Role of access to personal protective equipment, treatment prioritization decisions, and changes in job functions on health workers’ mental health outcomes during the initial outbreak of the COVID-19 pandemic.

Abstract

Background : During the initial COVID-19 outbreak, organizational changes were required to ensure adequate staffing in healthcare facilities. The extent to which organizational changes impacted the mental wellbeing of healthcare workers (HCWs) remains unexplored. Here we analyzed the association between three work-related stressors (reported access to protective equipment, change in job functions, and patient prioritization decision-making) and mental health outcomes (depression symptoms, psychological distress, suicidal thoughts, and fear of infection) in a large sample of Spanish HCWs during the initial COVID-19 outbreak. Methods : We conducted a cross-sectional study including HCWs from three regions of Spain between April 24 th and June 22 nd , 2020. An online survey measured sociodemographic characteristics, work-related stressors, fear of infection, and mental health outcomes (depression [PHQ-9], psychological distress [GHQ-12], death wishes [C-SSRS]). We conducted mixed-effects regression models to adjust all associations for relevant individual- and region-level sources of confounding. Results : We recruited 2,370 HCWs. Twenty-seven percent screened positive for depression and 74% for psychological distress. Seven percent reported death wishes. Respondents were more afraid of infecting their loved ones than of getting infected themselves. All work-related stressors were associated with depression symptoms and psychological distress in adjusted models. Limitations : Non-probabilistic sampling, potential reverse causation. Conclusions : Modifiable work-related stressors are associated with worse mental health among HCWs. Our results suggest that workplace prevention strategies for HCWs should provide sufficient protective equipment, minimize changes in job functions, favor the implementation of criteria for patient triage and on-call bioethics committees, and facilitate access to stepped-care, evidence-based mental health treatment.

Perceived Stress and Psychological Impact Among Healthcare Workers at a Tertiaty Hospital in China During the COVID-19 Outbreak: The Moderating Role of Resilience and Social Support

“…This study has several potential limitations. The non-probabilistic sampling we used may somewhat hinder the validity of our findings, as has been reported in many published literatures during the early stage of the pandemic ( 26 , 35 , 36 ). However, our sample's prevalence of psychological distress was close to that of other studies conducted during the same period, indicating that our sample was somewhat representative of all HCWs in our hospital ( 12 ).…”

The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers in Italy: Analyzing the Role of Individual and Workplace-Level Factors in the Reopening Phase After Lockdown

“…This is not a surprise considering that the financial cuts to the national health system left Italian health services with limited resources and personnel ( 8 ), and thus in a difficult position to face the pandemic effectively. This could also explain why the assignment to a new team and functions was associated with depressive symptoms in Italy but not, for instance, in a country such as Spain that, although close to Italy in terms of organization of services, did not experience the same lack of resources and personnel ( 36 – 38 ). When health services are understaffed, as in Italy, the changes of teams and functions are more frequent and stressful, and having a network of supportive colleagues at work becomes more critical to protect mental wellbeing ( 39 ).…”

COVID-19 Vaccination Did Not Change the Personal Protective Behaviors of Healthcare Workers in China

“…Because of their high susceptibility to infection, it is strongly recommended that HCWs should take sufficient protective equipment to minimize the infection risk (10). Mask and gloves wearing were primary suggested for risk reduction of HCWs and the use of a mask by the infected was very effective (11).…”