Observational study on the potential psychological factors that affected Italian nurses involved in the COVID-19 health emergency Nurses’ psychological factors during COVID-19 health emergency

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Elsa Vitale
Vito Galatola
Rocco Mea




Background and Aim of the work. The present study aimed to identify the potential psychological malaise factors affecting the Italian nurses on the front lines of Covid-19 patient care since evidence suggested that they are at high risk of developing psychological disorders.

Methods. An online questionnaire was administered to 291 Italian nurses, containing information on: sex, years of work experience, region of Italy where nurses worked and the intensive care unit assignment. Then, the anxiety disorders, the impact of the event, the depression and the insomnia conditions and their principal psychological factors influencing nurses during the health emergency. were assessed

Results. Nurses worked in Northern Italy registered higher anxiety scores than others (p=0.023); the assignment to the intensive care unit (p=0.042) not influenced these scores. The total impact of event (IES-R) values ​​evidenced that women recorded higher “Avoidance” (p=0.032) and “Hyperarousal” (p=0.003) values ​​than men. The nurses who worked in Northern Italy recorded higher scores of “Hyperarousal” (p=0.010) and IES-R total (p=0.044). More women than men showed insomnia conditions (p=0.038) and nurses with a number of years of work experience not exceeding 10 years recorded greater levels of depression than the others (p=0.031). The psychological factors affected nurses included: the “Pleasure/Interest” dimension which correlated with the “Uncontrollable Thinking” (p=0.007), the “Unsatisfactory sleep/wake rhythm” (p=0.004), and the “Unmanageable pain and weakness” (p=0.001).

Conclusions. Urgent need to intervene with psychological support programs for health professionals, such as nurses who are facing the health emergency from Covid-19 on the front line.



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1. World Health Organisation. WHO announces COVID-19 outbreak a pandemic. Available at: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid Accessed on 3 April 2020.
2. Docea AO, Tsatsakis A, Albulescu D, Cristea O, Zlatian O, Vinceti M, Moschos SA, Tsoukalas D, Goumenou M, Drakoulis N, Dumanov JM, Tutelyan VA, Onischenko GG, Aschner M, Spandidos DA, Calina D. A new threat from an old enemy: Re emergence of coronavirus (Review). Int J Mol Med. 2020, 45(6):1631-1643.
3. Vitale E, Mea R, Di Dio F, Canonico A, Galatola V. Anxiety, Insomnia and Body Mass Index scores in Italian nurses engaged in the care of COVID-19 patients. Endocr. Metab. Immune. Disord. Drug Targets 2020. Epub ahead of print. PMID: 33069203.
4. Fava GA, McEwen BS, Guidi J, Gostoli S, Offidani E, Sonino N. Clinical characterization of allostatic overload. Psychoneuroendocrinology 2019, 108:94-101.
5. Chen D, Jiang M, Shi X, Geng F, Qi H, Zhang Y, Lai Y, Fan F. Predictors of the initiation of shift work disorder among Chinese intern nurses: a prospective study. Sleep Med 2020, 68:199-206.
6. Vitale E, Galatola V, Mea R. Exploring within and between gender differences in burnout levels in Italian nurses engaged in the Covid-19 health emergency: a cohort observational study. Minerva Psichiatr. 2020, 61(4):162-70.
7. Al-Dossary R, Alamri M, Albaqawi H, Al Hosis K, Aljeldah M, Aljohan M, Aljohani K, Almadani N, Alrasheadi B, Falatah R, Almazan J. Awareness, Attitudes, Prevention, and Perceptions of COVID-19 Outbreak among Nurses in Saudi Arabia. Int J Environ Res Public Health. 2020, 17(21):8269.
8. Bai Y, Lin CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004, 55(9):1055-1057.
9. Chua SE, Cheung V, Cheung C, McAlonan GM, Wong JW, Cheung EP, Chan MT, Wong MM, Tang SW, Choy KM, Wong MK, Chu CM, Tsang KW. Psychological effects of the SARS outbreak in Hong Kong on high-risk health care workers. Can J Psychiatry. 2004, 49(6):391-3.
10. Maunder R, Hunter J, Vincent L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003, 168(10).
11. Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, Chu CM, Wong PC, Tsang KW, Chua SE. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry. 2007, 52(4):233-40.
12. Chong MY, Wang WC, Hsieh WC, Lee CY, Chiu NM, Yeh WC, Huang OL, Wen JK, Chen CL. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry. 2004, 185:127-133.
13. Goulia P, Mantas C, Dimitroula D, Mantis D, Hyphantis T. General hospital staff worries, perceived sufficiency of information and associated psychological distress during the A/H1N1 influenza pandemic. BMC Infect Dis. 2010, 10(322).
14. Lipley N. Covid-19: Not a “Mental Health Crisis”, Healthcare Experts Warn. Available at: https://rcni.com/nursing-standard/newsroom/news/COVID-19-not-a-mental-health-crisis-healthcare-experts-warn-159611. Accessed on 17 April 2020.
15. Vitale E, Cesano E, Germini F. Prevalence of Burnout among Italian Nurses: a descriptive study: Italian Nursing Burnout. Acta Bio Med 2020 , 91(4), e2020117.
16. Wańkowicz P, Szylińska A, Rotter I. Assessment of Mental Health Factors among Health Professionals Depending on Their Contact with COVID-19 Patients. Int J Environ Res Public Health. 2020, 17(16):5849.
17. Cai Z, Cui Q, Liu Z, Li J, Gong X, Liu J, Wan Z, Yuan X, Li X, Chen C, Wang G. Nurses endured high risks of psychological problems under the epidemic of COVID-19 in a longitudinal study in Wuhan China. J Psychiatr Res. 2020, 131:132-137.
18. Wu P. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Canadian journal of psychiatry. Revue canadienne de psychiatrie. 2009, 54:302-311.
19. Brooks SK, Dunn R, Amlôt R, Rubin GJ, Greenberg N. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occup Environ Med. 2018, 60:248-257.
20. Khattak SR, Saeed I, Rehman SU, Fayaz M. Impact of fear of COVID-19 pandemic on the mental health of nurses in Pakistan. J Loss Trauma 2020, 1-15.
21. Guntupalli KK, Wachtel S, Mallampalli A, Surani S. Burnout in the intensive care unit professionals. Indian J Crit Care Med. 2014, 18:139-43.
22. Divatia JV. Burnout in the ICU: Playing with fire? Indian J Crit Care Med. 2014, 18(3):127-8.
23. Vandevala T, Pavey L, Chelidoni O, Chang NF, Creagh-Brown B, Cox A. Psychological rumination and recovery from work in intensive care professionals: associations with stress, burnout, depression and health. J Intensive Care. 2017, 5:16.
24. Mohd Fauzi MF, Mohd Yusoff H, Mat Saruan NA, Muhamad Robat R, Abdul Manaf MR, Ghazali M. Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time. BMJ Open. 2020, 10(9):e036849.
25. Zhizhong W, Koenig HG, Yan T, Jing W, Mu S, Hongyu L, Guangtian L. Psychometric properties of the moral injury symptom scale among Chinese health professionals during the COVID-19 pandemic. BMC Psychiatry. 2020, 20(1):556.
26. Cheng V, Wong S, Chen J, Yip C, Chuang V, Tsang O, Yuen K. Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020, 41(5): 493-498.
27. Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, Wan SW, Liu Z, Shen Q, Yang J, He HG, Zhu J. Frontline nurses’ burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine. 2020, 24:100424.
28. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: Belastungen des medizinischen Personals [COVID-19 Pandemic: Stress Experience of Healthcare Workers - A Short Current Review]. Psychiatr Prax. 2020, 47(4): 190-197.
29. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 2006, 166(10), 1092-1097.
30. Garabiles MR, Lao CK, Yip P, Chan EWW, Mordeno I, Hall BJ. Psychometric Validation of PHQ-9 and GAD-7 in Filipino Migrant Domestic Workers in Macao (SAR), China. J Pers Assess. 2020,102(6):833-844.
31. Costantini A, Mazzotti E. Italian validation of CoViD-19 Peritraumatic Distress Index and preliminary data in a sample of general population. Riv Psichiatr. 2020, 55(3):145-151.
32. Rash CJ, Coffey SF, Baschnagel JS, Drobes DJ, Saladin ME. Psychometric properties of the IES-R in traumatized substance dependent individuals with and without PTSD. Addict Behav. 2008, 33(8):1039-47.
33. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001, 2(4):297-307.
34. Castronovo V, Galbiati A, Marelli S, Brombin C, Cugnata F, Giarolli L, Anelli MM, Rinaldi F, Ferini-Strambi L. Validation study of the Italian version of the Insomnia Severity Index (ISI). Neurol Sci. 2016, 37(9):1517-24.
35. Mazzotti E, Fassone G, Picardi A, Sagoni E, Ramieri L, Lega I, Camaioni D, Abeni D, Pasquini P. II Patient Health Questionnaire (PHQ) per lo screening dei disturbi psichiatrici: uno studio di validazione nei confronti della intervista clinica strutturata per il DSM-IV asse I (SCID-I) [II Patient Health Questionnaire (PHQ) for the screening of psychiatric disorders: a validation study against the structured clinical interview for the DSM-IV axis I (SCID-I)] Psychopathology 2003, 9:235-42.
36. Levis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019, 365: l1476.
37. Shaukat N, Ali DM, Razzak J. Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review. Int J Emerg Med. 2020, 13(1):40.
38. Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Sirscusano A, Rossi A. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Netw. Open 2020a; 3:e2010185.
39. Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, Min BQ, Tian Q, Leng HX, Du JL, Chang H, Yang Y, Li W, Shangguan FF, Yan TY, Dong HQ, Han Y, Wang YP, Cosci F, Wang HX. Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China. Psychother Psychosom. 2020, 89(4):242-250.
40. Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian Nurses’ Knowledge and Anxiety Toward COVID-19 During the Current Outbreak in Iran, Arch Clin Infect Dis. 2020, Online ahead of Print 15(COVID-19):e102848.
41. Maciaszek J, Ciulkowicz M, Misiak B, Szczesniak D, Luc D, Wieczorek T, Fila-Witecka K, Gawlowski P, Rymaszewska J. Mental Health of Medical and Non-Medical Professionals during the Peak of the COVID-19 Pandemic: A Cross-Sectional Nationwide Study. J Clin Med. 2020, 9(8):2527.
42. Galehdar N, Toulabi T, Kamran A, Heydari H. Exploring nurses' perception of taking care of patients with coronavirus disease (COVID‐19): A qualitative study. Nursing Open 2020, 8:171-179.
43. Calò F, Russo A, Camaioni C, De Pascalis S, Coppola N. Burden, risk assessment, surveillance and management of SARS-CoV-2 infection in health workers: a scoping review. Infect Dis Poverty. 2020, 9(1):139.
44. Alfawaz HA, Wani K, Aljumah AA, Aldisi D, Ansari MGA, Yakout SM, Sabico S, Al-Daghri NM. Psychological Well-being during Covid-19 Lockdown: Insights from a Saudi State University's Academic Community. J King Saud Univ Sci. 2020, 33(1):101262.
45. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H, Kang L, Yao L, Huang M, Wang H, Wang G, Liu Z, Hu S. Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020, 3(3):e203976.
46. Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, Yao L, Bai H, Cai Z, Xiang Yang B, Hu S, Zhang K, Wang G, Ma C, Liu Z. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun. 2020, 87:11-17.
47. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, Zheng J. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020, 287:112934.
48. Sim K, Chong PN, Chan YH, Soon WS. Severe acute respiratory syndrome-related psychiatric and posttraumatic morbidities and coping responses in medical staff within a primary health care setting in Singapore. J Clin Psychiatry. 2004, 65(8):1120-7.
49. Wu P. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can j psychiatry. 2009, 54:302–311.
50. Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, Min BQ, Tian Q, Leng HX, Du JL, Chang H, Yang Y, Li W, Shangguan FF, Yan TY, Dong HQ, Han Y, Wang YP, Cosci F, Wang HX. Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China. Psychother Psychosom. 2020, 89(4):242-250.
51. Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, Du H, Li R, Kang L, Su M, Zhang J, Liu Z, Zhang B. Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak. Front Psychiatry. 2020, 11:306.
52. Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, Min BQ, Tian Q, Leng HX, Du JL, Chang H, Yang Y, Li W, Shangguan FF, Yan TY, Dong HQ, Han Y, Wang YP, Cosci F, Wang HX. Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China. Psychother Psychosom. 2020, 89(4):242-250.