One Year Facing COVID. Systematic Evaluation of Risk Factors Associated With Mental Distress Among Hospital Workers in Italy

Abstract

IntroductionItaly was the first Western country affected by the COVID-19 pandemic that still constitutes a severe challenge for healthcare workers (HCWs), with a deep impact on their mental health. Several studies confirmed that a considerable proportion of HCW developed adverse psychological impairment (PsI). To focus on preventive and rehabilitation measures, it is fundamental to identify individual and occupational risk factors. We systematically assessed possible PsI among all employees in a large university hospital in Italy, using validated psychometric scales in the context of occupational health surveillance.MethodsIn the period of July 2020 to July 2021, we enrolled 990 HCWs. For each subject, the psychological wellbeing was screened in two steps. The first-level questionnaire collected gender, age, occupational role, personal and occupational COVID-19 exposure, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R), and anxiety (GAD-7). Workers showing PsI (i.e., test scores above the cutoff in at least one among GHQ-12, IES-R, and GAD-7) have been further investigated by the second-level questionnaire (psycho-diagnostic) composed by PHQ-9, DES-II, and SCL-90 scales. If the second-level showed clinically relevant symptoms, then we offered individual specialist treatment (third level).ResultsThree hundred sixteen workers (32%) presented signs of PsI at the first-level screening questionnaire. Women, nurses, and subjects engaged in the COVID-19 area and with an infected family member showed significantly higher PsI risk. PsI prevalence was strongly associated with the pandemic trend in the region but sensibly decreased after January 2021, when almost all workers received the vaccination. A proportion of subjects with PsI presented clinically relevant symptoms (second-level screening) on PHQ-9 (35%), DES (20%), and SCL-90 (28%). These symptoms were associated neither to direct working experience with patients with COVID-19 nor to COVID-19 experience in the family and seemed not to be influenced by the pandemic waves or workers vaccination.ConclusionsThe evaluation of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for PsI in situations of high stress and/or disasters, as well as variables associated with symptom chronicization.

Post-traumatic stress in healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

“…209 articles continued to the full text screening stage, of which 119 studies were selected for inclusion in our meta-analysis with a total of 117,143 participants ( Table 1A ). All 119 studies were cross-sectional observational studies ( Agberotimi et al., 2020 ; Alah et al., 2021 ; Ali et al., 2020 , 2022 , 2021 ; Alonso et al., 2021 ; Alshehri and Alghamdi, 2021 ; Asnakew et al., 2021 ; Ayalew et al., 2022 ; Azoulay et al., 2021 ; Bassi et al., 2021 ; Benzakour et al., 2022 ; Bizri et al., 2022 ; Bonzini et al., 2022 ; Bulut et al., 2021 ; Caillet et al., 2020 ; Caliandro et al., 2022 ; Carmassi et al., 2022 , 2021a , 2021b ; Chang et al., 2022 ; Chan et al., 2021 ; Chatzittofis et al., 2021 ; Chaudhary et al., 2021 ; B. Chen et al., 2022 ; Cheng et al., 2020 ; Chen et al., 2021 ; Chew et al., 2020 ; Chowdhury et al., 2021 ; Civantos et al., 2020a , 2020b ; Cortés-Álvarez and Vuelvas-Olmos, 2020 ; Costantini et al., 2022 ; Crowe et al., 2022 ; Demartini et al., 2020 ; Dobson et al., 2021 ; Dykes et al., 2022 ; Ergai et al., 2022 ; Essadek et al., 2022 ; Fattori et al., 2021 ; Geng et al., 2021 ; Gilleen et al., 2021 ; Gorini et al., 2020 ; Guo et al., 2021 ; Hajure et al., 2021 ; Hasanvandi et al., 2022 ; Honarmand et al., 2022 ; Hong et al., 2021 ; Huarcaya-Victoria et al., 2022 ; …”

The potential of the GHQ-12 questionnaire in assessing psychological impairment on a health-care workers population facing Covid-19: an item response theory-based analysis

“…with scores above the cut-off in at least one scale among GAD-7, IES-R and GHQ-12). Results obtained from the analysis of risk factors for psychological impairment, measured through the above-mentioned scales, are presented in details in a previous paper (Bonzini et al, 2022). GHQ-12 proved to be and effective screening tool since it was able to determine whether a subject required further evaluation through the second-level questionnaire.…”

Anxiety and Depression Levels and Coping Strategies among Polish Healthcare Workers during the COVID-19 Pandemic

“…Previous research has also indicated increased symptoms of anxiety and depression among healthcare workers during the COVID-19 pandemic [ 24 , 25 ]. The prevalence rate for anxiety symptoms reported in previous studies varied between 11.7% and 50% [ 24 , 26 ], while those observed for depression were between 13.7% and 42% [ 27 , 28 , 29 ]. The differences in rates across studies may have resulted from the characteristics of the course of infections in a given country, the conditions of the healthcare system, the precise moment of the pandemic when the study was carried out, and the measurement tools used.…”