Mental Health Outcomes Among Frontline and Second-Line Health Care Workers During the Coronavirus Disease 2019 (COVID-19) Pandemic in Italy

Abstract

Health care workers (HCWs) involved in the coronavirus disease 2019 (COVID-19) pandemic are exposed to high levels of stressful or traumatic events and express substantial negative mental health outcomes, 1 including stress-related symptoms and symptoms of depression, anxiety, and insomnia. In this cross-sectional study, we report on mental health outcomes among HCWs in Italy. Methods This cross-sectional, web-based study collected data between March 27 and March 31, 2020, using an online questionnaire spread via social networks using a snowball technique and sponsored social network advertisements. Approval for this study was obtained from the local institutional review board at University of L'Aquila. Online consent was obtained from the participants. The sampling period corresponded to the days immediately preceding the COVID-19 contagion peak, associated with the highest level of health care system utilization. All HCWs reporting that they work in Italy were eligible. Because of the self-selected and nonprobabilistic nature of the sample, invitations and response rates could not be quantifiable, as reported by American Association for Public Opinion Research (AAPOR) reporting guideline. The questionnaire investigated demographic variables, workplace characteristics (ie, being a frontline or second-line worker), and information regarding the direct consequences of COVID-19, including having colleagues infected or deceased. Frontline and second-line HCWs were defined by a single yes or no question, "Are you currently working with COVID-19 patients?" Key mental health outcomes were posttraumatic stress symptoms (PTSS), symptoms of depression, anxiety, insomnia, and perceived stress, assessed using the Italian version of the Global Psychotrauma Screen (GPS), 2 the 9-item Patient Health Questionnaire (PHQ-9), 3 the 7-item Generalized Anxiety Disorder scale (GAD-7), 4 the 7-item Insomnia Severity Index (ISI), 5 and the 10-item Perceived Stress Scale (PSS). 6 Participants were classified as endorsing the previously listed symptoms according to the following cutoffs: at least 3 on the 5 item GPS-posttraumatic stress disorder subscale, at least 15 on the PHQ-9, at least 15 on the GAD-7, and at least 22 on the ISI. Cutoffs were extracted from the original articles describing each measure. Because no official cutoff for the PSS was available, a quartile split was used. Age was standardized to a mean (SD) of 0 (1) and then reversed (ie, multiplied by −1) to show a positive coefficient. A multivariable logistic regression model was fitted to explore the association of the selected outcomes with sex, age, frontline working position, occupation, and self and colleagues' exposure to contagion. The association between outcomes and potential risk factors was assessed by seemingly unrelated regression models that allow joint modelling of correlated outcomes. Analyses were conducted in Stata version 16 (StataCorp). Statistical significance was set at P < .05, and all tests were 2-tailed. Results A total of 1379 HCWs completed th...

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“…Also, the constant fear of contagion leads to obsessive thoughts ( Brooks et al, 2020 ), increasing the progressive closure of the person and reducing social relationships. In line with these results, Rossi et al (2020) evaluated mental health outcomes among HCWs in Italy during the pandemic, confirming a high score of mental health issues, particularly among young women and front-line workers. Furthermore, Spoorthy et al (2020) conducted a review on the gendered impact of Covid-19 and found that 68.7–85.5% of medical staff is composed of women, and the mean age ranged between 26 and 40 years.…”

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“…In addition, they were also invited through WhatsApp, email and verbal reminders among each other. Sample size was calculated based on the precision of 0.05, level of confidence of 95%, and prevalence of depression (24.73%), anxiety (19.80%) and stress (21.90%) from a cross-sectional study among healthcare workers in the midst of the COVID-19 pandemic in Italy [ 12 ], and the results were 419, 246, and 264 samples, respectively. All participants participated on a voluntary basis, received information about the procedure of the investigation and gave their online consent before participation.…”

“…Multiple studies related to mental health have been conducted among healthcare workers. For instance, Rossi et al (2020) conducted a cross-sectional study in March 2020 immediately preceding the COVID-19 contagion peak in Italy through an online questionnaire among all healthcare workers in Italy [ 12 ]. A total of 1379 healthcare workers completed the questionnaire.…”

“…A total of 1379 healthcare workers completed the questionnaire. They found that 49.38% experienced post-traumatic stress symptoms, 24.73% had symptoms of depression, 19.80% reported symptoms of anxiety and 21.90% experienced high perceived stress [ 12 ]. Another study in China involved nearly 4000 healthcare workers using the General Health Questionnaire to assess their mental health status had revealed 40% of them had psychological distress, especially those from Wuhan [ 13 ].…”

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“…During pandemics, healthcare staff is exposed to contagious materials, high levels of An IP model for assignment in tele-psychoterapy during Covid-19 3 stress, sleep deprivation, or compassion fatigue [50,8,45]. Thus, health workers have a higher probability and disposition to develop mental health anguish and disorders [53]. An important component to effectively alleviate pandemic-related distress is to prioritize psychological intervention for healthcare professionals [48,17].…”