Published online Jun 19, 2022. doi: 10.5498/wjp.v12.i6.843
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
The current pandemic has generated a dramatic challenge to public health, in a set of contextual changes throughout the world, including millions of deaths, the collapse of health systems, economic disruption, and food insecurity. During frontline service, hospital workers (HWs) were exposed to an increased risk of becoming infected, fear of infecting family members, ethical conflicts, overwhelming workload, among other stressors. Facing these stressors may contribute to a decline in their psychological well-being. Supporting this suggestion, high rates of depression, anxiety, stress, burnout, and insomnia have been reported among hospital professionals.
Several observational studies have described rates of common psychological responses of HWs facing the current pandemic. Nevertheless, few studies have examined the structure of multiple co-occurring symptoms through exploratory factor analysis. The data reduction approach is a potential asset to expand our understanding of how to prevent or reduce emotional distress in healthcare settings using a smaller number of variables.
We aimed to show core dimensions of common psychological symptoms as well as their associated predictors among HWs in a coronavirus disease 2019 (COVID-19) reference hospital.
This is an observational study, and the data were cross-sectionally collected using an online survey during the first peak of the pandemic in Brazil. Data of 1000 HWs who completed the survey were analyzed (83.9% women and 34.3% aged 30 to 40). Self-reported symptoms of depression, anxiety, trauma-related stress, and burnout were subjected to exploratory factor analysis. Multiple linear regression models were then carried out to estimate predictors for each of the factors retained using questions on personal motivation, threatening events, and institutional support as independent variables.
HWs presented high rates of depression, anxiety, stress, and burnout during their frontline duty, as well as increased tobacco and alcohol consumption. The following three factors were the main dimensions of HWs’ distress: avoidance and re-experience, depression-anxiety, and sleep changes. Institutional support was the most significant protective factor for each of these dimensions. Furthermore, scores of the avoidance and re-experience dimension were associated with having a family member or a close friend with severe COVID-19 and having dealt with an ethical challenge. Contrary to expectation, participants’ personal motivation to work with COVID-19 patients was not associated with these factors.
This factor analytic study revealed distressing dimensions of avoidance and re-experience, depression-anxiety, and sleep changes as the core psychological reactions of a sample of Brazilian HWs during the pandemic. It also highlighted the importance of institutional support in preventing a worsening of hospital professionals’ mental health during their pandemic service. These findings have implications for tailoring interventions to maintain HWs’ mental health.
Data reduction methods, such as exploratory factor analysis, contribute to enlarging our understanding of the core psychological reactions of hospital professionals during a sanitary crisis. Multiple co-occurring symptoms can be clustered in a sound dimensional structure. In the future, institutional strategies based on these unobservable patterns could be planned to improve occupational well-being in health settings, either during subsequent waves of COVID-19 or during other future pandemic crises. Lastly, analyzing the longitudinal trajectory of the HWs’ reactions could help to elucidate coping mechanisms in similar stressful periods.