Stress and burnout in the context of workplace psychosocial factors among mental health professionals during the later waves of the COVID-19 pandemic in Hungary.

Background: While literature is abundant on the negative mental health impact of the COVID-19 outbreak, few studies focus on the Central and Eastern European region. Objectives: We examined stress, burnout, and sleeping troubles among mental health professionals in the context of psychosocial risk factors related to participation in COVID care during the fourth and fifth waves. Materials and methods: Mental health professionals (N=268) completed an online cross-sectional survey in Hungary, between November 2021 and April 2022. Of the respondents, 58.2% directly participated in COVID care. The main data collection instrument was the Copenhagen Psychosocial Questionnaire (COPSOQ II), including 20 subscales on work-related psychosocial factors and 3 outcome scales (stress, burnout, and sleeping troubles). We added a question on competence transgression, and items on sociodemographic and professional background. Results: Participation in COVID care was associated with higher work pace (59.08 versus 49.78), more role conflicts (55.21 versus 45.93), lower scores on the influence at work (38.18 versus 51.79), predictability (44.71 versus 57.03), reward (55.82 versus 65.03), role clarity (70.19 versus 75.37), social support from supervisor (59.24 versus 65.55), job satisfaction (54.36 versus 62.84), trust regarding management (55.89 versus 67.86), justice and respect (44.51 versus 54.35) scales. Among those involved in COVID care, only the stress score was higher (47.96 vs. 42.35) in the total sample; however, among psychiatrists, both stress (52.16 vs. 38.60) and burnout scores (58.30 vs. 47.06) were higher. Stepwise multiple regression revealed that work-family conflict, emotional demands and workplace commitment were independent predictors of higher stress and burnout scores; furthermore, competence transgression had a significant effect on stress, and being a psychiatric specialist had a significant effect on burnout. These models explained 40.5% of the variance for stress and 39.8% for burnout. Conclusion: During the fourth and fifth waves, although COVID care was more well-organized, psychiatrists, as specialist physicians responsible for the quality of the care, were still experiencing challenges regarding their competence and influence at work, which may explain their increased levels of stress and burnout.

The effect of animal-assisted interventions on the course of neurological diseases: a systematic review.

BACKGROUND: In our experience, working with a therapy animal strengthens endurance, maintains motivation, provides a sense of achievement, and boosts overall mental resilience. The aims of this work were to summarize the results of quantitative research on the possibilities of animal-assisted intervention (AAI) among people with neurodegenerative and cerebrovascular diseases and to attempt to assess the effects of animal-assisted interventions in an objective manner and to find supporting evidence based on published literature. METHODS: Our target groups are people diagnosed with Parkinson's disease, multiple sclerosis, or stroke. A systematic search of relevant articles was conducted by two independent researchers in April 2021 and August 2023. The search for studies was conducted using PubMed, Google Scholar, Web of Science, Scopus, and Ovid databases, specifying keywords and search criteria. The qualitative evaluation of the research reports was conducted by four independent researchers, using the Newcastle-Ottawa Quality Assessment Form. RESULTS: According to the scientific criteria and based on the Newcastle-Ottawa Quality Assessment Form, thirteen publications met the search criteria, out of which 9 publications were rated good and 4 publications were rated poor. Evaluating the publications we found evidence that AAI had a measurable impact on participants, as their physical and mental health status significantly improved; however, mental health improvement was more prominent. CONCLUSIONS: By developing evidence-based research methodology and standardized research settings, AAI could be measured effectively as part of health care practice. This would bring significant benefits to the rehabilitation of patients in need. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021255776.

[A study of the psychosocial characteristics of psychiatric teams in Hungary].

BACKGROUND: In this study, we examined psychiatric teams in a Hungarian sample before the COVID-19 pandemic. The aim of our research is to examine Hungarian psychiatric teams along different workplace psychosocial factors (collaboration management, organization and job, workplace requirements, work-life balance, trust, health and well-being) in order to assess them in terms of hierarchy and competence. Moreover we examine the mental and somatic effects of these factors. METHODS: We conducted a cross-sectional survey of Hungarian mental health care workers (N =79). The main question of the study was how perceived hierarchy and competence boundary violations are associated to psychosocial factors of the COPSOQ-II questionnaire (Copenhagen Psychosocial Questionnaire II) in general, and among employees in different job groups. RESULTS: Based on bootstrapped binary logistic regression performed on the full sample, we found that perceived hierarchy is associated with control, social support of co-workers and stress, while violation of competence boundaries is associated with job recognition, job clarity and fairness. DISCUSSION: Our results show that where mental health care workers experienced less perceived hierarchy within the team, they were more likely to feel that they had control over their work. Furthermore, in hierarchies perceived as superior-subordinate relations, the quality of the relationships within the team seems to be much more important. CONCLUSIONS: This research can be the starting point for a comprehensive study of other psychiatric teams with the aid of a widely used measure, providing an opportunity for comparison with other health teams at an international level.

[The impact of the coronavirus pandemic on the mental health of critical care workers]. / A koronavírus-világjárvány hatása az intenzív ellátásban dolgozók mentális egészségére.

INTRODUCTION: The coronavirus pandemic has focused attention on the importance of critical care and highlighted the shortage of critical care specialists. Due to increasing workloads and high mortality rates, healthcare professionals were exposed to higher levels of physical and psychological stress during the pandemic than before. OBJECTIVE: Our study investigated the effects of the coronavirus outbreak on the emotional, mental and moral stress of intensive care professionals. METHOD: Our workgroup performed paper-based surveys among caregivers in the Department of Anaesthesiology and Intensive Therapy at Semmelweis University. The first survey was conducted at the start of the pandemic in 2020, the second survey was conducted after the third wave in 2021. We applied validated questionnaires (Professional Quality of Life, Demoralization Scale, Perceived Stress Scale, Impact of Event Scale, and Posttraumatic Growth Inventory), collected demographic data and information on lifestyle, recreation, dietary habits, and accepting psychological support. RESULTS: The number and demographic characteristics of the participants in the two studies are different, reflecting the changes in the workforce during the pandemic. Our results revealed no differences between the working and socio-demographic groups before the outbreak, however, one year later, nurses scored significantly higher on all negative psychological scales compared to other groups. Only a minority of the respondents had sought psychological support (9.5-12.7%), although more than a third of respondents reported the need for psychological support. Employees in new work positions showed significantly increased posttraumatic growth (2.91 ± 0.82 vs. 2.20 ± 1.06, p = 0.016). DISCUSSION: These findings demonstrate that nurses are the most strained workgroup during an uncertain and stressful period. The available mental support alone is not enough to help caregivers. CONCLUSION: Further steps are needed to improve the mental health of critical care workers. Orv Hetil. 2023; 164(42): 1646-1655.

Differences in well-being and fear of death among female hospice employees and volunteers in Hungary.

BACKGROUND: Voluntary work plays a significant role in hospice care, but international research has mainly been conducted on the mental health and fear of death of paid hospice staff. The aim of the present study was to compare the Hungarian hospice volunteers with paid employees with regard to attitudes and fear of death, as well as mental health in order to see their role in hospice work and their psychological well-being more clearly. METHODS: The target population of the cross-sectional questionnaire study was hospice care providers in Hungary (N = 1255). The response rate was 15.5% (N = 195); 91.8% (N = 179) of them were women. The mean age of female hospice workers was 45.8 years (SD = 10.46 years, range: 23-73 years). One-quarter (27.9%, N = 50) of the female respondents were volunteers. The instruments were: the Multidimensional Fear of Death Scale, the Perceived Stress Scale, the WHO-5 Well-Being Index, and a shortened versions of the Beck Depression Inventory and the Maastricht Vital Exhaustion Questionnaire. RESULTS: Volunteers scored significantly lower on 5 dimensions of fear of death than paid employees, and showed significantly lower levels of vital exhaustion and significantly higher levels of psychological well-being than paid employees. Fear of the dying process was associated with an increased perceived stress, depressive symptoms, and vital exhaustion in both groups. Psychological well-being showed a significant negative, moderate correlation with four aspects of fear of death among paid staff; this pattern did not appear in the volunteer group. In addition, the association between fear of premature death and perceived stress, vital exhaustion, and depressive symptoms was more pronounced is case of paid workers. CONCLUSION: Higher levels of psychological well-being and lower levels of fear of death among hospice volunteers suggest that they are less exhausted than paid employees. Increasing the recruitment of volunteers in hospices may help reduce the overload and exhaustion of paid employees.

Influential factors of well-being among Hungarian female hospice workers examined through structural equation modelling.

According to national hospice data in Hungary, approximately 1,600 healthcare employees and volunteers work in hospice care (country population of 9.9 million). The aim of the study was to identify and examine influential relationships among several variables that may affect well-being among female hospice workers. Structural equation modeling analysis was conducted utilising survey responses of 179 female hospice workers, including 79 nurses. Path analysis revealed that work over-commitment (being employed in more than one job) contributed to decreased psychological well-being through increased perceived stress, sleep difficulties and vital exhaustion. A greater sense of coherence was associated with lower levels of subjective stress, depressive symptoms and vital exhaustion and negatively correlated with over-commitment. Overall, even though the physical and mental burden of the workers is increasing because of increased use of hospice, according to these results, most still engaged in hospice work. Deeper analysis of the sense of coherence may point to development of effective interventions that can help maintain well-being of hospice workers and reduce attrition.

[Validation of the Hungarian version of the Professional Quality of Life Scale]. / A szakmai élet minoségét méro kérdoív (Professional Quality of Life Scale) magyar változatának validálása.

INTRODUCTION: The Professional Quality of Life Scale, measuring the quality of professional life, has been developed to examine the positive and negative changes in the work of those who have undergone extremely stressful experiences. The quality of life of the personnel of palliative-hospice teams may be influenced physically as well as emotionally by their every-day experiences of suffering, death, dying and the patients' traumas. AIM: The aim of the study was the examination of the psychometric features and factor structure of the Hungarian version of the Professional Quality of Life Scale questionnaire, which can measure compassion fatigue and satisfaction, secondary traumatisation and burnout. Our long-term objective is the development of formative and intervention strategies for hospice workers in order to increase their satisfaction, physical and mental well-being and their willingness to work in hospice. METHOD: The cross-sectional, questionnaire study was made with hospice workers. The questionnaires were available in an anonym, printed form. We used the Hungarian versions of the Shortened Maastricht Vital Exhaustion Questionnaire and of the Shortened Beck Depression Scale, of the CES-D Depression Scale and of the Shortened WHO General Well-Being Scale to validate. STATISTICAL ANALYSIS: IBM SPSS 23.0© software was used for the analysis. To explore the factor structure of the measurement scale, explorative factor analysis was made (analysis of the main component, Varimax rotation); subsequently, 4 scales were prepared the Cronbach-alpha values of which were suitable for further examination. RESULTS: 188 questionnaires were sent back (female 86.2%, male 13.8%); the majority work as nurses and in home hospice care (94 people). The inner consistency of the created 4 scales is acceptable according to the Cronbach-alpha values. The inner consistency of the questions regarding burnout is low. The correlation of our measurement scales with the standardised scales for outer validity has sufficient strength and direction. CONCLUSIONS: Our questionnaire can measure the phenomena under examination according to the expected values, with suitable consistency on the basis of the inner and outer indicators. Orv Hetil. 2018; 159(35): 1441-1449.

A qualitative study of culturally embedded factors in complementary and alternative medicine use.

BACKGROUND: Within the intercultural milieu of medical pluralism, a nexus of worldviews espousing distinct explanatory models of illness, our research aims at exploring factors leading to complementary and alternative medicine (CAM) use with special attention to their cultural context. METHODS: The results are based on medical anthropological fieldwork (participant observation and in-depth interviews) spanning a period from January 2015 to May 2017 at four clinics of Traditional Chinese Medicine in Budapest, Hungary. Participant observation involved 105 patients (males N = 42); in-depth interviews were conducted with patients (N = 9) and practitioners (N = 9). The interviews were coded with Interpretative Phenomenological Analysis; all information was aggregated employing Atlas.ti software. RESULTS: In order to avoid the dichotomization of "push and pull factors," results obtained from the fieldwork and interviews were structured along milestones of the patient journey. These points of reference include orientation among sources of information, biomedical diagnosis, patient expectations and the physician-patient relationship, the biomedical treatment trajectory and reasons for non-adherence, philosophical congruence, and alternate routes of entry into the world of CAM. All discussed points which are a departure from the strictly western therapy, entail an underlying socio-cultural disposition and must be scrutinized in this context. CONCLUSIONS: The influence of one's culturally determined explanatory model is ubiquitous from the onset of the patient journey and exhibits a reciprocal relationship with subjective experience. Firsthand experience (or that of the Other) signifies the most reliable source of information in matters of illness and choice of therapy. Furthermore, the theme of (building and losing) trust is present throughout the patient journey, a determining factor in patient decision-making and dispositions toward both CAM and biomedicine.

[The everyday life of survivors. The quality of life of hospice workers]. / A túlélok mindennapjai. A hospice-ellátásban dolgozók életminosége.

INTRODUCTION: Each year, the number of hospice services and terminally ill patients increase while the number of hospice workers is falling. The intensification of the physical and mental burdens of the latter can lead to burnout and the fluctuation of the workers. AIM: The aim of the authors was to survey the physical and mental state of hospice workers, as well as the risk of burnout and coping strategies. METHOD: A questionnaire survey in hospice experts and volunteers (n ≈ 1500) based on the Hungarostudy survey was performed. RESULTS: Those who filled in the questionnaire (n = 195) had on average 1.86 workplaces and 45.8% of them reported working 12 or more hours a day. Most often, they suffered from lack of energy (65.1%), disturbing physical pain (46.9%), sleeping (56.9%) and digestion (35%), they considered themselves overweight (56.9%) and they were occupied with work problems even at bedtime (72.8%). CONCLUSIONS: Hospice workers are overloaded, they have physical and mental symptoms and they are characterized by compassion fatigue. At the same time, they are also characterized by compassion satisfaction as an ability to accept appreciation for the caretaking.

[Factors determining the selection of treatment options of complementary and alternative medicine]. / A komplementer és alternatív medicina felé orientálódó terápiaválasztást meghatározó tényezok.

INTRODUCTION: Complementary and alternative medicine have undoubtedly been gaining ground on the healthcare market, thus the vital question arises why patients choose these treatments, oftentimes at the cost of discontinuing the Western medical therapy. AIM: The aim of the authors was to investigate and scrutinize factors leading to the utilization of various alternative medical services. METHOD: The basis of this qualitative research was medical anthropological fieldwork conducted at a clinic of Traditional Chinese Medicine including participant observation (355 hours), unstructured interviews with patients (n = 93) and in-depth interviews (n = 14). RESULTS: Patients of alternative medical systems often do not receive a diagnosis, explanation or cure for their illness from Western medicine, or they do not agree with what they are offered. In other instances, patients choose alternative medicine because it exhibits a philosophical congruence with their already existing explanatory model, that is, previous concepts of world, man or illness. CONCLUSIONS: A particular therapy is always part of a cultural system and it is embedded in a specific psycho-social context, hence choice of therapy must be interpreted in accordance with this perspective.

[Impact of animal-assisted intervention on rehabilitation of patients with spinal cord injury]. / Az állatasszisztált intervenció hatása gerincvelosérült személyek rehabilitációjában.

INTRODUCTION: The animal-assisted programs represent an interdisciplinary approach. They can be integrated into preventive, therapeutic and rehabilitative processes as complementary methods. AIM: The aim of the study was to promote the psychological adaptation and social reintegration of patients who suffered spinal cord injury, as well as reducing depression and feelings of isolation caused by the long hospitalization. The hypothesis of the authors was that the animal-assisted intervention method can be effectively inserted into the rehabilitation process of individuals with spinal cord injury as complementary therapy. METHODS: 15 adults with spinal cord injury participated in the five-week program, twice a week. Participants first filled out a questionnaire on socio-demographics, and after completion of the program they participated in a short, directed interview with open questions. During the field-work, after observing the participants, qualitative data analysis was performed. RESULTS: The results suggest that the therapeutic animal induced a positive effect on the emotional state of the patients. Participants acquired new skills and knowledge, socialization and group cohesion had been improved. CONCLUSIONS: The authors conclude that the animal-assisted activity complemented by therapeutic elements can be beneficial in patients undergoing spinal cord injury rehabilitation and that knowledge obtained from the study can be helpful in the development of a future animal-assisted therapy program for spinal cord injury patients.

[Professions and fear of death--are they correlated?]. / Összefüggésbe hozható-e a halálfélelem a foglalkozással?

INTRODUCTION: There are relatively few data on the relationship between professions and fear of death. AIM: The aim of the authors was to examine the association between profession and fear of death. METHOD: Physicians, medical students and other healthcare workers, priests, psychologists and non-healthcare workers (N = 1062) were asked about their attitude to death by means of the Multidimensional Fear of Death Scale. RESULTS: Significant differences were found in the total and some factor scores among the study groups. Priests showed the lowest fear of death values. Scores on the Fear of the Dead Factor was the highest in psychologists and non-healthcare workers who had no contact with the dead and dying. CONCLUSIONS: Fear of death seems rather to be present in professions dealing less directly with the dead and dying.

[Attitude to death and changes of death image in Hungarian society. Study of the differences in generational value-judgments and of the possibilities of measurement. Is death still a taboo?]. / A halálkép alakulása és változása Magyarországon, a korosztályos értékítélet-különbségek és a lehetséges mérési módszerek vizsgálata. Tabu-e még a halál?

The aim of our research is to examine the sociological, anthropological, and psychological aspects of attitudes towards death; review the different approaches as a complex system; present the altered death image and the changes of tendency; analyze and interpret the most significant anxiety generating factors according to gender, age, and occupation; validate the fear of death and attitudes towards death scales in the Hungarian population; review the possibilities of interventions designed to reduce anxiety generating fear of death. Our hypotheses of our quantitative research were the following: women are characterized by a marked fear of death and anxiety; young people are more afraid of death; health care workers have a higher level death anxiety in comparison to other professionals due to the fact that they are face the suddenness and inevitability of death on daily basis, and this itself is an anxiety generating factor. We validated, adapted and calibrated two psychometric scales measuring fear of death and attitudes towards death. According to our findings, both the Neimeyer and Moore Multidimensional Fear of Death Scale and the Lester Attitude Toward Death Scale proved valid and suitable for measuring fear of death and attitudes towards death. The Hungarian version of the scales proved reliable. In accordance with our hypothesis, young people and women are characterized by higher level of fear of death and anxiety. Our hypothesis, namely that fear of death among health care workers higher as the normal population, was not confirmed. Yet, contrary to a segment of preceding measurements, lower level of fear and anxiety was found.