Longitudinal assessment and determinants of short-term and longer-term psychological distress in a sample of healthcare workers during the COVID-19 pandemic in Quebec, Canada

Abstract

IntroductionPrevious research has demonstrated the negative impact of the COVID-19 pandemic emergency on the wellbeing of healthcare workers. However, few research contributions reported a longitudinal evaluation of psychological distress and examined determinants of its duration and course over time. The present study aims to explore the impact of the pandemic emergency on HCWs mental health by adopting a longitudinal design and assessing mental health as combination of overlapping clinical symptoms (post-traumatic stress disorder, depression and anxiety).MethodsData were collected weekly through a mobile application during and after the first wave of COVID-19 in the province of Quebec, Canada, in 2020. Analysis was conducted on a final sample of 382 participants. Participants were grouped into “resilient” (RES) if they did not manifest clinical-level psychological distress during monitoring, “short-term distress” (STD) if distress exceeded the clinical threshold for 1–3 weeks, and longer-term distress (LTD) if it occurred for four or more weeks, even if not consecutively. Descriptive statistics for all variables were computed for each subgroup (RES, STD and LTD), and pairwise comparisons between each group for every descriptive variable were made using chi square statistics for categorical variables and t-test for continuous variables. Predictors of distress groups (STD and LTD vs RES) were assessed running multinomial hierarchical logistic regression models.ResultsIn our sample, almost two third (59.4%) HCWs did not manifest moderate or severe distress during the monitoring time. Short-term distress, mostly post-traumatic symptoms that lasted for less than 4 weeks, were the most common distress response, affecting almost one third of participants. Longer psychological distress occurred only in a smaller percentage (12.6%) of cases, as a combination of severe posttraumatic, depressive and anxiety symptoms. Perceived occupational stress was the most significant risk factor; moreover individual, peritraumatic work and family risk and protective factors, were likely to significantly affect the stress response.DiscussionResults tend to provide a more complex and resiliency-oriented representation of psychological distress compared to previous cross-sectional studies, but are in line with stress response studies. Findings allow us to better describe the profiles of distress response in STD and LTD groups. Participants that manifest short term distress experience acute stress reaction in which the interplay between personal, family and professional life events is associated with the stress response. Conversely, longer term distress response in HCWs presents a more complex mental health condition with an higher level of impairment and support needs compared to participants with short-term distress.

Longitudinal assessment of psychological distress and its determinants in a sample of firefighters based in Montreal, Canada

“…Unlike the other studies mentioned, in this study the methodology involved telephone contact between participants and experimenters: we can assume that this may have deterred participation by people who, manifesting more intense psychological distress, might have preferred the more complete anonymity of an online survey. Thus, our prevalence data confirm that a significant percentage of participants suffer from a short-term combination of clinical conditions, in which depressive symptoms are observed concurrently with anxiety and post-traumatic symptoms, as found in other studies on public safety personnel ( Carleton et al, 2018 ; Jitnarin et al, 2022 ) and healthcare personnel ( Rapisarda et al, 2023 ). Therefore, our results suggest that the estimates of depressive, post-traumatic, and anxiety symptoms often reported in studies should be considered cautiously since, in most cases, these represent a combined and transient layer of distress rather than being diagnoses of true mental disorders.…”

“…Frontiers in Psychology 08 frontiersin.org symptoms, as found in other studies on public safety personnel (Carleton et al, 2018;Jitnarin et al, 2022) and healthcare personnel (Rapisarda et al, 2023). Therefore, our results suggest that the estimates of depressive, post-traumatic, and anxiety symptoms often reported in studies should be considered cautiously since, in most cases, these represent a combined and transient layer of distress rather than being diagnoses of true mental disorders.…”

“…A total score can be calculated by adding the scores of each item. In this study, a cutoff of 13 was adopted to establish the presence of possible clinical-level PTSD symptoms; this cutoff has been adopted in previous studies ( Zuromski et al, 2019 ; Rapisarda et al, 2023 ) and, according to Price and colleagues ( Price et al, 2016 ), would demonstrate a sensitivity of 0.95 and a specificity of 0.23. The French version was adopted in the study ( Ashbaugh et al, 2016 ), and the Cronbach’s alpha was 0.87.…”

“…Minimal revisions have been made to the original version, which demonstrates strong validity and reliability ( Gray et al, 2004 ). A French version, already adopted by Rapisarda and colleagues in previous study ( Rapisarda et al, 2023 ), was used.…”

“…Additionally, the single measurement of psychological distress makes it impossible to distinguish transient from lasting clinical psychological distress likely to point to clinical diagnoses and result in more potent impact on functioning. For example, Rapisarda et al (2023) and colleagues, estimated that although 40% of healthcare workers manifested some form of psychological distress, only one-third reported distress lasting longer than 3 weeks out of an 8-week long assessment period. Another notable exception is a study conducted by Gulliver et al (2021) and colleagues who showed that lower prevalence of common mood and anxiety disorder in cohort of new firefighters recruits over a 3 years time (PTSD 0.5–1.2%, major depressive disorder 1.2–3.4%, and generalized anxiety disorder 0.0–1.1%).…”