Healthcare workers’ experiences of working on the frontline and views about support during COVID-19 and comparable pandemics: A rapid review and meta-synthesis

Billings, Jo; Ching, Bcf; Gkofa,; Greene, Talya; Bloomfield, Michael

doi:10.1101/2020.06.21.20136705

Cited by 47 publications

(69 citation statements)

References 53 publications

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“…These results indicate that it is paramount to provide adequate PPE to HSCWs throughout an infectious disease outbreak not only to protect their physical health but in order reduce the likelihood of mental distress. If HSCWs perceive themselves to be unsafe and vulnerable to contracting an infectious disease due to inadequate PPE, they may actively avoid loved ones in order to protect them, which may in turn lead to reduced social support 4 . Furthermore, it may be the case that others avoid socialising or being in close proximity to HSCWs due to fear of infection, which may be experienced as rejection and stigmatisation.…”

Section: Discussionmentioning

confidence: 99%

“…Since the COVID-19 global pandemic began, frontline health and social care workers (HSCWs) have been repeatedly identified as being at high risk for severe psychological distress 1-3 , and emerging research seems to support this 4-8 . The COVID-19 situation is dynamic within, and variable across, countries with a range of health care systems.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have shown that working in healthcare roles during epidemics and pandemics such as SARS, MERS, and Ebola disease, was associated with PTSD, depression, anxiety, and other mental health disorders 9-12 . Research conducted during previous pandemics has also highlighted potential risk factors, including being tasked to directly work with patients suspected of having the virus 13-16 , working as a nurse 4 9 10 17 18 , being younger 16 , being the parents of dependent children 16 and being a woman 19 . HCSWs may have concerns both about being infected, and also about passing the disease onto others 4 20 , and may feel stigmatised as a result of their role 10 11 20 .…”

Section: Introductionmentioning

confidence: 99%

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Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19

Greene

Harju-Seppänen

Adeniji

et al. 2020

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Objectives: The objectives of this study were to identify demographic, work-related and other predictors for clinically significant psychological distress, including PTSD, depression, and/or anxiety during the COVID-19 pandemic in UK frontline health and social care workers (HSCWs), and to compare rates of PTSD, depression and anxiety across different groups of HCSWs. Design: An online survey was conducted in the weeks following the initial peak in cases (27 May to 23 July 2020). Setting: The participants worked in a variety of healthcare roles UK hospitals, nursing or care homes and community settings. Participants: A convenience sample (n=1194) of frontline UK health and social care workers completed the survey (including allied healthcare professionals, carers, clinical support staff, nurses and midwives, and other health and social care roles). Main outcome measures: PTSD was assessed using the PTSD subscale of the International Trauma Questionnaire (ITQ); Depression assessed using the Patient Health Questionnaire-9 (PHQ-9); Anxiety was assessed using the Generalized Anxiety Disorder Scale (GAD-7). Results: Logistic regression analyses examined predictors for depression, anxiety and PTSD separately, and also investigated the predictors of meeting the criteria for at least one of the three conditions. Over 57% of respondents met the threshold for clinically significant PTSD, anxiety or depression, and symptom levels were reasonably high and comparable across occupational groups. Participants who were more concerned about infecting others, who felt they could not talk with their managers, who reported feeling stigmatised due to their role and who had not had reliable access to personal protective equipment (PPE) were more likely to meet criteria for a clinically significant mental disorder. Being redeployed during the pandemic, and having had COVID were associated with a higher likelihood of meeting criteria for PTSD. Higher household income was associated with reduced odds for a mental disorder. Conclusions: This study identifies predictors of clinically significant distress during COVID-19 and highlights the need for reliable access to PPE. Further research should investigate mental disorders in under-represented HSCW groups and examine barriers to communication between managers and staff. Identifying risk factors for PTSD, depression and anxiety among HSCWs, and providing treatment for those who need it, is critical given that subsequent waves of COVID-19 and other healthcare crises are inevitable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19

Greene

Harju-Seppänen

Adeniji

et al. 2020

Preprint

Self Cite

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“…It is interesting to note that more than three quarters of the workforce surveyed reported feeling heightened stress levels at work during the COVID-19 pandemic. Despite this, fewer than 1 in This phenomenon is not unusual amongst healthcare workers with a delay between eventtiming, and reflective practice that allows staff to acknowledge the emotional impact of their work (23). As not all of those recognising their need for support accessed support, this suggests that the structure through which the support is being offered may not be meeting the needs of those it is intended to serve.…”

Section: Discussionmentioning

confidence: 99%

Predictors of healthcare worker burnout during the COVID-19 pandemic

Ferry

Wereski

Mills

2020

Preprint

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Objective We aim to provide a snapshot of the levels of burnout, anxiety, depression and distress among healthcare workers during the COVID-19 pandemic. Design, setting, participants We distributed an online survey via social media in June 2020 that was open to any healthcare worker. The primary outcome measure was symptoms of burnout as measured using the Copenhagen Burnout Inventory (CBI). Secondary outcomes of depression, anxiety and distress as measured using the Patient Health Questionnaire-9, General Anxiety Scale-7, and Impact of Events Scale-Revised were recorded along with subjective measures of stress. Multivariate logistic regression analysis was performed to identify factors associated with burnout, depression, anxiety and distress. Results Of 539 persons responding to the survey, 90% were female, and 26% were aged 41-50 years, 53% were nurses. Participants with moderate-to-severe burnout were younger (49% [206/424] versus 33% [38/115] under 40 years, P=0.004), and more likely to have pre-existing comorbidities (21% versus 12%, P=0.031). They were twice as likely to have been redeployed from their usual role (22% versus 11%; adjusted odds ratio [OR] 2.2, 95% confidence interval [CI] 1.5-3.3, P=0.042), or to work in an area dedicated to COVID-19 patients (50% versus 32%, adjusted OR 1.6, 95% CI 1.4-1.8, P<0.001), and were almost 4-times more likely to have previous depression (24% versus 7%; adjusted OR 3.6, 95% CI 2.2-5.9, P=0.012). A supportive workplace team and male sex protected against burnout reducing the odds by 40% (adjusted OR 0.6, 95% CI 0.5-0.7, P<0.001) and 70% (adjusted OR 0.3, 95% CI 0.2-0.5, P=0.003), respectively. Conclusion Independent predictors of burnout were younger staff, redeployment to a new working area, working with patients with confirmed COVID-19 infection, and being female or having a previous history of depression. Evaluation of existing psychological support interventions is required with targeted approaches to ensure support is available to those most at risk.

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“…There is emerging evidence that psychosocial support may be most acceptable and effective when delivered in a phase-based way [8], although this warrants evaluation. Mental health awareness training, health promotion and ill-health prevention are likely to be most helpful in advance of crises with practical resources, peer support and informal psychological support most valued at the peak.…”

Section: Psychological Support Servicesmentioning

confidence: 99%

What support do frontline workers want? A qualitative study of health and social care workers’ experiences and views of psychosocial support during the COVID-19 pandemic

Billings

Seif

Hegarty

et al. 2020

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Background. The COVID-19 pandemic has placed a significant burden on the mental health and wellbeing of frontline health and social care workers. The need to support frontline staff has been recognised. However, there is to date little research specifically on how best to support the mental health needs of frontline workers, and none on their own experiences and views about what might be most helpful. Aims. We set out to redress this research gap by qualitatively exploring UK frontline health and social care workers own experiences and views of psychosocial support during the pandemic. Method. Frontline health and social care workers were recruited purposively through social media and by snowball sampling via healthcare colleagues. Workers who volunteered to take part in the study were interviewed remotely following a semi-structured interview guide. Transcripts of the interviews were analysed by the research team following the principles of Reflexive Thematic Analysis. Results. We conducted 25 interviews with frontline workers from a variety of professional groups working in health and social care settings across the UK. Themes derived from our analysis showed that workers experiences and views about psychosocial support were complex. Peer support was many workers first line of support but could also be experienced as a burden. Workers were ambivalent about support shown by organisations, media and the public. Whilst workers valued psychological support services, there were many disparities in provision and barriers to access. Conclusions. The results of this study show that frontline health and social care workers are likely to need a flexible system of support including peer, organisational and professional support. More research is needed to fully unpack the structural, systemic and individual barriers to accessing psychosocial support. Greater collaboration, consultation and co-production of support services and their evaluation is warranted. Keywords: health and social care workers, COVID-19, psychosocial support, experiences, views, qualitative, thematic analysis

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Healthcare workers’ experiences of working on the frontline and views about support during COVID-19 and comparable pandemics: A rapid review and meta-synthesis

Cited by 47 publications

References 53 publications

Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19

Predictors and rates of PTSD, depression and anxiety in UK frontline health and social care workers during COVID-19

Predictors of healthcare worker burnout during the COVID-19 pandemic

What support do frontline workers want? A qualitative study of health and social care workers’ experiences and views of psychosocial support during the COVID-19 pandemic

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