Anxiety, Depression and Risk of Post-Traumatic Stress Disorder in Health Workers: The Relationship with Burnout during COVID-19 Pandemic in Italy
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design and Sample
2.2. Study Instrument
2.2.1. Depressive Symptoms
2.2.2. Generalized Anxiety Disorder Symptoms
2.2.3. Insomnia Symptoms
2.2.4. Posttraumatic Stress Disorder symptoms
2.2.5. Burnout Symptoms
2.3. Data Analysis
3. Results
3.1. Sample Characteristics
3.2. Identification of Post-Traumatic Symptoms and Other Psychopathology Risk Factors
3.3. Burnout Impact on Health Workers Mental Health
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Main Categories | Variable | Frequencies | Percent | |
---|---|---|---|---|
Socio- Demographic | Gender | Female | 556 | 76 |
Male | 175 | 24 | ||
Marital status | Married/Common law | 483 | 66 | |
Stable relationship (not living together) | 69 | 10 | ||
Separated/divorced | 89 | 12 | ||
Single | 90 | 12 | ||
Living alone | No | 596 | 18 | |
Yes | 135 | 82 | ||
Offspring | No | 253 | 65 | |
Yes | 478 | 35 | ||
Employment | Job | Medical staff | 192 | 26 |
Nurse | 359 | 49 | ||
Social health worker | 72 | 10 | ||
Other | 108 | 15 | ||
Seniority | Less than 10 years | 197 | 27 | |
Between 11 and 20 years | 172 | 24 | ||
Between 21 and 30 years | 175 | 24 | ||
Over 30 years | 187 | 25 | ||
COVID-19 specific stressors | Working with COVID-19 positive patients | No | 232 | 32 |
Yes | 499 | 68 | ||
Have you changed your ward? | No | 577 | 79 | |
Yes | 154 | 21 | ||
Have you been exposed to covid-19? | No | 60 | 8 | |
Yes | 671 | 92 | ||
Have you been infected? | No | 549 | 75 | |
Yes | 114 | 16 | ||
Other | 68 | 9 | ||
Beloved with COVID-19 | No | 386 | 53 | |
Yes | 345 | 47 | ||
Beloved dead with COVID-19 | No | 587 | 80 | |
Yes | 144 | 20 | ||
Other psychological variables | Work impact on psychological well being | No | 280 | 38 |
Yes | 451 | 62 | ||
Need for psychological support | No | 435 | 60 | |
Yes | 296 | 40 | ||
Use of sleeping medication | No | 579 | 79 | |
Yes | 152 | 21 | ||
Use of anxiolytic medication | No | 586 | 80 | |
Yes | 145 | 20 | ||
Use of alcohol | No | 497 | 68 | |
yes | 234 | 32 | ||
Psychological Screening | PHQ9 | None | 278 | 38 |
Mild | 233 | 32 | ||
Moderate | 126 | 17 | ||
Moderately severe | 71 | 10 | ||
Severe | 23 | 3 | ||
GAD7 | None | 284 | 39 | |
Mild | 246 | 34 | ||
Moderate | 122 | 16 | ||
Severe | 79 | 11 | ||
ISI | None | 382 | 52 | |
Minimal or none | 220 | 30 | ||
Moderate | 105 | 14 | ||
Severe | 24 | 4 | ||
IESR Tot | None | 481 | 66 | |
Possible PTSD | 250 | 34 | ||
MBI—Exhaustion | Low | 334 | 46 | |
Medium | 127 | 17 | ||
High | 270 | 37 | ||
MBI—Depersonalization | Low | 379 | 52 | |
Medium | 192 | 26 | ||
High | 160 | 22 | ||
MBI—Personal Accomplishment | Low | 384 | 52 | |
Medium | 202 | 28 | ||
High | 145 | 20 |
Psychopatology | IES–R Tot | PHQ9 | GAD7 | ISI | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Predictor | β(SE) | t | p-Value | β(SE) | t | p-Value | β(SE) | t | p-Value | β(SE) | t | p-Value |
(Intercept) | 13.98 (5.18) | 2.70 | 0.001 ** | 4.48 (1.45) | 3.08 | 0.002 * | 5.05 (1.38) | 3.67 | <0.001 *** | 2.77 (1.78) | 1.56 | 0.119 |
Age | −0.04 (0.09) | −0.52 | 0.600 | 0.03 (0.02) | 1.32 | 0.188 | −0.02 (0.02) | −1.03 | 0.305 | 0.03 (0.03) | 1.17 | 0.244 |
Gender—male | −3.56 (1.29) | −2.75 | 0.006 ** | −0.64 (0.36) | −1.76 | 0.079 | −0.65 (0.34) | −1.89 | 0.058 | −0.10 (0.44) | −0.23 | 0.819 |
Job—Medical staff | 0.59 (1.69) | 0.34 | 0.731 | −0.02 (0.48) | −0.05 | 0.958 | 0.38 (0.45) | 0.85 | 0.397 | −0.43 (0.58) | −0.74 | 0.459 |
Job–Nurse | −0.32 (1.55) | −0.21 | 0.838 | −0.63 (0.44) | −1.45 | 0.149 | −0.27 (0.41) | −0.67 | 0.506 | −0.32 (0.53) | −0.60 | 0.548 |
Job—Social Health worker | 0.71 (2.19) | 0.32 | 0.747 | −0.48 (0.62) | −0.79 | 0.431 | 0.57 (0.58) | 0.98 | 0.329 | −1.07 (0.75) | −1.42 | 0.156 |
Seniority—11–20 years | −1.28 (2.22) | −0.58 | 0.565 | −0.87 (0.62) | −1.40 | 0.162 | −0.01 (0.59) | −0.02 | 0.981 | −0.27 (0.76) | −0.36 | 0.718 |
Seniority—21–30 years | −1.89 (1.69) | −1.12 | 0.263 | −0.62 (0.47) | −1.31 | 0.191 | 0.04 (0.49) | 0.09 | 0.924 | −0.52 (0.58) | −0.89 | 0.369 |
Seniority—Over 30 years | 0.93 (1.94) | 0.48 | 0.633 | −1.09 (0.55) | −1.99 | 0.046 * | −0.36 (0.51) | −0.69 | 0.489 | −0.39 (0.66) | −0.59 | 0.549 |
COVID-19 specific stressors | 0.57 (1.94) | 0.29 | 0.770 | −0.57 (0.54) | −1.06 | 0.289 | 0.19 (0.51) | 0.39 | 0.699 | 1.23 (0.66) | 1.86 | 0.064 |
Infected No | 0.65 (1.93) | 0.34 | 0.736 | −0.45 (0.54) | −0.83 | 0.406 | −0.70 (0.51) | −1.38 | 0.169 | 0.29 (0.66) | 0.44 | 0.663 |
Infected Yes | 1.33 (2.25) | 0.59 | 0.554 | 0.24 (0.64) | 0.38 | 0.705 | −0.41 (0.59) | −0.69 | 0.488 | 0.38 (0.77) | 0.50 | 0.617 |
Beloved with covid—Yes | 0.53 (1.25) | 0.42 | 0.674 | 0.19 (0.35) | 0.56 | 0.579 | 0.16 (0.33) | 0.48 | 0.633 | −0.11 (0.43) | −0.25 | 0.803 |
Beloved dead with covid—Yes | 1.59 (1.56) | 1.02 | 0.307 | −0.35 (0.44) | −0.79 | 0.431 | 0.21 (0.41) | 0.52 | 0.604 | 0.22 (0.53) | 0.41 | 0.681 |
Work impact on wellbeing—Yes | 5.73 (1.29) | 4.45 | <0.001 *** | 0.45 (0.36) | 1.26 | 0.209 | 0.69 (0.34) | 2.03 | 0.043 * | 0.46 (0.44) | 1.05 | 0.292 |
Need for psychological support—Yes | 7.19 (1.29) | 5.58 | <0.001 *** | 1.91 (0.36) | 5.28 | <0.001 *** | 1.71 (0.34) | 4.99 | <0.001 *** | 2.11 (0.44) | 4.77 | <0.001 *** |
Sleeping medication—Yes | 2.72 (1.49) | 1.84 | 0.067 | 0.94 (0.42) | 2.27 | 0.024 * | 0.61 (0.39) | 1.54 | 0.124 | 2.71 (0.51) | 5.33 | <0.001 *** |
Anxiolytic medication—Yes | 3.43 (1.54) | 2.23 | 0.026 * | 1.86 (0.43) | 4.31 | <0.001 *** | 1.31 (0.41) | 3.22 | 0.002 ** | 0.77 (0.53) | 1.46 | 0.145 |
Alcohol—Yes | −0.46 (1.19) | −0.39 | 0.698 | −0.02 (0.33) | −0.05 | 0.963 | 0.09 (0.32) | 0.31 | 0.759 | −0.01 (0.41) | 0.00 | 0.999 |
MBI Depersonalization | 0.18 (0.11) | 1.66 | 0.098 | −0.01 (0.03) | −0.37 | 0.711 | −0.01 (0.02) | −0.07 | 0.947 | −0.07 (0.04) | −1.82 | 0.069 |
MBI Personal Accomplishment | −0.09 (0.06) | −1.37 | 0.172 | −0.06 (0.01) | −3.50 | <0.001 *** | −0.05 (0.02) | −2.79 | 0.005 ** | −0.07 (0.02) | −3.01 | 0.002 ** |
MBI—Emotional Fatigue | 0.45 (0.05) | 8.94 | <0.001 *** | 0.19 (0.01) | 13.91 | <0.001 *** | 0.18 (0.01) | 13.63 | <0.001 *** | 0.19 (0.02) | 11.31 | <0.001 *** |
R 2 (adjusted R 2) | 0.49 (0.47) | 0.57 (0.55) | 0.56 (0.55) | 0.46 (0.44) | ||||||||
Residual std. error | 13.56 | 3.81 | 3.60 | 4.65 | ||||||||
F statistic (df = 21, 672) | 30.21 *** | 41.62 *** | 40.74 *** | 27.38 *** |
Variable | Mean and Standard Deviation | MBI | Mean and Standard Deviation (Low Risk) | Mean and Standard Deviation (Medium and High Risk) | t-Test for Risk of Burnout Differences |
---|---|---|---|---|---|
PHQ9 | 7.32 ± 5.69 | DP | 5.70 ± 4.90 | 9.10 ± 5.96 | t(638.19) = −8.17, p < 0.001 *** Cohen’s d = 0.62 |
EE | 3.78 ± 3.48 | 10.28 ± 5.48 | t(647.77) = −18.9, p < 0.001 *** Cohen’s d = 1.39 | ||
PA | 5.61 ± 4.66 | 9.23 ± 6.11 | t(606.46) = −8.67, p < 0.001 *** Cohen’s d = 0.67 | ||
GAD7 | 6.86 ± 5.84 | DP | 5.35 ± 4.74 | 8.53 ± 5.49 | t(653.49) = −8.14, p < 0.001 *** Cohen’s d = 0.62 |
EE | 3.53 ± 3.23 | 9.65 ± 5.17 | t(643.54) = −18.98, p < 0.001 *** Cohen’s d = 1.39 | ||
PA | 5.43 ± 4.74 | 8.47 ± 5.53 | t(646.39) = −7.72, p < 0.001 *** Cohen’s d = 0.59 | ||
ISI | 8.19 ± 6.23 | DP | 6.80 ± 5.58 | 9.73 ± 6.55 | t(649.6) = −6.31, p < 0.001 *** Cohen’s d = 0.48 |
EE | 4.63 ± 4.22 | 11.14 ± 6.08 | t(672.78) = −16.44, p < 0.001 *** Cohen’s d = 1.22 | ||
PA | 6.59 ± 5.71 | 9.98 ± 6.32 | t(661.09) = −7.39, p < 0.001 *** Cohen’s d = 0.56 | ||
IES–R | 26.6 ± 18.62 | DP | 20.93 ± 15.23 | 32.85 ± 19.99 | t(612.54) = −8.77, p < 0.001 *** Cohen’s d = 0.68 |
EE | 16.38 ± 13.06 | 35.14 ± 18.28 | t(676.17) = −15.72, p < 0.001 *** Cohen’s d = 1.16 | ||
PA | 22.05 ± 16.75 | 31.7 ± 19.31 | t(649.62) = −6.99, p < 0.001 *** Cohen’s d = 0.54 |
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Ghio, L.; Patti, S.; Piccinini, G.; Modafferi, C.; Lusetti, E.; Mazzella, M.; Del Sette, M. Anxiety, Depression and Risk of Post-Traumatic Stress Disorder in Health Workers: The Relationship with Burnout during COVID-19 Pandemic in Italy. Int. J. Environ. Res. Public Health 2021, 18, 9929. https://doi.org/10.3390/ijerph18189929
Ghio L, Patti S, Piccinini G, Modafferi C, Lusetti E, Mazzella M, Del Sette M. Anxiety, Depression and Risk of Post-Traumatic Stress Disorder in Health Workers: The Relationship with Burnout during COVID-19 Pandemic in Italy. International Journal of Environmental Research and Public Health. 2021; 18(18):9929. https://doi.org/10.3390/ijerph18189929
Chicago/Turabian StyleGhio, Lucio, Sara Patti, Giulia Piccinini, Cinzia Modafferi, Eleonora Lusetti, Massimo Mazzella, and Massimo Del Sette. 2021. "Anxiety, Depression and Risk of Post-Traumatic Stress Disorder in Health Workers: The Relationship with Burnout during COVID-19 Pandemic in Italy" International Journal of Environmental Research and Public Health 18, no. 18: 9929. https://doi.org/10.3390/ijerph18189929