Main Article Content
COVID-19, stress, healthcare workers
Background: Depression, anxiety, psychological distress, and poor sleep quality increased in healthcare workers (HCWs) during the COVID-19 pandemic. The aim of the study was to assess levels of psychological distress in Umbrian HCWs during the COVID-19 Phase 1 lockdown along with exploring the relationship between sociodemographic/occupational factors. Methods: Data on sociodemographic and occupational characteristics, change of job description, economic losses and emergency involvement and SARS-CoV2 infections in the workplace were collected using an anonymous online survey sent by healthcare professional associations. Data concerning psychological healthcare distress, were collected anonymously using BIAS 20 (stress balance) and Depression Anxiety Stress Scales (DASS-21). Results: One thousand and one healthcare workers responded to the questionnaire. Biological risk at work was perceived by all HCWs, less so from psychologists and more so from those working in hospitals. Stress symptoms (DASS21 >14) were associated with a younger age group (OR 0.98; 95% CI 0.97-0.99) and less work experience (OR 0.98; 95% CI 0.96-0.99). Younger age was also associated with anxiety symptoms (DASS 21 >7) (OR 0.98; 95% CI 0.97-0.99), as well as graduate/post graduate education level (OR 2.04; 95% CI 1.14-3.63). Working as an independent contractor was a risk factor for high stress health impact (OR 2.00; CI 1.40-2.86) and stress (OR 1.87; CI 1.20-2.92), anxiety (OR 1.89; CI 1.22-2.92) and depression (OR 1.57; CI 1.10-2.22) symptoms. Conclusions: Our study showed a possible relationship between healthcare type of employment and distress symptoms during Covid19 pandemic phase 1. Results of our study should be confirmed in other Italian healthcare settings and could serve as a preliminarily baseline for multidisciplinary Italian collaboration.
2. Mohammadzadeh, A. R. (2019). The effectiveness of electronic healthcare and pharmacy monitoring program to prevent COVID-19 (sars-cov-2 virus) and reduce of corona disease anxiety after bypass surgery-a pilot study, quarterly. Journal of Nursing Management (IJNV) Original Article, 8(3)26-34.
3. Koh, D., Lim, M, K., Chia, S. E., Ko, S. M., Qian, F., & NG, V., et al, (2005). Risk Perception and Impact of Severe Acute Respiratory Syndrome (SARS) on Work and Personal Lives of Healthcare Workers in Singapore What Can We Learn? Medical Care, 2005, 676-82.
4. Rosling, L., & Rosling, M. (2003). Pneumonia causes panic in Guangdong province. The BMJ, 326(7386), 416.
5. McAlonan, G.M., Lee, A.M., Cheung, V., et al., 2007. Immediate and sustained psychological impact of an emerging infectious disease outbreak on healthcare workers. Can J. Psychiat. 52 (4), 241–247.
6. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020 Aug;88:901-907.
7. Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun. 2020 Oct; 89:531-542.
8. Dosil Santamaría M, et al. Impacto psicológico de la COVID-19 en una muestra de profesionales sanitarios españoles. Rev Psiquiatr Salud Ment (Barc.) 2020.
9. De Leo A, Cianci E, Mastore P, Gozzoli C. Protective and Risk Factors of Italian Healthcare Professionals during the COVID-19 Pandemic Outbreak: A Qualitative Study. Int J Environ Res Public Health. 2021 January 8;18(2): 453.
10. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995 Mar;33(3):335-43.
11. Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G. The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates. J Clin Psychol. 2012 Dec;68(12):1322-38.
12. Marton G, Vergani L, Mazzocco K, Garassino MC, Pravettoni G. 2020s Heroes Are Not Fearless: The Impact of the COVID-19 Pandemic on Wellbeing and Emotions of Italian Health Care Workers During Italy Phase 1. Front Psychol. 2020 October 15;11: 588762.
13. Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis. Psychiatry Res. 2020 Sep; 291:113190.
14. Wittchen, H.-U.; Jacobi, F.; Rehm, J.; Gustavsson, A.; Svensson, M.; Jönsson, B.; Olesen, J.; Allgulander, C.; Alonso, J.; Faravelli, C.; et al. The size and burden of mental disorders and other disorders of the brain in Europe. Eur. Neuropsychopharmacol. 2010, 21, 655–679.
15. Brooks, S.K.; Webster, R.K.; Smith, L.E.;Woodland, L.;Wessely, S.; Greenberg, N.; Rubin, G.J. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020, 395, 912–920.
16. Luceño-Moreno L, Talavera-Velasco B, García-Albuerne Y, Martín-García J. Symptoms of Posttraumatic Stress, Anxiety, Depression, Levels of Resilience and Burnout in Spanish Health Personnel during the COVID-19 Pandemic. Int J Environ Res Public Health. 2020 July 30;17(15):5514.
17. 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 May; 287:112934.
18. Shrestha, R. Post-traumatic stress disorder among medical personnel after Nepal earthquake, 2015. J. Nepal Health Res. Counc. 2015, 13, 144–148.
19. Cheng, C.; Jun, H.; Liang, B. Psychological health diathesis assessment system: A nationwide survey of resilient trait scale for Chinese adults. Stud. Psychol. Behav. 2014, 12, 735–742.
20. Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr. 2020; 51:102076.
21. Wang Y, Di Y, Ye J, Wei W. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol Health Med. 2020; 30:1–10.
22. Zhang Y, Ma ZF. Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning Province, China: a crosssectional study. Int J Environ Res Public Health. 2020;17(7):2381.
23. Pisanti R, van der Doef M, Maes S, Violani C, Lazzari D. Psychosocial job characteristics and psychological distress / well-being: the mediating role of personal goal facilitation. J Occup Health. 2016;58(1): 36-46.
24. Zhu J, Su L, Zhou Y, Qiao J, Hu W. The effect of nationwide quarantine on anxiety levels during the COVID-19 outbreak in China. Brain Behav. 2020 November 11: e 01938.
25. Durankuş F, Aksu E. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study. J Matern Fetal Neonatal Med. 2020 May 18:1-7.
26. Li Y, Scherer N, Felix L, Kuper H. Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis. PLoS One. 2021 Mar 10;16(3):e0246454.
27. Wang, J., Mann, F., Lloyd-Evans, B., Ma, R., and Johnson, S. (2018). Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry 18:156.
28. Hill, E. M., and Hamm, A. (2019). Intolerance of uncertainty, social support, and loneliness in relation to anxiety and depressive symptoms among women diagnosed with ovarian cancer. Psycho-Oncology 28, 553–560.
29. Gozzoli C, Leo A. Receiving asylum seekers: Risks and resources of professionals. Health Psychol Open. 2020 June 1;7(1):2055102920920312.
30. Taylor, M.R.; Agho, K.E.; Stevens, G.J.; Raphael, B. Factors influencing psychological distress during a disease epidemic: Data from Australia’s first outbreak of equine influenza. BMC Public Health 2008, 8, 347.
31. Kühlmeyer K, Kuhn E, Knochel K, Hildesheim H, Witt VD, Friedrich O, Rogge A. Moral distress in medical students and young professionals: research desiderata in the context of the COVID-19 pandemic. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2020 Nov 12.
32. Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, Di Pierro R, Madeddu F, Calati R. The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence. Curr Psychiatry Rep. 2020 July 10;22(8):43
33. Tang L, Pan L, Yuan L, Zha L. Prevalence and related factors of post-traumatic stress disorder among medical staff members exposed to H7N9 patients. Int J Nurs Sci. 2017;4(1):63–7.
34. Wang, C., Pan, R., Wan, X., et al., 2020a. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health. 17 (5), 1729.
35. Alan H, Eskin Bacaksiz F, Tiryaki Sen H, Taskiran Eskici G, Gumus E, Harmanci Seren AK. "I'm a hero, but…": An evaluation of depression, anxiety, and stress levels of frontline healthcare professionals during COVID-19 pandemic in Turkey. Perspect Psychiatr Care. 2020 November 10.
36. Teshome A, Glagn M, Shegaze M, Tekabe B, Getie A, Assefa G, Getahun D, Kanko T, Getachew T, Yenesew N, Temtmie Z, Tolosie K. Generalized Anxiety Disorder and Its Associated Factors Among Healthcare Workers Fighting COVID-19 in Southern Ethiopia. Psychol Res Behav Manag. 2020 Nov 5;13: 907-917.
37. Buselli R, Corsi M, Veltri A, Baldanzi S, Chiumiento M, Lupo ED, Marino R, Necciari G, Caldi F, Foddis R, Guglielmi G, Cristaudo A. Mental health of Healthcare Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19. Psychiatry Res. 2021 March 2; 299:113847.
38. Pakpour AH, Griffiths MD, Lin CY. Assessing Psychological Response to the COVID-19: The Fear of COVID-19 Scale and the COVID-19 Stress Scales. Int J Ment Health Addict. 2020 May 29:1-4.