Stress and safety of maternal and newborn healthcare workers early in the COVID-19 pandemic: a repeat cross-sectional analysis from a global online survey from March 2020 to March 2021

Objectives
This study aims to characterise the physical and psychological well-being of maternal and newborn healthcare workers (MNHCWs) during the COVID-19 pandemic.

Design
Observational repeated cross-sectional study.

Setting
An online questionnaire was distributed to MNHCWs around the globe in three separate rounds from March 2020 to March 2021.

Participants
Total samples of N=1357 (round 1) and N=420 (round 3) primarily consisted of doctors, midwives and nurses in maternal and newborn specialties. Samples represented all WHO regions, with 33% (round 1) and 42% (round 3) from low- or middle-income countries (LMICs).

Primary and secondary outcome measures
Responses from rounds 1 (March–June 2020) and 3 (December 2020–March 2021) were analysed to measure self-reported levels of relative stress and workplace protection from COVID-19, while associated factors were determined through multivariable ordinal logistic regression.

Results
In round 1, 90% of MNHCWs reported increased stress levels and 45% reported insufficient personal protective equipment (PPE) access. Nurses and physicians were less likely to report increased stress than midwives at the pandemic onset. Factors associated with increased stress included being female, being from an LMIC and insufficient PPE. In round 3, 75% reported similar or increased stress while 10% reported insufficient PPE. In both rounds, over 50% of MNHCWs felt relatively or completely unprotected from COVID-19 in the workplace. Those from LMICs were more likely to report feeling unprotected, while receiving organisational information that valued safety was associated with better feelings of protection in the workplace.

Conclusions
Among our international sample of MNHCWs, we observed high rates of self-reported stress increase at the start of the pandemic with persistence or increase up to a year later. High rates of feeling unprotected persisted even as PPE became more available. These results may inform interventions needed to support and protect MNHCWs during this and future pandemics.

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Agosto 2023

Protocol for the COVID-19 Wellbeing and Stress Study: a longitudinal study of parent distress, biological stress and child biopsychosocial development during the pandemic and beyond

Introduction
The COVID-19 pandemic has had a unique impact on the mental health and well-being of pregnant individuals and parents of young children. However, the impact of COVID-19-related stress during pregnancy on early child biopsychosocial development, remains unclear. The COVID-19 Wellbeing and Stress Study will: (1) investigate the impact of different forms of prenatal stress experienced during the pandemic (including objective hardship, perceived psychological distress and biological stress) on child stress biology, (2) examine the association between child stress biology and child developmental outcomes, (3) determine whether child stress biology acts as a mechanism linking prenatal stress to adverse child developmental outcomes and (4) assess whether gestational age at the onset of the COVID-19 pandemic or child sex, moderate these associations.

Methods and analyses
The COVID-19 Wellbeing and Stress Study is a prospective longitudinal study, consisting of six time points, spanning from pregnancy to 3 years postpartum. The study began in June 2020, consisting of 304 pregnant people from Ontario, Canada. This multimethod study is composed of questionnaires, biological samples, behavioural observations and developmental assessments

Ethics and dissemination
This study was approved by the Hamilton Integrated Research Ethics Board (#11034) and the Mount Saint Vincent University Research Ethics Board (#2020-187, #2021-075, #2022-008). Findings will be disseminated through peer-reviewed presentations and publications, community presentations, and electronic forums (social media, newsletters and website postings).

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Agosto 2023

Psychological capital and perceived supervisor social support as mediating roles between role stress and work engagement among Chinese clinical nursing teachers: a cross-sectional study

Objective
This study aimed to investigate the work engagement of clinical nursing teachers and examine whether psychological capital and perceived supervisor social support mediates the association between role stress and work engagement among clinical nursing teachers.

Design
A cross-sectional study design was used.

Setting
This study was conducted in five tertiary hospitals affiliated with medical universities in Shandong Province, China.

Participants
A total of 412 clinical nursing teachers were recruited out of which 406 completed the questionnaires effectively.

Methods
Questionnaires were administered offline and the items consisted of social demographic characteristics, scale related to role stress, psychological capital, perceived supervisor social support and work engagement. T-tests, one-way analysis of variance and Pearson’s correlation analysis were conducted using SPSS, and mediation analysis was performed using structural equation modelling.

Results
The work engagement scores of clinical nursing teachers were high, with an average score of 4.76±0.69. Structural equation modelling showed a good fit of the data to the hypothesised model. Role stress did not directly affect work engagement (β=0.057, p >0.001). However, a strong indirect effect of role stress on work engagement (β=–0.373, p

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Agosto 2023

Co-development of traumatic stress symptoms and externalising behaviour problems among foster children and the effect of complex trauma: a latent growth curve model

Objectives
Foster children are disproportionately exposed to complex trauma, which may lead to multifaceted impairments that manifest in comorbid emotional and behavioural problems. As little is known about the interactions between comorbid disorders over time, the present study aims to explore the co-development of traumatic stress (TS) symptoms and externalising behaviour problems (EBP), as well as the influence of complex trauma operationalised as cumulative child maltreatment (CM).

Setting
As part of a 3-year longitudinal study, children from six foster care facilities in Lower Austria were interviewed at three measurement points.

Participants
Of, in total, 263 participating children, the data of 124 children aged 10–18 years (M=13.5, 28% female) could be analysed.

Primary and secondary outcome measures
Latent growth curve models were used to examine the co-development of TS symptoms (International Trauma Questionnaire) and EBP (Child Behaviour Checklist) over time; gender, age and cumulative CM (Childhood Trauma Questionnaire) acted as time-invariant covariates.

Results
While average TS symptoms decreased over time, EBP remained stable. Findings revealed that the initial severity of EBP was both related to the initial severity of TS symptoms and predictive of their rate of change. Cumulative CM was a significant predictor of initial TS symptoms and EBP even after controlling for age and gender, but not for the rates of change.

Conclusions
Taken together, our results indicate that EBP and TS symptoms are not only cross-sectionally associated but interact with each other over time. Furthermore, an underlying complex trauma could at least partly determine the severity of the two symptom groups. In accordance with a trauma-informed care approach, our study highlights the importance of trauma-specific screening of high-risk children with complex or diffuse symptoms and argues for the benefits of treatments that focus on improving emotion regulation and social skills in addition to addressing trauma.

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Agosto 2023

Exploring physical and biological manifestations of burnout and post-traumatic stress disorder symptoms in healthcare workers: a scoping review protocol

Introduction
The COVID-19 pandemic has strained the mental and physical well-being of healthcare workers (HCW). Increased work-related stress and limited resources have increased symptoms of anxiety, depression, insomnia and post-traumatic stress disorder (PTSD) in this population. Stress-related disorders have been strongly associated with long-term consequences, including cardiometabolic disorders, endocrine disorders and premature mortality. This scoping review aims to explore available literature on burnout, PTSD, and other mental health-associated symptoms in HCW to synthesise relationships with physiological and biological biomarkers that may be associated with increased risk of disease, creating an opportunity to summarise current biomarker knowledge and identify gaps in this literature.

Methods and analysis
This scoping review uses the Arksey and O’Malley six-step scoping review methodology framework. The research team will select appropriate primary sources using a search strategy developed in collaboration with a health sciences librarian. Three reviewers will initially screen the title and abstracts obtained from the literature searches, and two reviewers will conduct independent reviews of full-text studies for inclusion. The research team will be reviewing literature focusing on which burnout and/or PTSD-associated physiological and biological biomarkers have been studied, the methodologies used to study them and the correlations between the biomarkers and HCW experiencing burnout/PTSD. Data extraction forms will be completed by two reviewers for included studies and will guide literature synthesis and analysis to determine common themes.

Ethics and dissemination
This review does not require ethical approval. We expect results from this scoping review to identify gaps in the literature and encourage future research regarding improving biological and physiological biomarker research in HCW. Preliminary results and general themes will be communicated back to stakeholders. Results will be disseminated through peer-reviewed publications, policy briefs and conferences as well as presented to stakeholders to an effort to invest in HCW mental and physical health.

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Luglio 2023

Mind-body exercise interventions for prevention of post-traumatic stress disorder in trauma-exposed populations: a systematic review and meta-analysis

Objective
Mind-body exercise (MBE) interventions, such as yoga, are increasingly recognised as an adjunct treatment for trauma-related mental disorders but less is known about their efficacy as a preventative intervention. We aimed to systematically review if, and what type of, MBE interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) or acute stress disorder (ASD) in trauma-exposed populations.

Design
Systematic review and meta-analysis.

Methods
A systematic search of MEDLINE, PsycINFO, EMBASE and CENTRAL databases was conducted to identify controlled trials of MBE interventions aimed at preventing the development of PTSD or ASD in high-risk populations. Risk of bias was assessed using the revised Cochrane risk-of-bias and ROBINS-I tools. Pooled effect sizes using Hedges’ g and 95% CIs were calculated using random effects modelling for the main meta-analysis and planned subgroup and sensitivity analyses.

Results
Six studies (N analysed=399) were included in the final meta-analysis. Overall, there was a small effect for MBE interventions in preventing the development of PTSD (g=–0.25, 95% CI –0.56 to 0.06) among those with previous or ongoing exposure to trauma. Although a prespecified subgroup analyses comparing the different types of MBE intervention were conducted, meaningful conclusions could not be drawn due to the small number of studies. None of the included studies assessed ASD symptoms.

Conclusion
Limited evidence was found for MBE interventions in reducing PTSD symptomology in the short term. Findings must be interpreted with caution due to the small number of studies and possible publication bias.

PROSPERO registration number
CRD42020180375

Leggi
Luglio 2023