The role of resilience and coping among Italian healthcare workers during the COVID-19 pandemic

Main Article Content

Federica Marcolongo
Marco Ottaviani
Paola Romano
Stefano Bonassi
Ada Garramone
Francesco Infarinato
Patrizia Russo
Andrea Tamburrano
Carlo Tomino
Giulia Prinzi

Keywords

COVID-19, coping strategies, resilience, anxiety, depression, HCW

Abstract

Objective: To evaluate the psychological state of healthcare workers (HCWs) in the field of rehabilitation during the COVID-19 pandemic. Methods: Cross-sectional observational study. Sample of 334 HCWs including: nurses, medical doctors, therapists, scientists, and clerical workers working at the IRCCS San Raffaele Roma rehabilitation hospital during the second wave of the COVID-19 pandemic. Anonymous web-based questionnaire included 14-item Resilience Scale, Brief-COPE, Hospital Anxiety Depression Scale, Fear of COVID-19 Scale. Occupational and sociodemographic characteristics. Results: High levels of resilience, low levels of anxiety, depression, and fear were observed in the study population; the most frequently used coping strategies in the Brief-COPE were acceptance, planning, and active coping. Specifically, 87% of the participants reported a moderate to high level of resilience, with the highest level observed in nurses while physicians show the lowest level. HCWs showed symptoms of anxiety (29%), depressive symptoms (10%), and fear caused by the COVID-19 pandemic (44%). Statistically significant differences were observed between different occupations for fear (p <0.05) and resilience (p <0.01). Levels of anxiety and fear appeared to be higher in female and younger workers. The latter group - who also reported higher levels of depression - showed lower levels of resilience. Conclusions: In our study hospital and non-hospital workers show different emotional, cognitive, and behavioural resources when facing stressful situations, like in the case of the SARS-CoV-2 pandemics. Our results support the role of resilience and the proper use of problem-focused and emotion-focused coping strategies as protective factors from psychological distress.

Abstract 970 | PDF Downloads 571

References

1. Zhao Y, Cui C, Zhang K, et al. COVID19: A Systematic Approach to Early Identification and Healthcare Worker Protection. Front Public Health. 2020;8:205. doi:10.3389/fpubh.2020.00205
2. Rapporto ISS COVID-19, n 1/2020; n.2 Rev./2020; n.3 Rev./2020. (2020).
3. Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. Mar 2 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976
4. Zhang WR, Wang K, Yin L, et al. Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China. Psychother Psychosom. 2020;89(4):242-250. doi:10.1159/000507639
5. Kushal A GS, Mehta M, Singh MM. . Study of Stress among Health Care Professionals: A Systemic Review. International Journal of Research Foundation of Hospital and Healthcare Administration 2018;6(1):6-11. doi:10.5005/jp-journals-10035-1084
6. Lancee WJ, Maunder RG, Goldbloom DS, Coauthors for the Impact of SS. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. Jan 2008;59(1):91-5. doi:10.1176/ps.2008.59.1.91
7. 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. Sep 2020;291:113190. doi:10.1016/j.psychres.2020.113190
8. Liu X, Kakade M, Fuller CJ, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry. Jan 2012;53(1):15-23. doi:10.1016/j.comppsych.2011.02.003
9. Jaffee SR, Caspi A, Moffitt TE, Polo-Tomas M, Taylor A. Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: a cumulative stressors model. Child Abuse Negl. Mar 2007;31(3):231-53. doi:10.1016/j.chiabu.2006.03.011
10. Charney DS. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry. Feb 2004;161(2):195-216. doi:10.1176/appi.ajp.161.2.195
11. Iacoviello BM, Charney DS. Psychosocial facets of resilience: implications for preventing posttrauma psychopathology, treating trauma survivors, and enhancing community resilience. Eur J Psychotraumatol. 2014;5doi:10.3402/ejpt.v5.23970
12. Wagnild GM, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas. Winter 1993;1(2):165-78.
13. Miller TW. Advances in understanding the impact of stressful life events on health. Hosp Community Psychiatry. Jun 1988;39(6):615-22. doi:10.1176/ps.39.6.615
14. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76-82. doi:10.1002/da.10113
15. Fine SB. Resilience and human adaptability: who rises above adversity? 1990 Eleanor Clarke Slagle Lecture. Am J Occup Ther. Jun 1991;45(6):493-503. doi:10.5014/ajot.45.6.493
16. Garmezy N. Children in poverty: resilience despite risk. Psychiatry. Feb 1993;56(1):127-36. doi:10.1080/00332747.1993.11024627
17. Rutter M. Resilience, competence, and coping. Child Abuse Negl. Mar 2007;31(3):205-9. doi:10.1016/j.chiabu.2007.02.001
18. Richardson GE. The metatheory of resilience and resiliency. J Clin Psychol. Mar 2002;58(3):307-21. doi:10.1002/jclp.10020
19. Labrague LJ, Hammad K, Gloe DS, et al. Disaster preparedness among nurses: a systematic review of literature. Int Nurs Rev. Mar 2018;65(1):41-53. doi:10.1111/inr.12369
20. Cooper AL, Brown JA, Rees CS, Leslie GD. Nurse resilience: A concept analysis. Int J Ment Health Nurs. Aug 2020;29(4):553-575. doi:10.1111/inm.12721
21. Louise Duncan D. What the COVID-19 pandemic tells us about the need to develop resilience in the nursing workforce. Nurs Manag (Harrow). Jun 2 2020;27(3):22-27. doi:10.7748/nm.2020.e1933
22. Teles MA, Barbosa MR, Vargas AM, et al. Psychosocial work conditions and quality of life among primary health care employees: a cross sectional study. Health Qual Life Outcomes. May 15 2014;12:72. doi:10.1186/1477-7525-12-72
23. Labrague LJ, De Los Santos JAA. COVID-19 anxiety among front-line nurses: Predictive role of organisational support, personal resilience and social support. J Nurs Manag. Oct 2020;28(7):1653-1661. doi:10.1111/jonm.13121
24. Eckenrode J. The social context of coping. New York: Plenum. 1991;
25. Skinner E, Edge, K.,. Coping and development across the life span. International Journal of Behavioural Development. 1998;22:225-366.
26. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer. 1984:1-456.
27. Wong TW, Yau JK, Chan CL, et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med. Feb 2005;12(1):13-8. doi:10.1097/00063110-200502000-00005
28. Conversano CM,, Marchi L.; , Miniati, M. Psychological distress among healthcare professionals involved in the COVID-19 emer-gency: Vulnerability and resilience factors. Clin Neuropsychiatry. 2020;17:94–96. doi:doi.org/10.36131/CN20200212
29. 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. Jan 8 2021;18(2)doi:10.3390/ijerph18020453
30. Sanghera J, Pattani N, Hashmi Y, et al. The impact of SARS-CoV-2 on the mental health of healthcare workers in a hospital setting-A Systematic Review. J Occup Health. Jan 2020;62(1):e12175. doi:10.1002/1348-9585.12175
31. Pincha Baduge MS, Morphet J, Moss C. Emergency nurses' and department preparedness for an ebola outbreak: A (narrative) literature review. Int Emerg Nurs. May 2018;38:41-49. doi:10.1016/j.ienj.2017.12.002
32. De Brier N, Stroobants S, Vandekerckhove P, De Buck E. Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS & COVID-19): A rapid systematic review. PLoS One. 2020;15(12):e0244052. doi:10.1371/journal.pone.0244052
33. Labrague LJ. Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies. J Nurs Manag. Oct 2021;29(7):1893-1905. doi:10.1111/jonm.13336
34. Labrague LJ, De Los Santos JAA. Prevalence and predictors of coronaphobia among frontline hospital and public health nurses. Public Health Nurs. May 2021;38(3):382-389. doi:10.1111/phn.12841
35. Khalaf OO, Khalil, M. A., & Abdelmaksoud, R. Coping with Depression and Anxiety in Egyptian Physicians during COVID-19 Pandemic. Middle East Current Psychiatry. 2020;doi:10.1186/s43045-020-00070-9
36. Mosheva M, Hertz-Palmor, N., Dorman Ilan, S., Matalon, N., Pessach, I. M., Afek, A., Ziv, A., Kreiss, Y., Gross, R., & Gothelf, D.et al . Anxiety, pandemic-related stress and resilience among physicians during the COVID-19 pandemic. Depression and Anxiety. 2020;doi:https://doi.org/10.1002/da.23085
37. Lisi L., Ciaffi J, Bruni A., Mancarella L., Brusi V., Gramegna P., Ripamonti C., Quaranta E., Borlandelli E.,, Gallo G. GE, Chiaravalloti A., Viola P., Ruscitti P., Caio G., D’Onghia M., D’Amuri A.,, Cimellaro A. FG, La Regina M., Spinardi L.,, De Giorgio R. GR, Landini M.P., Berardi D.,, Meliconi R. UFet al. Levels and Factors Associated with Resilience in Italian Healthcare Professionals during the COVID-19 Pandemic: A Web-Based Survey doi:https://doi.org/10.3390/bs10120183
38. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. Mar 27 2020:1-9. doi:10.1007/s11469-020-00270-8
39. Soraci P, Ferrari A, Abbiati FA, et al. Validation and Psychometric Evaluation of the Italian Version of the Fear of COVID-19 Scale. Int J Ment Health Addict. May 4 2020:1-10. doi:10.1007/s11469-020-00277-1
40. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. Jun 1983;67(6):361-70. doi:10.1111/j.1600-0447.1983.tb09716.x
41. Costantini M, Musso M, Viterbori P, et al. Detecting psychological distress in cancer patients: validity of the Italian version of the Hospital Anxiety and Depression Scale. Support Care Cancer. May 1999;7(3):121-7. doi:10.1007/s005200050241
42. Carver CS. You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med. 1997;4(1):92-100. doi:10.1207/s15327558ijbm0401_6
43. Conti. Italian collection of the assessment scales in psychiatry. 2000.
44. Callegari C, Bertu L, Lucano M, Ielmini M, Braggio E, Vender S. Reliability and validity of the Italian version of the 14-item Resilience Scale. Psychol Res Behav Manag. 2016;9:277-284. doi:10.2147/PRBM.S115657
45. Foster K, Roche M, Giandinoto JA, Furness T. Workplace stressors, psychological well-being, resilience, and caring behaviours of mental health nurses: A descriptive correlational study. Int J Ment Health Nurs. Feb 2020;29(1):56-68. doi:10.1111/inm.12610
46. 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. Aug 2020;88:901-907. doi:10.1016/j.bbi.2020.05.026
47. Luceno-Moreno L, Talavera-Velasco B, Garcia-Albuerne Y, Martin-Garcia 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. Jul 30 2020;17(15)doi:10.3390/ijerph17155514
48. Dubow EF, & Rubinlicht, M. Coping. Encyclopedia of Adolescence. 2011;(3):109-118. doi:10.1016/B978-0-12-373951-3.00107-1
49. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. Mar 26 2020;368:m1211. doi:10.1136/bmj.m1211