Thirty-day suicidal thoughts and behaviors among hospital workers during the first wave of the Spain COVID-19 outbreak.

BACKGROUND: Healthcare workers are a key occupational group at risk for suicidal thoughts and behaviors (STB). We investigated the prevalence and correlates of STB among hospital workers during the first wave of the Spain COVID-19 outbreak (March-July 2020). METHODS: Data come from the baseline assessment of a cohort of Spanish hospital workers (n = 5450), recruited from 10 hospitals just after the height of the coronavirus disease 2019 (COVID-19) outbreak (May 5-July 23, 2020). Web-based self-report surveys assessed 30-day STB, individual characteristics, and potentially modifiable contextual factors related to hospital workers' work and financial situation. RESULTS: Thirty-day STB prevalence was estimated at 8.4% (4.9% passive ideation only, 3.5% active ideation with or without a plan or attempt). A total of n = 6 professionals attempted suicide in the past 30 days. In adjusted models, 30-day STB remained significantly associated with pre-pandemic lifetime mood (odds ratio [OR] = 2.92) and anxiety disorder (OR = 1.90). Significant modifiable factors included a perceived lack of coordination, communication, personnel, or supervision at work (population-attributable risk proportion [PARP] = 50.5%), and financial stress (PARP = 44.1%). CONCLUSIONS AND RELEVANCE: Thirty-day STB among hospital workers during the first wave of the Spain COVID-19 outbreak was high. Hospital preparedness for virus outbreaks should be increased, and strong governmental policy response is needed to increase financial security among hospital workers.

Health service and psychotropic medication use for mental health conditions among healthcare workers active during the Spain Covid-19 Pandemic - A prospective cohort study using web-based surveys.

Little is known about healthcare workers' (HCW) use of healthcare services for mental disorders. This study presents data from a 16-month prospective cohort study of Spanish HCW (n = 4,809), recruited shortly after the COVID-19 pandemic onset, and assessed at four timepoints using web-based surveys. Use of health services among HCW with mental health conditions (i.e., those having a positive screen for mental disorders and/or suicidal thoughts and behaviours [STB]) was initially low (i.e., 18.2 %) but increased to 29.6 % at 16-month follow-up. Service use was positively associated with pre-pandemic mental health treatment (OR=1.99), a positive screen for major depressive disorder (OR=1.50), panic attacks (OR=1.74), suicidal thoughts and behaviours (OR=1.22), and experiencing severe role impairment (OR=1.33), and negatively associated with being female (OR = 0.69) and a higher daily number of work hours (OR=0.95). Around 30 % of HCW with mental health conditions used anxiolytics (benzodiazepines), especially medical doctors. Four out of ten HCW (39.0 %) with mental health conditions indicated a need for (additional) help, with most important barriers for service use being too ashamed, long waiting lists, and professional treatment not being available. Our findings delineate a clear mental health treatment gap among Spanish HCW.

Traumatic stress symptoms among Spanish healthcare workers during the COVID-19 pandemic: a prospective study.

AIM: To investigate the occurrence of traumatic stress symptoms (TSS) among healthcare workers active during the COVID-19 pandemic and to obtain insight as to which pandemic-related stressful experiences are associated with onset and persistence of traumatic stress. METHODS: This is a multicenter prospective cohort study. Spanish healthcare workers (N = 4,809) participated at an initial assessment (i.e., just after the first wave of the Spain COVID-19 pandemic) and at a 4-month follow-up assessment using web-based surveys. Logistic regression investigated associations of 19 pandemic-related stressful experiences across four domains (infection-related, work-related, health-related and financial) with TSS prevalence, incidence and persistence, including simulations of population attributable risk proportions (PARP). RESULTS: Thirty-day TSS prevalence at T1 was 22.1%. Four-month incidence and persistence were 11.6% and 54.2%, respectively. Auxiliary nurses had highest rates of TSS prevalence (35.1%) and incidence (16.1%). All 19 pandemic-related stressful experiences under study were associated with TSS prevalence or incidence, especially experiences from the domains of health-related (PARP range 88.4-95.6%) and work-related stressful experiences (PARP range 76.8-86.5%). Nine stressful experiences were also associated with TSS persistence, of which having patient(s) in care who died from COVID-19 had the strongest association. This association remained significant after adjusting for co-occurring depression and anxiety. CONCLUSIONS: TSSs among Spanish healthcare workers active during the COVID-19 pandemic are common and associated with various pandemic-related stressful experiences. Future research should investigate if these stressful experiences represent truly traumatic experiences and carry risk for the development of post-traumatic stress disorder.

Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among hospital workers in a severely affected institution in Madrid, Spain: A surveillance cross-sectional study.

OBJECTIVE: To analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic in workers of a hospital located in one of the most affected areas in Spain. DESIGN, SETTINGS, AND PATIENTS: Cross-sectional study performed between March and May 2020 over all workers of a secondary hospital in Madrid, Spain. METHODS: We employed polymerase chain reaction (PCR, for symptomatic individuals) and serology (for both PCR-negative symptomatic workers and asymptomatic workers) as diagnostic tests for severe acute respiratory coronavirus virus 2 (SARS-CoV-2). We analyzed the prevalence of the virus in healthcare workers (HCWs) and nonhealthcare workers (nHCWs). We also collected information about the use of personal protective equipment (PPEs) and possible contacts prior to infection. RESULTS: In total, 2,963 workers were included: 1,092 were symptomatic, and of these, 539 were positive by PCR (49.4% of symptomatic workers). From the remaining symptomatic workers, 197 (35.6%) were positive by serology. Regarding asymptomatic workers, 345 were positive by serology (31.9% of infected workers). In total, 1,081 (36.5%) presented a positive diagnostic test for SARS-CoV-2. Infection rates were different between HCWs (37.4%) and nHCWs (29.8%) (P = .006). In the multivariate logistic regression analysis, the use of PPE (protective: OR, 0.56; 95% CI, 0.44-0.72; P < .001) and previous contact with COVID-19 patients (risk factor: OR, 1.69; 95% CI, 1.28-2.24; P < .001) were independent factors that were associated with SAS-CoV-2 infection. CONCLUSIONS: Overall, >36% of our workers became infected with SARS-CoV-2, and the rate of asymptomatic infections accounted for almost 32% of all SARS-CoV-2 infections. We detected differences in the rates of infection between HCWs and nHCWs. The use of PPE and previous contact with COVID-19 patients were associated with SARS-CoV-2 infection.

[SARS-CoV-2 seroprevalence among workers in a hospital in Madrid.] / Seroprevalencia frente a SARS-CoV-2 en los trabajadores de un hospital de Madrid.

OBJECTIVE: The impact of the first wave of the pandemic due to SARS-CoV-2 has been enormous in Spanish hospitals, being Madrid one of the most affected communities. The aim of this study was to analyze the impact of the pandemic on the workers of a hospital located in one of the most affected areas of Madrid (Alcalá de Henares) using a chemiluminescence immunoassay (CLIA). METHODS: We conducted a seroprevalence survey between June 25th and July 31st, 2020, over hospital workers from our institution. This study population was previously analyzed using a diagnostic approach which consisted of PCR and a serologic rapid test. For the present survey, prevalence of IgG antibodies against SARS-CoV-2 was studied using chemiluminescence. We analyzed the prevalence in healthcare workers (HCW) and non-healthcare workers (nHCW). Information about professional category, use of personal protective equipment (PPEs) and previous COVID-19 contacts was collected to determine the risk factors associated with SARS-CoV-2 seropositivity. Comparisons were made using the Mann-Whitney U test (continuous variables) and the two-tailed Fisher's exact test (categorical variables). Risk factors for seropositivity were analyzed using multivariate logistic regression. RESULTS: A total of 2,219 workers were included and 847 of them (38.2%) presented IgG antibodies against SARS-CoV-2, being seroprevalence significantly higher for HCW (39.3%) than for nHCW (30.7%, p=0.006). We found no differences regarding positivity rates compared with the first diagnostic approach for symptomatic and asymptomatic workers, or infected workers per professional category. In the multivariate logistic regression analysis, the use of PPE (protective, OR=0.65; 95%CI: 0.48-0.89; p<0.001) and previous contact with COVID-19 patients (risk factor, OR=1.93; 95%CI: 1.37-2.72; p<0.001) were independent factors that were associated with SARS-CoV-2 seropositivity. CONCLUSIONS: More than 38% of our workers presented IgG antibodies against SARS-CoV-2. We found no differences in the positivity rates between diagnostic approaches. The use of PPE (protective) and previous contact with COVID-19 patients (risk factor) were associated with infection.

OBJETIVO: El impacto de la primera oleada de la pandemia debida a SARS-CoV-2 ha sido enorme en los hospitales españoles, siendo Madrid una de las comunidades más afectadas. El objeto de este estudio fue analizar el impacto de la pandemia en los trabajadores de un hospital situado en una de las zonas más afectadas de Madrid (Alcalá de Henares) mediante un inmunoensayo de quimioluminiscencia. METODOS: Realizamos un estudio de seroprevalencia entre el 25 de junio y el 31 de julio de 2020 entre los trabajadores de nuestro centro, que se estudió previamente utilizando otra aproximación diagnóstica (PCR y test rápido serológico). Para este estudio, analizamos la prevalencia de anticuerpos tipo IgG contra SARS-CoV-2 mediante quimioluminiscencia. Analizamos la prevalencia en personal sanitario (PS) y no sanitario (PNS). Se recopiló información sobre la categoría profesional, uso de equipos de protección individual (EPI) y contactos COVID-19 para determinar los factores de riesgo asociados con la seropositividad. Las comparaciones se hicieron con el test de la U de Mann-Whitney (variables continuas) y la prueba exacta de Fisher de dos colas (variables categóricas). Los factores de riesgo para la seropositividad se analizaron mediante regresión logística multivariable. RESULTADOS: Incluimos a 2.219 trabajadores, de los cuales 847 (38,2%) presentaron anticuerpos IgG, siendo la seroprevalencia significativamente mayor en PS (39,3%) que en PNS (30,7%, p=0,006). No encontramos diferencias respecto a la primera aproximación diagnóstica en los porcentajes de positividad para personal sintomático, asintomático, o estratificando por categoría profesional. Mediante regresión logística multivariable, el uso de EPI (protector, OR=0,65; IC95%:0,48-0,89; p<0,001) y el contacto previo con pacientes COVID-19 (factor de riesgo, OR=1,93; IC95%:1,37-2,72; p<0,001) fueron factores asociados de forma independiente con la seropositividad. CONCLUSIONES: Más del 38% de nuestros trabajadores presentaron anticuerpos IgG contra SARS-CoV-2. No encontramos diferencias en los porcentajes de positividad entre ésta y la anterior aproximación diagnóstica. El uso de EPI (protector) y el contacto con pacientes con COVID-19 (factor de riesgo) se asociaron de forma independiente con la infección.

Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey.

INTRODUCTION: Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain. METHODS: All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders. RESULTS: 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95). CONCLUSIONS: One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.

Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey.

INTRODUCTION: Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain. METHODS: All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders. RESULTS: 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95). CONCLUSIONS: One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.