adult U.S. residents (n = 1,666; 68% female; Age M = 46.24, SD = 15.14) recruited through websites, mailing lists, social media, and demographically-targeted sampling collected between March and May 2020. Participants reported on their adversity history, subjective experiences of autonomic reactivity, PTSD and depression symptoms, and intensity of worry related to the COVID-19 pandemic using a combination of standardized questionnaires and questions developed for the study. Formal mediation testing was conducted using path analysis and structural equation modeling. Results: Respondents with prior adversities reported higher levels of destabilized autonomic reactivity, PTSD and depression symptoms, and worry related to COVID-19. Autonomic reactivity mediated the relation between adversity and all mental health variables (standardized indirect effect range for unadjusted models: 0.212-0.340; covariate-adjusted model: 0.183-0.301). Discussion: The data highlight the important role of autonomic regulation as an intervening variable in mediating the impact of adversity on mental health. Because of the important role that autonomic function plays in the expression of mental health vulnerability, brain-body oriented therapies that promote threat response reduction should be investigated as possible therapeutic targets.

Describing Perceived Racial Bias Among Youth With Sickle Cell Disease.

Objectives: Sickle cell disease (SCD) predominately affects Black Americans. This is the first study of its kind to describe the racial bias experiences of youth with SCD and their reactions to these experiences. Methods: Participants were 20 youth with SCD (ages 13-21 years) who were asked to describe any racial bias events they experienced, as recorded on the Perception of Racism in Children and Youth measure (PRaCY). Interviews were recorded, transcribed, and analyzed by two independent raters using a conventional content analysis approach. Results: All participants reported at least one incident of racial bias. Content analysis of racial bias events (n = 104) yielded 4 categories and 12 subcategories as follows: Perpetrator (Peers, Authority Figures, and General Public), Type of Racial Bias (Explicit, Implicit), Behavioral Reaction (Approach, Avoidant), and Emotional Response (Dysphoria, Anger, Unconcerned, Inferior, Anxious). Discussion: This study provides a description of racial bias experiences within community and medical settings and highlights the need for further evaluation of the impact of racial bias among youth with SCD.

College females with maltreatment histories have atypical autonomic regulation and poor psychological wellbeing.

OBJECTIVES: This study uniquely examined the impact of maltreatment (without a diagnosis of posttraumatic stress disorder [PTSD]) on physiological responses to a physical and an emotional stressor. The study sample was composed exclusively of women, because men may differ in maltreatment experience and neural regulation of physiological reactivity. METHOD: Participants were 60 female college students. A significant proportion of the participants reported experiencing childhood maltreatment without a history of PTSD. Participants completed measures assessing psychological and PTSD symptomatology. Heart rate was monitored before, during, and after riding a stationary bike (physical stressor) and viewing a video of a child being maltreated (emotional stressor). Baseline and stressor related patterns of heart rate and respiratory sinus arrhythmia (RSA) were quantified from the beat-to-beat heart rate. RESULTS: Women with maltreatment histories reported more psychological distress and PTSD symptomatology, had lower levels of RSA and faster heart rate, and reacted to the stressors with atypical vagal regulation of RSA and heart rate. CONCLUSION: Accompanying psychological difficulties, women with maltreatment histories exhibit atypical physiological regulation to stressors consistent with clinical observations of lower thresholds to defensiveness and other manifestations of compromised resilience. The findings are consistent with polyvagal theory, which emphasizes the role of the "vagal brake" in social engagement and coregulation behaviors-features frequently compromised in survivors of emotional and physical abuse. Future research should investigate whether these features of atypical autonomic regulation are lead indicators of mental and physical health risks and whether these features can be reversed. (PsycINFO Database Record

Perceived Racial Bias and Health-Related Stigma Among Youth with Sickle Cell Disease.

OBJECTIVE: Little is known about the role of perceived racial bias and health-related stigma on the health of youth with sickle cell disease (SCD). The purpose of this study was to investigate the occurrence of perceived racial bias and health-related stigma among youth with SCD and its relationship with psychological and physical well-being. METHODS: Twenty-eight youth with SCD, ages 13 to 21, were recruited from outpatient and inpatient settings at an urban children's medical center. Participants completed measures of perceived racial bias, perceived health-related stigma, depression, quality of life, and pain burden. RESULTS: Most participants endorsed occurrences of racial bias and health-related stigma. The findings indicate that greater perceived racial bias was associated with greater pain burden, and greater perceived health-related stigma was related to lower quality of life. CONCLUSION: Perceived racial bias and health-related stigma may be important to consider for future research investigating the psychological and physiological features of SCD for youth.

Measures of infant behavioral and physiological state regulation predict 54-month behavior problems.

This study investigated whether measures of infant temperament, regulatory disorders, and physiological reactivity and concurrent measures of family environment were predictors of child behavior problems at 54 months of age. The sample consisted of 23 children-mother dyads. The sample recruitment strategy emphasized testing both typical and fussy/difficult infants at 9 months of age. Children were categorized into low and high behavioral problem groups at 54 months of age. The children in the high behavioral problem group were more likely at 9 months to have been temperamentally difficult, to have been classified as regulatory disordered, and to have displayed respiratory sinus arrhythmia (RSA) regulation difficulties. These children also were more likely to come from families described as less cohesive and providing less focus on active/recreational activities when the children were 54 months old. A logistic regression analysis, including only the 9-month infant measures (i.e., difficultness, regulatory disorders classification, and RSA regulation), resulted in a significant model with 100.0% accurate classification into high or low behavioral problem groups. Data suggest that infant measures of behavioral and physiological state regulation may be early indicators of child behavior problems, especially internalizing problems.

Program ratings do not predict negative content in commercials on children's channels.

OBJECTIVE: The aim of this study was to determine the presence of negative content in commercials airing on 3 children's channels (Disney Channel, Nickelodeon, and Cartoon Network). METHOD: The 1681 commercials were coded with a reliable coding system and content comparisons were made. RESULTS: Although the majority of the commercials were coded as neutral, negative content was present in 13.5% of commercials. This rate was significantly more than the predicted value of zero and more similar to the rates cited in previous research examining content during sporting events. The rate of negative content was less than, but not significantly different from, the rate of positive content. Thus, our findings did not support our hypothesis that there would be more commercials with positive content than with negative content. Logistic regression analysis indicated that channel, and not rating, was a better predictor of the presence of overall negative content and the presence of violent behaviors. Commercials airing on the Cartoon Network had significantly more negative content, and those airing on Disney Channel had significantly less negative content than the other channels. Within the individual channels, program ratings did not relate to the presence of negative content. CONCLUSION: Parents cannot assume the content of commercials will be consistent with the program rating or label. Pediatricians and psychologists should educate parents about the potential for negative content in commercials and advocate for a commercials rating system to ensure that there is greater parity between children's programs and the corresponding commercials.

Infant regulatory disorders: temperamental, physiological, and behavioral features.

OBJECTIVES: Successful development during the first year of life is dependent on the infant's ability to regulate behavioral and physiological state in response to unpredictable environmental challenges. Although most infants develop skills to self-soothe and regulate behavior, a subset lacks these skills and develops regulatory disorders (RD). The purpose of this study was to evaluate the component features of RD by determining if infants with RD differ from typically developing infants on measures of temperament, respiratory sinus arrhythmia, heart rate, and mother-infant interactions. METHODS: Parents of 50 9-month-old infants completed behavioral questionnaires that provided information necessary to complete the Regulatory Disorders Checklist, which evaluates for difficulties in self-regulation and hypersensitivities. Infants with difficulties in both domains were assigned to the RD group. Mothers and their infants were videotaped interacting for 10 minutes. Infant heart rate was monitored before and during the mental development test. RESULTS: The RD group (n = 10) was more temperamentally difficult and exhibited atypical physiological regulation relative to infants with difficulties in either self-regulation or hypersensitivity (n = 25) or infants with no difficulties (n = 15). During the mother-infant interactions, the RD group exhibited more high-level withdrawal behaviors, including verbal and physical protests, although there were no differences in the quantity and quality of the maternal approaches. CONCLUSION: Infants with RD have both temperamental and physiological regulation difficulties and may be in a physiological state that makes it difficult to moderate behavior in response to social demands. Mothers of RD infants might be taught to modify their behavior to help their infants to regulate behavioral and physiological state.

Abuse history is related to autonomic regulation to mild exercise and psychological wellbeing.

We investigated the potential impact of abuse history on autonomic regulation and psychological wellbeing in a sample of women who reported a history of abuse without Post Traumatic Stress Disorder. To measure autonomic regulation, heart rate data was collected before and after the participant rode a stationary bike for one mile. We found that abuse history was associated with less vagal regulation of the heart (i.e., respiratory sinus arrhythmia) and an inability to rapidly re-engage vagal regulation immediately following mild exercise to support a calm physiological state. These findings are consistent with clinical impressions that abused individuals may have a lower threshold to express fight/flight behaviors in response to stress and have difficulty shifting from mobilization to calmness. We also found that abuse history was related to psychological wellbeing. Women with an abuse history reported a greater use of dysfunctional coping methods and lower self-concept. Further, analyses indicated that there was a cumulative effect, whereby women who reported more recent abuse reported using more dysfunctional coping methods, having more mood disturbance, and lower self-concept. The findings underscore the importance of evaluating both the psychological and physiological effects of trauma, even in the absence of a diagnosis of PTSD.