Differences in the Long-term Impact of the COVID-19 Pandemic on the Mental Health and Professional Quality of Life of Resident and Specialist Physicians

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Valentina Delle Donne
Valentina Massaroni
Nicoletta Ciccarelli
Alberto Borghetti
Arturo Ciccullo
Gianmaria Baldin
Gabriele Giuliano
Alex Dusina
Elena Visconti
Enrica Tamburrini
Simona Di Giambendetto


Covid-19, Healthcare workers, Mental health, Professional quality of life, Burnout


Background: The COVID-19 pandemic created an extremely difficult situation for healthcare workers (HCWs) worldwide. We aimed to compare the mental health and professional quality of life of residents and specialist physicians in a cohort of Italian HCWs caring for patients with COVID-19 about two years after the start of the COVID-19 pandemic. Methods: In November 2021, an online survey investigating the emotional states of depression, anxiety, stress, compassion satisfaction and compassion fatigue was administered to HCWs (N= 78) at the Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome. Results: Our findings suggest that from 5 to 20% of our cohort of HCWs still showed the effects of the adverse psychological impact of the pandemic and more than half of them experienced medium levels of compassion fatigue as well as a medium level of compassion satisfaction. Our results also show that those with fewer years of clinical practice might be at greater risk of burnout (p= 0.021), anxiety and stress symptoms (both ps= 0.027) and might develop a lower level of compassion satisfaction (p=0.018). Moreover, the factors that potentially contribute to poor mental health, compassion fatigue and compassion satisfaction seem to differ between residents and specialist physicians. Conclusions: This overview presents one of the first pictures of the long-term effects of the pandemic on the mental health and professional quality of life of an Italian sample of HCWs. Moreover, it also helps identify professionals who are most in need of support and emphasises the importance of improving the psychological and professional wellbeing of these individuals especially during a pandemic-like crisis with long lasting effects.



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1. De Sio S, Buomprisco G, La Torre G, et al. The impact of COVID-19 on doctors’ well-being: results of a web survey during the lockdown in Italy. Eur Rev Med Pharmacol. 2020;24(14):7869-7879. Doi: https://doi.org/10.26355/eurrev_202007_22292
2. Pérez-Chacón M, Chacón A, Borda-Mas M, & Avargues-Navarro ML. Sensory Processing Sensitivity and Compassion Satisfaction as Risk/Protective Factors from Burnout and Compassion Fatigue in Healthcare and Education Professionals. Int J Env Res Pub Health. 2021;18(2),611. Doi: https://doi.org/10.3390/ijerph18020611.
3. Nathiya D, Suman S, Singh P, Raj P, Tomar BS. Mental Health outcome and Professional quality of Life among Healthcare Worker during COVID-19 pandemic: A (FRONTLINE-COVID) survey. Ann Med Psy-chol (Paris). 2021. Doi: 10.1016/j.amp.2020.12.017
4. Buselli R, Corsi M, Baldanzi S, et al. Professional Quality of Life and Mental Health Outcomes among Health Care Workers Exposed to Sars-Cov-2 (COVID-19). Int J Env Res Pub Health. 2020;17(17):6180. Doi: https://doi.org/10.3390/ijerph17176180
5. Cabarkapa S, Nadjidai SE, Murgier J, Ng CH. The psychological impact of COVID-19 and other viral epi-demics on frontline healthcare workers and ways to address it: A rapid systematic review. BBI-Health. 2020;8:100144. Doi: https://doi.org/10.1016/j.bbih.2020.100144
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. BBI-Health. 2020;88:901-907. Doi: https://doi.org/10.1016/j.bbi.2020.05.026
7. World Health Organization. Mental health and psychosocial considerations during the COVID-19 out-break. 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf
8. Xiang YT, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is ur-gently needed. Lancet Psychiat. 2020;7(3):228-229. Doi: https://doi.org/10.1016/S2215-0366(20)30046-8
9. Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and as-sociated factors in Covid-19 pandemics. Psychiatry Res. 2020;290:113130. Doi: https://doi.org/10.1016/j.psychres.2020.113130
10. British Medical Association. The mental health and wellbeing of the medical workforce – now and beyond COVID-19. 2020. Available at https://www.bma.org.uk/media/2475/bma-covid-19-and-nhs-staff-mental-healthwellbeing-report-may-2020.pdf
11. Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, et al. Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. J Affect Disord. 2020;275:48–57. Doi: https://doi.org/10.1016/j.jad.2020.06.022
12. Maslach C. Comprendiendo el burnout. Cienc Trab. 2009;11:37-43.
13. Figley CR. Compassion fatigue: psychotherapists’ chronic lack of self care. J Clin Psychol. 2002;58(11):1433-1441. Doi: https://doi.org/10.1002/jclp.10090
14. Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Work-ers: A Systematic Review. Int J Env Res Pub Health. 2016;13(6):618. Doi: https://doi.org/10.3390/ijerph13060618
15. Brooks SK, Dunn R, Amlôt R, Rubin GJ, Greenberg N. A Systematic, Thematic Review of Social and Oc-cupational Factors Associated with Psychological Outcomes in Healthcare Employees During an Infec-tious Disease Outbreak. J Occup Environ Med. 2018;60(3):248-257. Doi: https://doi.org/10.1097/JOM.0000000000001235
16. Wallace CL, Wladkowski SP, Gibson A, White P. Grief During the COVID-19 Pandemic: Considerations for Palliative Care Providers. J Pain Symptom Manag. 2020;60(1):e70–e76. Doi: https://doi.org/10.1016/j.jpainsymman.2020.04.012
17. Dosil M, Ozamiz-Etxebarria N, Redondo I, Picaza M, Jaureguizar J. Psychological Symptoms in Health Professionals in Spain After the First Wave of the COVID-19 Pandemic. Front Psychol. 2020;11:606121. Doi: https://doi.org/10.3389/fpsyg.2020.606121
18. Salimi R, Gomar R, Heshmati B. The COVID-19 outbreak in Iran. J Global Health. 2020;10(1):010365. Doi: https://doi.org/10.7189/jogh.10.010365
19. Wu Y, Wang J, Luo C, et al. A Comparison of Burnout Frequency Among Oncology Physicians and Nurses Working on the Frontline and Usual Wards During the COVID-19 Epidemic in Wuhan, China. J Pain Symptom Manag. 2020;60(1):e60–e65. Doi: https://doi.org/10.1016/j.jpainsymman.2020.04.008
20. Ruiz-Fernández MD, Pérez-García E, Ortega-Galán ÁM. Quality of Life in Nursing Professionals: Burn-out, Fatigue, and Compassion Satisfaction. Int J Env Res Pub Health. 2020;17(4):1253. Doi: https://doi.org/10.3390/ijerph17041253
21. Bettinsoli ML, Di Riso D, Napier JL, et al. Mental Health Conditions of Italian Healthcare Professionals during the COVID-19 Disease Outbreak. Appl Psychol Health Well Being. 2020;12(4):1054-1073. Doi: https://doi.org/10.1111/aphw.12239
22. Di Mattei VE, Perego G, Milano F, et al. The "Healthcare Workers’ Wellbeing (Benessere Operatori)" Project: A Picture of the Mental Health Conditions of Italian Healthcare Workers during the First Wave of the COVID-19 Pandemic. Int J Env Res Pub Health. 2021;18(10):5267. Doi: https://doi.org/10.3390/ijerph18105267
23. Farì G, de Sire A, Giorgio V, et al. Impact of COVID-19 on the mental health in a cohort of Italian reha-bilitation healthcare workers. J Med Virol. 2022;94(1):110-118. Doi: https://doi.org/10.1002/jmv.27272
24. Corradini E, Ventura P, Ageno W, et al. Clinical factors associated with death in 3044 COVID-19 pa-tients managed in internal medicine wards in Italy: results from the SIMICOVID-19 study of the Italian society of internal medicine (SIMI). Intern Emerg Med. 2021;16(4):1005-1015. Doi: https:// doi. org/ 10. 1007/ s11739- 021- 02742-8
25. Cicco S, Guerra R, Leaci A, et al. Coronavirus disease 19 (CoViD-19) impact on cardiovascular disease in a non-CoViD-19 emergency setting. Intern Emerg Med. 2021;16(5):1377-1379. Doi: https://doi.org/10. 1007/s11739-020-02573-z.
26. Li W, Frank E, Zhao Z, et al. Mental health of young physicians in china during the novel coronavirus disease 2019 outbreak. JAMA Netw Open. 2020;3(6):e2010705. Doi: https://doi.org/10. 1001/jamanetworkopen.2020.10705
27. Farr S, Berry JA, Berry DK, et al. The impact of the COVID-19 pandemic on resident physicians well-being in the surgical and primary care specialties in the United States and Canada. Cureus. 2021;13(11):e19677. Doi: https://doi.org/10.7759/cureus.19677
28. Barac A, Krnjaic P, Vujnovic N, et al. The impact of the COVID-19 pandemic on resident physicians: a cross-sectional study. Work. 2021;69(3):751-758. Doi: https://doi. org/10.3233/WOR- 205253
29. Cravero AL, Kim NJ, Feld LD, et al. Impact of exposure to patients with COVID-19 on residents and fel-lows: an international survey of 1420 trainees. Postgrad Med J. 2021;97(1153):706-715. Doi: https://doi. org/10.1136/postg radme dj-2020-138789
30. Thomas NK. Resident burnout. JAMA, 2004;292:2880-2889.
31. Eckleberry-Hunt J, Lick D, Boura J, et al. An exploratory study of resident burnout and wellness. Acad. Med. 2009,84:269-277.
32. Romiti GF, Bencivenga L, Villani R, et al. The impact of COVID-19 pandemic on well-being of Italian physicians: a report from the Italian Society of Internal Medicine (SIMI) national survey. Intern Emerg Med. 2023;18:53-65. Advance online publication. Doi: https://doi.org/10.1007/s11739-022-03108-4
33. Zoorob D, Shah S, La Saevig D, et al. Insight into resident burnout, mental wellness, and coping mecha-nisms early in the COVID-19 pandemic. PLoS ONE. 2021;16:e0250104.
34. Mion G, Hamann P, Saleten M, et al. Psychological impact of the COVID-19 pandemic and burnout se-verity in French residents: A national study. Eur J Psychiatry. 2021;35:173-180.
35. Holmes EA, O'Connor RC, Perry VH, et al. Multidisciplinary research priorities for the COVID-19 pan-demic: a call for action for mental health science. Lancet Psychiat. 2020;7(6):547-560. Doi: https://doi.org/10.1016/S2215-0366(20)30168-1
36. Wu P, Fang Y, Guan Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psuchiatry. 2009;54(5):302-311. Doi: https://doi.org/10.1177/070674370905400504
37. Stamm B. The Concise ProQOL Manual: The concise manual for the Professional Quality of Life Scale, 2 nd Edition. Pocatello; 2010.
38. Palestini L, Prati G, Pietrantoni L, Cicognani E. The professional quality of life in accident and emer-gency work: A contribution to the Italian validation of the Professional Quality of Life Scale (ProQOL). Psicoter Cogn e Comportamentale. 2009;15:2.
39. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(Pt2):227-239. Doi: https://doi.org/10.1348/014466505X29657
40. Bottesi G, Ghisi M, Altoè G, Conforti E, Melli G, Sica C. The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples. Compr Psychiatry. 2015;60:170-181. Doi: https://doi.org/10.1016/j.comppsych.2015.04.005
41. Restauri N, Sheridan AD. Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. J Am Coll Radiol. 2020;17(7):921-926. Doi: https://doi.org/10.1016/j.jacr.2020.05.021
42. De Kock JH, Latham HA, Leslie SJ, et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC Public Health. 2021;21(1):104. Doi: https://doi.org/10.1186/s12889-020-10070-3
43. Della Monica A, Ferrara P, Dal Mas F, Cobianchi L, Scannapieco F, Ruta F. The impact of Covid-19 healthcare emergency on the psychological well-being of health professionals: a review of literature. Ann Ig. 2022;34(1):27-44. Doi: https://doi.org/10.7416/ai.2021.2445
44. Magnavita N, Tripepi G, Di Prinzio RR. Symptoms in Health Care Workers during the COVID-19 Epi-demic. A Cross-Sectional Survey. Int J Env Res Pub Health. 2020;17(14):5218. Doi: https://doi.org/10.3390/ijerph17145218
45. Xu J, Xu QH, Wang CM, Wang J. Psychological status of surgical staff during the COVID-19 outbreak. Psychiatry Res. 2020;288:112955. Doi: https://doi.org/10.1016/j.psychres.2020.112955
46. Huang Z, Zhuang D, Xiong B, Deng DX, Li H, Lai W. Occupational exposure to SARS-CoV-2 in burns treatment during the COVID-19 epidemic: Specific diagnosis and treatment protocol. Biomed Pharma-cother. 2020;127:110176. Doi: https://doi.org/10.1016/j.biopha.2020.110176
47. Cai H, Tu B, Ma J, et al. Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID 19) in Hu-bei, China. Med Sci Monit. 2020;26:e924171. Doi: https://doi.org/10.12659/MSM.924171
48. Bozdağ F, Ergün N. Psychological Resilience of Healthcare Professionals During COVID-19 Pandemic. Psychol Rep. 2021,124(6):2567-2586. Doi: https://doi.org/10.1177/0033294120965477
49. Shacham M, Hamama-Raz Y, Kolerman R, Mijiritsky O, Ben-Ezra M, Mijiritsky E. COVID-19 Factors and Psychological Factors Associated with Elevated Psychological Distress among Dentists and Dental Hy-gienists in Israel. Int J Env Res Pub Health. 2020;17(8):2900. Doi: https://doi.org/10.3390/ijerph17082900
50. Pietromonaco PR, Overall NC. Implications of social isolation, separation, and loss during the COVID-19 pandemic for couples’ relationships. Current Opin Psychol. 2022;43:189-194. Doi: https://doi.org/10.1016/j.copsyc.2021.07.014
51. Lee SJ, Ward KP, Rodriguez CM. Longitudinal Analysis of Short-term Changes in Relationship Conflict During COVID-19: A Risk and Resilience Perspective. J Interpers Violence. 2021;37:15-16. Advance online publication. Doi: https://doi.org/10.1177/08862605211006359
52. Sun N, Wei L, Shi S, et al. A qualitative study on the psychological experience of caregivers of COVID-19 patients. Am J Infect Control. 2020;48(6):592-8. Doi: https://doi.org/10.1016/j.ajic.2020.03.018
53. Lai J, Ma S, Wang Y, et al. Factors Associated with Mental Health Outcomes Among Health Care Work-ers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. Doi: https://doi.org/10.1001/jamanetworkopen.2020.3976
54. Eid RS, Gobinath AR, Galea L. Sex differences in depression: Insights from clinical and preclinical stud-ies. Prog Neurobiol .2019;176:86-102. Doi: https://doi.org/10.1016/j.pneurobio.2019.01.006
55. Brera AS, Arrigoni C, Dellafiore F, et al. Burnout syndrome and its determinants among healthcare workers during the first wave of the Covid-19 outbreak in Italy: a cross-sectional study to identify sex-related differences. Med Lav. 2021;112(4):306-319. Published 2021 Aug 26. Doi:10.23749/mdl.v112i4.11316
56. Di Tella M, Romeo A, Benfante A, Castelli L. Mental health of healthcare workers during the COVID-19 pandemic in Italy. J Eval Clin Pract. 2020;26(6):1583-1587. Doi:10.1111/jep.13444
57. Azzolina D, Lorenzoni G, Silvestri L, Prosepe I, Berchialla P, Gregori D. Regional Differences in Mortality Rates During the COVID-19 Epidemic in Italy. Disaster Med Public Health Prep. 2022;16(4):1355-1361. Doi: 10.1017/dmp.2020.486
58. Buselli R, Corsi M, Veltri A, et al. Mental health of Health Care Workers (HCWs): a review of organiza-tional interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19. Psychiatry Res. 2021;299:113847. Doi: https://doi.org/10.1016/j.psychres.2021.113847
59. Halms T, Strasser M, Kunz M, Hasan A. How to Reduce Mental Health Burden in Health Care Workers During COVID-19? – A Scoping Review of Guideline Recommendations. Front Psychiatry. 2022;12,770193. Doi: https://doi.org/10.3389/fpsyt.2021.770193
60. De Vera MIV, Gabari MI. Associated factors with resilience and burnout: A cross-sectional study in a teaching group in Spain. Aula Abierta. 2020;49,177-184.
61. Galindo-Domínguez H, Pegalajar M, Uriartec JD. Mediator and moderator effect of resilience between self-efficacy and burnout amongst social and legal sciences faculty members. Rev Psicodidáctica. 2020;25:127-135.
62. Soons I, Brouwers A, Tomic W. An experimental study of the psychological impact of a Mindful-ness-Based Stress Reduction Program on highly sensitive persons. Eur J Psycol. 2010;4:148-169. Doi: 10.5964/ejop.v6i4.228
63. Albott CS, Wozniak JR, McGlinch BP, Wall MH, Gold BS, Vinogradov S. Battle Buddies: Rapid Deployment of a Psychological Resilience Intervention for Health Care Workers During the COVID-19 Pandemic. Anesth Analg. 2020;131(1):43-54. Doi: https://doi.org/10.1213/ANE.0000000000004912
64. Giorgi G, Lecca LI, Alessio F, et al. COVID-19-Related Mental Health Effects in the Workplace: A Narrative Review. Int J Environ Res Public Health. 2020;17(21):7857. Doi. https://doi.org/10.3390/ijerph17217857
65. Morina N, Weilenmann S, Dawson K, et al. RECHARGE – A Brief Psychological Intervention to Build Re-silience in Health Care Workers During the COVID-19 Pandemic: Study Protocol for a Randomized Con-trolled Trial. 15 March 2021, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-212942/v1] .