COVID-19: Risk Factors and Protective Role of Resilience and Coping Strategies for Emergency Stress and Secondary Trauma in Medical Staff and Emergency Workers—An Online-Based Inquiry

Abstract

The COVID-19 crisis has placed a heavy burden on medical staff and emergency workers, who may be at risk of developing psychological distress and secondary trauma. Coping and resilience to stress during a pandemic are protective factors that can mitigate the potential adverse psychological effects. Here, we investigated the direct and mediated effects of coping strategies and hardiness on secondary trauma among Italian medical staff (physicians and nurses, n = 140) and emergency workers (firefighters, civil protection, and ambulance personnel, n = 100) involved in the first phase of the pandemic. For this purpose, we collected data from participants through online questionnaires to measure emergency stress, coping strategies, hardiness, and secondary trauma. Other variables analyzed were age, sex, direct contact with COVID-19 patients, and use of personal protective equipment (PPE). We performed a correlational analysis, regressions, and a mediation analysis. The results show that nurses and physicians experienced higher levels of emergency stress than emergency workers. Direct contact with COVID-19 patients, female sex, unexpected events, and lack of PPE were risk factors for emergency stress, while resilience and coping strategies played a protective role. Mediation analysis shows that coping strategies and hardiness are protective factors and reduce the effect of stress on secondary trauma.

Psychological resilience, coping behaviours, and social support among healthcare workers during the COVID-19 pandemic: A systematic review of quantitative studies

“…Nine studies described the interaction between coping skills and mental health in HCWs during the COVID-19 pandemic (Baboe et al ., 2020; Chew et al ., 2020; Di Monte et al ., 2020; Hou et al ., 2020; Maiorano et al ., 2020; Mi et al ., 2020; Nie et al ., 2020; Vagni et al ., 2020; Zhu et al ., 2020;). The use of positive coping mechanisms such as seeking social support, positive thinking, and problem solving were associated with lower levels of traumatic stress, stigma (Chew et al ., 2020), psychological distress (Baboe et al ., 2020), stress symptoms (Nie et al ., 2020), anxiety, and depression (Zhu et al ., 2020; Mi et al ., 2020).…”

“…In one study, the use of emotion-centred and avoidant coping styles were associated with increased levels of emotional exhaustion, while problem-centred coping styles were strongly associated with decreased scores on the depersonalization subscale and increased scores on the personal accomplishment subscale of the MBI (Di Monte et al ., 2020). Interestingly, unlike previous studies, a two separate studies in Italy found that the use of a negative coping style – specifically, the blocking of unpleasant emotions and thoughts – was found to effectively reduce psychological distress (Vagni et al ., 2020) and PTSD (Maiorano et al ., 2020). Vagni et al .…”

Mental health of Health Care Workers (HCWs): a review of organizational interventions put in place by local institutions to cope with new psychosocial challenges resulting from COVID-19

“…Reports from all over the world have already ascertained that HCWs have significant levels of self-reported anxiety, depression, insomnia and even symptoms of post-traumatic stress disorder ( Buselli et al, 2020a , 2020b ; Digby et al, 2020 ; Firew et al, 2020 ; Krishnamoorthy et al, 2020 ; Maiorano et al, 2020 ; Pappa et al, 2020 ; Trumello et al, 2020 ; Vagni et al, 2020 ) and a recent canadian meta-analysis further evidenced that the prevalence of insomnia seems to be more than two times higher among HCWs than in the general population ( Cenat et al, 2021 ).…”

Protective and Risk Factors of Italian Healthcare Professionals during the COVID-19 Pandemic Outbreak: A Qualitative Study

“…The most difficult moments occurred especially during the first weeks of pandemic when HCPs had to deal with insufficient personal protective equipment (i.e., gowns, masks, and face shields) [ 3 ] which exposed the personnel to higher risk of contracting coronavirus than the general public [ 4 ] making it particularly vulnerable [ 4 , 5 , 6 , 7 ]. These objective difficulties were coupled with psychological difficulties linked to the fear of contracting the virus, infecting one’s family members, and, above all, to one’s sense of helplessness in the face of patient losses [ 8 ].…”