[Psychotherapeutic burnout interventions-an umbrella review]. / Psychotherapeutische Interventionen bei Burnout ­ Ein Umbrella-Review und Impulse für die Therapie.

BACKGROUND: Although burnout is not an F­Diagnosis in the ICD-11, many people are suffering from it. This has many economic and health-related consequences, because burnout is closely tied to an inability to work and significant secondary illnesses. This article provides an umbrella review of therapy approaches for burnout that have already been used and evaluated and shows in which areas there are promising, but still little researched, therapeutic support options for those affected. METHODS: A systematic literature search of studies was carried out in PubMed and Google Scholar between 2010 and 2024. The search terms were "burnout," "therapy," and "intervention" combined with "systematic review" and "meta-analysis." Overall, 10 systematic reviews or meta-analyses met the inclusion criteria. RESULTS: In five systematic reviews or meta-analyses, the therapy approaches focused on a specific professional group (nurses, doctors, and teachers); the others related to students or various groups of people. In seven studies, the effects of mindfulness-based stress reduction on burnout were shown. The effects of cognitive behavioral therapy (CBT) were shown in four studies. Acceptance and commitment-therapy (ACT) as well as rational emotive therapy (RET) also proved to be effective. CONCLUSION: It still needs to be researched whether established thinking and behavioral patterns can be changed through the therapies discussed. The professional context should be given more attention. Some resource-oriented approaches like optimism, a sense of control, self-efficacy, and self-acceptance seem promising in the treatment of burnout.

[Workplace-related stress experience and mental health of healthcare workers during the COVID-19 pandemic: risk and protective factors from the VOICE study]. / Arbeitsplatzbezogenes Belastungserleben und psychische Gesundheit der Beschäftigten im Gesundheitswesen während der COVID-19-Pandemie: Risiko- und Schutzfaktoren aus der VOICE-Studie.

BACKGROUND: Healthcare workers have an increased risk of depression and anxiety, and medical staff have faced a wide variety of challenges, especially during the COVID-19-pandemic. The aim of the VOICE study was to investigate risk and protective factors for workplace-related stress experience and mental health. METHOD: A multicentre, web-based and prospective survey (VOICE study) was initiated in the spring of 2020 by a network of five psychosomatic university clinics (Erlangen, Ulm, Bonn, Cologne and Dresden). More than 25,000 respondents took part in the study at five measurement points. RESULTS: Of 3678 employees examined in a hospital setting during the first wave of the pandemic, 17.4% and 17.8% of physicians, 21.6% and 19.0% of nurses and 23.0% and 20.1% of medical-technical assistants (MTA) were affected by symptoms of depression and anxiety, respectively, to a clinically relevant extent. The most important risk factors for depressive and anxiety symptoms were insufficient relaxation during leisure time, increased alcohol consumption, lower trust in colleagues in difficult work situations and increased fear of becoming ill with COVID-19. Predictors for increased post-traumatic symptoms were increased generalized anxiety and depression as well as increased fear of infecting family members. Sense of coherence, social support, optimism and reward level acted as protective factors. DISCUSSION: The psychological effects of workplace-related stress during the pandemic were found to be significant. Therefore, regular mental health screening and prevention programmes for healthcare workers are indicated.

[Mental distress of intensive care staff in Germany during the COVID-19 pandemic. Results from the VOICE study]. / Psychische Belastung des intensivmedizinischen Personals in Deutschland im Verlauf der COVID-19-Pandemie. Evidenz aus der VOICE-Studie.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic posed major challenges to the healthcare system worldwide and led to particular stress among healthcare workers. The aim of this analysis was to investigate the level of global mental stress of direct healthcare workers in Germany during the COVID-19 pandemic. METHODS: In this prospective cross-sectional study with four measurement points (T1: 4-5/2020, T2:11/2020-1/2021, 5-7/2021, 2-5/2022), psychological distress symptoms were recorded in an online survey with the Patient Health Questionnaire (PHQ-4) among hospital staff working in direct patient care (N = 5408 datasets). The total dataset was exploratively analyzed according to field of activity, gender, and professional group affiliation. RESULTS: Clinically relevant psychological distress (PHQ-4 ≥ 5) was present in 29.3% (n = 419/1429) of intensive care staff. A comparison of the four cross-sectional surveys showed a significant increase in the rate of clinically relevant mental distress in the first pandemic year (23.2% at T1 vs. 30.6% at T2; p < 0.01), which stabilized at a high level in the second pandemic year (33.6% at T3 and 32.0% at T4). Women did not differ from men in this respect (n = 280/919, 30.4% vs. n = 139/508, 27.4%; p = 0.74). Nursing staff were significantly more often psychologically stressed than physicians (n = 339/1105, 30.7% vs. n = 80/324, 24.7%; p = 0.03). Intensive care staff did not show significantly higher stress than staff working in nonintensive care areas (n = 419/1429, 29.3% vs. n = 1149/3979, 28.7%, p = 0.21). CONCLUSION: German healthcare workers reported high levels of mental distress during the pandemic, which increased during the course of the pandemic, but no significant difference was found between intensive care and nonintensive care staff in our sample. This may be due to the fact that the pandemic in Germany was comparatively moderate internationally and neither a collapse of the healthcare system in general nor a collapse of intensive care structures in particular took place.

The mental health of first- and second-generation migrant vs. native healthcare workers during the COVID-19 pandemic: The VOICE survey of 7,187 employees in the German healthcare sector.

The COVID-19 pandemic exacerbated the challenging working conditions of healthcare workers (HCWs) in many regions. A considerable proportion of HCWs in Germany are migrants facing additional migration-related stressors. The aim of this cross-sectional web-based survey was to examine depressive and generalized anxiety symptoms among migrant and native HCWs in Germany during the pandemic. We compared 780 migrant (first- and second-generation) HCWs from different backgrounds with 6,407 native HCWs. Multiple linear regression analyses were used to examine associations between occupational and COVID-19 related variables, controlling for sociodemographics. Migrant HCWs from low-/middle-income countries more frequently had clinically relevant depressive symptoms (PHQ-2 ≥ 3) than did those from high-income countries (29.9% vs. 16.7%, p = .002, ϕ = .156) (all other ϕs/Cramer's Vs ≤ .036). There were no clinically relevant differences in anxiety levels (GAD-2 ≥ 3) between native vs. migrant HCWs, native vs. the individual migrant HCW groups, or between the sexes (all ϕs/Cramer's Vs ≤ .036). After controlling for key sociodemographic characteristics, native HCWs did not differ from the individual migrant HCW groups on depression and anxiety severity (depression: all ßs ≤ |.030|, anxiety: all ßs ≤ |.014|). A high percentage of HCWs reported distress, with migrants from low-/middle-income countries reporting highest burden. The results indicate the need to establish prevention programmes for HCWs, with special consideration to vulnerable populations including certain migrant groups.

Depression and anxiety among nurses during the COVID-19 pandemic: Longitudinal results over 2 years from the multicentre VOICE-EgePan study.

AIMS: To examine symptoms of depression and generalised anxiety among nurses over 2 years during the pandemic and compare them to the general population. BACKGROUND: The COVID-19 pandemic has led to a significant increase in mental stress among the population worldwide. Nursing staff have been identified as being under remarkable strain. DESIGN: A multicentre prospective longitudinal study. METHODS: Symptoms of depression and generalised anxiety in 507 nurses were examined at four different time points (T1: April-July 2020, T2: November 2020-January 2021, T3: May-July 2021, T4: February-May 2022). Results were compared with values of the German general population, presence of gender-specific differences was analysed and frequencies of clinically relevant levels of depression and anxiety were determined. RESULTS: Throughout the study (T1-T4), a significant increase in depressive and anxiety symptoms was observed. At all four measurement time points, nurses showed significantly higher prevalence for depression and anxiety compared to the German general population. No significant gender differences were found. Frequencies for probable depression and generalised anxiety disorder among nurses were: 21.6% and 18.5% (T1), 31.4% and 29.2% (T2), 29.5% and 26.2% (T3), 33.7% and 26.4% (T4). CONCLUSION: During the pandemic, symptoms of depression and generalised anxiety among nurses increased significantly and remained elevated. Their symptom levels were permanently higher than in the general population. These findings strongly suggest that the circumstances of the pandemic severely affected nurses´ mental health. RELEVANCE TO CLINICAL PRACTICE: The COVID-19 pandemic caused a great mental strain on caregivers. This study was able to demonstrate the significant increase in depression and anxiety among nurses during the pandemic. It highlights the urgent need for prevention, screening and support systems in hospitals. IMPLICATIONS FOR THE PROFESSION: Supportive programmes and preventive services should be developed, not least to prevent the growing shortage of nurses in the health care systems. REPORTING METHOD: The study adhered to relevant EQUATOR guidelines. The STROBE checklist for cohort study was used as the reporting method. PATIENT CONTRIBUTION: Five hundred and seven nurses completed the questionnaire and provided data for analysis. TRIAL AND PROTOCOL REGISTRATION: The study was registered with the German Clinical Trials Register (https://drks.de/search/en) under the following ID: DRKS00021268.

Spirituality and anxiety in pastoral care workers and physicians in the first wave of the COVID-19 pandemic.

Background: The COVID-19 pandemic had serious impact on the well-being of health care workers and highlighted the need for resources to help hospital staff to cope with psychologically negative consequences. The purpose of this study was to investigate the potentially protective effect of spirituality, as measured by the construct of transpersonal trust, against anxiety in physicians and in hospital pastoral care workers. In addition, transpersonal trust was compared to the effects of other potential resources, namely sense of coherence, optimism, and resilience. We also explored the relationship between transpersonal trust and anxiety and how it was moderated by sense of coherence and expected a significant effect. Method: The sample included N = 405 participants (n = 151 pastoral care workers and n = 254 physicians) who completed an online survey during the first wave of the COVID-19 pandemic between 20th April and 05th July, 2020, that comprised established questionnaires assessing anxiety, transpersonal trust, sense of coherence, and resilience. Results: There was no statistically significant negative relationship between transpersonal trust and anxiety in either profession or broken down by occupational group. Multiple regression analysis revealed that sense of coherence inversely predicted generalized anxiety, while transpersonal trust, resilience, and optimism did not. As hypothesized, the association between transpersonal trust and anxiety was moderated by sense of coherence. However, we could not confirm our hypothesis of a protective effect of transpersonal trust against anxiety. Conclusion: Our results point to the significant role of sense of coherence as a protective factor against anxiety and highlight the complexity of the relationship among spirituality, transpersonal trust, and anxiety.

Depressive and anxiety symptoms in the course of the COVID-19 pandemic among physicians in hospitals: results of the longitudinal, multicenter VOICE-EgePan survey over two years.

BACKGROUND: This longitudinal, multicenter web-based study explored the trajectories of depressive and anxiety symptoms during the COVID-19 pandemic among physicians over two years. METHODS: At four measurement points between 4/2020 and 5/2022 depressive (Patient Health Questionnaire-2, PHQ-2) and anxiety symptoms (Generalized Anxiety Disorder Scale-2, GAD-2) among physicians in German hospitals were assessed. Time, gender and age effects were analyzed with linear mixed regression models. Comparisons with norm values for the German population during the COVID-19 pandemic were also performed and frequencies of probable depression and anxiety are reported. RESULTS: The physicians (N = 340) showed a significant increase of depressive symptoms from T1 (M = 1.35, SD = 1.33) to T4 (M = 1.64, SD = 1.34) (p < .001) and of anxiety symptoms from T1 (M = 1.35, SD = 1.42) to T2 (M = 1.59, SD = 1.43) (p = .024). The main effect of gender was only significant for anxiety symptoms (p = .001): women demonstrated higher scores than men. A significant age class difference was observed only for depressive symptoms: the youngest age group (18-40 years) revealed higher values than the oldest group (> 50 years, p = .003). As compared to the general population, the physicians reported significantly elevated PHQ-2 (T1: M = 1.35, SD = 1.33; T2: M = 1.53, SD = 1.37; T3: M = 1.55, SD = 1.40; T4: M = 1.64, SD = 1.34) and GAD-2 scores (T1: M = 1.35, SD = 1.42; T2: M = 1.59, SD = 1.43; T3: M = 1.61, SD = 1.57; T4: M = 1.49, SD = 1.46) for all measurement points (all p < .001). The frequencies of probable depression (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) were: 14.1% and 17.0% (T1), 16.5% and 21.9% (T2), 17.8% and 22.6% (T3) and 18.5% and 17.3% (T4), respectively. CONCLUSIONS: Mental distress of physicians in German hospitals has increased in the course of the COVID-19 pandemic with gender and age-related differences. Possible causes should be explored and regular monitoring of mental health and prevention programmes for physicians should be established. TRIAL REGISTRATION: The study was registered on ClinicalTrials (DRKS-ID: DRKS00021268) on 9.4.2020.

The prevalence of effort-reward imbalance and its associations with working conditions, psychosocial resources and burden among health care workers during the COVID-19 pandemic: Results of the egePan-Voice study.

OBJECTIVE: The association between a measure of effort-reward imbalance (ERI) and profession as well as gender in a sample of health care workers (HCW) during the first wave of the COVID-19 pandemic in Germany using the egePan-Voice study. In addition, we examined, which factors are associated with an effort-reward imbalance ratio (ERI ratio) >1. METHODS: In a large sample of HCW (N = 6174) we assessed occupational stress with the short version of the effort-reward imbalance (ERI) questionnaire, working conditions, COVID-19-related problems and psychosocial resources (ENRICHD Social Support Inventory, ESSI; Sense of Coherence Scale, SOC-3 and optimism, SOP2). RESULTS: The prevalence of a ERI ratio >1 among HCW was 50.9%. The prevalence's of an ERI ratio >1 were statistically significant different between gender as well as the occupational profession. The proportion of women (51.8%) with ERI ratio >1 was significantly higher than among men (47.8%). The highest ERI imbalance was found among nurses (62.8%), followed by medical technical assistants (MTA) (58.8%), while psychologists/psychotherapists revealed the lowest value (37.8%), followed by physicians (41.8%). In the total sample, most essential factors reported at this time for increased ERI ratio were: insufficient staff for the current work load, insufficient recovery, feeling insufficiently protected by measures taken by the hospital/the employer, high occupancy rate of the wards, insufficient trust in colleagues and being a nurse as compared with being a physician. CONCLUSION: The findings indicate a high proportion of HCW with effort-reward imbalance and substantial profession-related differences. Preventive interventions should be offered to vulnerable groups among the HCW to decrease the imbalance measured by work stress.

The transformation of masculinity orientations and work-related attitudes in men treated for depression (TRANSMODE): study protocol for a mixed-methods observational study.

BACKGROUND: Masculinity norms play a crucial role in men's help-seeking behaviors, service-use, and coping strategies for depression. While previous studies provided evidence for the association between gender role orientations, work related attitudes, stigmatization of men with depression and depressive symptoms, it remains unclear to what extent gender role orientations change over time and whether psychiatric and psychotherapeutic treatment have an impact on these transformations. Additionally, the role of partners in supporting depressed men and the impact of dyadic coping on these processes have not been explored. The aim of this study is to investigate how masculinity orientations and work-related attitudes change over time in men treated for depression, and to examine the role of their partners and dyadic coping in these transformation processes. METHODS: TRANSMODE is a prospective longitudinal mixed-methods study investigating the transformation of masculinity orientations and work-related attitudes in men treated for depression between the ages of 18 and 65 from different settings in Germany. The study will recruit 350 men from various settings for quantitative analysis. By applying a latent transition analysis, the primary outcome are changes in masculine orientations and work-related attitudes over time, measured at four times (t0, t1, t2, t3) with intervals of 6 months. Qualitative interview with a subsample of depressed men selected using latent profile analysis, will be conducted between t0 and t1 (a1) with a follow-up of 12 months (a2). In addition, qualitative interviews with the partners of depressed men will be conducted between t2 and t3 (p1). Qualitative data will be analysed using qualitative structured content analysis. DISCUSSION: A comprehensive understanding of the transformation processes of masculinity orientations over time including the impact of psychiatric/psychotherapeutic treatment and the role of partners can lead to the development of gender-sensitive depression treatment tailored to the unique needs of men with depression. Thus, the study can promote more effective and successful treatment outcomes and further contribute to reducing the stigma surrounding mental health issues among men and encourage them for mental health service use. TRIAL REGISTRATION: This study is registered in the German Clinical Trail Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00031065 (Date of registration 06 February 2023).

Mental distress of physicians in the outpatient care throughout the COVID-19 pandemic: emotional and supportive human relations matter - Cross-sectional results of the VOICE-study.

BACKGROUND: The aim of this cross-sectional study was to evaluate the course of self-reported mental distress and quality of life (QoL) of physicians, working in the outpatient care (POC). Outcomes were compared with a control group of physicians working in the inpatient care (PIC), throughout the Corona Virus Disease (COVID)-19 pandemic. The impact of risk and protective factors in terms of emotional and supportive human relations on mental distress and perceived QoL of POC were of primary interest. METHODS: Within the largest prospective, multi-center survey on mental health of health care workers (HCW), conducted during the first (T1) and second (T2) wave of the COVID-19 pandemic in Europe, we investigated the course of current burden (CB), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2) and QoL, cross-sectionally, in n = 848 POC (T1: n = 536, T2: n = 312). The primary outcomes were compared with an age- and gender-matchted control group of n = 458 PIC (T1: n = 262, T2: n = 196). COVID-19-, work-related, social risk and protective factors were examined. RESULTS: At T1, POC showed no significant differences with respect to CB, depression, anxiety, and QoL, after Bonferroni correction. Whereas at T2, POC exhibited higher scores of CB (Cohen´s d/ Cd = .934, p < .001), depression (Cd = 1.648, p < 001), anxiety (Cd = 1.745, p < .001), work-family conflict (Cd = 4.170, p < .001) and lower QoL (Cd = .891, p = .002) compared with PIC. Nearly all assessed parameters of burden increased from T1 to T2 within the cohort of POC (e.g. depression: CD = 1.580, p < .001). Risk factors for mental distress of POC throughout the pandemic were: increased work-family conflict (CB: ß = .254, p < .001, 95% CI: .23, .28; PHQ-2: ß = .139, p = .011, 95% CI: .09, .19; GAD-2: ß = .207, p < .001, 95% CI: .16, .26), worrying about the patients´ security (CB: ß = .144, p = .007, 95% CI: .07, .22; PHQ-2: ß = .150, p = .006, 95% CI: .00, .30), fear of triage situations (GAD-2: ß = .132, p = .010, 95% CI: -.04, .31) and burden through restricted social contact in spare time (CB: ß = .146, p = .003, 95% CI: .07, .22; PHQ-2: ß = .187, p < .001, 95% CI: .03, .34; GAD-2: ß = .156, p = .003, 95% CI: -.01, .32). Protective factors for mental distress and QoL were the perceived protection by local authorities (CB: ß = -.302, p < .001, 95% CI: -.39, -.22; PHQ-2: ß = -.190, p < . 001, 95% CI: -.36, -.02; GAD-2: ß = -.211, p < .001, 95% CI: -.40, -.03; QoL: ß = .273, p < .001, 95% CI: .18, .36), trust in colleagues (PHQ-2: ß = -.181, p < .001, 95% CI: -.34, -.02; GAD-2: ß = -.199, p < .001, 95% CI: -.37, -.02; QoL: ß = .124, p = .017, 95% CI: .04, .21) and social support (PHQ-2: ß = -.180, p < .001, 95% CI: -.22, -.14; GAD-2: ß = -.127, p = .014, 95% CI: -.17, -.08; QoL: ß = .211, p < .001, 95% CI: .19, .23). CONCLUSIONS: During the pandemic, the protective role of emotional and supportive human relations on the mental distress and quality of life of POC should be taken into account more thoroughly, both in practice and future research.

Individual Stress Burden and Mental Health in Health Care Workers during the COVID-19 Pandemic: Moderating and Mediating Effects of Resilience.

Introduction: The COVID-19 pandemic generated a significant burden on the German health care system, affecting the mental health of health care workers (HCW) in particular. Resilience may serve as an essential protective factor for individuals' well-being. Objective: Our objective was to identify demographic and work-related correlates of individual resilience and to investigate the association between pandemic-related stress, resilience and mental health using different resilience models. Methods: Our sample comprised 1034 German HCW in different medical professions who completed an online survey from 20 April to 1 July 2020. Resilience was assessed using the Resilience Scale-5 (RS-5). The pandemic-related self-reported stress burden was captured by a single item, while depression and anxiety symptoms were measured with the PHQ-2 and GAD-2, respectively. Additionally, various sociodemographic and work-related factors were assessed. Results: Overall, we found high levels of resilience in the sample compared to a German sample before the pandemic, which were significantly associated only with the older age of participants and having children in both univariate and multivariate analyses. Regarding mechanisms of resilience, moderation analysis revealed that low individual resilience and high pandemic-related stress burden independently contributed to both anxiety and depression symptoms while resilience additionally moderated the relationship between stress burden and anxiety symptoms. The link between self-reported stress burden and mental health symptoms was also partially mediated by individual resilience. Conclusion: Taken together, the findings based on the present sample during the COVID-19 pandemic suggest that resilience plays a central role in the mental health of healthcare workers and that resilience-building interventions should be expanded, especially with a focus on younger employees.

Symptom burden correlates to impairment of diffusion capacity and exercise intolerance in long COVID patients.

After acute infection with the SARS-CoV-2 virus, a considerable number of patients remains symptomatic with pathological changes in various organ systems. This study aimed to relate the physical and mental burden of symptoms of long COVID patients to the findings of a somatic evaluation. In patients with persistent long COVID symptoms three months after acute infection we assessed physical and mental health status using the SF-36 questionnaire. The cohort was dichotomised by the results (upper two quartiles vs. lower to quartiles) and compared with regard to transthoracic echocardiography, body plethysmography (including diffusion capacity), capillary blood gas analysis and 6-min walk test (6-MWT). From February 22 to September 13, 2021, 463 patients were prospectively examined, of which 367 completed the SF-36 questionnaire. A positive correlation between initial disease severity (need for hospitalization, intensive care medicine) and resulting symptom burden at follow-up could be demonstrated. Patients with impaired subjective physical and mental status were significantly more likely to be women. There was a significant correlation between symptom severity and reduced exercise tolerance in the 6-MWT (495.6 ± 83.7 m vs 549.7 ± 71.6 m, p < 0.001) and diffusion capacity for carbon monoxide (85.6 ± 14.3% of target vs 94.5 ± 14.4, p < 0.001). In long COVID patients, initial disease severity is correlated with symptom burden after at least 3 months of follow-up. Highly symptomatic long COVID patients show impaired diffusion capacity and 6-MWT despite average or mildly affected mechanical lung parameters. It must be further differentiated whether this corresponds to a transient functional impairment or whether it is a matter of defined organ damage.

The impact of the COVID-19 pandemic on pediatric developmental services: a cross-sectional study on overall burden and mental health status.

BACKGROUND: The COVID-19 outbreak has taken a heavy toll on the mental well-being of healthcare workers, even those who have not been directly involved in the care of acutely ill patients. The aims of this study were to identify the overall burden and mental health status of healthcare workers in pediatric developmental services under the influence of the COVID-19 pandemic, and to identify the risk and protective factors associated with mental health. METHODS: This cross-sectional web-based study was part of a large multicenter VOICE study conducted among employees ((neuro-)pediatricians, psychologists, speech therapists, occupational therapists, etc.) from various pediatric developmental services between June and July 2020. A total of 1291 questionnaires regarding overall burden, mental health status (depression, generalized anxiety disorder and emotional exhaustion) and risk and protective factors for mental health (working conditions, potential problems during the COVID-19 pandemic and psychological resources) were analyzed. Descriptive statistics and multiple linear regression were used for data analysis. RESULTS: A total of 44.5% (574/1291) participants felt a high or very high overall burden during the COVID-19 pandemic. Of all the participants, 14.6% (171/1173) reported clinically significant levels of depressive symptoms, 17.0% (199/1173) reported generalized anxiety disorder symptoms and 44.6% (532/1192) reported emotional exhaustion. Multiple linear regression analyses identified several common risk and protective factors for mental health status variables. The burden of an increase in the quantity of work, fear of work and fear of becoming infected showed the strongest negative associations, whereas psychological resources and sufficient relaxation in leisure time exhibited the strongest positive associations. CONCLUSION: Employees who were not directly involved in the care of acutely ill patients were also exposed to considerable stress, some of which was not different from that experienced by professionals who were directly affected. These employees should not be lost sight of and must be offered appropriate support.

Sick Leave and Intention to Quit the Job among Nursing Staff in German Hospitals during the COVID-19 Pandemic.

BACKGROUND: Sick leave and turnover of nurses exacerbate an already existing nursing shortage during the COVID-19 pandemic in Germany and other countries. Frequency and associated factors of sick leave and intention to quit among nurses need to be examined to maintain healthcare. METHODS: An online survey among nursing staff (N = 757) in German hospitals was conducted between May and July 2021. Sick leave days, intention to quit, working conditions, depression, anxiety and sleep disorder symptoms, effort-reward imbalance (ERI), COVID-19-related and sociodemographic variables were measured. Regression analyses were performed. RESULTS: The intention to quit was present in 18.9%. One third (32.5%) reported sick leave of ≥10 and 12.3% more than 25 days in 12 months. Significant predictors for ≥10 sick leave days were infection with SARS-CoV-2, a pre-existing illness, exhaustion, trust in colleagues and fear of becoming infected. Higher ERI reward levels, perception of sufficient staff and contact with infected patients were associated with lower odds for ≥10 sick leave days. Lower reward levels, having changed work departments during the pandemic, working part-time and higher depression levels significantly predicted turnover intention. CONCLUSION: Alarmingly, many nurses intend to quit working in healthcare. Perceived reward seems to buffer both sick leave and turnover intention. Enhancing protection from COVID-19 and reducing workload might also prevent sick leave. Depression prevention, improved change management and support of part-time workers could contribute to reducing turnover intention among nurses.

The impact of the COVID-19 pandemic on the mental health of medical staff considering the interplay of pandemic burden and psychosocial resources-A rapid systematic review.

BACKGROUND: In times of the global corona pandemic health care workers (HCWs) fight the disease at the frontline of healthcare services and are confronted with an exacerbated load of pandemic burden. Psychosocial resources are thought to buffer adverse effects of pandemic stressors on mental health. This rapid review summarizes evidence on the specific interplay of pandemic burden and psychosocial resources with regard to the mental health of HCWs during the COVID-19 pandemic. The goal was to derive potential starting points for supportive interventions. METHODS: We conducted a rapid systematic review following the recommendations of the Cochrane Rapid Reviews Methods Group. We searched 7 databases in February 2021 and included peer-reviewed quantitative studies, that reported related data on pandemic stressors, psychosocial resources, and mental health of HCWs. RESULTS: 46 reports were finally included in the review and reported data on all three outcomes at hand. Most studies (n = 41) applied a cross-sectional design. Our results suggest that there are several statistically significant pandemic risk factors for mental health problems in HCWs such as high risk and fear of infection, while resilience, active and emotion-focused coping strategies as well as social support can be considered beneficial when protecting different aspects of mental health in HCWs during the COVID-19 pandemic. Evidence for patterns of interaction between outcomes were found in the context of coping style when facing specific pandemic stressors. CONCLUSIONS: Our results indicate that several psychosocial resources may play an important role in buffering adverse effects of pandemic burden on the mental health of HCWs in the context of the COVID-19 pandemic. Nevertheless, causal interpretations of mentioned associations are inadequate due to the overall low study quality and the dominance of cross-sectional study designs. Prospective longitudinal studies are required to elucidate the missing links.

[Fatherhood and Depression: Dealing with Depression in the Family from the Fathers' Perspective - A Qualitative Study]. / Vaterschaft und Depression: familiärer Umgang mit einer depressiven Erkrankung aus Sicht von Vätern ­ eine qualitative Untersuchung.

OBJECTIVE: Investigation of the experiences of depressed fathers in dealing with their depressive disorder in the family. METHODS: 17 semi-structured narrative interviews were conducted and analyzed following a Grounded Theory Approach. RESULTS: Fathers describe individual coping strategies in dealing with their depressive disorder that aim at independently coping from their family (self-management, [non])disclosure of the disorder). CONCLUSION: Fathers should be supported in (the decision-making process of) disclosing their illness to the family and developing coping strategies that take family needs further into account.

[Vaccination willingness against COVID-19 among healthcare workers in Germany : Results from a University Medicine Network survey between November 2020 and January 2021]. / Bereitschaft zur COVID-19-Impfung unter Beschäftigten im Gesundheitswesen in Deutschland : Befragungsergebnisse aus dem Netzwerk Universitätsmedizin (NUM), November 2020 bis Januar 2021.

BACKGROUND: The COVID-19 pandemic is a continuing burden on society and the health system. The vaccination willingness among healthcare workers is of particular interest, as these groups play a key role in the pandemic response. OBJECTIVES: The present study investigated how the willingness of healthcare workers in Germany to get vaccinated depends on sociodemographic, occupational, and COVID-19-specific characteristics, as well as mental health. METHODS: Between November 2020 and January 2021, 6217 employees in the German healthcare system were questioned about their vaccination willingness, sociodemographic, occupational, COVID-19-specific, and psychosocial characteristics using the online VOICE survey within the framework of the University Medicine Network (NUM). RESULTS: The vaccination willingness of the sample group was 65.3%. A higher vaccination willingness was associated with male gender; age > 40 years; having no children or no migration background; not working in direct patient care; belonging to a COVID-19 risk group or professional group of physicians and psychologists in comparison with nursing staff; feeling sufficiently informed about COVID-19 and protected by the measures of the national or local authorities and the employer; fear of infection; and lack of signs of depression. Physicians showed the highest willingness to get vaccinated. CONCLUSIONS: During the study period, an overall moderate vaccination willingness against COVID-19 in the health sector was described. Information about the disease and vaccination, especially for younger people, females, and non-physicians, adequate protective measures and prevention of depressive symptoms could increase the vaccination willingness.

[Mobbing Among Hospital Physicians]. / Mobbing unter Klinikärztinnen und -ärzten.

OBJECTIVES: Bullying in the workplace is considered an interpersonal stress factor. Occupational stress and mental health among physicians is increasingly becoming the focus of public attention. The extent to which mobbing plays a role in this has hardly been investigated yet. The aim of this study is to provide data on the prevalence of bullying among hospital physicians in Germany and possible correlations with occupational stress and mental health. METHODS: Within the framework of two cross-sectional studies, 692 hospital physicians in the field of psychiatry/psychotherapy (P/PT) and 667 hospital physicians in intensive care (IM) were interviewed at conferences. Standardized questionnaires on mobbing experience, occupational stress and mental health (single item from COPSOQ, BDI-II, ERI, MBI) were used. RESULTS: Bullying was experienced by 4.6% (n=61) of the respondents. IM and women physicians were more often affected (not significant) and correlations with occupational stress (ERI), overcommitment (OC), emotional exhaustion (MBI) and depression (BDI-II) were found. CONCLUSION: Our data on a large cohort of physicians in specialties with different exposure profiles show that a relevant proportion is affected by bullying and that bullying is related to the experience of occupational stress as well as mental health impairments. From this, implications for institutional and individual prevention and support services can be derived.

[egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among - medical technical assistants]. / egePan-VOICE-Studie zur psychosozialen Belastung durch die Covid-19-Pandemie bei medizinischtechnischen Assistent*innen.

egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among - medical technical assistants Objectives: The Covid-19 pandemic is associated with increased demands on healthcare workers. A previously neglected occupational group is medical technical assistants (MTA). The aim is therefore to identify stress factors among MTA in Germany during the pandemic. Methods: A cross-sectional online survey of medical staff was conducted in spring 2020 (N = 8088). Results: N = 1483 records of MTA were analyzed. Retrospectively, the stress increased under the pandemic, and 60.1 % of MTA suffered from work stress (ERI). Staff shortages and extra work were associated with an increase in work stress. Problems of work-life balance and contact with contaminated material/infected persons favored stressful experiences. Conclusions: Some working conditions in the pandemic pose a potential health risk to MTA. It seems necessary to create improvements in the general conditions that enable healthily and effective work.

Moral Distress in Hospitals During the First Wave of the COVID-19 Pandemic: A Web-Based Survey Among 3,293 Healthcare Workers Within the German Network University Medicine.

Objective: The present study aimed to investigate the correlation between moral distress and mental health symptoms, socio-demographic, occupational, and COVID-19-related variables, and to determine differences in healthcare workers' (HCW) moral distress during the first wave of the COVID-19 pandemic. Method: Data from 3,293 HCW from a web-based survey conducted between the 20th of April and the 5th of July 2020 were analyzed. We focused on moral distress (Moral Distress Thermometer, MDT), depressive symptoms (Patient Health Questionnaire-2, PHQ-2), anxiety symptoms (Generalized Anxiety Disorder-2, GAD-2), and increased general distress of nurses, physicians, medical-technical assistants (MTA), psychologists/psychotherapists, and pastoral counselors working in German hospitals. Results: The strongest correlations for moral distress were found with depressive symptoms, anxiety symptoms, occupancy rate at current work section, and contact with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nurses and MTA experienced significantly higher moral distress than physicians, psychologists/psychotherapists, and pastoral counselors. The average level of moral distress reported by nurses from all work areas was similar to levels which before the pandemic were only experienced by nurses in intensive or critical care units. Conclusion: Results indicate that moral distress is a relevant phenomenon among HCW in hospitals during the COVID-19 pandemic, regardless of whether they work at the frontline or not and requires urgent attention.