Objective: This study examined how best to identify modifiable protective and risk factors for burnout in healthcare workers in the face of the COVID-19 pandemic. Individual, occupational, organizational and social factors were investigated. The study also assessed the impact of these factors on post-traumatic stress disorder (PTSD), anxiety, and depression.Methods: Healthcare workers in the Quebec (Canada) healthcare system were recruited between May 21 to June 5, 2020. Participants answered an electronic survey 3 months after the COVID-19 epidemic outbreak began in Canada. Using the Maslach Burnout Inventory, PTSD Checklist for DSM-5, and Hospital Anxiety and Depression Scale, we studied the prevalence of burnout, PTSD, anxiety and depression in this cohort. Multivariable logistic or linear regression models including resilience, social and organizational support, workload and access to mental health help, simulation techniques and protective personal equipment (PPE) as well as perception of PPE security were conducted for each outcome.Results: In mid-June 2020, 467 participants completed the survey. We found that half (51.8%) of the respondents experienced burnout characterized by emotional exhaustion and/or depersonalization at least once a week. In total, 158 healthcare workers (35.6%) displayed severe symptoms of at least one of the mental health disorders (24.3% PTSD, 23.3% anxiety, 10.6% depression). Resilience (OR = 0.69, 95% CI: [0.55–0.87]; p = 0.002) and perceived organizational support (OR = 0.75, 95% CI: [0.61–0.93]; p = 0.009) were significantly associated with burnout and other outcomes. Social support satisfaction, perception of PPE security, work type and environment, mental health antecedents and reassignment were associated with PTSD and/or anxiety and/or depression, but not burnout.Conclusion: Future studies should address primarily resilience and perceived organizational support to promote mental health and prevent burnout, PTSD, anxiety and depression.

Background The COVID-19 pandemic has put chronic pressure on worldwide healthcare systems. While the literature regarding the prevalence of psychological distress and associated risk factors among healthcare workers facing COVID-19 has exploded, biological variables have been mostly overlooked. Methods 467 healthcare workers from Quebec, Canada, answered an electronic survey covering various risk factors and mental health outcomes three months after the onset of the COVID-19 pandemic. Of them, 372 (80%) provided a hair sample, providing a history of cortisol secretion for the three months preceding and following the pandemic's start. We used multivariable regression models and a receiver operating characteristic curve to study hair cortisol as a predictor of burnout and psychological health, together with individual, occupational, social, and organizational factors. Results As expected, hair cortisol levels increased after the start of the pandemic, with a median relative change of 29% ( IQR = 3% - 59%, p <0.0001). There was a significant association between burnout status and change in cortisol, with participants in the second quarter of change having lower odds of burnout. No association was found between cortisol change and post-traumatic stress disorder, anxiety, and depression symptoms. Adding cortisol to individual-occupational-socio-organizational factors noticeably enhanced our burnout logistic regression model’s predictability. Conclusion Change in hair cortisol levels predicted burnout at three months in health personnel at the onset of the COVID-19 pandemic. This non-invasive biological marker of the stress response could be used in further clinical or research initiatives to screen high-risk individuals to prevent and control burnout in health personnel facing an important stressor.

Background Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psychiatry; 2021) remained associated when assessed several months later. Methods We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multivariable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equivalent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective factors at both time points. Results Prevalence of burnout and anxiety were similar at three and 12 months (52% vs. 51%, p = 0.66; 23% vs. 23%, p = 0.91), while PTSD (23% vs. 11%, p < 0.0001) and depression (11% vs. 6%, p = 0.001) decreased significantly over time. Higher resilience was associated with a lower probability of all outcomes at both time points. Perceived organizational support remained significantly associated with a reduced risk of burnout at 12 months. Social support emerged as a protective factor against burnout at 12 months and persisted over time for studied PTSD, anxiety, and depression. Conclusions Healthcare workers’ occupational and mental health stabilized or improved between three and 12 months after the pandemic onset. The predominant protective factors against burnout remained resilience and perceived organizational support. For PTSD, anxiety and depression, resilience and social support were important factors over time.

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Objectives Emergency department (ED) visits for high blood pressure are increasing in frequency. We aimed to map those patients’ trajectory, from referral sources to the type of care received at the ED to anticipated actions for future high blood pressure concerns, and to better understand their reasons for consulting the ED for high blood pressure values. Methods Between 2018 and 2020, patients who presented to the Montreal Heart Institute’s ED for elevated blood pressure were recruited in a prospective observational study including a post hoc structured telephone interview and medical chart review. Five possible referral sources were predetermined. We provided proportions and 95% confidence intervals. Results A total of 100 patients were recruited (female: 59%, mean age: 69 ± 12). A majority (93%, 95% CI 88–98%) possessed a home blood pressure device, among which 46% (95% CI 36–56%) remembered receiving advice for its use. The main referral sources for high blood pressure to the ED were self-reference (53%, 95% CI 43–63%), advice of a lay person (19%, 95% CI 11–27%) or a nurse (13%, 95% CI 6–20%). Mainly, patients reported being concerned by concomitant symptoms or experiencing acute medical consequences (44%, 95% CI 34–54%), having followed the recommendation of a third party (33%, 95% CI 24–42%), or having concerns about their medication (6%, 95% CI 1–11%). Two weeks following their ED visits, consulting ED remained the main choice for future concerns about high blood pressure for 27% of participants. When specifically asked if they would return to the ED for elevated blood pressure, 73% (95% CI 64–83%) said yes. Conclusions Most patients who consulted the ED for elevated blood pressure values were self-referred. More can be done to promote blood pressure education, effective use of personal blood pressure devices, and recommendations for patients and health professionals when confronted with high blood pressure results.

Anxiety is the most common mental health disorder in the United States, affecting nearly a third of the population. As for depression, it is associated with increased risk of incident coronary heart disease (CHD) and poor cardiac prognosis. The pathophysiological mechanism underlying this "deleterious" association is not well defined. While several hypotheses have been proposed, few seem proven in original studies. A narrative literature review was thus performed to identify all original studies that looked at any biomarkers that can be implicated in the relation between anxiety and CHD. Surprisingly, only four cohorts or observational studies on anxiety and CHD reported biophysiopathological variables. Of the overall populations studied, only 15% were women. In term of biomarkers, plasma lipid levels, C-reactive protein, cortisol, norepinephrine, body mass index, blood pressure and heart rate variability were mostly not significantly different between anxious patients and controls. Only two variables, myocardial perfusion and coronary artery calcium, were found different between the two groups. In summary, underlying biomarkers explaining the increased risk of CHD in anxious patients are still poorly understood. Although based on very limited data, myocardial perfusion and coronary artery calcium seem to be plausible biomarkers. Clearly, more studies are needed to better understand this problematic, especially in women. This step is essential so that personalized care for patients with both anxiety and CHD can be implemented.

IntroductionA large body of evidence indicates a significant and morbid association between posttraumatic stress disorder (PTSD) and cardiovascular disease (CVD). Few studies, however, have addressed the range of trauma in this medical population, from massive heart attack, to defibrillator shock to previous interpersonal aggression.ObjectiveThe main objective of this study was to examine the nature of trauma associated with the development of PTSD in CVD patients. More precisely, we were interested in knowing if trauma was medical in nature and whether cumulative trauma resulted in PTSD.MethodsWe performed a 1:3 case-control study. The authors compared CVD patients diagnosed with PTSD (n=37) to those with adjustment disorder (n=111) in terms of trauma/stressor types and medical and demographic characteristics.ResultsHalf (51%) of CVD patients suffering from PTSD had endured a medical trauma, 35% an external (non-medical) trauma, and 14% both. There were no significant differences with CVD patients diagnosed with adjustment disorder, 40% of them having experienced a medical stressor, 40% an external (non-medical) stressor and 20% both. Cumulative trauma was seen in only 19% of CVD patients suffering from PTSD. Traditional risk factors (female sex, younger age) were not prominent in CVD patients with PTSD as compared to those with adjustment disorder. Cases were, however, significantly more likely to have psychiatric antecedents and recent surgical interventions.ConclusionsBy uncovering characteristics of PTSD patients/trauma in CVD patients, this work will serve future research and clinical initiatives to better screen at-risk patients or at-risk medical situations.