The Elephant in the Room: A Cross-Sectional Study on the Stressful Psychological Effects of the COVID-19 Pandemic in Mental Healthcare Workers

Abstract

Despite extensive research on COVID-19’s impact on healthcare workers, few studies have targeted mental health workers (MHWs) and none have investigated previous traumatic events. We investigated psychological distress in MHWs after the first lockdown in Italy to understand which COVID-19, sociodemographic, and professional variables represented greater effects, and the role of previous trauma. The survey included sociodemographic and professional questions, COVID-19 variables, and the questionnaires Life Events Checklist for DSM-5 (LEC-5), Impact of Event Scale—Revised (IES-R), and Depression Anxiety Stress Scales 21 (DASS-21). On the 271 MHWs who completed the survey (73.1% female; mean age 45.37), we obtained significant effects for contagion fear, experience of patients’ death, increased workload, and worse team relationship during the first wave. Nurses were more affected and showed more post-traumatic stress symptoms, assessed by IES-R, and more depressive, anxiety, and stress symptoms, assessed by DASS-21. The strongest risk factors for distress were greater age, professional role, increased workload, worse team relationship, and separation from family members. Previous experience of severe human suffering and unwanted sexual experiences negatively impacted IES-R and DASS-21 scores. Being a psychiatrist or psychologist/psychotherapist and good team relationships were protective factors. Recent but also previous severe stressful events might represent relevant risk factors for distress, reducing resilience skills. Identifying vulnerable factors and professional categories may help in the development of dedicated measures to prevent emotional burden and support psychological health. Highlights: Psychological distress in mental health workers in the COVID-19 pandemic is more frequent in nurses, who experience more depression, anxiety, and post-traumatic stress symptoms. Previous and recent stressful events are risk factors for distress and should guide intervention strategies.

Fear of COVID-19 Impact on Professional Quality of Life among Mental Health Workers

“…STS and PTSD are highly overlapping syndromes since STS in MHWs is characterized by symptoms of reliving, avoidance, and hyperarousal in response to the traumatized patients with whom they are empathically engaged [ 30 ]. According to our findings, traumatic impact when dealing with secondary exposure to stressful events is aggravated due to FCV-19 in both MHWs and HCWs [ 17 , 21 , 25 , 32 , 56 , 57 ]. However, we found that FCV-19 explained a significant yet relatively low percentage of STS variation.…”

“…However, the comparison of our results with those of the above studies should be considered with caution given that in many of them, FCV-19 was measured through ad hoc questions and not with validated tools. Only a few studies have examined, among other variables, the association of FCV-19 with mental health, well-being, perception of the working environment, and levels of BO in MHWs [ 17 , 21 , 22 , 24 , 25 ]. Specifically, the link between greater BO and severe FCV-19 in our study is similar with the studies by Pappa et al [ 17 ] and Rapisarda et al [ 22 , 24 ], which reported that worries about self-infection or transferring the illness were positively associated with specific aspects of BO.…”

“…Additionally, MHWs are routinely subjected to stressful conditions, especially those caring for patients with serious mental illnesses (SMI), as was the case in our study. Specifically, SMI patients are more susceptible to anxiety symptoms and psychological distress [ 25 ]. Furthermore, SMI patients typically present deficits in cognition [ 48 , 49 ], social cognition [ 50 ], and psychosocial functioning [ 51 ].…”

“…Furthermore, a positive association between STS and severe FCV-19 has also been found in prior reports examining determinants of STS [ 55 ] or PTSD [ 43 ] in HCWs. However, in the only study in MHWs that examined FCV-19 as a predictor of PTSD, among other factors, no significant relationship emerged [ 25 ]. STS and PTSD are highly overlapping syndromes since STS in MHWs is characterized by symptoms of reliving, avoidance, and hyperarousal in response to the traumatized patients with whom they are empathically engaged [ 30 ].…”

“…Most of the studies that have examined the effects of the COVID-19 pandemic on the mental health of MHWs have concisely concluded that the levels of psychological distress, burnout, post-traumatic stress symptoms, depression, and sleep problems have risen significantly [ 14 , 16 , 17 , 18 , 22 , 24 , 25 ] and that systematic support is needed to minimize the complex challenges and to safeguard the mental wellbeing of MHWs. However, only a small number of studies have explored the impact of FCV-19 on MHWs’ mental health [ 17 , 22 , 24 , 25 ]. In these studies, FCV-19 was explored, among other work-related risk factors, to merely test its relationship with mental health symptoms and burnout in MHWs.…”