Has the COVID-19 Pandemic Changed the Daily Practices and Psychological State of Orthopaedic Residents?

Abstract

Background The coronavirus-19 (COVID-19) pandemic has been an unprecedented time for healthcare and has substantially changed resource availability in surgeons’ work practices and routines. Many orthopaedic departments suspended elective surgery, and some re-deployed orthopaedic residents to stressful nonorthopaedic tasks; long hours were commonplace. Stress-reaction symptoms such as anxiety and depression have been reported in about 10% of healthcare workers during previous infectious-diseases outbreaks (including the Ebola virus), but little is known about the psychological needs of residents faced with this global disaster. Questions/purposes (1) Have anxiety and depression symptoms among orthopaedic residents worsened from the period before to the period after the lockdown in Italy? (2) Are there differences in anxiety and depression symptoms between residents who worked in a COVID-19 department and those who did not? Methods The Italian Association of Orthopaedic and Traumatology Residents is comprised of 365 members who were recruited through the organization’s mailing list; they were asked to respond to a survey about their health and well-being at the beginning and end of the first COVID-19 Italian lockdown (March 9, 2020 to May 3, 2020). For the survey’s development, 10 orthopaedic surgery residents at the Magna Graecia University of Catanzaro were preliminarily asked to answer the surveys, and both face validity and content validity were tested. The test-retest reliability was 0.9. Impact on and future concerns about family life and daily work practice, as well as sleep disorders, were investigated. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), which includes 14 questions (seven for anxiety, HADS-A; and seven for depression, HADS-D) on a Likert scale (0-3); thus, a patient can have a score between 0 and 21 for either the HADS-A or HADS-D, with higher scores indicating a greater likelihood of anxiety or depression. Previously reported minimum clinically important differences ranged from 1.5 to 1.7. For each scale, total scores of ≤ 7 , 8 to 10, and ≥ 11 were taken to represent normal, borderline, or abnormal level of anxiety or depression, respectively. Overall, 75% (272 of 365) of residents completed the survey at both the beginning and end of the lockdown; 72% (196 of 272) were men, the mean ± SD age was 30 ± 3 years, 72% (197 of 272) worked in a hospital setting with patients who were COVID-19-positive, 20% (55 of 272) served in a COVID-19 department, and 5% (7 of 139) tested positive for COVID-19 by nasal-pharyngeal swab. Overall, 9% (24 of 272) of residents had family members who contracted COVID-19, and 3% (8 of 272) had a relative who died. Because of the risk of possible COVID-19 exposure, 18% (48 of 272) of residents needed to temporarily change their household given that social distancing was considered the best way to slow the spread of COVID-19. Results At the end of the lockdown, orthopaedic residents exhibited signs of worsening anxiety and depression as measured by the overall HADS score (median 9 [IQR 5 to 14] versus median 11 [IQR 6 to 17.8], respectively; median difference -1 [95% CI -1.5 to -0.5]; effect size [r] = -0.24; p < 0.001) as well as in the depression subscale (median 4 [IQR 2 to 7] versus median 5.5 [IQR 3 to 8], respectively; median difference -1 [95% CI -1.5 to -0.5]; r = -0.36; p < 0.001). We found no difference in the development of anxiety or depression between residents who worked in a COVID-19 department and those who did not, as demonstrated by comparing the change in HADS scores between these groups (median 1 [IQR -3 to 4] versus median 1 [IQR -2 to 4] in HADS change score over time; median difference 0 [95% CI -1 to 2]; r = -0.03; p = 0.61). Conclusion The COVID-19 pandemic has affected the daily practice of orthopaedic residents and has had important, far-reaching consequences on their health and well-being, including social implications. Residents showed higher anxiety and depression symptoms at the end of the lockdown. No differences were found in changes of anxiety and depression, over time, for residents who worked in a COVID-19 department compared with those who did not. The evaluation of anxiety and depression through standardized questionnaires could help to identify residents at risk of higher psychological distress who could be referred to regular psychological counseling as a possible prevention strategy during stressful times. Future studies should confirm the long-term effects of these findings. Level of Evidence Level II, prognostic study.

The prevalence of probable mental health disorders among hospital healthcare workers during COVID-19: A systematic review and meta-analysis

“…Chene et al (2021) results (n-T1:1565, n-T2:1109) showed that after lockdown, no significant changes were observed in the prevalence of depression and anxiety. Consistent with this, Castioni et al (2021)’s result (n=272) showed that the prevalence of anxiety remained the same but the prevalence of depression significantly increased after lockdown.…”

“…18 datasets conducted in 11 countries during COVID-19 reported the prevalence of probable mental health disorders across different timepoints (details in S10 Appendix) (Algattas et al, 2021; Baumann et al, 2021; Cai et al, 2020; Castioni et al, 2021; Chene et al, 2021; De Kock et al, 2022; Doulias et al, 2021; Gündoĝmuş et al, 2021; Katsuta et al, 2021; Lasalvia et al, 2021; Lasalvia et al, 2020; Li et al; Magnavita et al, 2021a, b; Magnavita et al, 2020; Moore et al, 2021; Mosolova et al, 2021; Noaimi et al, 2021; Schmid et al, 2021; Shechter et al, 2021; Th’ng et al, 2021). Due to the variation in timepoints, differences in context, and the small number of studies, the temporal relationship between prevalence rates of mental health outcomes and the COVID-19 pandemic were narratively synthesised to avoid combining quantitative data inappropriately.…”

“…Two studies (Castioni et al, 2021; Chene et al, 2021) compared prevalence rates before and after lockdown measures were implemented in their local area. Chene et al (2021) results (n-T1:1565, n-T2:1109) showed that after lockdown, no significant changes were observed in the prevalence of depression and anxiety.…”

Factors Influencing Residents' Psychological Status During Standardized Training in COVID-19

“…However, the results are in line with those reported by previous similar cross-sectional study on psychological state of residents. Indeed, the study that examined the psychological impact of COVID-19 on Italian orthopedic residents found that the pandemic had an important social impact on residents' perceptions and emotional well-being ( 42 ), manifesting in the worsening by the HADS score and the depression subscale of this score after the national lockdown.…”

COVID-19 exposure and health status of orthopedic residents: A survey study

“…As part of these measures, all healthcare professionals have and continue to fight the COVID-19 infection alongside their primary duties, through regulations and decree laws. Although elective surgeries were stopped during the first and second waves, orthopedic residents continued to manage trauma patients while at the same time caring for COVID-19 patients and were inevitably affected both physically and psychologically during this process (5). Moreover, increasing patient burden and intense work pace also augmented these effects (6,7).…”