Burnout in residents during the first wave of the COVID-19 pandemic: a systematic review and meta-analysis.

Introduction: The high prevalence of burnout in resident physicians is expected to have increased as a result of the expansion of the pandemic. We conducted a systematic review with a meta-analysis of studies conducted during the first wave of the COVID-19 pandemic on burnout in residents and potential associated risk factors. Methods: The search was done in the Web of Science, MEDLINE, Scopus, and Lillac databases (April 2020-October 2021) using a priori protocol based on the PRISMA guidelines. The Newcastle Ottawa Scale was used to assess the risk of bias in the included studies. We estimated the pooled prevalence (95% CI) of burnout and the prevalence ratio (95% CI) of each risk factor associated. Results: We included 23 studies from 451 potential initial articles and those written in the English language; all of the collected studies were cross-sectional with anonymous online surveys, involving 4,998 responders (34%), of which 53.2% were female responders, 51% were R1-2, and 71% were in direct contact with COVID-19 patients. Eighty-seven percent presented a low-to-moderate risk of bias. Publication bias was not shown. The estimated pooled prevalence of burnout was 40% (95% CI = 0.26 - 0.57). Burnout was associated with psychiatry history (PR = 4.60, 95% CI = 1.06 - 20.06). There were no differences by gender, civil status, children in-charge, year of residency, or time exposure to COVID-19. Discussion: The overall prevalence of burnout in residents during the first wave of the pandemic was in line with the results described in this collective before the pandemic. The presence of a psychiatry history was a potential burnout risk factor, suggesting a high vulnerability during the peak of the stress period and the need to implement mental health surveillance for this subgroup.

Incidence of depression in patients with hepatitis C treated with direct-acting antivirals

Objective: Depression has been associated with hepatitis C, as well as with its treatment with proinflammatory cytokines (i.e., interferon). The new direct-acting antiviral agents (DAAs) have minimal adverse effects and high potency, with a direct inhibitory effect on non-structural viral proteins. We studied the incidence and associated factors of depression in a real-life prospective cohort of chronic hepatitis C patients treated with the new DAAs. Methods: The sample was recruited from a cohort of 91 patients with hepatitis C, of both sexes, with advanced level of fibrosis and no HIV coinfection, consecutively enrolled during a 6-month period for DAA treatment; those euthymic at baseline (n=54) were selected. All were evaluated through the depression module of the Patient Health Questionnaire (PHQ-9-DSM-IV), at three time points: baseline, 4 weeks, and end-of-treatment. Results: The cumulative incidence (95%CI) of major depression and any depressive disorder during DAA treatment was 13% (6.4-24.4) and 46.3% (33.7-59.4), respectively. No differences were observed between those patients with and without cirrhosis or ribavirin treatment (p > 0.05). Risk factors for incident major depression during DAA treatment included family depression (relative risk 9.1 [1.62-51.1]), substance use disorder (11.0 [1.7-73.5]), and baseline PHQ-9 score (2.1 [1.1-3.1]). Conclusions: The findings of this study highlight the importance of screening for new depression among patients receiving new DAAs, and identify potential associated risk factors.

Estructura factorial de la versión española de la Escala de Depresión Postnatal de Edimburgo / Factor Structure of the Spanish Version of the Edinburgh Postnatal Depression Scale

Introducción. La Escala de Depresión Postnatal de Edimburgo (EPDS) es considerada el gold standard para el cribado de depresión postparto. Aunque la versión española ha sido ampliamente utilizada, su estructura factorial no ha sido todavía analizada. Metodología. Un total de 1.204 mujeres completaron la EPDS a las 32 semanas del parto. Para evitar pruebas múltiples dividimos la muestra en dos mitades de 602 participantes. Se realizó un análisis factorial exploratorio (AFE) con rotación oblimin con la primera sub-muestra. Posteriormente, con la segunda de las muestras se realizó un análisis factorial confirmatorio (AFC) mediante la estimación Weighted Least Squares Means and Variance (WLSMV). Se exploraron diferentes soluciones entre dos y cuatro factores. Comparamos los factores en dos grupos de participantes con depresión y sin depresión (evaluados con la Entrevista Diagnóstica para Estudios Genéticos (DIGS) para el DSM-IV). Resultados. El AFE mostró un modelo de tres factores compuesto por ansiedad, depresión y anhedonia. Los resultados del AFC confirmaron el modelo de tres factores (χ2=99,203, p<0,001; RMSEA=0,06, 90% CI=0,04/0,07, CFI=0,87 y TLI=0,82). Mujeres con depresión a las 32 semanas tuvieron puntuaciones más elevadas en ansiedad, depresión y anhedonia (p<0,001). Conclusiones. Primer estudio de análisis confirmatorio de la versión española de la EPDS, en una amplia muestra de mujeres sin tratamiento psiquiátrico durante el embarazo. Un modelo de tres factores compuesto por ansiedad, depresión y anhedonia ha sido obtenido. Mujeres con depresión tuvieron una mayor puntuación en las tres dimensiones de la EPDS

Introduction. The Edinburgh Postnatal Depression Scale (EPDS) is considered the gold standard in screening for postpartum depression. Although the Spanish version has been widely used, its factorial structure has not yet been studied. Methods. A total of 1,204 women completed the EPDS 32 weeks after delivery. To avoid multiple testing, we split the sample into two halves, randomly drawing two subsamples of 602 participants each. We conducted exploratory factor analysis (EFA), followed by an oblimin rotation with the first sub-sample. Confirmatory factor analysis (CFA) was conducted using a Weighted Least Squares Means and Variance (WLSMV) estimation of the data. We explored different solutions between two and four factors. We compared the factors between two groups with depression and non-depression (evaluated with the Diagnostic Interview for Genetic Studies (DIGS) for the DSM-IV). Results. The EFA indicated a three-factor model consisting of anxiety, depression and anhedonia. The results of the CFA confirmed the three-factor model (χ2=99.203, p<0.001) RMSEA=0.06, 90% CI=0.04/0.07, CFI=0.87 and TLI=0.82). Women with depression in the first 32 weeks obtained higher scores for anxiety, depression and anhedonia dimensions (p<0.0101). Conclusions. This is the first study of confirmatory analysis with the Spanish version of EPDS in a large sample of women without psychiatric care during pregnancy. A three-factor model consisting of anxiety, depression and anhedonia was used. Women with depression had a higher score in the three dimensions of the EPDS

Estrés laboral: implicaciones para la salud física y mental / Work-related stress: implications for physical and mental health

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Dual diagnosis in the psychiatric emergency room in Spain

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Background and Objectives: Dual diagnosis is associated with increased emergency department service use. During recent years, increased emphasis has been given to monitor the decision to hospitalise the most sever patients. Many rating scales have developed based on patient-related factors. To assess the level of severity of dual diagnosis patients measured by the Severity Psychiatric Illness (SPI) Scale and to evaluate it as a tool for predicting discharge in emergency psychiatric practice. Methods: Data on 1,227 consecutive admissions visited in a psychiatric emergency room of a general teaching hospital during a period of six months were collected. A routine computerised protocol was completed which included socio-demographic, clinical and social factors and the SPI scale. Results: 206 admissions (17 percents) had dual diagnosis disorder, 106 (9 percents) had substance abuse disorder (SUD), and 906 (74 percents) had non-substance abuse disorder (NSUD). Differences among groups were found in clinical characteristics, discharge decision, readmissions, previous psychiatric history, reason for referral, DSM-IV diagnosis and illicit drug use. Dual diagnosed patients had the highest scores of severity. Logistic regression analyses revealed the independent contribution of different SPI'items. The model showed a good fit and indicated excellent calibration in the sample studied, predicting 87.6 percents of discharge decisions. Conclusions: Dual diagnosed patients at the emergency psychiatric room presented the highest levels of severity both in clinical and social problems. While the SPI was a good tool for assessing severity of illness in our patients, only some dimensions predicted discharge decision (AU)