COVID-19-Related Occupational Burnout and Moral Distress among Nurses: A Rapid Scoping Review.

BACKGROUND: The COVID-19 pandemic is placing unprecedented pressure on a nursing workforce that is already under considerable mental strain due to an overloaded system. Convergent evidence from the current and previous pandemics indicates that nurses experience the highest levels of psychological distress compared with other health professionals. Nurse leaders face particular challenges in mitigating risk and supporting nursing staff to negotiate moral distress and fatigue during large-scale, sustained crises. Synthesizing the burgeoning literature on COVID-19-related burnout and moral distress faced by nurses and identifying effective interventions to reduce poor mental health outcomes will enable nurse leaders to support the resilience of their teams. AIM: This paper aims to (1) synthesize existing literature on COVID-19-related burnout and moral distress among nurses and (2) identify recommendations for nurse leaders to support the psychological needs of nursing staff. METHODS: Comprehensive searches were conducted in Medline, Embase and PsycINFO (via Ovid); CINAHL (via EBSCOHost); and ERIC (via ProQUEST). The rapid review was completed in accordance with the World Health Organization Rapid Review Guide. KEY FINDINGS: Thematic analysis of selected studies suggests that nurses are at an increased risk for stress, burnout and depression during the ongoing COVID-19 pandemic. Younger female nurses with less clinical experience are more vulnerable to adverse mental health outcomes.

Suboptimal baseline mental health associated with 4-month premature all-cause mortality: Findings from 18 years of follow-up of the Canadian National Population Health Survey.

OBJECTIVE: To investigate: 1) whether baseline non-flourishing mental health is associated with a higher probability of all-cause mortality over 18-year follow-up after controlling for many risk factors for premature mortality; and 2) what other factors, independent of mental health status, are associated with all-cause mortality after adjustment for known risk factors. METHODS: Data were derived from waves 1 and 9 (1994/1995; 2010/2011) of the Canadian National Population Health Survey. An analytic sample of 12,424 participants 18 years and above was selected. Baseline information on flourishing and predictors of all-cause mortality was from wave 1 and mortality data was ascertained by the Canadian Vital Statistics-Death Database in wave 9. Mean time to all-cause mortality was estimated using Kaplan-Meir procedure. Cox proportional hazards models were used to assess the association of baseline non-flourishing mental health and potential predictors with time to all-cause mortality. RESULTS: About one in five participants was classified as non-flourishing at baseline. At the end of the study period 2317 deaths were observed. Baseline non-flourishing mental health was associated with a 19% higher probability of all-cause mortality during 18-year follow-up (HR = 1.19; 95% CI 1.08-1.32), corresponding to a 4.7-month shorter survival time. After controlling for baseline chronic health conditions, past-year depression, sociodemographics, health behaviors, social support, pain and functioning, baseline non-flourishing mental health status was associated with a 14% higher probability of death (HR = 1.14; 95% CI 1.02-1.27). CONCLUSIONS: Suboptimal mental health is associated with premature mortality even after accounting for many risk factors for early death. Future research should explore the physiological pathways through which non-flourishing influences mortality.

Is exposure to family member incarceration during childhood linked to diabetes in adulthood? Findings from a representative community sample.

OBJECTIVES: Diabetes is a prevalent and serious public health problem, particularly among older adults. A robust literature has shown that adverse childhood experiences contribute to the development of health problems in later life, including diabetes. Family member incarceration during childhood is an under-investigated yet increasingly common adverse childhood experience in the United States. The purpose of this study was to investigate the relationship between family member incarceration during childhood and diabetes in adulthood, while considering the role of gender as well as the impact of a range of potential confounds. METHODS: A large representative community sample of adults aged 40 and older (n = 8790 men, 14,255 women) was drawn from the Behavioral Risk Factor Surveillance System 2012 optional adverse childhood experiences module to investigate the association between family member incarceration during childhood and diabetes. For each gender, nine logistic regression analyses were conducted using distinct clusters of variables (e.g. socioeconomic status and health behaviors). RESULTS: Among males, the odds of diabetes among those exposed to family member incarceration during childhood ranged from 2.00 to 1.59. In the fully adjusted model, they had elevated odds of 1.64 (95% confidence interval = 1.27, 2.11). Among women, the odds of diabetes was much lower, hovering around 1.00. CONCLUSION: Findings suggest that family member incarceration during childhood is associated with diabetes in men, even after adjusting for a wide range of potential risk factors (e.g. sociodemographics, health behaviors, healthcare access, and childhood risk factors). Future research should explore the mechanisms linking family member incarceration during childhood and long-term negative health outcomes in men.

Bearing Witness: Exploring the End-of-Life Needs of Homeless Persons and Barriers to Appropriate Care.

Traditional models of palliative care are largely inaccessible to homeless persons, and their preferences regarding end-of-life care are poorly understood. The purpose of the present scoping review is to summarize the burgeoning gray and academic literature on end-of-life care for homeless persons. Five medical databases, seven social science databases, and four gray literature databases were searched, resulting in 57 relevant titles. Six themes emerged: (a) Characteristics of homeless persons who require end-of-life care; (b) preferences and concerns of homeless persons approaching the end of life; (c) the role of spirituality for homeless persons at the end of life; (d) barriers to care at the patient, provider, and institutional or structural levels; (e) inclusive models of palliative care; and (f) implications for policy and practice. Practitioners and homeless persons must negotiate many obstacles in the provision and receipt of palliative care. However, there is tremendous potential and opportunity to improve the quality of life at the end of life for this vulnerable population.

The tide does turn: Predictors of remission from suicidal ideation and attempt among Canadians who previously attempted suicide.

The objectives of this study were to identify factors that contribute to (1) remission from suicidal ideation, and (2) remission from suicide attempt, among Canadians with a lifetime history of suicide attempt. Data for this study came from Statistics Canada's nationally representative 2012 Canadian Community Health Survey-Mental Health. A sample of 769 adult respondents who had ever attempted suicide was analyzed with remission from past year suicidal ideation and remission from past year suicide attempt as outcome variables. Of the 769 respondents who had ever attempted suicide, more than two-thirds (69%) were free from suicidal ideation within the past year, and approximately 87% were free from suicide attempts within the past year. Compared to men, odds were 2.66 times greater for women to be free of suicide attempt and 2.65 times greater to be free of suicidal ideation in the past year. Older age, being free of sleep problems and major depressive episode, having no history of chronic childhood physical abuse, and having two or fewer previous suicide attempts were associated with higher odds of remission from both suicide attempt and ideation in the past year.

Flourishing despite a cancer diagnosis: factors associated with complete mental health in a nationally-representative sample of cancer patients aged 50 years and older.

Objectives: This study investigated the association between cancer and complete mental health (CMH). CMH includes optimal functioning as well as the absence of psychopathology. Methods: Secondary data analyses of the nationally representative 2012 Canadian Community Health Survey-Mental Health. This study used bivariate and logistic regression analyses to estimate the odds ratios of CMH among community dwellers aged 50 and older with current cancer (n = 438), previous cancer (n = 1,174) and no cancer history (n = 9,279). CMH had three elements: (1) absence of mental illness, addictions and suicidal thoughts in the past year; (2) almost daily happiness or life satisfaction in the past month; (3) psychosocial well-being. Control variables included socio-demographics, health behaviours, current physical health and lifetime history of mental illness and childhood maltreatment. Results: Adults aged 50 and over with current cancer had a much lower prevalence of CMH (66.1%) than those with previous cancer (77.5%) and those with no cancer history (76.8%). After adjusting for 17 variables, the odds of CMH among those with current cancer remained substantially lower (OR = 0.63; 95% CI = 0.49-0.79) than those without cancer. Among those who had ever had cancer, the odds of CMH were higher for female, white, married, and older respondents, as well as those with higher socioeconomic status, and no history of childhood physical abuse, substance abuse, depression or anxiety disorder. Conclusions: Those with former cancer have comparable odds of CMH to those with no cancer history, suggesting a high level of resilience among cancer survivors.

Childhood Maltreatment Is Associated with Ulcerative Colitis but Not Crohn's Disease: Findings from a Population-based Study.

BACKGROUND: Previous research suggests a link between childhood adversities and inflammatory bowel disease (IBD); however, study limitations prevent generalization of findings. To address this, the current study uses a Canadian population-based sample to investigate the relationship between 3 childhood adversities and 2 types of IBD while controlling for a range of factors. METHODS: Secondary data analysis of a subsample of the nationally representative 2012 Canadian Community Health Survey-Mental Health consisted of those with no missing data on any of the variables of interest (n = 21,852). The survey response rate was 68.9%. This study used logistic regression to estimate odds ratios of 3 types of childhood adversities (physical abuse, sexual abuse, and witnessing parental domestic violence) separately for ulcerative colitis and Crohn's disease, each compared with those without IBD. The final model controls for sociodemographics, health behaviors, and mental health. The exposure was assessed by retrospective self-report, and the outcome was by self-report of a health professional diagnosis. RESULTS: In a fully adjusted model, those who are physically (odds ratio = 2.28; confidence interval, 1.39-3.75) or sexually abused (odds ratio = 2.64; confidence interval, 1.61-4.33) during childhood had significantly higher odds of ulcerative colitis than their non-maltreated peers. No relationship is found between witnessing parental domestic violence and ulcerative colitis. None of the early adversities are significantly related to Crohn's disease. CONCLUSIONS: Childhood physical and sexual abuse are related to ulcerative colitis, but not Crohn's disease. Future research that can address epigenetic and neuroendocrine factors should investigate pathways through which early adversities may translate into one type of IBD but not another.