Palestinian Health Care Workers’ Stress and Stressors During COVID-19 Pandemic: A Cross-Sectional Study

Abstract

Background: COVID-19 is thought to be the most significant public health threat the modern world has encountered. Health care workers (HCWs) face enormous pressure due to work overload, negative emotions, exhaustion, lack of contact with their families, and risk of catching the infection and death. Aim: This study aims to assess the level of stress perceived by HCWs and possible associated factors during the COVID-19 outbreak in Palestine. Methods: A cross-sectional sample of 430 frontlines HCWs was conducted using an online self-reported questionnaire. HCWs’ stress from the COVID-19 outbreak, factors that increase stress, and the activities that reduced stress were assessed. Chi-square test was used to compare between a categorical variable and the study outcome; associations are presented as odds ratios (OR) and confidence intervals (95% CI) with 0.05 significance level. Al-Najah National University institutional review board granted ethics approval. Results: Most respondents (74.0%) reported high-stress levels during the outbreak. Fear of transmitting the virus to family was the most stressful factor (91.6%). HCWs who did not have training on the outbreak response were more likely to have high-stress levels (OR = 2.7 [95% CI = 1.7-4.4], P < .001). Those with high stress reported being disappointed (OR = 2.4 [95% CI = 1.5-3.6], P < .001), and strongly considered taking sick leave (OR = 3.9 [95% CI = 1.9-7.9], P < .001). Conclusion: HCWs are under tremendous stress, given the ongoing COVID-19 pandemic. Understanding the psychological impact of the outbreak on HCWs and the activities that mitigate the stress is crucial to guide policies and interventions that can maintain psychological well-being.

Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence

“…Similarly, HCW during the SARS outbreak who had confidence in the information they received from their organization ( 130 ), and who received clear communication about directives and how to take precautionary measures ( 41 ), experienced reduced psychological distress. HCW working during the COVID-19 outbreak who felt that they did not receive sufficient information, scored significantly higher on anxiety and acute stress than those who were satisfied with the information provided ( 60 , 99 , 116 , 142 ).…”

“…In nurses working during the SARS outbreak in Canada, higher perceived organizational support in the form of receiving positive performance feedback from doctors and co-workers, was associated with lower perceptions of SARS-related threat and reduced feelings of emotional exhaustion ( 59 ). Similarly, nurses, physicians, and HCW working during the MERS, COVID-19, and SARS outbreaks who perceived support from their supervisors and colleagues, experienced better mental health in the form of lower PTSD symptoms, lower distress, and being less likely to develop psychiatric symptoms, respectively ( 24 , 28 , 41 , 54 , 59 , 70 , 79 , 80 , 88 , 99 , 116 ).…”

“…Similarly, medical staff receiving inadequate training related to managing H7N9 had higher PTSD symptoms than those who received appropriate training ( 81 ). During COVID-19, HCW who felt HCW who felt that they did not have adequate information, training, personal protective equipment (PPE), felt unsafe, and perceived lower logistic support, reported higher levels of depression, anxiety, and acute stress symptoms ( 51 , 54 , 60 , 65 , 72 , 74 , 99 , 100 , 102 , 106 , 120 , 142 ).…”

Psychological resilience, coping behaviours, and social support among healthcare workers during the COVID-19 pandemic: A systematic review of quantitative studies

“…Fourteen studies identified specific coping mechanisms employed by HCWs during the pandemic (Blanco-Donoso et al ., 2020; Cai, 2020; Chen et al ., 2020; Chew et al ., 2020; Dong et al ., 2020; Giusti et al ., 2020; Labrague & De los Santos, 2020; Maraqa et al ., 2020; Mi et al ., 2020; Nie et al., 2020; Salman et al, 2020; Shechter et al ., 2020; Vagni et al ., 2020; Xiao et al ., 2020). During the pandemic, HCWs utilized both negative and positive coping styles to manage stress.…”

“…Among these ten studies reporting specific coping styles among HCWs during the pandemic, eleven quantitative studies (Cai, 2020; Blanco-Donoso et al ., 2020; Chew et al ., 2020; Dong et al ., 2020; Giusti et al ., 2020; Labrague & De los Santos, 2020; Nie et al ., 2020; Xiao et al ., 2020; Chen et al ., 2020; Maraqa et al ., 2020; Vagni et al ., 2020) indicated that HCWs use support from and communication with family, friends, and colleagues as their primary coping mechanisms to manage the adverse mental health consequences of the COVID-19 pandemic. Religious coping mechanisms such as praying were reported as an important coping mechanism in three cross-sectional studies.…”