Association of depressive symptoms with incidence and mortality rates of COVID-19 over 2 years among healthcare workers in 20 countries: multi-country serial cross-sectional study.

BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic. METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates. RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017). CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.

Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic.

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.

The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 HEalth caRe wOrkErS (HEROES) study.

BACKGROUND: Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. METHODS: Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country's income level. RESULTS: As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. CONCLUSIONS: This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.

Conectividad cerebral en la regulación emocional: la solución de problemas emocionales / Brain connectivity in emotional regulation: the emotional solving problems

La solución de problemas emocionales es un mecanismo de regulación emocional que utiliza estrategias cognitivo-lingüísticas para reducir el impacto afectivo de una situación y lograr un objetivo propuesto. Es considerado un mecanismo saludable junto con la revaluación, a diferencia de la supresión y la rumiación. Estudios con técnicas de neuroimágenes han propuesto áreas cerebrales asociadas al funcionamiento de los diferentes mecanismos de regulación emocional. En este trabajo se propuso investigar los gradientes de conectividad cerebral de sustancia blanca asociados a la solución de problemas emocionales, con el objetivo de proponer una red de conectividad neuronal de este mecanismo de regulación emocional. Para evaluar la efectividad de la solución de problemas emocionales se utilizó una tarea conductual desarrollada recientemente basada en la recuperación semántica esforzada con estímulos de alto impacto afectivo. Participaron del estudio 32 mujeres jóvenes (M= 24,34; DS=5,24). Se obtuvieron coeficientes de correlación de Pearson entre las medidas del porcentaje de acierto de la tarea conductual y la anisotropía fraccional de los fascículos de sustancia blanca de interés. Los resultados proponen un red neuronal de solución de problemas emocionales en la que participarían principalmente el Fascículo Arqueado y Fronto Occipital Inferior del hemisferio izquierdo, cruciales en la implementación de estrategias de carácter léxico y semántico para la disminución del impacto afectivo (AU)

Emotional solving problems is an emotional regulation mechanism that implements cognitive-linguistics strategies to reduce the affective impact in a situation and to accomplish a proposed objective. Together with the reappraisal, it is considered a healthy mechanism, in difference with suppression and rumination. Researches that have used neuroimaging techniques have proposed cerebral areas associated to the functioning of the different emotional regulation mechanisms. The objective of this research was to study the brain connectivity gradients of white matter associated to emotional solving problems, to propose a brain connectivity network of this emotional regulation mechanism. The efficacy of emotional solving problems was measured with a behavioral task recently developed, based on semantic effortful retrieval with high affective impact stimulus. 32 young women (M= 24,34; DS=5,24) participated of the study. Correlations of Pearson were performed between accuracy measures of the behavioral task and fractional anisotropy of the white matter fascicles of interest. The results propose a brain connectivity network of emotional solving problems with the main participation of the Arcuate and Fronto Occipital Inferior fascicles of left hemisphere, both crucial in the implementation of lexical and semantic strategies to the reduction of affective impact (AU)