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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 in an Italian cohort of healthcare workers


  • Valentina Delle Donne a:1:{s:5:"en_US";s:35:"Catholic University of Sacred Heart";}
  • 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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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. European review for medical and pharmacological scienc-es.2020;24(14):7869–7879.

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. International journal of environmental research and public health. 2021; 18(2), 611.

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. Annales medi-co-psychologiques. 2021;10.1016/j.amp.2020.12.017. Advance online publication.

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). International journal of environmental research and pub-lic health. 2020;17(17):6180.

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. Brain, behavior, & immunity – health.2020; 8,100144.

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, behavior, and immunity.2020;88: 901–907.

World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. 2020. Available at

Xiang YT, Yang Y, Li W, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The lancet. Psychiatry. 2020; 7(3):228–229.

Elbay RY, Kurtulmuş A, Arpacıoğlu S, & Karadere E. Depression, anxiety, stress levels of physicians and as-sociated factors in Covid-19 pandemics. Psychiatry research. 2020;290: 113130.

British Medical Association. The mental health and wellbeing of the medical workforce – now and beyond COVID-19. 2020. Available at

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. Journal of affective disorders. 2020;275:48–57.

Maslach C. Comprendiendo el burnout. Cienc. Trab. 2009;11:37–43.

Figley CR. Compassion fatigue: psychotherapists' chronic lack of self care. Journal of clinical psychology. 2002;58(11):1433–1441.

Cocker F, & Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. International journal of environmental research and public health. 2016;13(6):618.

Brooks SK, Dunn R, Amlôt R, Rubin GJ, & Greenberg N. A Systematic, Thematic Review of Social and Occu-pational Factors Associated With Psychological Outcomes in Healthcare Employees During an Infectious Disease Outbreak. Journal of occupational and environmental medicine. 2018;60(3):248–257.

Wallace CL, Wladkowski SP, Gibson A, & White P. Grief During the COVID-19 Pandemic: Considerations for Palliative Care Providers. Journal of pain and symptom management. 2020; 60(1):e70–e76.

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. Frontiers in psycholo-gy.2020;11:606121.

Salimi R, Gomar R, & Heshmati B. The COVID-19 outbreak in Iran. Journal of global health. 2020;10(1):010365.

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. Journal of pain and symptom management. 2020;60(1):e60–e65.

Ruiz-Fernández MD, Pérez-García E, & Ortega-Galán ÁM. Quality of Life in Nursing Professionals: Burnout, Fatigue, and Compassion Satisfaction. International journal of environmental research and public health. 2020;17(4):1253.

Bettinsoli ML, Di Riso D, Napier JL, et al. Mental Health Conditions of Italian Healthcare Professionals dur-ing the COVID-19 Disease Outbreak. Applied psychology. Health and well-being. 2020;12(4):1054–1073.

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. International journal of environmental research and public health. 2021;18(10):5267.

Farì G, de Sire A, Giorgio V, et al. Impact of COVID-19 on the mental health in a cohort of Italian rehabilita-tion healthcare workers. Journal of medical virology. 2022;94(1):110–118.

Corradini E, Ventura P, Ageno W et al. Clinical factors associated with death in 3044 COVID-19 patients 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. https:// doi. org/ 10. 1007/ s11739- 021- 02742-8.

Cicco S, Guerra R, Leaci A et al. Corona virus disease 19 (CoViD-19) impact on cardiovascular disease in a non-CoViD-19 emergency setting. Intern Emerg Med 2021; 16(5):1377–1379. https:// doi. org/ 10. 1007/ s11739- 020- 02573-z.

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. https:// doi. org/ 10. 1001/ jaman etwor kopen. 2020. 10705.

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. https:// doi. org/ 10. 7759/ cureus. 19677.

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. https:// doi. org/ 10. 3233/ WOR- 205253.

Cravero AL, Kim NJ, Feld LD et al. Impact of exposure to patients with COVID-19 on residents and fellows: an international survey of 1420 trainees. Postgrad Med J 2021; 97(1153):706–715. https:// doi. org/ 10. 1136/ postg radme dj- 2020- 138789.

Thomas NK. Resident burnout. JAMA, 2004; 292, 2880–2889.

Eckleberry-Hunt J, Lick D, Boura J et al. An exploratory study of resident burnout and wellness. Acad. Med. 2009, 84, 269–277.

Romiti GF, Bencivenga L, Villani R et al. The impact of COVID-19 pandemic on well-being of Italian physi-cians: a report from the Italian Society of Internal Medicine (SIMI) national survey. Internal and emergency medicine 2022; 1–13. Advance online publication.

Zoorob D, Shah S, La Saevig D et al. Insight into resident burnout, mental wellness, and coping mechanisms early in the COVID-19 pandemic. PLoS ONE 2021; 16, e0250104.

Mion G, Hamann P, Saleten M et al. Psychological impact of the COVID-19 pandemic and burnout severity in French residents: A national study. Eur. J. Psychiatry 2021, 35, 173–180.

Holmes EA, O'Connor RC, Perry VH, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The lancet. Psychiatry. 2020;7(6):547–560.

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. Canadian journal of psychiatry. Revue canadi-enne de psychiatrie. 2009;54(5):302–311.

Stamm B. The Concise ProQOL Manual: The concise manual for the Professional Quality of Life Scale, 2 nd Edition. Pocatello; 2010.

Palestini L, Prati G, Pietrantoni L & Cicognani E. The professional quality of life in accident and emergency work: A contribution to the Italian validation of the Professional Quality of Life Scale (ProQOL). Psicotera-pia Cognitiva e Comportamentale. 2009;15:2.

Henry JD, & Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): con-struct validity and normative data in a large non-clinical sample. The British journal of clinical psychology. 2005;44(Pt2):227–239.

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. Comprehen-sive psychiatry. 2015;60:170–181.

Restauri N, & Sheridan AD. Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. Journal of the American College of Radiol-ogy : JACR. 2020;17(7):921–926.

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.

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. An-nali di igiene: medicina preventiva e di comunita. 2022;34(1):27–44.

Magnavita N, Tripepi G, & Di Prinzio RR. Symptoms in Health Care Workers during the COVID-19 Epidemic. A Cross-Sectional Survey. International journal of environmental research and public health. 2020;17(14):5218.

Xu J, Xu QH, Wang CM, & Wang J. Psychological status of surgical staff during the COVID-19 outbreak. Psy-chiatry research. 2020;288:112955.

Huang Z, Zhuang D, Xiong B, Deng DX, Li H, & Lai W. Occupational exposure to SARS-CoV-2 in burns treat-ment during the COVID-19 epidemic: Specific diagnosis and treatment protocol. Biomedicine & pharma-cotherapy = Biomedecine & pharmacotherapie. 2020;127: 110176.

Cai H, Tu B, Ma J, et al. Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Be-tween January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID 19) in Hubei, China. Medical science monitor: international medical journal of experimental and clinical research. 2020; 26: e924171.

Bozdağ F, & Ergün N. Psychological Resilience of Healthcare Professionals During COVID-19 Pandemic. Psychological reports. 2021,124(6):2567–2586.

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 Hygien-ists in Israel. International journal of environmental research and public health. 2020;17(8):2900.

Pietromonaco PR, & Overall NC. Implications of social isolation, separation, and loss during the COVID-19 pandemic for couples' relationships. Current opinion in psychology. 2022; 43:189–194.

Lee, SJ, Ward KP, & Rodriguez CM. Longitudinal Analysis of Short-term Changes in Relationship Conflict During COVID-19: A Risk and Resilience Perspective. Journal of interpersonal violence. 2021;8862605211006359. Advance online publication.

Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the psychological experience of care-givers of COVID-19 patients. Am J Infect Control. 2020;48(6):592–8.

Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA network open. 2020;3(3): e203976.

Eid RS, Gobinath AR, & Galea L. Sex differences in depression: Insights from clinical and preclinical studies. Progress in neurobiology .2019; 176:86–102.

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 dif-ferences. Med Lav. 2021;112(4):306-319. Published 2021 Aug 26. doi:10.23749/mdl.v112i4.11316.

Di Tella M, Romeo A, Benfante A, Castelli L. Mental health of healthcare workers during the COVID-19 pan-demic in Italy. J Eval Clin Pract. 2020;26(6):1583-1587. doi:10.1111/jep.13444.

Buselli R, Corsi M, Veltri A, et al. Mental health of Health Care Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19. Psychiatry research. 2021;299:113847.

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. Frontiers in psychiatry. 2022;12,770193.

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.

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.

Soons I, Brouwers A & Tomic W. An experimental study of the psychological impact of a Mindfulness-Based Stress Reduction Program on highly sensitive persons. Europe's Journal of Psychology. 2010;4:148-169.10.5964/ejop.v6i4.228.

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. Anes-thesia and analgesia. 2020;131(1):43–54.

Giorgi G, Lecca LI, Alessio F, et al. COVID-19-Related Mental Health Effects in the Workplace: A Narrative Review. International journal of environmental research and public health. 2020;17(21): 7857.

Morina N, Weilenmann S, Dawson K, et al. RECHARGE – A Brief Psychological Intervention to Build Resili-ence in Health Care Workers During the COVID-19 Pandemic: Study Protocol for a Randomized Controlled Trial. 2021;10.21203/



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