The Impact of COVID-19 on the Mental-Emotional Wellbeing of Primary Healthcare Professionals: A Descriptive Correlational Study

The present study aimed to examine work environment related factors and frontline primary healthcare professionals’ mental-emotional wellbeing during the COVID-19 pandemic in school communities of Hong Kong. A total of 61 (20%) school health nurses (frontline primary healthcare professionals) participated in a cross-sectional online survey from March to June 2020. Outcomes of mental-emotional health were measured using the Mental Health Continuum-Short Form (14-item scale with three subscales related to emotional, social and psychological wellbeing); the Perceived Stress Scale (10-item scale with two subscales related to perceived helplessness and lack of self-efficacy; and the Coping Orientation to Problems Experienced Inventory (Brief COPE), a 28-item inventory with two subscales related to adaptive and maladaptive strategies. Almost half (42.6%) of participants experienced mental health problems. Those employed in government subsidized schools had signifi- cantly lower scores in mental health wellbeing than those who worked in private schools. Factors relating to increased mental health problems included lack of emotional support, inadequate training relating to infection prevention and control measures, disengagement and self-blame. A variety of factors influencing school health nurses’social, emotional and psychological wellbeing in their work environment during the COVID-19 pandemic were also reported. The mental-emotional wellbeing of school nurses may relate to their subjective feeling of loneliness as participants were the sole frontline primary healthcare professional working in the school community during the COVID-19 pandemic. Study findings provide relevant evidence for management teams to build a culture of psychological and social support into workplace policies and procedures. Continuous staff development and adequate social support are important to promote the mental-emotional wellbeing of primary healthcare professionals in school communities as they play a significant role in safeguarding resources during pandemics.     

Bridging the Gap between Ethical Climate and Nurses’ Service Behaviors: the Critical Role of Professional Well-Being

Although the importance of nurses’ service behaviors has been increasingly emphasized, few studies accounted for how organizational or individual antecedents affect nurses’ psychological processes to implement service behaviors. Additionally, they mainly focused on the one side of roleprescribed service behavior and ignored the effect on extra-role service behavior. This study seeks to explore the relationship between ethical climate and nurses’ service behaviors from a comparative view, of the role-prescribed and extra-role service behavior and examine the mediating effect of nurses’ professional wellbeing (as characterized by positive attitudes toward work, specifically harmonious work passion and obsessive work passion). Survey data from 378 nurses in China indicate that nurses’ harmonious work passion mediated the effects of ethical climate on both their role-prescribed and extra-role service behavior; however, obsessive work passion only mediated the effect of ethical climate on roleprescribed service behavior. Managerial implications and future research directions are discussed in this study.     

Community Workers’ Social Support and Sleep Quality during the Coronavirus Disease 2019 (COVID-19): A Moderated Mediation Model

To explore the relationship between social support and sleep quality of community workers in Wuhan during the coronavirus disease 2019 (the COVID-19 infection epidemic), this research constructed a mediating effect model to explore the mediating psychological mechanism of social support influencing sleep quality of front-line community workers. A total of 500 front-line community workers in Wuhan were investigated. We used the perceived social support scale (PSSS), the Connor-Davidson Resilience Scale (CD-RISC), the perceived stress scale (PSS), and the Pittsburgh sleep quality index (PSQI) to measure social support, psychological resilience, perceived stress and sleep quality. Specifically, the higher the PSQI, the worse the sleep quality. Pearson correlation structural equation model was used to analyze the relationship between these factors. The results showed that: (1) There was a significant negative correlation between social support, psychological resilience, and perceived stress of community workers and PSQI, that means, the higher the level of social support, psychological resilience, and perceived stress, the higher the sleep quality. (2) Social support positively predicted psychological resilience and perceived stress, and perceived stress negatively predicted PSQI. (3) Social support can affect sleep quality through the mediating role of psychological resilience and perceived stress, and the mediating role includes two paths: the single mediating role of perceived stress and the chain mediating role of psychological resilience-perceived stress. (4) Gender moderates the relationship between social support and perceived stress, and the influence of social support on perceived stress of women is higher than that of men. Gender moderates the relationship between psychological resilience and PSQI, and only women’s psychological resilience had a negatively predictive effect on PSQI, while men did not, which means that psychological resilience of female frontline community workers can positively predict sleep quality. This research reveals the relationship between social support and sleep quality and its mechanism and verifies that social support can indirectly affect physical health through psychological resilience and perceived stress. It provides reference suggestions and intervention guidance for improving the sleep quality of community workers.     

Perceived Risk and Mental Health Problems among Healthcare Professionals during COVID-19 Pandemic: Exploring the Mediating Effects of Resilience and Coronavirus Fear

During coronavirus (COVID-19) pandemic, healthcare professionals were particularly at high-risk of developing symptoms of mental health problems due to being on the frontline in the battle against COVID-19. This study examined the mediating roles of resilience and coronavirus fear in the relationship between perceived risk and mental health problems among healthcare professionals including doctors and nurses who were actively treating patients confirmed with COVID-19. We recruited 204 healthcare professionals (50% females) with a mean age of 32.92 years (SD?=?7.01). Results showed that perceived risk and coronavirus fear positively predicted depression, anxiety, and stress while resilience negatively predicted those mental health problems. Coronavirus fear mediated the relationship between perceived risk and resilience, depression, anxiety, and stress. Additionally, resilience mitigated the effect of coronavirus fear on depression, anxiety, and stress. This study is among the first indicating the importance of resilience and fear as a critical mechanism that explains the relationship between perceived risk and mental health problems among health professionals directly caring for COVID-19 patients.

     

Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old

Different concepts have been presented which denote driving forces and strengths that contribute to a person's ability to meet and handle adversities, and keep or regain health. The aim of this study, which is a part of The Umeå 85+ study, was to describe resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health in a sample of the oldest old. The study sample consisted of 125 participants 85 years of age or older, who ranked themselves on the Resilience Scale, Sense of Coherence Scale, Purpose in Life Scale and Self-Transcendence Scale and answered the SF-36 Health Survey questionnaire. The findings showed significant correlations between scores on the Resilience Scale, the Sense of Coherence Scale, the Purpose in Life Test, and the Self-Transcendence Scale. Significant correlations were also found between these scales and the SF-36 Mental Health Summary among women but not among men. There was no significant correlation between perceived physical and mental health. The mean values of the different scales showed that the oldest old have the same or higher scores than younger age groups. Regression analyses also revealed sex differences regarding mental health. The conclusions are that, the correlation between scores on the different scales suggests that the scales measure some dimension of inner strength and that the oldest old have this strength at least in the same extent as younger adults. Another conclusion is that the dimensions that constitute mental health differ between women and men.     

Negative life events and mental health of Chinese medical students: the effect of resilience, personality and social support

The present study was conducted on a large sample of Chinese medical students to test the moderating effect of resilience between negative life events and mental health problems, and investigate the factors that affect the mental health problems of the students. The Adolescent Self-Rating Life Events Check List, Eysenck Adult Personality Questionnaire-Revised, Social Support Rating Scale, Connor-Davidson Resilience Scale, and Symptom Check List were adopted for a survey with 1,998 Chinese medical students as respondents. Mental health problems had a positive correlation with negative life events and neuroticism. On the other hand, mental health problems had a negative correlation with social support, extraversion, and resilience. Regression analysis showed that resilience moderated negative life events and mental health problems. Promoting resilience may be helpful for the adjustment of college students.     

Stigma-related stress,shame and avoidant coping reactions among members of the general population with elevated symptom levels

BackgroundIt is unclear whether mental illness stigma affects individuals with subthreshold syndromes outside clinical settings. We therefore investigated the role of different stigma variables, including stigma-related stress and shame reactions, for avoidant stigma coping among members of the general population with elevated symptom levels.MethodsBased on a representative population survey, general stress resilience, stigma variables, shame about having a mental illness as well as avoidant stigma coping (secrecy and social withdrawal) were assessed by self-report among 676 participants with elevated symptom levels. Stigma variables and resilience were examined as predictors of avoidant stigma coping in a path model.ResultsIncreased stigma stress was predicted by lower general stress resilience as well as by higher levels of perceived stigma, group identification and perceived legitimacy of discrimination. More shame was associated with higher perceived legitimacy. Lower resilience as well as more perceived stigma, group identification and perceived legitimacy predicted avoidant coping. Stigma stress partly mediated effects of resilience, perceived stigma and group identification on avoidant coping; shame partly mediated effects of perceived legitimacy on coping. Stigma stress and shame were also directly and positively related to avoidant stigma coping. Analyses were adjusted for symptoms, neuroticism and sociodemographic variables.ConclusionsStigma may affect a larger proportion of the population than previously thought because stigma variables predicted secrecy and withdrawal among members of the general population with elevated, but overall mild symptom levels. Avoidant stigma coping likely has harmful effects, potentially exacerbating pre-existing psychological distress and undermining social networks. This highlights the need to reduce public stigma as well as to support individuals with subthreshold syndromes in their coping with stigma stress and shame reactions.     

Longitudinal variations and predictors of increased perceived impact of multiple sclerosis, a two-year study

OBJECTIVE: To explore variations and the capacity of selected factors - contextual factors, disease-related characteristics, cognition, fatigue, mood and time - to predict an increase in the perceived physical and psychological impact of multiple sclerosis (MS) over a two-year period. METHODS: At an MS specialist clinic, 219 outpatients were included in the study and data were collected every 6 months. The Multiple Sclerosis Impact Scale was used for assessment of the perceived physical and psychological impact of MS. For statistical analysis of changes in impact during the study period, Friedman ANOVA was used and predictors of increased impact were explored with Generalized Estimating Equations employing proportional odds models. RESULTS: The majority had changes in perceived physical impact of established important magnitude and the psychological impact varied significantly. A period of more than 10 years since diagnosis, cognitive disability, fatigue and signs of depression were independent predictors of increase in physical impact. Weak or moderate sense of coherence, absence of immunomodulatory treatment, fatigue and signs of depression were independent predictors of increase in psychological impact. CONCLUSION: The fluctuation in perceived impact should be taken into account in clinical decision-making and when designing studies and interpreting the results. This study identifies the predictors of increased perceived physical and psychological impact that health-related services should pay special attention to, in order to provide interventions aimed at minimizing the perceived impact of MS.     

Resilience Moderates the Relationship Between Exposure to Violence and Posttraumatic Reexperiencing in Mi’kmaq Youth

This study is part of a school-based collaborative research project with a Nova Scotian Mi’kmaq community that hopes to shed light on the relationship between exposure to violence and mental health in First Nations youth. This particular study sought to examine how the multifaceted construct of resilience might act as a protective factor, buffering some students from the negative mental health consequences of exposure to violence. The present paper focuses on whether the construct of resilience, measured by the Child and Youth Resiliency Measure (CYRM; Ungar et al. 2008), has a moderating impact on the relationship between exposure to violence (emotional, physical, and sexual), measured by the Childhood Experience of Violence Questionnaire (CEVQ; Walsh, MacMillan, Trocmé, Jamieson, & Boyle, in press), and posttraumatic stress symptoms, measured by the Child PTSD Symptom Scale (CPSS, Foa et al. 2001). Results showed that the positive relationship between exposure to violence—measured as emotional, physical, and sexual abuse, and witnessing domestic violence—and the reexperiencing symptom cluster of PTSD was moderated by resilience, such that exposure to violence was only predictive of reexperiencing at lower levels of resilience. These findings not only help provide further cross-cultural validation for the CYRM as a measure, but provide support for an ecological conceptualization of resilience.     

Quality of life in multiple sclerosis: the impact of depression, fatigue and disability.

This study deals with the assessment of quality of life and its main clinical and demographical determinants in a clinical series of 103 patients with multiple sclerosis (MS) (37 men; 66 women; mean age 44.89 years; mean disease duration 12.40 years; mean EDSS score 4.07). We used the MSQOL-54 inventory, a disease-specific instrument recently validated in an Italian population. Each patient underwent a complete clinical assessment, including that of disability status (Expanded Disability Status Scale), cognitive function (Mini Mental State Examination), depression (Hamilton Rating Scale for Depression) and fatigue (Fatigue Severity Scale). In terms of Pearson's correlations, there was a moderate inverse relationship between disability level and the MSQOL-54 physical composite score, and a moderate to strong inverse correlation between depression or fatigue severity and both the physical and mental composite scores. In a stepwise linear regression analysis, depression, fatigue and disability level were confirmed to be significant and independent predictors of quality of life. Quality of life instruments can help to provide a broader measure of the disease impact and to develop a care program tailored to the patient's needs.     

Effects of home-based exercise on fatigue in postpartum depressed women: Who is more likely to benefit and why?

Objectives

(1) To explore moderators of the effects of home-based exercise on reductions in physical and mental fatigue scores in postpartum depressed women and (2) to explore mediators of the intervention on changes in physical fatigue.

Method

Eighty-eight women in the postpartum period (4-38 weeks) obtaining a score ≥10 on the Edinburgh Postnatal Depression Scale were randomly assigned to a 12-week individualized home-based exercise intervention (n=46) or a no-treatment control group (n=42). The present analyses include the 35 women who adhered to the intervention and the no-treatment control group. Participants completed a cardiovascular fitness test, and a battery of questionnaires assessing the outcomes (Physical and Mental Fatigue) as well as potential moderators and mediators at baseline and posttreatment.

Results

Hierarchical linear regressions evaluating moderators of changes in mental fatigue with exercise showed that the intervention was effective for women entering the study later in the postpartum period (P=.001) and women with higher depression scores (P=.014). Reductions in physical fatigue with exercise were partially mediated by reductions in perceived stress and increased exercise-related energy expenditure.

Conclusion

Identification of moderators allows for the tailoring of exercise interventions to particular subgroups of women that are most likely to benefit. The identified mediators may be enhanced and directly tested in future trials.     

The contribution of disease severity, depression and negative affectivity to fatigue in multiple sclerosis: A comparison with ulcerative colitis

Background

Fatigue is one of the most common and troubling symptoms of multiple sclerosis (MS) and more severe and disabling than fatigue in other somatic populations. Although fatigue seems MS specific, its pathogenesis is still poorly understood.

Objective

To study the disease specificity of fatigue in MS by comparing its level, its physical and psychological correlates to those of patients with ulcerative colitis (UC), a peripheral chronic auto-immune disease. We focused on the relative contribution of disease severity, depression and negative affectivity to fatigue in both patient samples.

Methods

A total of 88 MS and 76 UC patients were included in this cross-sectional study. Fatigue, depression and negative affectivity were assessed respectively with the physical and mental fatigue subscales of the Multidimensional Fatigue Inventory, the depression subscale of the Hospital Anxiety and Depression Scale, and the neuroticism subscale of the Dutch NEO Five-Factor Inventory. The Expanded Disability Status Scale and the Colitis Activity Index were used to measure disease severity in MS and UC patients respectively.

Results

While levels of both physical and mental fatigue were significantly higher in MS patients than in UC patients, there were no group differences in the contribution of disease severity, depression and negative affectivity to both physical and mental fatigue.

Conclusion

Although levels of fatigue are higher for MS patients when compared with UC patients, the correlates of fatigue do not indicate MS specificity. As such our results support a transdiagnostic approach to fatigue in MS.     

Autonomy versus support: self-reliance and help-seeking for mental health problems in young people

Purpose

Many young people with mental ill-health do not seek support, and developmental growth in self-reliance may be a barrier to help-seeking. Increasing autonomy is a positive developmental task for youth and a key aspect of resilience. This study examined the influence of perceived social support and resilience on the previously unexamined relationship between self-reliance and intentions to seek help from informal, professional, and self-help sources for mental health problems.

Methods

An online survey was completed by a representative Australian community sample of 5,203 young people aged 12–25 years (half female), in May–June 2020.

Results

Path analysis showed the hypothesised conceptual model did not fit the data well, but a modified model was a good fit. Higher self-reliance was associated with lower intentions to seek informal and professional help, as expected, but not with greater intentions for self-help. The relationship between self-reliance and informal help-seeking intentions was fully mediated by perceived social support, whereas the relationship between self-reliance and professional help-seeking was also direct. Perceived social support fully mediated the relationship between self-reliance and resilience. Intentions to use self-help were not influenced by variables in the study, but higher self-help intentions were associated with higher professional help-seeking intentions. Associations were consistent across age and gender groups.

Conclusion

The results show the critical role of social support for combating some of the unhelpful aspects of self-reliance for mental health help-seeking in young people. Future research should explore how self-reliance can hinder or be harnessed to facilitate accessing appropriate mental health.

     

Social support and change in health-related quality of life 6 months after coronary artery bypass grafting

OBJECTIVE: We determined whether perceived social support predicted change in health-related quality of life, operationalized as change in mental health and physical functioning, 6 months after coronary artery bypass grafting (CABG). METHODS: A prospective cohort of 1164 patients undergoing first CABG was interviewed prior to hospital discharge and 6 months later. Perceived instrumental and emotional support were assessed predischarge. Change in mental health and physical functioning was calculated as the difference between 6-month and predischarge SF-36 subscale scores. Stepwise linear regression analyses controlling for prior health-related quality of life, demographics, and clinical presentation were conducted. RESULTS: A total of 1072 (1072/1164=92%) participants completed the 6-month interview; mean age 65.7 (+/-11.1) years. Frequent instrumental support predicted positive change in mental health (beta=3.27, P=.02); change scores were higher when participants had low pre-CABG mental health. Neither social support variable predicted change in physical functioning. CONCLUSIONS: Assessing perceived instrumental support may help clinicians predict post-CABG mental health. More research regarding this relationship is needed before recommending intervention efforts.     

Effects of College Students’ Perceived Stress on Anxiety in the Time of COVID-19: The Chain Mediation Role of Psychological Resilience and Regulatory Emotional Self-Efficacy

COVID-19 has changed the way of learning and life of college students. The purpose is to explore the relationship between perceived stress and anxiety, and the mediating effect of resilience and regulatory emotional self-efficacy in college students during COVID-19. 309 students from three colleges were selected as research participants (average age 19.79 ± 1.11 years). SPSS was used to measure the correlation between variables. Amos was used to test the path coefficient and mediating effect of the hypothetical model. The results show that: Firstly, perceived stress has a significantly and positively predictive effect on anxiety. Secondly, psychological resilience and regulatory emotional self-efficacy independently played a significant and partially mediating effect between perceived stress and anxiety. Among them, perceived stress had a negative predictive effect on psychological resilience and regulatory emotional self-efficacy. Psychological resilience and regulatory emotional self-efficacy had a negative predictive effect on anxiety. Thirdly, psychological resilience and regulatory emotional self-efficacy play a chain mediation role between psychological stress and anxiety. Regulatory emotional self-efficacy cannot only directly predict the level of anxiety, but also indirectly predict the level of anxiety by regulating psychological resilience. This study reveals the relationship between college students’ perceived stress and anxiety, and the mediating effect of psychological resilience and regulatory emotional self-efficacy in the new time of COVID-19. The chain mediation role of psychological resilience and regulatory emotional self-efficacy reminds college mental health educators that improving students’ regulatory emotional self-efficacy is an important way to promote students’ mental health.     

Assessment of resilience in the aftermath of trauma

Resilience is a crucial component in determining the way in which individuals react to and deal with stress. A broad range of features is associated with resilience; these features relate to the strengths and positive aspects of an individual's mental state. In patients with posttraumatic stress disorder, resilience can be used as a measure of treatment outcome, with improved resilience increasing the likelihood of a favorable outcome. Resilience can be monitored using the Connor-Davidson Resilience Scale, and perceived vulnerability to the effects of stress can be monitored with the Sheehan Stress Vulnerability Scale. Both scales are well validated, self-rated, easy to use, and easily translatable. Within a short period of time, nonspecialists can be taught to use these in the field.     

Exacerbated physical fatigue and mental fatigue in Parkinson's disease.

OBJECTIVE: To characterize fatigue in Parkinson's disease (PD). BACKGROUND: Fatigue is a recognized problem in PD. Fatigue can be in the physical realm or in the mental realm. Fatigue has not been characterized in PD. METHODS: We characterized fatigue in 39 PD patients and 32 age-matched normal controls using five questionnaires: A. The Multidimensional Fatigue Inventory (MFI), which measures five dimensions of fatigue independently including general fatigue, physical fatigue, reduced motivation, reduced activity, and mental fatigue. B. The Fatigue Severity Inventory (FSI), which quantifies fatigue in general. C. The Profile of Mood States (POMS), which assesses six subjective subscales: tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, vigor-activity, and confusion-bewilderment. D. Center for Epidemiological Studies-Depression Scale (CES-D). E. Visual Analog linear scale of energy (VA-E). RESULTS: PD patients scored higher in all of the five dimensions of fatigue in the MFI including general fatigue, physical fatigue, reduced motivation, reduced activity, and mental fatigue (P < 0.001 except for mental fatigue P = 0.005). The severity of physical fatigue did not correlate with that of mental fatigue. PD patients scored higher on the FSI, POMS, CES-D, and scored lower on the VA-E. The scores in the FSI correlated with general fatigue, physical fatigue, reduced activity, and reduced motivation but not with mental fatigue in the MFI. Depression correlated with all dimensions of fatigue except physical fatigue in the MFI. Disease severity, as measured by Modified Hoehn and Yahr staging, did not correlate with any of the measures. CONCLUSIONS: PD patients have increased physical fatigue and mental fatigue compared to normals. Physical fatigue and mental fatigue are independent symptoms in PD that need to be assessed and treated separately.     

Survey of Australian mental health nurses on physical activity promotion

Physical activity is important to the physical and mental health of people with serious mental illness (SMI). This study investigated views of public mental health nurses on physical activity promotion for consumers with SMI, through a national electronic survey in Australia. Consumers with SMI were viewed to be less physically active than the general community. Two-thirds of nurses wanted training on exercise support of consumers. Motivation of consumers was indicated to be a major barrier. There was great variability in discussion frequency between nurses and exercise physiologists. An analysis of open comments revealed two themes: (1) access – opportunities for health education, participation in physical activity programmes and nurses' connections to exercise physiologists; and (2) commitment – nurses promoting physical activity and building competencies. Findings indicate that initiatives to increase physical activity promotion for people with SMI are likely to be supported by nurses in the mental health sector of Australia.     

Anxiety and depression in primary care patients: predictors of symptom severity and developmental correlates

OBJECTIVE: A study in a German general practice used the Hospital Anxiety and Depression Scale (HADS) to determine the prevalence of anxiety and depression in 242 consecutive patients. The study had two additional goals: (1) to identify indicators of symptom severity and (2) to validate the HADS by relating it to measures of developmental psychopathology. METHODS: In addition to the HADS, clinical/sociodemographic data were collected. Patients filled up additional questionnaires measuring attachment characteristics, recalled parental rearing behavior, resilience, adverse childhood experiences, and physical complaints. RESULTS: Using HADS cutoff scores of > or =11 in total, we found that 21.1% of the patients showed clinically relevant anxiety levels; the rate for depression was 12.0%, that for anxiety or depression was 26.1%, and that for anxiety and depression combined was 7%. With the exception of psychiatric disorders, the HADS did not differentiate between subgroups with different somatic diseases. HADS scores were shown to be predicted by the patients' sex, family status, number of consultations, and subjective physical complaints. Patients with higher HADS scores also indicated lower resilience, more insecure attachment, and negative recalled parental rearing behavior. Resilience, attachment security, and specific parental behavior (control/warmth) independently predicted anxiety, depression, and physical complaints. CONCLUSION: This study provides further support for the usefulness of the HADS as a measure for routine screening for anxiety and depression and its relationship with constructs from developmental psychopathology. We recommend the use of the HADS in combination with potential indicators of symptom severity (fatigue, cardiovascular symptoms, high number of consultations) to identify patients needing psychosocial support.