Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jun 19, 2022; 12(6): 843-859
Published online Jun 19, 2022. doi: 10.5498/wjp.v12.i6.843
Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital: A factor analytical study
Marcos O Carvalho-Alves, Vitor A Petrilli-Mazon, Andre R Brunoni, Andre Malbergier, Pedro Fukuti, Guilherme V Polanczyk, Euripedes C Miguel, Felipe Corchs, Yuan-Pang Wang
Marcos O Carvalho-Alves, Vitor A Petrilli-Mazon, Andre R Brunoni, Andre Malbergier, Pedro Fukuti, Guilherme V Polanczyk, Yuan-Pang Wang, Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
Marcos O Carvalho-Alves, Felipe Corchs, Program in Neuroscience and Behavior, Department of Experimental Psychology, Institute of Psychology, University of Sao Paulo, Sao Paulo 01060-970, Brazil
Euripedes C Miguel, Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo 05403-010, Brazil
Felipe Corchs, Department of Psychiatry, University of Sao Paulo, Sao Paulo 05403-010, Brazil
Author contributions: Carvalho-Alves MO, Brunoni AR, Malbergier A, Fukuti P, Polanczyk GV, Miguel EC and Corchs F contributed to the study design, data acquisition and interpretation, and revised the manuscript; Wang YP conceived the statistical analysis; Carvalho-Alves MO, Petrilli-Mazon VA, Corchs F and Wang YP conducted the statistical analysis and wrote the preliminary draft; all authors reviewed and approved the manuscript in its final version.
Institutional review board statement: This study was approved by the National Research Ethics Commission of the Ministry of Health, Brazil.
Informed consent statement: All study participants gave their informed consent before study inclusion.
Conflict-of-interest statement: There are no conflicts of interest in this work.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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 and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan-Pang Wang, MD, MSc, PhD, Research Scientist, Department of Psychiatry, School of Medicine, University of Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785, Cerqueira César, Sao Paulo 05403-010, Brazil. gnap_inbox@hotmail.com
Received: December 21, 2021
Peer-review started: December 21, 2021
First decision: March 13, 2022
Revised: April 22, 2022
Accepted: May 13, 2022
Article in press: May 13, 2022
Published online: June 19, 2022
Processing time: 174 Days and 11 Hours
ARTICLE HIGHLIGHTS
Research background

The current pandemic has generated a dramatic challenge to public health, in a set of contextual changes throughout the world, including millions of deaths, the collapse of health systems, economic disruption, and food insecurity. During frontline service, hospital workers (HWs) were exposed to an increased risk of becoming infected, fear of infecting family members, ethical conflicts, overwhelming workload, among other stressors. Facing these stressors may contribute to a decline in their psychological well-being. Supporting this suggestion, high rates of depression, anxiety, stress, burnout, and insomnia have been reported among hospital professionals.

Research motivation

Several observational studies have described rates of common psychological responses of HWs facing the current pandemic. Nevertheless, few studies have examined the structure of multiple co-occurring symptoms through exploratory factor analysis. The data reduction approach is a potential asset to expand our understanding of how to prevent or reduce emotional distress in healthcare settings using a smaller number of variables.

Research objectives

We aimed to show core dimensions of common psychological symptoms as well as their associated predictors among HWs in a coronavirus disease 2019 (COVID-19) reference hospital.

Research methods

This is an observational study, and the data were cross-sectionally collected using an online survey during the first peak of the pandemic in Brazil. Data of 1000 HWs who completed the survey were analyzed (83.9% women and 34.3% aged 30 to 40). Self-reported symptoms of depression, anxiety, trauma-related stress, and burnout were subjected to exploratory factor analysis. Multiple linear regression models were then carried out to estimate predictors for each of the factors retained using questions on personal motivation, threatening events, and institutional support as independent variables.

Research results

HWs presented high rates of depression, anxiety, stress, and burnout during their frontline duty, as well as increased tobacco and alcohol consumption. The following three factors were the main dimensions of HWs’ distress: avoidance and re-experience, depression-anxiety, and sleep changes. Institutional support was the most significant protective factor for each of these dimensions. Furthermore, scores of the avoidance and re-experience dimension were associated with having a family member or a close friend with severe COVID-19 and having dealt with an ethical challenge. Contrary to expectation, participants’ personal motivation to work with COVID-19 patients was not associated with these factors.

Research conclusions

This factor analytic study revealed distressing dimensions of avoidance and re-experience, depression-anxiety, and sleep changes as the core psychological reactions of a sample of Brazilian HWs during the pandemic. It also highlighted the importance of institutional support in preventing a worsening of hospital professionals’ mental health during their pandemic service. These findings have implications for tailoring interventions to maintain HWs’ mental health.

Research perspectives

Data reduction methods, such as exploratory factor analysis, contribute to enlarging our understanding of the core psychological reactions of hospital professionals during a sanitary crisis. Multiple co-occurring symptoms can be clustered in a sound dimensional structure. In the future, institutional strategies based on these unobservable patterns could be planned to improve occupational well-being in health settings, either during subsequent waves of COVID-19 or during other future pandemic crises. Lastly, analyzing the longitudinal trajectory of the HWs’ reactions could help to elucidate coping mechanisms in similar stressful periods.