Harnessing the Neurobiology of Resilience to Protect the Mental Well-Being of Healthcare Workers During the COVID-19 Pandemic

Abstract

Healthcare workers are at a high risk of psychological morbidity in the face of the COVID-19 pandemic. However, there is significant variability in the impact of this crisis on individual healthcare workers, which can be best explained through an appreciation of the construct of resilience. Broadly speaking, resilience refers to the ability to successfully adapt to stressful or traumatic events, and thus plays a key role in determining mental health outcomes following exposure to such events. A proper understanding of resilience is vital in enabling a shift from a reactive to a proactive approach for protecting and promoting the mental well-being of healthcare workers. Research in the past decade has identified six areas that provide promising leads in understanding the biological basis of individual variations in resilience. These are: (1) the key role played by the monoamines noradrenaline and serotonin, (2) the centrality of the hypothalamic-pituitary-adrenal axis in influencing stress vulnerability and resilience, (3) the intimate links between the immune system and stress sensitivity, (4) the role of epigenetic modulation of gene expression in influencing the stress response, (5) the role played by certain neuropeptides as a natural “brake” mechanism in the face of stress, and (6) the neurobiological mechanisms by which environmental factors, such as exercise, diet, and social support, influence resilience to subsequent life events. Though much of this research is still in its early stages, it has already provided valuable information on which strategies – including dietary changes, lifestyle modification, environmental modification, psychosocial interventions, and even pharmacological treatments – may prove to be useful in fostering resilience in individuals and groups. This paper examines the above evidence more closely, with a specific focus on the challenges faced by healthcare workers during the COVID-19 pandemic, and provides suggestions regarding how it may be translated into real-world interventions, as well as how the more tentative hypotheses advanced in this field may be tested during this critical period.

How do Vaccinators Experience the Pandemic? Lifestyle Behaviors in a Sample of Italian Public Health Workers during the COVID-19 Era

“…Moreover, the COVID-19 virus may be affected by host nutritional deficiency; it may be more virulent if it replicates in a nutritionally deficient host [29]. Moreover, there is preliminary evidence that some nutrients may modulate stress resilience in humans [32], which could help in planning healthy meals for HCWs [33].…”

Hair cortisol change at COVID-19 pandemic onset predicts burnout among health personnel

“…Another explanation for the absence of association between cortisol change and PTSD, anxiety, and depression can be that cortisol may not be an important pathophysiological mechanism underlying these disorders. A recent review summarized six possible biological mechanisms responsible for variations in resilience in healthcare workers facing the COVID-19 pandemic ( Rajkumar, 2021a ). In addition to the hypothalamic-pituitary-adrenal axis studied in the present paper, they identified brain neurotransmitters, immune system, neuropeptides, epigenetic and environmental factors as possible mediators.…”

“…In addition to the hypothalamic-pituitary-adrenal axis studied in the present paper, they identified brain neurotransmitters, immune system, neuropeptides, epigenetic and environmental factors as possible mediators. Another lead would be heart rate variability as it is a known measure of the autonomous nervous system balance ( Rajkumar, 2021b ) and is reduced in anxiety disorders ( Chalmers et al, 2014 ). Finally, while we did not study the downstream effects of changes in cortisol levels on burnout, Onen Sertoz et al did, and their results suggest that the serum brain-derived neurotrophic factor circulating biomarkers may be involved ( Onen Sertoz et al, (2008.…”

Resilience Improves the Quality of Life and Subjective Happiness of Physiotherapists during the COVID-19 Pandemic

“…This outcome was observed in our data, which showed that Brazilian physiotherapists who maintained and engaged in physical activity had better perceptions of QoL and happiness. Regular physical exercise may: increase the local expression of the brain-derived neurotrophic factor (BDNF) gene in brain areas involved in resilience, such as the hippocampus and prefrontal cortex; minimize the risk of post-traumatic stress symptoms; increase heart rate variability; and promote neuropeptide secretion [ 98 ].…”