Family Experiences of Living With Frontline Healthcare Workers During the COVID‐19 Pandemic in the United Kingdom: Perspectives From the Black and Asian Community

A proactive, team-based, psychological solution to burnout

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, also known as COVID-19, has developed into an alarming situation around the world. Healthcare workers are playing the role of frontline defense to safeguard the lives of everyone during the COVID-19 pandemic. The present study aimed to investigate the anxiety levels and sleep quality among frontline and second-line healthcare workers during the COVID-19 pandemic. In this cross-sectional study, a validated, self-administered, electronic questionnaire was distributed through email to healthcare workers. The selection of 1678 healthcare workers was based on a convenience sampling technique. The General Anxiety Disorder-7 (GAD-7) and Pittsburgh Sleep Quality Index (PSQI) instrument scales were used to assess healthcare workers’ anxiety levels and sleep quality during the COVID-19 pandemic. Out of 1678 respondents, 1200 (71.5%) were frontline healthcare workers, while 478 (28.5%) were second-line healthcare workers. Among all the healthcare workers, 435 (25.92%) were experiencing moderate to severe anxiety. Among them, 713 (59.4%) frontline healthcare workers were experiencing anxiety in comparison with 277 (57.9%) second-line healthcare workers. Severe anxiety symptoms were seen in 137 (11.41%) frontline healthcare workers compared to 44 (9.20%) second-line healthcare workers. In total, 1376 (82.0%) healthcare workers were found to have poor sleep quality; 975 (58.10%) were frontline, and 407 (23.89%) were second-line healthcare workers. The highest poor sleep quality levels were found among 642 (84.6%) of the healthcare workers who work in frontline areas (emergency departments, intensive care units, and wards) compared to 734 (79.9%) of the healthcare workers who work in second-line areas. These findings provide a substantial contribution to the consolidation of evidence concerning the negative impact of the pandemic on the mental health of healthcare workers (HCWs). These results have established an association that the COVID-19 pandemic causes larger negative psychological symptoms in frontline healthcare workers, such as severe anxiety and poor sleep quality. Preventive measures to minimize anxiety levels and maintain sleep quality, addressing this issue nationally and globally, are essential to support the healthcare workers who are sacrificing their mental health for the future of our nations.

Healthcare workers (HCWs) treating and caring for patients with emerging infectious diseases often experience psychological distress. However, the psychological impact and behavior change of the coronavirus disease 2019 (COVID-19) pandemic among HCWs are still unknown. This study aimed to investigate the worries and concerns of HCWs regarding the COVID-19 pandemic. In this cross-sectional survey, a web-based questionnaire was distributed among HCWs working in hospitals or clinics across Japanese medical facilities from April 20 to May 1, 2020. The questionnaire comprised items on demographics, worries and concerns, perceptions regarding the sufficiency of information, and behavioral changes pertaining to the COVID-19 pandemic. A total of 4386 HCWs completed the survey; 1648 (64.7%) were aged 30–39 years, 2379 (54.2%) were male, and 782 (18.1%) were frontline HCWs, directly caring for patients with COVID-19 on a daily basis. 3500 HCWs (79.8%) indicated that they were seriously worried about the pandemic. The most frequent concern was the consequence of becoming infected on their family, work, and society (87.4%). Additionally, the majority (55.5%) had restricted social contact and almost all HCWs endorsed a shortage in personal protective equipment (median, 8/9 (interquartile range; 7–9) on a Likert scale). There was no significant difference in the degree of worry between frontline and non-frontline HCWs (8/9 (7–9) vs. 8/9 (7–9), p = 0.25). Frontline HCWs, compared to non-frontline HCWs, were more likely to have the need to avoid contact with families and friends (24.8% vs. 17.8%, p < 0.001) and indicated that they cannot evade their professional duty during the COVID-19 pandemic (9/9 (7–9) vs. 8/9 (6–9), p < 0.001). Further, the extremely low proportion of frontline HCWs reported that they would take a leave of absence to avoid infection (1.2%). In conclusions, both frontline and non-frontline HCWs expressed comparable concerns regarding the COVID-19 pandemic. Because HCWs, especially frontline HCWs, reported that they cannot be obliged to do avoid their duty, effective mental health protection strategies should be developed and implemented for HCWs.

BackgroundDue to long working hours, shifts, poor working conditions, and high risk of exposure to traumatic incidents at work, healthcare workers (HCWs) are at high risk of developing mental health and wellbeing issues. Family members and close friends of HCWs are often the primary support source for the HCWs. However, while supporting the HCWs, family members’ and friends’ mental health and wellbeing may be impacted negatively. According to the findings of previous literature, family members of other high-risk workers may experience secondary traumatic stress. To date, there has been no research focusing on secondary traumatic stress in family members and friends of HCWs.MethodsIn this cross-sectional, mixed-method study, we examined secondary traumatic stress and associated factors amongst 320 household members (family members and housemates) of HCWs in the UK using the Secondary Traumatic Stress Scale. We used multivariable linear regression to examine the predictors of secondary traumatic stress, specifically sex, age, job role of the HCW, and the relationship with the HCW. Then we used content analysis of responses to open-ended questions to explore the experiences of household members in-depth.Results33.8% of household members reported secondary traumatic stress within the severe range. Female spouses and partners of HCWs with clinical roles showed higher STS compared to male and other household members of HCWs with non-clinical roles. In our regression model, we found that being female, having a HCW household member with a clinical role, and being a spouse or a partner of a HCW were statistically significant predictors of high STS. Open-ended responses showed that household members reported that HCWs tended to be irritated, quieter/distant, anxious/stressed, in low moods, and exhausted after having a difficult day at work. These feelings and behaviours impacted the rest of the household members negatively.ConclusionThis is the first study which has examined secondary traumatic stress amongst household members of HCWs. While trying to support the HCW, household members were at high risk of developing secondary traumatic stress. There are research implications to understand HCWs’ and their household members’ experiences better, including extending current research and conducting further research exploring secondary traumatic stress in HCWs’ household members, and factors associated with it, which go beyond the demographics examined here. There are also organisational and clinical implications to protect and support both HCWs and their household members, such as improved working conditions for HCWs and carefully planned psychological support for both HCWs and their household members.

Seasonal flu, vaccinations and COVID-19

This study aims to identify the determinants of exhaustion of frontline and second-line healthcare workers (HCW) during the third wave of the COVID-19 pandemic. A case–control study was conducted based on an anonymously distributed questionnaire, which was completed by 1872 HCW. Exhaustion was assessed with a validated Romanian questionnaire. The Siegrist questionnaire was used to determine workload, reward and overcommitment. Frontline HCW reported significantly more frequent longer working hours (p = 0.0009) and a better perception of the management of the risk for infection (p = 0.0002) than second-line HCW. The effort and overcommitment scores were higher in frontline HCW (9.51 + 1.98 vs. 8.45 + 21, p < 0.001 and 16.34 ± 2.80 vs. 15.24 ± 2.94, p < 0.001, respectively) and the reward scores were lower (5.21 ± 1.522 vs. 5.99 ± 1.44, p < 0.001). In the fully adjusted regression model, age, imbalance between effort and reward, overcommitment and management of the risk of infection in the workplace were associated with the exhaustion score in each category of HCW. The number of working hours was correlated with exhaustion in frontline HCW and occupation in second-line HCW. There were more similarities than differences between frontline and second-line HCW. Even if frontline HCW had a higher risk of exhaustion, the risk was not negligible for all HCW.

Background: Burnout is a known professional phenomenon caused by chronic workspace stress that has not been successfully managed. This study aimed to compare the prevalence of burnout syndrome during the COVID-19 pandemic in frontline health care workers (HCWs) versus other HCWs among Makkah and Jeddah hospitals in Saudi Arabia. Methods: A cross-sectional study was conducted among HCWs in Makkah and Jeddah in Saudi Arabia. An online questionnaire was sent through the different social media platforms to collect data and direct collection from HCWs in the hospitals gathered by data collectors. The questionnaire composed of two sections. The first one was concerned with sociodemographic data. The second part of the questionnaire included the Oldenburg Burnout Inventory (OLBI). Result: Out of 460 HCWs, 345 individuals were evaluated after exclusion. In this study, burnout was prevalent among 81.3% of frontline HCWs and 77.4% of non-frontline HCWs (p = 0.475). The total prevalence of burnout among HCWs was 80% (N = 276). We found that frontline HCWs had a higher mean total score of OLBI than non-frontline HCWs (40.42 ± 7.14 vs. 38.83 ± 6.80, respectively) (p = 0.0494). Conclusion: The prevalence of burnout was statistically indifferent between frontline and non-frontline HCWs. However, frontlines had a higher mean of burnout score compared to non-frontlines. The necessity of successful strategies for preventing burnout should be considered to create a better work environment. Such strategies include reducing working hours, promoting mental, emotional, and physical self-care, and applying mindfulness-based stress reduction exercises.

Healthcare workers (HCWs) are at the forefront of the fight against coronavirus. The purpose of this study was to evaluate COVID-19 phobia levels of HCWs of a pandemic hospital and explore associated factors. This was a descriptive cross-sectional study conducted on HCWs employed in a pandemic hospital. A total of 365 HCWs (95 physicians, 187 nurses and 83 assistant healthcare staffs) were included in the study. In order to evaluate COVID-19 phobia, coronavirus-19 phobia scale (C19P-S) was administrated. Chronophobia levels of frontline and nonfrontline HCWs were compared. Additionally, the effect of working in different departments, profession and associated factors on COVID-19 phobia was evaluated. Overall, 172 HCWs completed the C19P-S and agreed to participate in the study. Mean total CP19P-S score of the HCWs included in the study was 50.1 ± 17.3. Of the study population, 59.3% participants were frontline HCWs and 40.7% were non-frontline HCWs. When frontline HCWs and nonfrontline HCWs were compared in terms of total C19P-S and subscales scores (psychological, psycho-somatic, economic, social), no statistically significant differences were found (p= 0.914, p= 0.687, p= 0.766, p= 0.347, p= 0.794, respectively).When the HCWs were divided into three groups according to departments (clinics, intensive care unit (ICU), emergency department) where they worked regardless of whether they cared for patients with COVID-19, HCWs employed in the ICUs had the highest scores regarding total C19P-S and subscales scores (p= 0.002, p= 0.001, p= 0.001, p= 0.012, p= 0.002,respectively) . Profession based comparison revealed no significant difference between the groups regarding total C19P-S score (p= 0.117). It is essential to make a comprehensive evaluation regarding the effects of pandemics on HCWs, not only for controlling the COVID-19 pandemic but also to protect the mental health of HCWs. Critical care professions appear to need particular attention among HCWs. The C19P-S, which assesses coronaphobia levels with psychological, psycho-somatic, economic, and social aspects could be a convenient screening tool for evaluating COVID-19 phobia levels in HWCs.

Healthcare workers (HCWs) are at high risk of experiencing work-related stress, burnout syndrome, and depression, especially during infectious disease outbreaks like COVID-19. Contributing factors include increased workload, lack of personal protective equipment, and inadequate support from the healthcare administration. Longitudinal studies have shown that the mental health status of HCWs has deteriorated over time. Social support and compassion satisfaction (CS) are protective factors that can mitigate adverse mental health effects. The present longitudinal study examined the mental health status of HCWs during the COVID-19 outbreak and aimed to identify potential predictors and protective factors. The study comprised 386 healthcare workers in Hungary and was conducted in two waves (T1 and T2) from January 2021 to January 2022. Participants completed an online survey including the Professional Quality of Life Scale, Maslach Burnout Inventory, demographic and work-related background factors. Statistical analyses included descriptive statistics, and a cross-lagged panel model (CLPM). Frontline HCWs had higher levels of secondary traumatic stress (STS) and emotional exhaustion (EE) than non-frontline healthcare workers. Both groups experienced significant increases in these measures between T1 and T2. The CLPM indicated that EE had a significant lagged effect on STS among frontline workers, while STS had a significant lagged effect on EE among non-frontline workers. CS had a significant protective effect on both STS and EE in both groups. The findings suggest that CS protects EE and STS, particularly among frontline HCWs. The study also showed that different causative relationships exist between these factors among frontline and non-frontline HCWs, which underlines the possible cyclical relationship between the two depending on the circumstances. The results provide insights into the protective role of positive work experiences and the importance of considering the needs of both frontline and non-frontline HCWs in preventive intervention programs.

SARS-CoV-2 Transmission Risk to Household and Family Contacts by Vaccinated Healthcare Workers.

Association between SARS-CoV-2 exposure and antibody status among healthcare workers in two London hospitals: a cross-sectional study

Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal. Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches. Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients. Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coordination mechanism between various tiers of health structure (including private sector) in addition to incentivizing the health-care workers for the current and future pandemics.

IntroductionDuring the COVID-19 pandemic, healthcare workers in Italy have been exposed to an unprecedented pressure and traumatic events. However, no direct comparison with the general population is available so far. The aim of this study is to detail mental health outcomes in healthcare workers compared to the general population.Methods24050 respondents completed an on-line questionnaire during the contagion peak, 21342 general population, 1295 second-line healthcare workers, and 1411 front-line healthcare workers. Depressive, anxious, post-traumatic symptoms and insomnia were assessed. Specific COVID-19 related potential risk factors were also considered in healthcare workers.ResultsDepressive symptoms were more frequent in the general population (28.12%) and front-line healthcare workers (28.35%) compared to the second-line healthcare workers (19.98%) groups. Anxiety symptoms showed a prevalence of 21.25% in the general population, 18.05% for second-line healthcare workers, and 20.55% for front-line healthcare workers. Insomnia showed a prevalence of 7.82, 6.58, and 9.92% for the general population, second-line healthcare workers, and front-line healthcare workers, respectively. Compared to the general population, front-line healthcare workers had higher odds of endorsing total trauma-related symptoms. Both second-line healthcare workers and front-line healthcare workers had higher odds of endorsing core post-traumatic symptoms compared to the general population, while second-line healthcare workers had lower odds of endorsing negative affect and dissociative symptoms. Higher total traumatic symptom score was associated with being a front-line healthcare worker, having a colleague infected, hospitalized, or deceased, being a nurse, female gender, and younger age.ConclusionThis study suggests a significant psychological impact of the COVID-19 pandemic on the Italian general population and healthcare workers. Front-line healthcare workers represent a specific at-risk population for post-traumatic symptoms. These findings underline the importance of monitoring and intervention strategies.

Knowledge, Attitudes, and Beliefs of Pediatric Health Care Workers: Understanding the Response to COVID-19.

BackgroundThe detrimental impacts of COVID-19 on the mental well-being of frontline healthcare workers (HCWs) have been well studied. However, the long-term trajectory of their mental well-being remains relatively unexplored. We examined the magnitude and predictors of the psychological impact of COVID-19 on frontline HCWs during the transition into the “new normal” phase.MethodsA cross-sectional survey was performed on frontline HCWs at two largest designated COVID-19 hospitals in Ho Chi Minh City between May and November 2022. A self-administered questionnaire captured participants’ demographic characteristics and psychological distress including depression, anxiety, and insomnia. Multivariable logistic regression models were used to examine factors associated with psychological distress.ResultsAmong 462 HCWs, 85.3% self-reported having good, very good, or excellent mental health before their COVID-19 deployment, compared to 40.7% during the deployment and 55.6% at the time of the study. The prevalence of moderate-to-severe depression was 26.8%, anxiety (20.8%), insomnia (23.4%), and overall psychological distress (73.2%). Predictors for depression included pre-existing physical (adjusted odds ratio [aOR] = 2.09, 95%CI 1.03–4.22, P = 0.04) and mental health (aOR = 3.59, 95%CI 1.31–9.84, P = 0.01) conditions and being deployed during the 3rd (aOR = 6.28, 95%CI 1.12–35.08, P = 0.04) and 4th (aOR = 5.01, 95%CI 1.08–23.16, P = 0.04) COVID-19 wave. Those with mental health conditions before the deployment (aOR = 3.95, 95%CI 1.42–11.0, P = 0.008) were more likely to report anxiety symptoms. Predictors for insomnia included physical health conditions before the deployment (aOR = 2.73, 95%CI 1.37–5.44, P = 0.004), working at field hospitals (aOR = 2.44, 95%CI 1.43–4.16, P = 0.001), and currently being deployed to respond to COVID-19 (aOR = 0.35, 95%CI 0.19–0.67, P = 0.001).ConclusionsGiven the substantial impact of COVID-19 deployment on HCWs’ long-term mental well-being, comprehensive mental health support strategies are urgently needed. As HCWs may overlook their mental health issues, a screening program with psychological support services should accompany them early in future pandemics. Further nationwide studies with longer follow-ups are necessary to understand the full extent of psychological distress among frontline HCWs in Vietnam.