Mental health impact on healthcare workers due to the COVID-19 pandemic: a U.S. cross-sectional survey study.

BACKGROUND: The COVID-19 pandemic has impacted the mental health and well-being of health care workers (HCWs). This study examined mental health outcomes and COVID-related stress impacts among a diverse sample of ambulatory HCWs, including clinicians and support staff, as well as the associations between mental health outcomes and work impairments in this population. Detailing these results can help in designing interventions to alleviate this burden. METHODS: "The Health Care Worker Stress Survey" was administered to ambulatory care providers and support staff at three multispecialty care delivery organizations as part of an online, cross-sectional study conducted between June 8, 2020, and July 13, 2020. RESULTS: The greatest stress impact reported by HCWs was the uncertainty regarding when the COVID-19 outbreak would be under control, while the least reported concern was about self-dying from COVID-19. Differences in COVID-19 stress impacts were observed by age, gender, and occupational risk factors. Approximately 50% of participants reported more than a minimal level of anxiety, including 22.5% who indicated moderate to severe levels of anxiety. Higher levels of anxiety were observed with younger ages and female gender, while occupational roles with increased exposure risk did not report higher levels of anxiety. Roughly two-thirds of the sample reported less than good sleep quality and one-third to one-half of the sample reported other sleep related problems that differed by age and gender. Role limitations due to emotional health correlated with COVID-19 related stress, anxiety and sleep problems. CONCLUSIONS: Using established, validated measures, we quantified mental health outcomes within a diverse sample of ambulatory care HCWs during the pandemic. Younger and female HCWs reported greater anxiety burden; HCWs with higher occupational risk of COVID exposure did not report higher levels of anxiety. Notable proportions of HCWs reported sleep and work impairments. Due to the cross-sectional nature of the study, it is difficult to attribute these patterns to the pandemic. These results underscore the depth and extent of mental health outcomes in HCWs in ambulatory settings and raise important questions on new interventions to relieve that burden. Further research is needed to study specific interventions to support the mental health and wellbeing of HCWs.

The Influence of Combat Experience on Psychologically Healthy Soldiers' Attentiveness to Environmental Threats.

INTRODUCTION: In contrast to previous research that has primarily examined how psychological disorders (e.g., post-traumatic stress disorder [PTSD], anxiety) are affected by and affect individuals' threat perceptions, this study examines the relationship between combat experience and threat-monitoring in psychologically healthy Soldiers. Existing research has established how prolonged or intense experiences with war-related stressors can lead individuals to undergo an unconscious fear-conditioning process that affects the circuitry of the prefrontal cortex, hippocampus, amygdala, and anterior cingulate cortex regions of the brain. We predict that the intensity of one's combat experience positively influences Soldiers' attention to environmental threats. MATERIALS AND METHODS: Participants included U. S. Army Soldiers with a score of 50 or below on the PTSD Checklist-Military Version. Participants completed the Combat Exposure Scale and the State-Trait Anxiety Inventory. The experimental prediction task we employed assesses the expectation of an intrusively loud white noise sound that occurred on three variable patterns in a pseudorandomized order. Each tone pattern was used 20 times over a total of 60 trials. The experimental prediction task included two neutral tones (700 and 1,300 Hz) that were presented in a repeated pattern along with a 100-dB burst of white noise (0.5-second duration). In each trial, one of three possible tone combinations was presented. To assess their attentiveness to threats, participants were asked to continuously rate their expectancy of the burst of white noise using a visual analogue scale (VAS) ranging from 0 to 100. VAS ratings were collected at controlled points throughout the task. RESULTS: None of the participants reported scores on any of the diagnostic surveys that met standards for clinical significance. A repeated-measures analysis of variance was conducted to assess the overall effect of the three prediction conditions on participants' VAS ratings. There was a significant main effect for Combat Exposure Scale scores on VAS ratings [F(1, 27) = 5.19, p = 0.031], with high scorers demonstrating a generally higher expectancy of the white noise burst throughout the entire experimental sequence. Results suggest that within subclinical populations of Soldiers, the intensity of one's combat experience is positively associated with their attention to threats. CONCLUSION: These findings suggest that Soldiers who experience combat should be observed for signs of increased threat-attention bias, as this may indicate that their capacities for information processing, decision-making, and emotion regulation could be compromised. The positive relationship we observe between a level of combat experience and attentional biases toward threatening stimuli may also help to explain why these veterans engage in "externalizing" behaviors that are risky, aggressive, or violent as well as relational problems and antisocial behaviors that are reported in higher-than-average rates among these populations of Soldiers. Acknowledging that increased threat attention may be a preclinical indication of developing PTSD or other related psychological conditions (e.g., depression, anxiety) should motivate clinicians to more actively diagnose and treat this condition.

Evaluation of the Military Functional Assessment Program: Preliminary Assessment of the Construct Validity Using an Archived Database of Clinical Data.

BACKGROUND: Several important factors must be considered when deciding to return a soldier to duty after a traumatic brain injury (TBI). Premature return increases risk for not only second-impact syndrome during the acute phase but also permanent changes from repetitive concussions. Thus, there is a critical need for return-to-duty (RTD) assessment criteria that encompass the spectrum of injury and disease experienced by US soldiers, particularly TBI. OBJECTIVES: To provide evidence-based standards to eventually serve as criteria for operational competence and performance of a soldier after injury. Specifically, the relationships between clinical assessments and novel military-specific tasks were evaluated. METHOD: Exploratory analyses (including nonparametric tests and Spearman rank correlations) of an archived database. PARTICIPANTS: A total of 79 patients with TBI who participated in an RTD assessment program at a US Army rehabilitation and recovery center. MAIN MEASURES: Military Functional Assessment Program (to determine a soldier's operational competence and performance after TBI) tasks; Dizziness Handicap Inventory; Dynamic Visual Acuity (vestibular function); Sensory Organization Test (postural control); Repeatable Battery for the Assessment of Neuropsychological Status (neuropsychological screening test); Beck Depression Inventory-II; Beck Anxiety Inventory; Comprehensive Trail Making Test (visual search and sequencing); posttraumatic stress disorder checklist military version; Alcohol Use Disorders Identification Test; Epworth Sleepiness Scale; Patient Health Questionnaire; and Military Acute Concussion Evaluation. RESULTS: Selected military operational assessment tasks correlated significantly with clinical measures of vestibular function, psychological well-being, and cognitive function. Differences on occupational therapy assessments, a concussion screening tool, and a self-report health questionnaire were seen between those who passed and those who failed the RTD assessment. Specifically, those who passed the RTD assessment scored more favorably on these clinical assessments. CONCLUSIONS: This study demonstrated convergent validity between Military Functional Assessment Program tasks and clinical assessment scores. The Military Functional Assessment Program shows promise for augmenting decision making related to RTD and soldier skills. Additional research is needed to determine the effectiveness of this program in predicting RTD success.

Mindless decision making and environmental issues: gestalt/feature-intensive processing and contextual reasoning in environmental decisions.

In the absence of relevant information in working memory during decision consideration, respondents tend to rely on a style of cognitive processing that may result in premature or inaccurate decision making (M. J. Sharps, 2003). M. J. Sharps and S. S. Martin (2002) demonstrated this effect in executive decision making. In the present study, the authors extended these methods to decisions about environmental issues. Respondents rated decisions about issues such as overpopulation, energy policy, and food production in the presence or absence of simple pertinent information. The presence of such information in the immediate context of environmental decisions, and therefore in working memory, significantly improved respondents' ability to understand negative decision consequences. These results demonstrate the importance of contextual information in environmental decision making.