Stress, Burnout, and Resilience among Healthcare Workers during the COVID-19 Emergency: The Role of Defense Mechanisms

Abstract

The experience of working on the frontlines of the COVID-19 healthcare crisis has presented a cumulative traumatic experience that affects healthcare professionals’ well-being. Psychological resources such as resilience and adaptive defense mechanisms are essential in protecting individuals from severe stress and burnout. During September 2020, 233 healthcare workers responded to an online survey to test the impact of demographic variables, COVID-19 exposure, and psychological resources in determining stress and burnout during the COVID-19 emergency. Frontline workers reported higher scores for stress, emotional exhaustion, and depersonalization (p < 0.001) as compared to colleagues working in units not directly serving patients with COVID-19. Mature defensive functioning was associated with resilience and personal accomplishment (r = 0.320; p < 0.001), while neurotic and immature defenses were related to perceived stress and burnout. Stress and burnout were predicted by lower age, female gender, greater exposure to COVID-19, lower resilience, and immature defensive functioning among healthcare professionals (R2 = 463; p < 0.001). Working on the frontlines of the COVID-19 pandemic appears to provoke greater stress and burnout. On the other hand, resilience and adaptive defense mechanisms predicted better adjustment. Future reaction plans should promote effective programs offering support for healthcare workers who provide direct care to patients with COVID-19.

Resilience, Coping Strategies and Posttraumatic Growth in the Workplace Following COVID-19: A Narrative Review on the Positive Aspects of Trauma

“…In our view, this may be partly related to the tremendous workload of nursing professionals in caring for COVID-19 patients, who have demanding needs (e.g., pronation in ICU). Interestingly, being a female worker and having less work experience appear to be negative factors for developing adequate forms of coping and resilience, and this may be associated with previous findings on the need for specific training and education to build resilience mechanisms [ 66 , 72 , 86 ]. Arguably, professional experience and higher education levels can be seen as protective factors, as ‘experienced’ workers have more psychological and even professional resources to learn from the disaster rather than being overwhelmed.…”

“…Moreover, resilience played a mediating role between depression and burnout [ 40 , 62 , 70 ]. Individuals at high risk of burnout showed significantly lower levels of resilience [ 66 ]. Furthermore, an Inquiry-Based Stress Reduction (IBSR) intervention improved resilience for a sample of teachers in Israel [ 41 ].…”

“…Positive and negative coping strategies were identified. The former were associated with a reduction in poor mental health outcomes [ 38 , 42 , 51 , 66 , 71 , 72 , 74 , 75 ]. Active coping strategies were also positively associated with resilience [ 71 ].…”

“…Religious practices were also investigated as coping strategies, being highlighted as common [ 43 ] but not significant in reducing stress levels [ 38 , 51 ], although workers with higher levels in the hope/optimism dimension in the field of spirituality showed less coronavirus-related anxiety [ 51 ]. Finally, lower age and female gender, along with lower resilience and less adaptive defensive functioning, were predictors of stress [ 38 , 50 , 66 ]. Even in non-healthcare workers, coping strategies were common methods for dealing with the new conditions dictated by the pandemic [ 34 ].…”

Defensive Functioning of Individuals Diagnosed With Gender Dysphoria at the Beginning of Their Hormonal Treatment

“…For instance, mature defenses (e.g., anticipation, humor, self-assertion) mitigate negative emotions and representations associated with conflict and distress (MacGregor and Olson, 2005;Martino et al, 2020), whereas immature defenses (e.g., splitting, denial, passive aggression) are linked to maladaptive personality traits at the base of several forms of psychopathology (Zimmerman et al, 2019;Boldrini et al, 2020;Perry et al, 2020). Several studies have shown that defense styles contribute significantly to individual differences in responses to stressful environments (Vaillant, 1992;Schulz et al, 2005;Cramer, 2006;Prout et al, 2020;Conversano, 2021;Di Giuseppe et al, 2021). Individuals with GD may be subject to numerous stressful events, due to social discrimination and stigma.…”