Perceived Stress, Stigma, Traumatic Stress Levels and Coping Responses amongst Residents in Training across Multiple Specialties during COVID-19 Pandemic—A Longitudinal Study

Abstract

This study aimed to explore changes in psychological responses (perceived stress, traumatic stress, stigma, coping) over time in residents, as well as their predictors. The level of perceived stress, traumatic stress, stigma, and coping responses were assessed using the Perceived Stress Scale, Impact of Event-Revised, Healthcare Workers Stigma Scale, and Brief Coping Orientation to Problems Experienced (COPE) Inventory, respectively. We collected responses from 274 residents at baseline and 221 residents at 3 months follow-up (timepoint 2) from the National Healthcare Group (NHG) residency programs in Singapore. All residents reported lower perceived stress and lower perceived stigma compared to baseline. Use of avoidance coping was associated with all three psychological responses (perceived stress, traumatic stress, and stigma) across the two timepoints. Compared to baseline, specific factors associated with perceived stress and traumatic stress at timepoint 2 were living alone, less problem solving, and seeking social support. Residency programs should encourage active coping strategies (e.g., seeking social support, positive thinking, problem solving) among residents, and proactively identify residents who may be at higher risk of psychological sequelae due to circumstances that contribute to isolation.

Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic

“…Most of these studies have been cross-sectional, although some longitudinal studies currently exist. In comparison, our findings of decreasing distress over time are like those observed among resident physicians in Singapore [ 27 ]. There, lower stress was observed at three months, and significant predictors included living alone, less ability to problem solve, and seeking social support [ 27 ]).…”

“…In comparison, our findings of decreasing distress over time are like those observed among resident physicians in Singapore [ 27 ]. There, lower stress was observed at three months, and significant predictors included living alone, less ability to problem solve, and seeking social support [ 27 ]). Our findings also echo the pattern observed in the Chinese general population, where psychiatric distress decreased significantly between the COVID-19 onset and peak number of cases one month later [ 28 ].…”

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

“…Fourteen studies identified specific coping mechanisms employed by HCWs during the pandemic (Blanco-Donoso et al ., 2020; Cai, 2020; Chen et al ., 2020; Chew et al ., 2020; Dong et al ., 2020; Giusti et al ., 2020; Labrague & De los Santos, 2020; Maraqa et al ., 2020; Mi et al ., 2020; Nie et al., 2020; Salman et al, 2020; Shechter et al ., 2020; Vagni et al ., 2020; Xiao et al ., 2020). During the pandemic, HCWs utilized both negative and positive coping styles to manage stress.…”

“…Among these ten studies reporting specific coping styles among HCWs during the pandemic, eleven quantitative studies (Cai, 2020; Blanco-Donoso et al ., 2020; Chew et al ., 2020; Dong et al ., 2020; Giusti et al ., 2020; Labrague & De los Santos, 2020; Nie et al ., 2020; Xiao et al ., 2020; Chen et al ., 2020; Maraqa et al ., 2020; Vagni et al ., 2020) indicated that HCWs use support from and communication with family, friends, and colleagues as their primary coping mechanisms to manage the adverse mental health consequences of the COVID-19 pandemic. Religious coping mechanisms such as praying were reported as an important coping mechanism in three cross-sectional 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). On the other hand, utilization of negative coping skills, such as avoidance, were strongly linked with increased levels of emotional stress (Chew et al ., 2020), PTSD symptoms (Hou et al ., 2020), psychological distress (Nei et al ., 2020; Baboe et al ., 2020), and fatigue (Hou et al ., 2020).…”