Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study.

BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic. METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates. RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017). CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.

Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial.

BACKGROUND: During the COVID-19 pandemic, health care professionals experienced high levels of depression. However, extant research has not highlighted effective internet-based psychological interventions to improve the mental health in this population during the pandemic. It remains unclear whether self-guided, internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a smartphone-based iCBT stress management program for reducing the depression experienced by nurses in Vietnam and Thailand. METHODS: From March to April 2022, a 2-arm, parallel-group randomized controlled trial was implemented. One arm offered a 7-week self-guided iCBT program, and the other offered treatment as usual as a control arm. Full-time nurses were recruited from 6 hospitals: 2 hospitals in Vietnam and 4 hospitals in Thailand. The primary outcome of this program was the severity of depression measured by the Depression Anxiety Stress Scale-21 items. Follow-up surveys were conducted to measure the change in depression severity at 3 months (July-August 2022) and at 6 months (October-November 2022) after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-up. RESULTS: A total of 1203 nurses were included in this study: 602 in the intervention group and 601 in the control group. The follow-up rate at 3 and 6 months ranged from 85.7% (515/601) to 87.5% (527/602). The completion rate for the program was 68.1% (410/602). The group difference in depression was significant at the 3-month follow-up (coefficient=-0.92, 95% CI -1.66 to -0.18; P=.02) and nonsignificant at the 6-month follow-up (coefficient=-0.33, 95% CI -1.11 to 0.45; P=.41). The estimated effect sizes were -0.15 and -0.06 at the 3- and 6-month follow-ups, respectively. CONCLUSIONS: Our study shows that the smartphone-based iCBT program was effective in reducing depression at the 3-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. However, the effect size was small, and therefore, these results may not be clinically meaningful. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000044145; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050128. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.20944/preprints202303.0450.v1.

Effects of participatory organizational interventions on mental health and work performance: a protocol for systematic review and meta-analysis.

INTRODUCTION: Participatory organizational interventions to improve psychosocial working conditions are important for a safe and healthy work environment. However, there are few systematic reviews or meta-analyses investigating the effects of these interventions on workers' mental health and work-related outcomes. We intend to apply the protocol for systematic review and meta-analysis to examine the effect of participatory organizational intervention on mental health and work performance. METHODS AND ANALYSIS: The participants, interventions, comparisons, and outcomes (PICO) of the studies in this systematic review and meta-analysis are defined as follows: (P) inclusion of all workers, (I) participatory organizational intervention, (C) treatment as usual or no intervention (including waitlist control), and (O) mental health and work performance. Published studies will be searched using the following electronic databases: PubMed, Embase, PsycINFO, PsycArticles, and Japan Medical Abstracts Society. Studies that (1) include participatory organizational intervention, (2) include participants who were working as of the baseline survey period, (3) assess mental health or work performance outcomes, (4) use a cluster randomized controlled trials design, (5) are published in English or Japanese, and (6) are published in peer-reviewed journals (including advanced online publication) will be included. Study selection and the risk-of-bias assessment will be performed independently by 2 reviewers. A meta-analysis will be performed to statistically synthesize the included studies. Publication bias will be assessed for meta-bias using Egger's test as well as visually on a funnel plot. We will assess heterogeneity by using the Q statistic.

Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic.

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.

Reliability and validity of the Japanese version of the Professional Fulfillment Index among healthcare professionals: A validation study.

OBJECTIVES: Translation of the Professional Fulfillment Index (PFI) into Japanese would be more useful than the currently developed scales for appropriately measuring burnout and professional fulfillment in healthcare professionals. This study aimed to develop the Japanese version of the PFI and examine its internal consistency, structural validity, and convergent validity in healthcare professionals. METHODS: Healthcare professionals in Japan were recruited online. The survey was conducted from October to November 2022. Internal consistency was tested using Cronbach's α. Structural validity was tested using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Convergent validity was tested using Pearson's correlation coefficients, which were calculated between each score of the PFI scale and burnout (the Japanese Burnout Scale: JBS), depressive symptoms (the Patient Health Questionnaire-9), and QOL (the General Health Questionnaire-12). RESULTS: The Cronbach's alpha was .91 in professional fulfillment, .80 in burnout: work exhaustion, .90 in burnout: interpersonal disengagement, and .89 in burnout: total score. Confirmatory factor analysis demonstrated a modest fit, and EFA yielded a three-factor structure the same as the original PFI. The all three subscales and total score of burnout were significantly correlated with the scores of all the scales (p < .001; e.g., burnout: work exhaustion correlated emotional exhaustion in JBS, r = .71). CONCLUSIONS: The Japanese version of the PFI demonstrated acceptable high internal consistency, structural validity, and convergent validity of the scale with a three-factor structure the same as in the original PFI. The Japanese version of PFI proved to be reliable and valid for use in healthcare professionals.

Association Between Attitudes Toward Trauma Informed Care and Psychological First-Aid Training Experience Among Health Care Professionals in Japan.

OBJECTIVE: Trauma informed care (TIC) is an important approach for people who have experienced trauma. Although psychological first aid (PFA) may be effective training in TIC, no study reported an association between PFA training and TIC. This study aimed to investigate the association between PFA training and attitudes toward TIC among health care professionals in Japan. METHODS: Japanese health care professionals were recruited for a survey conducted from May 21 to June 18, 2021. TIC was assessed by the Attitudes Related to Trauma Informed Care Scale 10-item short form (ARTIC-10). A question about PFA training participation was originally developed through discussion among researchers. Univariate and multiple linear regression analyses were used to examine the association between the PFA experience and ARTIC-10. RESULTS: In total, 484 (3.6%) health care professionals completed all questions. Among them, 77 (15.9%) had experienced PFA training. Univariate and multiple linear regression analyses showed that PFA experience (B = 0.19, 95% CI: 0.02-0.36, P = 0.03; B = 0.17, 95% CI: 0.01-0.34, P = 0.04) was significantly associated with ARTIC-10. CONCLUSIONS: This study was the first to show an association between PFA training and attitudes toward TIC among health care professionals, which was a significant result for future research on PFA training, TIC, and trauma care.

Research note reliability and validity of Japanese version of the trauma-informed care provider survey (TIC provider survey).

OBJECTIVE: Robust instruments to evaluate the ability of trauma-informed care among healthcare workers need to be developed, as this would help the implementation of trauma-informed care to prevent re-traumatization of patients. This study aims to assess the reliability and validity of the Japanese version of the Trauma-Informed Care (TIC) Provider Survey. A total of 794 healthcare workers were surveyed using a self-administered questionnaire, including the TIC Provider Survey, and six measures that were considered to be correlated with it. We calculated the Cronbach's alpha coefficient to investigate the internal consistency of each category of the TIC Provider Survey (knowledge, opinions, self-rated competence, practices, and barriers). Spearman's rank correlation coefficients were used to investigate the correlation between each category of the TIC Provider Survey, and other measures of construct validity. RESULTS: Cronbach's alpha coefficients of each category of the TIC Provider Survey were 0.40 (Knowledge), 0.63 (Opinions), 0.92 (Self-rated competence), 0.93 (Practices), and 0.87 (Barriers). The Spearman's rank correlation coefficients were small. We confirmed the reliability of the acceptable levels and examined the validity of modest or unacceptable levels of the Japanese version of the TIC provider survey among Japanese workers in a healthcare setting.

A proposed definition of participatory organizational interventions.

Participatory organizational interventions offer an effective way to promote occupational safety and health. Despite an increasing number of studies, a common definition of participatory organizational interventions has yet to be established. Therefore, we aimed to form a definition using the following process. First, we developed a tentative draft definition of organizational interventions and participatory elements, based on the relevant literature. The tentative definition was revised in several rounds of an extensive discussion by the authors. This resulted in the draft definition. We asked 15 selected international experts in occupational safety and health to review and comment on the draft definition. We carefully reviewed their comments, and formulated our final proposed definition. To summarize the key points of the final version of the definition, organizational interventions are planned actions that primarily directly target working conditions with the aim of promoting and maintaining of the highest degree of physical, mental, and social well-being of workers in all occupations. In addition, as participatory elements of organizational interventions in the final definition, ideally, all workers participate in every step of the intervention, while participating in part of the steps of the intervention in some cases. Furthermore, in principle, all workers participate in each step of intervention, while it is also acceptable that only elected representatives among workers participate in the intervention.

Usage of the Brief Job Stress Questionnaire: A Systematic Review of a Comprehensive Job Stress Questionnaire in Japan from 2003 to 2021.

The Brief Job Stress Questionnaire (BJSQ) is used widely in occupational health studies and practice. Summarizing scientific production based on measurement is crucial. This study aimed to systematically review observational studies that used the BJSQ and the New BJSQ to show their usability. A systematic search was conducted for studies investigating relationships between the BJSQ or the New BJSQ subscales and other validated measurements on 13 September 2021, in various literature databases. The BJSQ subscales, scoring methods, and other validated measurements in the studies were qualitatively summarized. In total, 145 published reports between 2003 and 2021 were included. Among the BJSQ subscales, job stressors (n = 95) such as quantitative job overload (n = 65) and job control (n = 64) were most often used. The subscales were utilized to investigate the relationships with several other measurements. Five reports used subscales from the New BJSQ. In the last two decades, the BJSQ and the New BJSQ help measure psychosocial factors (PF) at work and contribute to the publication of scientific papers in the occupational health field. This study would encourage the utilization of the questionnaires for future research and practice.

Effects of workplace measures against COVID-19 and employees' worry about them on the onset of major depressive episodes: A 13-month prospective study of full-time employees.

BACKGROUND: Workplace measures against COVID-19 may prevent the onset of major depressive episode (MDE) in the working population. This 13-month prospective study aimed to investigate the association of the number of workplace measures against COVID-19 and employees' worry about the measures on the onset of MDE during COVID-19 outbreaks in Japan. METHODS: Data were collected from employees by using online questionnaires at baseline (May 2020) and the 7th survey (June 2021). The onset of MDE during the follow-up was retrospectively measured at the 7th survey, with a self-report scale based on the Mini-International Neuropsychiatric Interview according to the DSM-IV/DSM-5 criteria. Participants were asked to report the number of workplace measures against COVID-19 in their companies/organizations and their worry about these measures (scored 0-3). Multiple logistic regression was conducted of MDE on the number of workplace measures and worry about these, adjusting for demographic and work-related covariates and psychological distress at baseline. RESULTS: Among 968 respondents employed in May 2020, 827 completed the 7th survey in June 2021 (80%). We excluded 75 respondents who reported they had an MDE in May 2020 or earlier. Worry about workplace measures was significantly associated with the onset of MDE after adjusting for the covariates (OR for 1 score increase, 1.53; 95% CI, 1.02-2.32; p = 0.042). No significant association was found between the number of workplace measures and the onset of MDE. CONCLUSIONS: Worrying about workplace measures taken by company/organization may be a risk factor for the onset of an MDE among employees during the COVID-19 pandemic.

Reliability and Validity of the Japanese Version of the Attitudes Related to Trauma-Informed Care (ARTIC-10) Scale.

BACKGROUND: Trauma-informed care is recommended to avoid the inadvertent retraumatization of patients by health care providers. Psychometric evaluation of trauma-informed care instruments is needed. The Japanese version of the Attitudes Related to Trauma-Informed Care (ARTIC-10) Scale has not yet been psychometrically validated. OBJECTIVE: The study's objective was to examine the reliability and validity of the ARTIC-10. METHODS: This psychometric study of the ARTIC-10 compared with five other scales associated with attitudes related to trauma-informed care used a cross-sectional survey design conducted in November 2020 with a convenience sample of Japanese physicians and nurses recruited from an internet research agency. Participants completed self-administered questionnaires including the (a) ARTIC-10; (b) the Japanese version of the Moral Sensitivity Questionnaire 2018; (c) Patient Health Questionnaire-9; (d) Generalized Anxiety Disorder-7; (e) Stress Underestimation Beliefs; and (f) Negative Acts Questionnaire-Revised. Cronbach's α measured reliability internal consistency, and construct validity was measured by Spearman's rank. RESULTS: A total of 794 physicians and nurses completed the surveys. Cronbach's α value of ARTIC-10 was 0.56. Higher scores of ARTIC-10 were positively and significantly correlated with Moral Sensitivity Questionnaire 2018 and negatively and significantly correlated with other scales (r =-.12 to .30). CONCLUSION: This study found only modest internal consistency and construct validity of the Japanese version of ARTIC-10 in physicians and nurses. Further study is needed to identify factors that affect the reliability and validity of this Japanese scale to improve its psychometric properties.

The Survey Measure of Psychological Safety and Its Association with Mental Health and Job Performance: A Validation Study and Cross-Sectional Analysis.

OBJECTIVES: This study validated the Japanese version of O'Donovan et al.'s (2020) composite measure of the psychological safety scale and examined the associations of psychological safety with mental health and job-related outcomes. METHODS: Online surveys were administered twice to Japanese employees in teams of more than three members. Internal consistency and test-retest reliability were tested using Cronbach's α and intra-class correlation coefficient (ICC), respectively. Structural validity was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Convergent validity was tested using Pearson's correlation coefficients. Multiple linear regression analyses were conducted to examine the relationship between psychological safety and psychological distress, work engagement, job performance, and job satisfaction. RESULTS: Two hundred healthcare workers and 200 non-healthcare workers were analyzed. Internal consistency, test-retest reliability, and convergent validity were acceptable. CFA demonstrated poor fit, and EFA yielded a two-factor structure, with team leader as one factor and peers and team forming the second factor. The total score showed significant and expected associations with all outcomes in the adjusted model for all workers. CONCLUSIONS: The Japanese version of the measure of the psychological safety scale presented good reliability and validity. Psychological safety is important for employees' mental health and performance.

Effects of workplace measures against COVID-19 on psychological distress of full-time employees: A 12-month prospective study in the COVID-19 pandemic.

OBJECTIVE: This study aimed to investigate the prospective effects of corporate and organizational workplace measures against COVID-19 on reducing employees` psychological distress during a 12-month follow-up in the COVID-19 pandemic. METHODS: Data were retrieved from an online longitudinal panel survey of full-time employees in Japan, with the 1st survey in March 2020, and the 2nd to 6th surveys in May, August, November 2020, February and March 2021, respectively. Seven area-specific workplace measures were assessed using a self-report 23-item scale at the 2nd follow-up. Psychological distress was measured using an 18-item scale of the Brief Job Stress Questionnaire at each survey. Linear regressions and mixed model analysis were conducted of psychological distress at follow-ups on scores of the area-specific workplace measures, adjusting for psychological distress and other covariates at the 1st survey. RESULTS: A total of 941 employees responded at baseline; most of them (86.9-90.9%) participated in the follow-up surveys. Linear regression analysis indicated that workplace measures of facilitating employees' preventive measures (ie, hygiene behaviors) statistically significantly and negatively correlated with psychological distress at the 5th survey [b=-0.518, standard error (SE) 0.259, P=0.046]. A statistically significant and negative interaction between the scores and time of follow-up was observed in the mixed model analysis (b=-0.096, SE 0.047, P=0.041). No such correlation or interaction was found for any of other subcategorical workplace measures. CONCLUSIONS: The study provides prospective evidence for a protective effect of workplace measures to facilitate employee's hygiene behaviors on reducing psychological distress of full-time employees in the COVID-19 pandemic. The association seems stronger at a later follow-up.

Effectiveness of an Online Peer Gatekeeper Training Program for Postsecondary Students on Suicide Prevention in Japan: Protocol for a Randomized Controlled Trial.

BACKGROUND: Postsecondary student suicide is one of Japan's most severe public health problems. Gatekeeper training (GKT) programs are a generally recommended suicide prevention intervention in Japan. For suicide countermeasures, an online program tailored to students may enhance self-efficacy as a gatekeeper. OBJECTIVE: This study aims to describe a research protocol to investigate the effect of a newly developed internet-delivered online peer GKT program to improve postsecondary student self-efficacy as gatekeepers for suicide countermeasures in Japan. METHODS: This study is a 2-arm, parallel, randomized controlled trial with a 1:1 (intervention: waiting list) allocation. Participants (n=320) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or waiting list control group. An approximately 85-minute, 6-section, internet-based gatekeeper program for postsecondary students has been developed that includes videos to help participants acquire skills as gatekeepers. The intervention group will complete the program within 10 days. The primary outcome, self-efficacy as a gatekeeper, is measured using the Gatekeeper Self-Efficacy Scale at baseline, immediately after taking the program, and 2 months after the survey after completing the program follow-up. To compare the primary outcomes, a t test, where the significance level is 5% (2-sided), will be used to test the intervention effect on an intention-to-treat basis. RESULTS: The study was at the stage of data collection at the time of submission. We recruited participants for this study during August and September 2021, and data collection will continue until December 2021. The data analysis related to the primary outcome will start in December 2021, and we hope to publish the results in 2022 or 2023. CONCLUSIONS: This is the first study to investigate the effectiveness of an online GKT program for postsecondary students to improve self-efficacy as a gatekeeper using a randomized controlled trial design. The study will explore the potential of an online peer gatekeeper program for postsecondary students that can be disseminated online to a large number of students with minimal cost. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry UMIN000045325; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051685. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34832.

The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study.

BACKGROUND: Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS: Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. RESULTS: As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS: This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.

Longitudinal change in depressive symptoms among healthcare professionals with and without COVID-19 vaccine hesitancy from October 2020 to June 2021 in Japan.

This study aimed to compare the longitudinal change in depressive symptoms among healthcare professionals in Japan who are willing to receive novel coronavirus disease (COVID-19) vaccination and those who are unwilling to receive COVID-19 vaccination. The baseline survey was conducted in October 2020 (Survey time 1: T1); respondents in T1 were invited to participate in May 2021 (Survey time 2: T2). Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Group comparisons of the estimated mean of PHQ-9 score at T1 and T2 were estimated by the analysis of covariance. In T1, 597 participants (response rate: 4.4%) completed all questions. In T2, 211 participants (follow up rate: 35.3%) completed all questions. The group and time interaction effect was significant (F(1, 207)=3.9, p=0.049); depressive symptoms were worse among healthcare professionals who were unwilling to receive vaccination than among those who were willing to receive vaccination. This study showed that depressive symptoms were worse among healthcare professionals who were unwilling to receive COVID-19 vaccination than those who are willing to receive COVID-19 vaccination. This suggests that it is important to take care of healthcare professionals who are unwilling to receive vaccination to prevent mental health deterioration.

Workplace Bullying and Patient Aggression Related to COVID-19 and its Association with Psychological Distress among Health Care Professionals during the COVID-19 Pandemic in Japan.

The novel coronavirus disease (COVID-19) pandemic has spread throughout the world. Poor mental health has been reported among healthcare professionals responding to COVID-19. However, no study has examined the impact of COVID-19-related workplace bullying or patient aggression on the mental health of healthcare professionals during the COVID-19 outbreak. This study examined the prevalence of COVID-19-related workplace bullying and patient aggression and its association with psychological distress among healthcare professionals during the COVID-19 outbreak in Japan. This was a cross-sectional study conducted from May 22 to 26, 2020, inviting participants (n = 1,421) from an online survey of full-time employees. We limited the sample to healthcare professionals for further analyses. Using an online self-report questionnaire, workplace bullying and patient aggression related to COVID-19 was measured using nine items with dichotomous response options. Psychological distress was measured using the Japanese version of Brief Job Stress Questionnaire. Among 1,032 participants (72.6%) who completed the survey, 111 healthcare professionals were identified. Among them, 19 participants (17.1%) had experienced any COVID-19-related workplace bullying or patient aggression: 11 participants (9.9%) had experienced any workplace bullying and 12 participants (10.8%) had experienced any patient aggression. Multiple linear regression analysis showed that any bullying or patient aggression related to COVID-19 significantly correlated with psychological distress. It was suggested that a non-negligible proportion of participants experienced workplace bullying or patient aggression related to COVID-19. Preventing and reducing workplace bullying and patient aggression may be effective in improving mental health of healthcare professionals during the COVID-19 outbreak.

Longitudinal Change of Psychological Distress among Healthcare Professionals with and without Psychological First Aid Training Experience during the COVID-19 Pandemic.

This study aimed to compare longitudinal change of the psychological distress of a group with psychological first aid (PFA) experience and a group without PFA experience among physicians and other healthcare professionals from before the novel coronavirus disease (COVID-19) pandemic to during the pandemic. The baseline survey was conducted in January 2020 (T1). The respondents in T1 were invited to participate in March (T2) and November 2020 (T3). Psychological distress was assessed by the Kessler 6 Scale. Participants were divided into two categories: a group with and a group without PFA experience. Participants were further divided between physicians and healthcare professionals other than physicians, because physicians are more likely to experience morally injurious events. A mixed-model repeated-measures ANOVA was conducted as an indicator of the group differences. In T1, 398 healthcare professionals participated. The longitudinal analysis of healthcare professionals other than physicians showed that psychological distress was significantly greater in the group without PFA experience than in the group with PFA experience (T1 vs. T3). This study showed psychological distress among healthcare professionals other than physicians was significantly greater in the group without PFA experience than in the group with PFA experience during the COVID-19 pandemic, but the results were not consistent among physicians.

Changes in COVID-19 measures in the workplace: 8-month follow-up in a cohort study of full-time employees in Japan.

OBJECTIVES: It is unclear how many workplace COVID-19 preventive measures were maintained during repeated outbreaks. The aim of this study was to investigate a longitudinal change of implementation of workplace preventive measures responding to COVID-19 in Japan. METHODS: An online longitudinal study was conducted using a cohort of full-time employees in Japan, starting in March 2020 (T1), with follow-up surveys in May (T2), August (T3), and November (T4) 2020. A repeated measures analysis of variance was performed to compare the difference among the four surveys in the mean number of 23 predetermined items of the measures implemented. RESULTS: The final sample comprised 800 employees. The mean number of the implemented measures increased from T1 to T2, but did not change from T2 to T3, then decreased from T3 to T4. The number of workplace preventive measures significantly increased from T1 to T2 for 21 items (P < .001), and significantly decreased from T3 to T4 for 14 items (P < .001 to P = .005). CONCLUSIONS: While the preventive measures responding to COVID-19 in the workplace were well-implemented during the earlier phase of the outbreak, they seem to have been relaxed after a huge outbreak (T3 to T4: August to November 2020). Workplaces should be encouraged to continue the preventive measures over repeated outbreaks.

Sustained poor mental health among healthcare workers in COVID-19 pandemic: A longitudinal analysis of the four-wave panel survey over 8 months in Japan.

OBJECTIVES: This study aimed to compare the longitudinal change of the psychological distress of healthcare workers (HCWs) with non-HCWs during the repeated outbreaks of the COVID-19 in Japan. METHODS: The data were retrieved from the Employee Cohort Study in the Covid-19 pandemic in Japan study. An online survey was conducted on March 2020 (T1), on May 2020 (T2), on August 2020 (T3), and on November 2020 (T4). Psychological distress was measured by the Brief Job Stress Questionnaire. A mixed-model repeated-measures ANOVA was conducted as an indicator of the group differences. RESULTS: A total sample of analysis was n = 996 (HCWs, n = 111; non-HCWs, n = 885). HCWs consisted of physicians/nurses/midwives and other HCWs (eg, pharmacists, clinical laboratory technicians) in the clinical settings (n = 19; 17% and n = 61; 55%, respectively), and HCWs not working in the clinical settings (n = 31; 28%). Being HCWs were associated with a significant increase in psychological distress from T1 to T2, T3 and T4 (P = .001, P = .002, P < .001; respectively). CONCLUSIONS: The mental health of HCWs deteriorated through the COVID-19 outbreaks compared with non-HCWs. HCWs are continuously the important targets to provide mental health support.