Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support

Abstract

Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = .24 (0.12–0.98)], hostility toward health workers [OR = .21 (1.23–4.21)], putting into perspective [OR = .91 (0.43–0.98)], self-blame [OR = .44 (1.11–2.39)], catastrophizing [OR = .85 (1.01–4.28)], blaming others [OR = .77 (1.04–3.32)], emotional support [OR = .83 (0.49–0.98)], instrumental support [OR = .74 (0.28–0.94)], and informational support [OR = .73 (0.43–0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54–3.78)], self-blame [OR = .57 (1.02-2.11)], rumination [OR = .49 (1.11-3.13)] and emotional support [OR = .94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers’ wellbeing. HIGHLIGHTS Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits. Acute stress disorder and de...

On the path to recovery: traumatic stress research during the COVID-19 pandemic 2021–2023

“…As the largess of data has shown, individuals, populations and countries have been differentially affected by COVID-19 (Bapolisi et al, 2022 ; Berkhout et al, 2022 ; Zhang et al, 2022 ; Zhang & Chen, 2021 ), and ‘evidence-based mapping of risk and protective factors’ has been ‘important to inform governance of the pandemic’ (Lotzin et al, 2022 ). Nimble pivoting to tele-mental health services and rollout of e-health interventions, the higher demand for mental health services, the normalisation of mental distress and the reduction in stigma, and enhanced help-seeking, all have had unexpectedly positive and far-reaching effects (BinDhim et al, 2021 ).…”

“…Despite preventive recommendations from the World Health Organization as early as March 2020, front-line workers caring for patients infected with the coronavirus experienced multiple potentially traumatic stressors including exposure to the virus without consistent or sufficient access to adequate personal protective equipment and personal viral testing, and feeling entrapped in life threatening conditions by external coercion and a sense of obligation to do whatever was necessary to save the lives or ameliorate the suffering of their patients while not abandoning or betraying the trust of co-workers (D'Alessandro-Lowe et al, 2023 ; McGlinchey et al, 2021 ). These stressors were amplified in settings that lacked economic and medical resources: frontline workers in low and middle-income countries were more likely to view occupational health/safety and infection prevention /control programmes as inadequate than workers in high-income countries (Bapolisi et al, 2022 ; Harrigan et al, 2022 ; Zhang & Chen, 2021 ).…”

“…Healthcare workers who have experienced significant adversity in their childhood also may be at particularly high risk for burnout and behavioural and mental health problems (Clemens et al, 2021 ), but it is essential that childhood (or adult) victimisation not become a source of stigma for these crucial personnel in addition to the stigma they already often face due to their courageous willingness to care for COVID-infected patients (Bapolisi et al, 2022 ). Difficulties with dissociation may be an important indicator of risk for healthcare workers, considering its role as a mediator between PTSD symptoms and alcohol-related problems (Laurent et al, 2022 ).…”

“…This is arguably critical in low- and middle- income countries where the high disease burden is compounded by health worker shortages, and less access to psychological support. A study on Congolese health workers in this Special Issue (Bapolisi et al, 2022 ) underscores the need to incorporate emotion regulation and social support strategies in psychological interventions aimed at mitigating high rates of psychopathology among healthcare workers.…”

“… Research on the Impact of the COVID-19 Pandemic on Front-Line Healthcare Workers 29. Bapolisi et al ( 2022 ). Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic.…”