Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs ('Resilience Hubs') using normalisation process theory.

OBJECTIVES: Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic. DESIGN: Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach. SETTING: Three Resilience Hubs in the North of England. PARTICIPANTS: Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63). RESULTS: Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs. CONCLUSIONS: Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context.

Lower Likelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups.

PURPOSE: We investigated whether physician race and ethnicity were associated with burnout among a nationally representative sample of family physicians. METHODS: We undertook a cross-sectional observational study using survey data from 1,510 American Board of Family Medicine recertification applicants in 2017 and 1,586 respondents to the 2017 National Graduate Survey. Of the 3,096 total family physicians, 450 (15%) were from racial and ethnic groups underrepresented in medicine. We used structural equation models to test the effects of underrepresented status on single-item measures of emotional exhaustion and depersonalization. RESULTS: Family physicians underrepresented in medicine were significantly less likely than their non-underrepresented counterparts to report emotional exhaustion (adjusted odds ratio = 0.82; 95% CI, 0.69-0.99; total effect) and depersonalization (adjusted odds ratio = 0.54; 95% CI, 0.41-0.71; total effect). The underrepresented physicians were more likely than non-underrepresented peers to practice in more racially and ethnically diverse counties and less likely to practice obstetrics, both of which partly mediated the protective effect of underrepresented status on depersonalization. CONCLUSIONS: Although factors such as racism might be expected to adversely affect the well-being of underrepresented clinicians, underrepresented family physicians reported a lower frequency of emotional exhaustion and depersonalization. The mediating protective effect of working in more racially and ethnically diverse counties is consistent with evidence of the beneficial effect of cultural diversity on health outcomes for minorities. Because physician burnout is a known predictor of job turnover and may also be associated with poorer quality of care, the lower burnout observed among underrepresented family physicians may be an asset for the health care system as a whole.

Workplace stress and discrimination effects on the physical and depressive symptoms of underrepresented minority faculty.

Evidence-based research and interventions to address systemic institutional racism have never been more urgent. Yet, underrepresented minority (URM) professionals in research institutions who primarily produce that evidence have remained abysmally low for decades. This unique study of URM university professors assesses factors-vocational strain, role overload, discrimination, coping strategies-that contribute to health and well-being, research productivity, and ultimately their retention in high impact research positions. We administered a web-based survey assessing demographics, workplace stressors, perceived discrimination, life events, coping strategies, and physical and depressive symptoms. Study participants include 404 faculty of whom 254 are African Americans, 99 are Mexican Americans, and 51 are Puerto Ricans. Hierarchical regression analyses were employed to assess the associations between workplace stress, coping strategies, and symptoms. Results show that perceived discrimination, vocational strain, role overload, and life events directly affected physical symptoms, with self-care (p < 0.001) moderating these effects. Vocational strain and life events had direct effects on depressive symptoms with self-care (p < 0.05) and social support (p < 0.001) moderating these effects. Findings inform health care providers and university leaders about work stress and health conditions that may explain early morbidity and premature departures of URM faculty, and proffer institutional interventions to retain these faculty.

Sources of functioning, symptoms of trauma, and psychological distress: A cross-sectional study with Palestinian health workers operating in West Bank and Gaza strip.

Health-care workers operating in conflict zones are at severe risk of psychological consequences, given their extended exposure to traumatic events under conditions of stress and violence. This quantitative, cross-sectional study was designed to explore the relationships between personal resources (sources of functioning)-operationalized as sense of coherence, posttraumatic growth, and perceived well-being-psychological distress, and trauma symptoms in a specific population of health workers exposed to war and violence. Palestinian health professionals (N = 181) completed quantitative measures of well-being, posttraumatic growth, sense of coherence, psychological distress, and traumatic response. The data were analyzed using structural equation modeling (SEM). The outcomes suggest that sources of psychological functioning consistently play a role in the mental health of different types of health professionals. Health-care workers in an environment characterized by instability and ongoing risk need to protect their own mental health by mobilizing sources of resistance and resilience, such as a sense of coherence, subjective well-being, and growth. We discuss the clinical implications of these findings and offer recommendations for training and supervision. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Descriptive study of workplace demand, control and bullying among migrant and Australian-born workers by gender: does workplace support make a difference?

OBJECTIVE: The objective of this study is to examine the relationship between bullying in migrants and Australians and types of workplace Iso-strain, by gender. DESIGN AND SETTING: Two descriptive cross-sectional surveys of the Australian working population. PARTICIPANTS: Australian-born workers of Caucasian ancestry (n=1051, participant response rate=87.3%) and workers born in New Zealand (n=566), India (n=633) and the Philippines (n=431) (participant response rate=79.5%). PRIMARY AND SECONDARY OUTCOMES MEASURES: Using logistic regression, we examined whether self-reported assessment of various forms of bullying in the workplace was associated with Iso-strain (job with high demands and low control and without social support), gender and migrant status. RESULTS: The prevalence of workplace bullying within the previous year was 14.5%. Sexual harassment, though rare (n=47, 1.8%), was reported by more women than men (83% vs 17%, χ2=19.3, p<0.0001) and more Australia or New Zealand born workers compared to India or the Philippines workers (75.5% vs 25.5%, χ2=4.6, p=0.032). Indian-born women had lower adjusted OR for being bullied and for being intimidated compared to other women. Independent of migrant status, Iso-strain (1), (low support from boss) and Iso-strain (2), (low support from colleagues) predicted being bullied. Women were more likely to be in an Iso-strain (1) job than men (18.7% vs 13.6%, p=0.013) and had twice the risk of being both verbally abused and intimidated compared to men (OR 9 vs OR 5.5, p<0.0001). CONCLUSION: Workplace bullying was more likely for women than men. There were few differences between workers from different migrant groups. Iso-strain was the strongest predictor of workplace bullying. Workplaces should encourage supportive and collegiate work environments.

Differential associations between psychosocial stress and obesity among Ghanaians in Europe and in Ghana: findings from the RODAM study.

PURPOSE: Psychosocial stress is associated with obesity in some populations, but it is unclear whether the association is related to migration. This study explored associations between psychosocial stress and obesity among Ghanaian migrants in Europe and non-migrant Ghanaians in Ghana. METHODS: Cross-sectional data from the RODAM study were used, including 5898 Ghanaians residing in Germany, the UK, the Netherlands, rural Ghana, and urban Ghana. Perceived discrimination, negative life events and stress at work or at home were examined in relation to body mass index (BMI) and waist circumference (WC). Linear regression analyses were performed separately for migrants and non-migrants stratified by sex. RESULTS: Perceived discrimination was not associated with BMI and WC in both migrants and non-migrants. However, negative life events were positively associated with BMI (ß = 0.78, 95% CI 0.34-1.22) and WC (ß = 1.96, 95% CI 0.79-3.12) among male Ghanaian migrants. Similarly, stress at work or at home was positively associated with BMI (ß = 0.28, 95% CI 0.00-0.56) and WC (ß = 0.84, 95% CI 0.05-1.63) among male Ghanaian migrants. Among non-migrant Ghanaians, in contrast, stress at work or at home was inversely associated with BMI and WC in both males (ß = - 0.66, 95% CI - 1.03 to - 0.28; ß = - 1.71 95% CI - 2.69 to - 0.73, respectively) and females (ß = - 0.81, 95% CI - 1.20 to - 0.42; ß = - 1.46, 95% CI - 2.30 to - 0.61, respectively). CONCLUSIONS: Negative life events and stress at work or at home are associated with increased body weight among male Ghanaians in European settings, whereas stress at work or at home is associated with reduced body weight among Ghanaians in Ghana. More work is needed to understand the underlying factors driving these differential associations to assist prevention efforts.

Cross-cultural differences in the relationship between conformity to masculine norms and health behaviour among men in Hong Kong.

OBJECTIVE: Examine differences in the relationship between conformity to masculine norms and engagement in health behaviour among a cross-cultural sample of Hong Kong Chinese, mainland Chinese, Caucasian, and South Asian men living in Hong Kong. DESIGN: Cross-sectional. METHODS: A community sample of 495 Hong Kong Chinese (n = 161), mainland Chinese (n = 107), Caucasian (n = 122), and South Asian (n = 105) men enrolled in the study. Ages ranged from 18 to 81 years (M = 39.87). Participants completed self-report measures of conformity to masculine norms, health behaviour, social support, and job stress. RESULTS: Younger age was predictive of greater engagement in health behaviour among all men. Stronger conformity to masculine norms was predictive of engagement with health behaviour among Hong Kong, mainland Chinese, and Caucasian men, but not South Asian men. Social support was negatively predictive of engagement in health behaviour among Hong Kong Chinese, mainland Chinese, and South Asian men, suggesting that greater levels of social support may hinder engagement in health behaviour in some men. Job stress had a negative impact on engagement with health behaviour among Hong Kong Chinese and South Asian men only. CONCLUSIONS: Present findings demonstrate the need for a broader examination of the relationship between masculinity and health behaviour, focusing not only on the negative, but also the positive impact that masculinity can have on men's health behaviour. Findings are discussed in terms of their implication on men's health and health promotion. Statement of contribution What is already known about this subject? Men around the globe have higher mortality and morbidity across all leading diseases. Explanations have focused on men's poor health-seeking behaviour and how this impedes on health. The pursuit of masculinity is thought to contribute to poor health outcomes in men. What does this study add? Conformity to masculine norms was predictive of engagement in health behaviour. This is one of few studies cross-culturally examining masculinity and health in a Chinese context. Findings provide examples of how conformity can support engagement in health behaviour.

[Prospective cohort study on the occupational stress and mental disorder among the oilfield workers in Xinjiang Autonomous Region in 2013-2015].

OBJECTIVE: To explore the relationship between occupational stress and psychological disorder among oilfield workers. METHODS: In 2013, 1485 psychological normal oilfield workers using the stratified cluster sampling in Xinjiang Autonomous Region were investigated, and the follow-up was conducted in 2015. Occupational stress and mental health status were assessed by questionnaire for the occupation stress and self-rating symptom. RESULTS: The people with mental disorder was 556, the incidence rate was40. 29%. The level of occupational stress level low-high group( RR = 2. 689, 95% CI1. 342-5. 391) and middle-high group( RR = 2. 878, 95% CI 1. 205-6. 875) of mental disorder were higher than the low-low group, the level of Personal Strain Questionnaire low-middle group( RR = 2. 500, 95% CI 1. 700-3. 763) and low-high group( RR =3. 907, 95% CI 1. 955-7. 651) and middle-middle group( RR = 2. 141, 95% CI 1. 016-4. 512) of mental disorder were higher than low-low group. Without drinking( RR =0. 779, 95% CI = 0. 622-0. 976) was protective factor for mental disorders. CONCLUSION: Occupational stress and drinking are the risk factors of mental disorder, it is more practical to multiple measurement of the psychological disorder of occupational stress exposure than single one.

The Roles of Motivation and Coping Behaviours in Managing Stress: Qualitative Interview Study of Hong Kong Expatriate Construction Professionals in Mainland China.

Driven by fast-growing economies worldwide, the number of international construction projects is booming, and employing expatriates has inevitably become a strategy used by construction firms. However, stress arising from expatriate assignments can lead to early return, assignment failure, and staff turnover, causing in significant losses to an organisation. Extensive research has focused on the effectiveness of coping behaviours in relation to stress. However, studies investigating the antecedents of coping are rare. The limited studies to date tend to focus on content-based motivations (identifying what), instead of on how coping behaviours can be motivated in the stress management process (identifying how). Focus on expatriate construction professionals (ECPs) is further limited. Hence, this study aims to investigate from a process theory perspective the role of motivation in the stress management process. Using a qualitative interview study approach, involving 22 in-depth interviews, this study first identifies the content of motivation, coping behaviours, performance, and stress in the context of Hong Kong ECPs working on cross-cultural projects in China; it then unveils and explains the associations between the identified variables. Based on the results, stakeholders are recommended to review pre-departure training, so as to ensure that key elements such as personal awareness of stress (cognitive, affective, and physical), expectancies of coping strategies on stress (adaptive or maladaptive), and expectancies of the influence of stress on performance are covered.

Ethnicity, work-related stress and subjective reports of health by migrant workers: a multi-dimensional model.

OBJECTIVES: This study integrates different aspects of ethnicity and work-related stress dimensions (based on the Demands-Resources-Individual-Effects model, DRIVE [Mark, G. M., and A. P. Smith. 2008. "Stress Models: A Review and Suggested New Direction." In Occupational Health Psychology, edited by J. Houdmont and S. Leka, 111-144. Nottingham: Nottingham University Press]) and aims to test a multi-dimensional model that combines individual differences, ethnicity dimensions, work characteristics, and perceived job satisfaction/stress as independent variables in the prediction of subjectives reports of health by workers differing in ethnicity. DESIGN: A questionnaire consisting of the following sections was submitted to 900 workers in Southern Italy: for individual and cultural characteristics, coping strategies, personality behaviours, and acculturation strategies; for work characteristics, perceived job demands and job resources/rewards; for appraisals, perceived job stress/satisfaction and racial discrimination; for subjective reports of health, psychological disorders and general health. To test the reliability and construct validity of the extracted factors referred to all dimensions involved in the proposed model and logistic regression analyses to evaluate the main effects of the independent variables on the health outcomes were conducted. RESULTS: Principal component analysis (PCA) yielded seven factors for individual and cultural characteristics (emotional/relational coping, objective coping, Type A behaviour, negative affectivity, social inhibition, affirmation/maintenance culture, and search identity/adoption of the host culture); three factors for work characteristics (work demands, intrinsic/extrinsic rewards, and work resources); three factors for appraisals (perceived job satisfaction, perceived job stress, perceived racial discrimination) and three factors for subjective reports of health (interpersonal disorders, anxious-depressive disorders, and general health). Logistic regression analyses showed main effects of specific individual and cultural differences, work characteristics and perceived job satisfaction/stress on the risk of suffering health problems. CONCLUSION: The suggested model provides a strong framework that illustrates how psychosocial and individual variables can influence occupational health in multi-cultural workplaces.

Associations of Work Stress, Supervisor Unfairness, and Supervisor Inability to Speak Spanish with Occupational Injury among Latino Farmworkers.

Little is known about how psychosocial work factors such as work stress, supervisor fairness, and language barriers affect risk of occupational injury among Latino farmworkers. This study attempts to address these questions. Surveys were administered via interviews to 225 Latino thoroughbred farmworkers. Multivariable logistic regression analyses were performed to calculate odds ratios (OR) and 95% confidence intervals (CI) of occupational injury in the past year in relation to occupational characteristics. Work stress (OR 6.70, 95% CI 1.84-24.31), supervisor unfairness (OR 3.34, 95% CI 1.14-9.73), longer tenure at farm (OR 2.67, 95% CI 1.13-6.34), and supervisor inability to speak Spanish (OR 2.29, 95% CI 1.05-5.00) were significantly associated with increased odds of occupational injury. Due to the associations between work stress, supervisor unfairness, supervisor inability to speak Spanish and injury, supervisor training to improve Spanish language ability and equitable management practices is merited. Future research is needed to understand the antecedents of work stress for Latino farmworkers.

Addressing patient biases toward physicians.

[Full article available at http://rimed.org/rimedicaljournal-2017-12.asp].

Posttraumatic growth is related to subjective well-being of aid workers exposed to cumulative trauma in Palestine.

The present study examined how stress reactions after traumatic events influence subjective well-being (SWB) via the indirect effect of posttraumatic growth (PTG) in two samples of Palestinian professional helpers from the Gaza Strip and West Bank ( n = 201). Using the General Health Questionnaire (GHQ-12) as a dependent measure of well-being, and PTGI-10, PANAS-20, WHO-5 BREF, and IES-13 questionnaires as independent variables, structural equation modelling (SEM) was used to examine whether: (a) cumulative trauma was negatively and directly related to subjective well-being; (b) levels of trauma were positively and directly related to posttraumatic growth; and (c) PTG was positively and directly related to subjective well-being. The findings suggest that posttraumatic growth contributes to mitigating and buffering (on the order of approximately 10%) the effect of trauma on subjective well-being. PTG seems to be a resource that can help aid workers deal with the consequences of stressful life events. Clinical implications and directions for supervision and training are discussed.