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\begin{document}

\title{Mental health of healthcare workers during the COVID-19 pandemic in
Italy}



\author[1]{Marialaura Di Tella}%
\author[2]{Annunziata Romeo}%
\author[1]{Agata Benfante}%
\author[1]{Lorys Castelli}%
\affil[1]{Affiliation not available}%
\affil[2]{University of Turin}%


\vspace{-1em}



  
  \date{May 27, 2024}


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\selectlanguage{english}
\begin{abstract}
Background: The COVID-19 pandemic represents one of the most stressful
events of recent times. Among the population, healthcare professionals
who treat COVID-19 patients are most likely to develop psychological
distress and posttraumatic stress symptoms (PTSS). The present study
thus aimed to investigate the psychological impact of the COVID-19
outbreak on Italian healthcare workers. Methods: The responses of 145
healthcare workers (72 medical doctors and 73 nurses) were included in
the final dataset. Participants were asked to provide sociodemographic
and clinical information, and to complete: 1) quality of life and
health-related Visual Analogue Scales, 2) State-Trait Anxiety
Inventory-Form Y1, 3) Beck Depression Inventory, and 4) PTSD Checklist
for DSM-5. Results: A comparison between healthcare professionals
working in COVID-19 wards and other units revealed that the former
reported higher levels of both depressive symptoms and PTSS. Moreover,
the results of regression analyses showed that in healthcare
professionals working with COVID-19 patients, gender and marital status,
and gender and age significantly predicted depressive symptoms and PTSS,
respectively. Particularly, being female and not in a relationship were
found to be associated with higher levels of depressive symptoms,
whereas being female and older were found to be related to higher levels
of PTSS. Conclusions: The current findings suggest that specific
predisposing factors could identify healthcare workers who are at high
risk of developing mental health symptoms when faced with COVID-19
patients.%
\end{abstract}%



\sloppy


\textbf{1. INTRODUCTION}

The COVID-19 pandemic represents one of the most stressful events in
recent times worldwide. This pandemic poses a major challenge to social,
economic, and, above all, the psychological resources of the population.
Undoubtedly, healthcare workers are the most exposed category. Their
psychological burden is likely due to the staff reorganisation, the
working intensity, and the anxiety of being exposed to the virus at
hospital and, in turn, of bringing the infection
home.\textsuperscript{1} The healthcare workers directly involved in the
care of patients with COVID-19 are at high risk of developing
psychological distress and other mental health symptoms such as
posttraumatic stress symptoms (PTSS).\textsuperscript{2}

The main aim of the present study was to investigate the psychological
impact of the COVID-19 outbreak on Italian healthcare workers. First, we
compared the levels of psychological distress (i.e., anxiety/depressive
symptoms) and PTSS between healthcare professionals working in the front
line of COVID-19 and healthcare professionals working in other units.
Second, we explored which sociodemographic and clinical factors could
significantly predict psychological distress and PTSS levels in the
group of healthcare workers involved in the care of COVID-19 patients.

\textbf{2. METHODS}

The data were collected using an online survey from March 19 to April 5,
2020. An anonymised, individual, and unique code to complete the survey
was provided to those who agreed to participate in the study.

The responses of 145 healthcare workers (72 medical doctors and 73
nurses) were included in the final dataset. Participants were asked to
provide sociodemographic and clinical information, and to complete: 1)
quality of life and health-related Visual Analogue Scales (VAS); 2)
State-Trait Anxiety Inventory-Form Y1 (STAI Y1); 3) Beck Depression
Inventory (BDI-II); and 4) PTSD Checklist for DSM-5 (PCL-5) to
investigate the presence of PTSS.

The study was approved by the University of Turin Ethics Committee and
conducted in

accordance with the Declaration of Helsinki. All the participants gave
their written informed

consent to participate in the study.

\textbf{3. RESULTS}

The total sample had a mean age of 42.90 (SD = 11.20) years, 72\% (105)
of participants were female, and 43\% (63) worked in COVID-19 wards. The
majority of the participants had at least one child (56\%, 81) and were
in a relationship (61\%, 88).

The group comparisons of sociodemographic and clinical characteristics,
quality of life and health-related data, and psychological measures
(BDI, STAI Y2, and PCL-5) are presented in \textbf{Fig. 1} .

The results of comparisons showed that healthcare professionals who work
in COVID-19 wards were younger (mean \selectlanguage{ngerman}± SD: 39.05 ± 8.28 vs. 45.87 ±
12.24, \emph{t} (140.91) = -3.993, \emph{p} \textless{} .001, \emph{d} =
0.65) and more likely not in a relationship (\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}(1) =
4.573, \emph{p} = .032), compared to healthcare professionals working in
other facilities.

With regard to the psychological assessment, healthcare professionals
who work COVID-19 wards reported higher levels of both depressive
symptoms (\emph{p} = .005, \emph{d} = 0.40) and PTSS (\emph{p} =
.015,\emph{d} = 0.47) compared to healthcare professionals working in
non-COVID-19 facilities. A chi-square test confirmed the presence of a
significant association between participants who scored above the PCL-5
cut-off ([?] 33) and those who worked in COVID-19 wards
(\selectlanguage{greek}χ\selectlanguage{english}\textsuperscript{2}(1) = 4.374, \emph{p} = .036).

Considering the high levels of depressive symptoms and PTSS reported by
healthcare professionals who work COVID-19 wards, two multiple
regression analyses were performed to assess whether sociodemographic
and clinical variables (age, gender, having/not having children,
being/not being in a relationship, having/not having a medical
condition) significantly predicted the BDI and PCL-5 scores in this
subgroup of healthcare workers.

With regard to depressive symptoms, the multiple regression model
statistically significantly predicted the BDI total score, \emph{F} (5,
57) = 4.970, \emph{p} = .001, adj. \emph{R\textsuperscript{2}} = .24.
Among the five predictors, gender (\selectlanguage{greek}\emph{β} \selectlanguage{english}= -0.252, \emph{p} = .032)
and marital status (\selectlanguage{greek}\emph{β} \selectlanguage{english}= 0.441, \emph{p} = .001) were
statistically significant. Particularly, being female and not in a
relationship were found to be associated with higher levels of
depressive symptoms.

Regarding PTSS, the multiple regression model statistically
significantly predicted the PCL-5 total score, \emph{F} (5, 57) =
5.127,\emph{p} = .001, adj. \emph{R\textsuperscript{2}} = .25. Among the
five predictors, age (\selectlanguage{greek}\emph{β} \selectlanguage{english}= 0.554, \emph{p} = .001) and gender
(\selectlanguage{greek}\emph{β}\selectlanguage{english}= -0.398, \emph{p} = .001) were statistically significant.
Particularly, being female and older were found to be related to higher
levels of PTSS.

\textbf{4. DISCUSSION}

The present results showed that healthcare professionals who work in
COVID-19 wards reported higher levels of depressive symptoms and PTSS
than those who work in other healthcare units. These findings are very
understandable in view of the fact that healthcare workers involved in
the frontline of COVID-19 are in a daily struggle to keep the patients
alive. Furthermore, medical health workers constantly find themselves
exposed to highly risky situations, which can make them feel unsafe at
work. The relentless spread of the virus, the lack of sufficient rest,
the permanent threat of being infected, the workload, the shortage of
medical protective equipment, and frequent isolation from family are all
factors that can contribute to the high risk of acute mental health
conditions in healthcare workers in the long
term.\textsuperscript{4-6}In particular, the prolonged exposure to
traumatic events, such as the death of patients and colleagues, may lead
to the development of severe anxiety and depressive symptoms, as well as
PTSS.\textsuperscript{2, 3}

Possible predisposing factors for the mental health symptoms observed in
healthcare professionals working in COVID-19 wards were found to be
being female and not in a relationship for depressive symptoms and being
female and older for PTSS.

With regard to gender differences, our findings are in line with
previous studies\textsuperscript{2, 3} that showed a higher prevalence
of PTSS in women than men, in both general population and healthcare
workers. Regarding age differences, the available evidence is still
controversial and, in some cases, no differences\textsuperscript{3} or
opposite results have been obtained\textsuperscript{2}. For instance, in
contrast to our data, the study of Tang et al.\textsuperscript{2} showed
that the healthcare workers aged between 20 and 30 years obtained the
highest PTSS scores during a previous pandemic. Conversely, Liu et
al.\textsuperscript{3} found that in the general population, the
youngest reported the lowest level of PTSS, but age did not represent a
predictive factor for developing PTSS during the COVID-19 epidemic.
Furthermore, it is well known that women are more vulnerable to
developing depressive symptoms\textsuperscript{7, 8} and that adequate
social support provided by partners or spouses represents a protective
factor for the psychological well-being.\textsuperscript{9, 10}

Taken together, our findings suggest that healthcare professionals
involved in COVID-19 management display high levels of both depressive
symptoms and PTSS. Moreover, specific predisposing factors seem to
characterise those healthcare worker members who are at high risk of
developing depressive symptoms and PTSS when faced with COVID-19
patients.

During the extraordinary events associated with the COVID-19 pandemic,
it is essential to take on healthcare workers' needs, providing timely
psychosocial and mental health support, particularly for those groups
identified at risk. Indeed, healthcare professionals expect to be
welcomed, listened to, supported, and protected by their
organisations.\textsuperscript{1}

\textbf{References}

\begin{enumerate}
\tightlist
\item
  Shanafelt T, Jonathan R, Mickey T. Understanding and addressing
  sources of anxiety among health care professionals during the COVID-19
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  doi:\emph{https://doi.org/10.1001/jama.2020.5893}.
\item
  Tang L, Pan L, Yuan L, Zha L. Prevalence and related factors of
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\item
  Liu N, Zhang F, Wei C, et al. Prevalence and predictors of PTSS during
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\item
  Zhang WR., Wang K, Yin L, et al. Mental health and psychosocial
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\item
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\item
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  Braithwaite S, Holt-Lunstad J. Romantic relationships and mental
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\end{enumerate}

\textbf{Conflict of Interest}

The authors declare that they have no conflicts of interest.

\textbf{Ethical Approval}

The study was approved by the University of Turin Ethics Committee
(Prot. n. 142069) and was conducted in accordance with the Declaration
of Helsinki. All the participants gave their written informed consent to
participate in the study.

\textbf{Fig. 1. Group comparisons on sociodemographic and clinical data,
quality of life and health-related items, and psychological outcomes of
healthcare professionals working in COVID-19 wards vs other wards (N =
145). (A)} Percentages of healthcare workers based on gender, marital
status, children, and medical condition. \textbf{(B)} Mean (SE) scores
of healthcare workers for the three Visual Analog Scales (0--10),
assessing health concern, health evaluation, and life
satisfaction.\textbf{(C)} Mean (SE) scores of healthcare workers for the
State-Trait Anxiety Inventory (STAI-Y1, range 20--80), Beck Depression
Inventory (BDI-II, range 0--55), and Posttraumatic Stress Disorder
Checklist for DSM-5 (PCL-5, range 0--80).

Note: * p-value \textless{} .05; ** p-value \textless{} .01.

\textbf{Hosted file}

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