Covid-19 pandemic impact on mental health: a web-based cross-sectional survey on a sample of Italian general practitioners
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Covid-19, General practitioners, Mental Health, Italy
Background: Since the World Health Organization declared the new 2019 coronavirus disease (Covid-19) outbreak first a Public Health Emergency of International Concern and then a pandemic, Italy held more than 195.350 cases and 26.380 deaths. Working in the frontline with suspected Covid-19 infection patients, general practitioners (GPs) are daily under both physical and psychological pressure. Methods: A web-based cross-sectional survey was carried out on italian GPs working in Genoa (Italy), to assess the impact of Covid-19 pandemic on mental health. The survey was anonymous and a free Google Forms® software was used. Results: One hundred thirty-one GPs completed the survey. Compared to GPs with absent or mild depressive symptoms (PHQ-9 < 10), GPs reporting moderate to severe depressive symptoms (N=30, 22.9%; PHQ-9 ≥ 10) reported more helplessness (96.7% vs. 79.2%, p=.025), spent more than three hours searching for COVID-19 information (43.3% vs. 19.8%, p=.024), perceived less adequate personal protective equipment (PPE) (6.7% vs. 23.8%, p=.049) and visited more COVID-19 infected patients (16.63 ± 27.30 vs. 9.52 ± 11.75, p=.041). Moreover, PHQ-9 ≥ 10 GPs reported a significant higher severity for both anxiety and insomnia (13.43 ± 4.96 vs. 4.88 ± 3.53 and 11.60 ± 5.53 vs. 4.84 ± 3.81, respectively; p<.001), and a worse quality of life in both mental (34.60 ± 7.45 vs. 46.01 ± 7.83, p<.001) and physical (43.50 ± 9.37 vs. 52.94 ± 4.78, p<.001) component summary. Conclusions: Our results give early insight into the urgent need to provide continuity of care for patients at the community-level, adequate PPE to GPs and a clear guidance from public health institutions. A precarious healthcare system both at a national and regional level might have triggered negative mental health outcomes in Italian GPs.
2. Odone A, Landriscina T, Amerio A, et al. The impact of the current economic crisis on mental health in Italy: evidence from two representative national surveys. Eur J Public Health 2018;28(3):490-495.
5. Fiorino G, Colombo M, Natale C, et al. Clinician Education and Adoption of Preventive Measures for COVID-19: A Survey of a Convenience Sample of General Practitioners in Lombardy, Italy. Ann Intern Med 2020 [Online ahead of print]
6. Li DKT, Zhu S. Contributions and challenges of general practitioners in China fighting against the novel coronavirus crisis. Fam Med Community Health 2020;8(2):e000361.
7. Shanafelt T, et al. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA 2020 [Online ahead of print]
8. Rimmer A. Covid-19: GPs call for same personal protective equipment as hospital doctors. BMJ 2020;368:m1055.
9. Spitzer R, Kroken K, Williams JB. Validation and Utility of a Self-Report Version of PRIME-MD: The PHQ Primary Care Study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999;282:1737.
10. Spitzer RL, Kroenke K, Williams JBW, et al. A Brief Measure for Assessing Generalized Anxiety Disorder. Arch Intern Med 2006;166:1092.
11. Morin CM, Belleville G, Bélanger L, et al. The Insomnia Severity Index: Psychometric Indicators to Detect Insomnia Cases and Evaluate Treatment Response. Sleep 2011;34:601–608.
12. Ware JJr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care 1996;34(3):220–233.
13. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. 2nd Ed. 2018, New York, NY: Guilford Press.
14. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020;368:m1211.
15. Thornton J. Covid-19: how coronavirus will change the face of general practice forever. BMJ 2020;368:m1279.
16. Omboni S. Telemedicine During The COVID-19 in Italy: A Missed Opportunity? Telemed J E Health 2020 [Epub ahead of print]
17. Signorelli C, Odone A, Cella P, et al. Childhood vaccine coverage in Italy after the new law on mandatory immunization. Ann Ig 2018;30(4 Supple 1):1–10.
18. Amerio A, Starace F, Costanza A, et al. Putting Codman’s lesson to work: Measuring and improving the quality of Italian mental health care. Acta Psychiatr Scand 2020;141(1):91-92.
19. Odone A, Delmonte D, Scognamiglio T, et al. COVID-19 deaths in Lombardy, Italy: data in context. Lancet Public Health 2020 [Epub ahead of print]
20. Chang BB, Chiu TY. Ready for a long fight against the COVID-19 outbreak: an innovative model of tiered primary health care in Taiwan. BJGP Open 2020 [Epub ahead of print]
21. Kidd M. Australia’s primary care COVID-19 response. Aust J Gen Pract 2020 [Epub ahead of print]