Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jun 19, 2022; 12(6): 843-859
Published online Jun 19, 2022. doi: 10.5498/wjp.v12.i6.843
Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital: A factor analytical study
Marcos O Carvalho-Alves, Vitor A Petrilli-Mazon, Andre R Brunoni, Andre Malbergier, Pedro Fukuti, Guilherme V Polanczyk, Euripedes C Miguel, Felipe Corchs, Yuan-Pang Wang
Marcos O Carvalho-Alves, Vitor A Petrilli-Mazon, Andre R Brunoni, Andre Malbergier, Pedro Fukuti, Guilherme V Polanczyk, Yuan-Pang Wang, Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
Marcos O Carvalho-Alves, Felipe Corchs, Program in Neuroscience and Behavior, Department of Experimental Psychology, Institute of Psychology, University of Sao Paulo, Sao Paulo 01060-970, Brazil
Euripedes C Miguel, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo 05403-010, Brazil
Felipe Corchs, Department of Psychiatry, University of Sao Paulo, Sao Paulo 05403-010, Brazil
Author contributions: Carvalho-Alves MO, Brunoni AR, Malbergier A, Fukuti P, Polanczyk GV, Miguel EC and Corchs F contributed to the study design, data acquisition and interpretation, and revised the manuscript; Wang YP conceived the statistical analysis; Carvalho-Alves MO, Petrilli-Mazon VA, Corchs F and Wang YP conducted the statistical analysis and wrote the preliminary draft; all authors reviewed and approved the manuscript in its final version.
Institutional review board statement: This study was approved by the National Research Ethics Commission of the Ministry of Health, Brazil.
Informed consent statement: All study participants gave their informed consent before study inclusion.
Conflict-of-interest statement: There are no conflicts of interest in this work.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan-Pang Wang, MD, MSc, PhD, Research Scientist, Department of Psychiatry, School of Medicine, University of Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, Sao Paulo 05403-010, Brazil. gnap_inbox@hotmail.com
Received: December 21, 2021
Peer-review started: December 21, 2021
First decision: March 13, 2022
Revised: April 22, 2022
Accepted: May 13, 2022
Article in press: May 13, 2022
Published online: June 19, 2022
Processing time: 174 Days and 11 Hours
Abstract
BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for public health and has caused the loss of millions of lives worldwide. Hospital workers play a key role in averting the collapse of the health system, but the mental health of many has deteriorated during the pandemic. Few studies have been devoted to identifying the needs of workers on frontline duty.

AIM

To investigate dimensions of common emotional symptoms and associated predictors among Brazilian workers in a COVID-19 reference hospital.

METHODS

This is an observational study of the mental health of professionals in a COVID-19 hospital in the city of São Paulo. We invited all hospital employees to respond to an online survey between July and August 2020, during the first peak of the pandemic. Data of 1000 participants who completed the survey were analyzed (83.9% were women and 34.3% were aged 30 to 40). Hospital workers self-reported the presence of symptoms of depression, anxiety, trauma-related stress, and burnout through the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised and the Mini-Z Burnout Assessment respectively. Responses were assembled and subjected to exploratory factor analysis to reveal workers’ core emotional distress. Multiple linear regression models were subsequently carried out to estimate the likelihood of dimensions of distress using questions on personal motivation, threatening events, and institutional support.

RESULTS

Around one in three participants in our sample scored above the threshold of depression, anxiety, post-traumatic stress disorder, and burnout. The factor analysis revealed a three-factor structure that explained 58% of the total data variance. Core distressing emotional domains were avoidance and re-experience, depression-anxiety, and sleep changes. Regression analysis revealed that institutional support was a significant protective factor for each of these dimensions (β range = -0.41 to -0.20, P < 0.001). However, participants’ personal motivation to work in healthcare service was not associated with these emotional domains. Moreover, the likelihood of presenting the avoidance and re-experience dimension was associated with having a family member or close friend be hospitalized or die due to COVID-19 and having faced an ethical conflict.

CONCLUSION

Distressing emotional domains among hospital workers were avoidance and re-experience, depression and anxiety, and sleep changes. Improving working conditions through institutional support could protect hospital workers' mental health during devastating public health crises.

Keywords: COVID-19; Pandemics; Health personnel; Mental health; Psychological distress; Occupational medicine

Core Tip: Although the literature contains many reports on the deteriorating mental health of hospital workers during pandemics, few investigations have focused on the core mental health needs of this specific population. Hence, we subjected the common emotional symptoms of hospital workers to exploratory factor analysis. The main emotional dimensions were avoidance and re-experience, depression-anxiety, and sleep changes. Institutional support was found to be the most relevant protective factor for these emotional dimensions. This investigation could contribute to a better understanding of work-related distress from a dimensional perspective and has indicated comprehensive coping strategies in healthcare settings during a public health emergency.