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      Psychological distress of frontline healthcare workers in the intensive care unit during the early stage of the COVID-19 pandemic: a qualitative study from China

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          Abstract

          Objective

          The rapid spread of COVID-19 has overwhelmed healthcare systems across the world. During the early stage of the pandemic, frontline healthcare workers (FHWs) caring for patients at intensive care units (ICUs) faced extreme pressure and challenges. This qualitative study aimed to describe the different phases of psychological distress of FHWs during the early stage of the COVID-19 pandemic.

          Design

          Qualitative study.

          Setting

          The First Affiliated Hospital of Zhengzhou University, a designated hospital for patients with COVID-19 in central China.

          Participants

          Eight physicians and six nurses working in the ICU who provided direct patient care for COVID-19 patients.

          Methods

          A descriptive phenomenological study using thematic analysis was applied. Semi-structured one-on-one interviews over telephone or Wechat (a social platform in China) rather than face-to-face interviews were conducted due to quarantine. Interviews were audio-recorded and transcribed verbatim and then were analysed thematically.

          Findings

          A total of 14 interviews were conducted, and each interview lasted 20–60 min. Five thematic categories were identified, and the participants’ psychological experiences were classified into five stages (1) the mobilisation period: a sense of responsibility with worries; (2) the preparation period: worries, fears and doubts about the epidemic; (3) the transitional period: complex and diverse psychological feelings; (4) the adaptation period: self-adjustment and help from external support and (5) the reflection period: a reflection on life and nature.

          Conclusion

          The study showed that the COVID-19 pandemic had significant psychological impacts on FHWs. Self-regulation and external support help FHWs to overcome challenges to a certain extent. More attention should be paid to the psychological wellbeing of ICU FHWs in COVID-19-designated hospitals.

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          Most cited references33

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          The psychological impact of quarantine and how to reduce it: rapid review of the evidence

          Samantha K. Brooks, Rebecca K Webster, Louise E. Smith … (2022)
          Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
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            A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak

            Nicholas W.S. Chew, Grace K.H. Lee, Benjamin Tan … (2020)
            Highlights • Commonly reported symptoms are headache, throat pain and lethargy. • A large number of healthcare workers report more than four symptoms. • Those with physical symptoms had higher rates of depression, anxiety, stress, PTSD. • Those with physical symptoms had higher mean scores in the IES-R, DASS subscales. • Association between physical symptoms and psychological outcomes may be bidirectional.
            Article 0 comments Cited 765 times – based on 0 reviews     Review now
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              Mental Health and Psychosocial Problems of Medical Health Workers during the COVID-19 Epidemic in China

              Wen-rui Zhang, Kun Wang, Lu Yin … (2020)
              Objective We explored whether medical health workers had more psychosocial problems than nonmedical health workers during the COVID-19 outbreak. Methods An online survey was run from February 19 to March 6, 2020; a total of 2,182 Chinese subjects participated. Mental health variables were assessed via the Insomnia Severity Index (ISI), the Symptom Check List-revised (SCL-90-R), and the Patient Health Questionnaire-4 (PHQ-4), which included a 2-item anxiety scale and a 2-item depression scale (PHQ-2). Results Compared with nonmedical health workers (n = 1,255), medical health workers (n = 927) had a higher prevalence of insomnia (38.4 vs. 30.5%, p < 0.01), anxiety (13.0 vs. 8.5%, p < 0.01), depression (12.2 vs. 9.5%; p< 0.04), somatization (1.6 vs. 0.4%; p < 0.01), and obsessive-compulsive symptoms (5.3 vs. 2.2%; p < 0.01). They also had higher total scores of ISI, GAD-2, PHQ-2, and SCL-90-R obsessive-compulsive symptoms (p ≤ 0.01). Among medical health workers, having organic disease was an independent factor for insomnia, anxiety, depression, somatization, and obsessive-compulsive symptoms (p < 0.05 or 0.01). Living in rural areas, being female, and being at risk of contact with COVID-19 patients were the most common risk factors for insomnia, anxiety, obsessive-compulsive symptoms, and depression (p < 0.01 or 0.05). Among nonmedical health workers, having organic disease was a risk factor for insomnia, depression, and obsessive-compulsive symptoms (p < 0.01 or 0.05). Conclusions During the COVID-19 outbreak, medical health workers had psychosocial problems and risk factors for developing them. They were in need of attention and recovery programs.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2022
                Publication date (Electronic): 21 February 2022
                Publication date PMC-release: 21 February 2022
                Volume: 12
                Issue: 2
                Electronic Location Identifier: e049627
                Affiliations
                [1 ]departmentDepartment of Pharmacy , The First Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan, China
                [2 ]departmentBlood Purification Center , The First Affiliated Hospital of Zhengzhou University , Zhengzhou, Henan, China
                Author notes
                [Correspondence to ] Dr Xiaohong Yue; Yuexiaohong2009@ 123456126.com
                Author information
                http://orcid.org/0000-0003-2589-0962
                http://orcid.org/0000-0001-7792-252X
                Article
                Publisher ID: bmjopen-2021-049627
                DOI: 10.1136/bmjopen-2021-049627
                PMC ID: 8861884
                PubMed ID: 35190413
                SO-VID: d3fb2900-0bba-437a-a97e-0a97309d9c65
                Copyright © © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 04 February 2021
                Date accepted : 22 December 2021
                Categories
                Subject: Public Health
                Subject: 1506
                Subject: 2474
                Subject: 1724
                Series title: Original research
                Custom metadata
                special-feature unlocked

                ScienceOpen disciplines: Medicine
                Keywords: covid-19,mental health and psychiatry,qualitative study
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: covid-19, mental health and psychiatry, qualitative study

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