Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital: A factor analytical study

Table 1 Sociodemographic and clinical characteristics of participants (n = 1000)

Characteristics	n (%)
Age bracket
18-30	211 (21.1)
30-40	343 (34.3)
40-50	252 (25.2)
> 50	194 (19.4)
Gender
Female	839 (83.9)
Male	159 (15.9)
Other	2 (0.2)
Marital status
Unmarried	426 (42.6)
Married	574 (57.4)
Educational level
< University graduate	271 (27.1)
≥ University graduate	729 (72.9)
Living with elderly (> 60 yr)
Yes	233 (23.3)
No	767 (76.7)
Living with children
Yes	450 (45.0)
No	550 (55.0)
Occupation
Medical doctor	140 (14.0)
Nurse and nursing assistants	348 (34.8)
Other healthcare professionals1	253 (25.3)
Administrative workers2	259 (25.9)
Work sector
Emergency room	60 (6.0)
Inpatient ward	176 (17.6)
Intensive care unit	157 (15.7)
Outpatient care	128 (12.8)
Operating room	44 (4.4)
Pharmacy	36 (3.6)
Laboratory	84 (8.4)
Other sectors	163 (16.3)
Direct contact with COVID-19 patient (h/wk)
0	204 (20.4)
1-20	311 (31.1)
21-40	285 (28.5)
> 40	200 (20.0)
Had COVID-19 (self-reported)
Yes	328 (32.8)
No	672 (67.2)
Close family or friend hospitalized or who died due to COVID-19
Yes	386 (38.6)
No	614 (61.4)
Changes in daily routine due to pandemic
Financial failure	387 (38.7)
Lack of public safety	199 (19.9)
Lack of public transport	297 (29.7)
Lack of medical care	292 (29.2)
Distancing from family and friends	620 (62.0)
Previous psychiatric or psychological treatment
Yes	280 (28.0)
No	720 (72.0)
Previous self-reported diagnoses
Anxiety	91 (9.1)
Depression	78 (7.8)
PTSD	6 (0.6)
Previous psychotherapy treatment	199 (19.9)
Previous pharmacological treatment	177 (17.7)
Psychological or psychiatric treatment after pandemic beginning	138 (13.8)
Protective health actions
Physical activities	274 (27.4)
Meditative practices	182 (18.2)
Leisure activities/hobbies	320 (32.0)
Religious practices	310 (31.0)
I'm not doing anything in this sense	354 (35.4)
Ethical conflict	119 (11.9)

¹Other healthcare professionals: dentists, speech therapists, psychologists, occupational therapists, dieticians, physical therapists, social workers, pharmacists, clinical laboratory technicians, and radiological technologists.

²Administrative workers: receptionist, information technicians, secretary, security guard.

COVID-19: Coronavirus disease 2019; PTSD: Post-traumatic stress disorder.

Table 2 Frequency of categories of distress symptoms (n = 1000)

Scale and severity categories	n (%)
The Patient Health Questionnaire-9	7 (4-13)1
Minimal (< 5)	312 (31.2)
Mild (5-9)	309 (30.9)
Moderate (10-14)	177 (17.7)
Moderately severe (15-19)	116 (11.6)
Severe (≥ 20)	86 (8.6)
The Generalized Anxiety Disorder-7	6 (3-12)1
Minimal (< 5)	347 (34.7)
Mild (5-9)	328 (32.8)
Moderate (10-14)	154 (15.4)
Severe (≥ 15)	171 (17.1)
The Impact of Event Scale-Revised	24 (11-42)1
Minimal (< 9)	197 (19.7)
Mild (9-25)	335 (33.5)
Moderate (26-43)	225 (22.5)
Severe (≥ 44)	243 (24.3)
Mini-Z Burnout Assessment (≥ 3)2	349 (34.9)
Increased tobacco consumption	76 (7.6)
Increased alcohol consumption	171 (17.1)

¹Interquatile range.

²Participants with a score above the cut-off point for burnout.

Table 3 Pattern matrix of rotated Oblimin solution as extracted through principal axis factoring

Description	Item	Avoidance and re-experience	Depression-anxiety	Sleep changes	Communality
I tried to remove it from my memory	IES-R-17	0.81	-0.10	0.05	0.60
I found myself acting or feeling as though I was back at that time	IES-R-14	0.79	0.03	-0.01	0.66
I was aware that I still had a lot of feelings about it, but I didn't deal with them	IES-R-12	0.79	-0.13	0.02	0.53
I tried not to think about it	IES-R-11	0.78	-0.12	0.04	0.53
Pictures about it popped into my mind	IES-R-9	0.76	0.10	0.01	0.70
I was jumpy and easily startled	IES-R-10	0.75	0.12	0.02	0.71
I tried not to talk about it	IES-R-22	0.75	-0.06	-0.03	0.48
My feelings about it were kind of numb	IES-R-13	0.72	-0.02	-0.02	0.48
I thought about it when I didn't mean to	IES-R-6	0.70	0.14	0.09	0.73
I had waves of strong feelings about it	IES-R-16	0.68	0.12	0.12	0.71
I stayed away from reminders about it	IES-R-8	0.68	-0.10	0.03	0.40
I felt watchful or on-guard	IES-R-21	0.65	0.19	0.01	0.62
I felt as if it hadn't happened or wasn't real	IES-R-7	0.62	0.05	-0.02	0.42
I avoided letting myself get upset when I thought about it or was reminded of it	IES-R-5	0.62	0.05	0.07	0.48
Other things kept making me think about it	IES-R-3	0.61	0.12	0.22	0.70
Reminders of it caused me to have physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart	IES-R-19	0.60	0.20	0.03	0.59
Any reminder brought back feelings about it	IES-R-1	0.59	0.19	0.07	0.59
I had dreams about it	IES-R-20	0.49	0.12	0.10	0.41
I had trouble concentrating	IES-R-18	0.45	0.32	0.12	0.61
I felt irritable and angry	IES-R-4	0.45	0.34	0.09	0.60
Feeling down, depressed, or hopeless	PHQ-9-2	0.01	0.84	-0.05	0.68
Feeling tired or having little energy	PHQ-9-4	-0.15	0.78	0.15	0.60
Little interest or pleasure in doing things	PHQ-9-1	-0.07	0.75	0.09	0.58
Feeling nervous, anxious, or on edge	GAD-7-1	0.06	0.74	0.02	0.63
Feeling bad about yourself - or that you are a failure or have let yourself or your family down	PHQ-9-6	0.05	0.74	-0.09	0.52
Not being able to stop or control worrying	GAD-7-2	0.16	0.72	-0.01	0.69
Becoming easily annoyed or irritable	GAD-7-6	0.11	0.72	-0.03	0.61
Trouble concentrating on things, such as reading the newspaper or watching television	PHQ-9-7	0.04	0.68	0.07	0.55
Worrying too much about different things	GAD-7-3	0.13	0.68	0.03	0.62
Trouble relaxing	GAD-7-4	0.01	0.68	0.22	0.69
Overall, based on your definition of burnout, how would you rate your level of burnout	Mini-Z	-0.05	0.67	0.05	0.45
Moving or speaking so slowly that other people could have noticed	PHQ-9-8	0.18	0.62	-0.08	0.49
Poor appetite or overeating	PHQ-9-5	0.04	0.56	0.13	0.45
Feeling afraid as if something awful might happen	GAD-7-7	0.31	0.56	-0.12	0.53
Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual	PHQ-9-9	0.02	0.49	-0.08	0.21
Being so restless that it's hard to sit still	GAD-7-5	0.27	0.46	-0.06	0.41
I had trouble falling asleep	IES-R-15	0.21	-0.03	0.81	0.85
I had trouble staying asleep	IES-R-2	0.17	0.05	0.74	0.77
Trouble falling or staying asleep, or sleeping too much	PHQ-9-3	-0.16	0.46	0.53	0.60
Eigenvalue; Explained variance (%)		10.76; 28.00	9.22; 24.00	2.50; 6.00
Total explained variance (%)		28.00	52.00	58.00

Loadings above 0.40 are typed in bold. PHQ-9: The Patient Health Questionnaire-9; GAD-7: The Generalized Anxiety Disorder-7; IES-R: The Impact of Event Scale-Revised; Mini-Z: Single-item Mini-Z Burnout Assessment.

Table 4 Multiple linear regressions between predictable variables and each of the emotional dimensions of hospital workers (n = 1000)

	Avoidance and re-experience		Depression-anxiety		Sleep changes
	β (95%CI)	β (95%CI)1	β (95%CI)	β (95%CI)1	β (95%CI)	β (95%CI)1
Direct contact with COVID-19 patient (h/wk)	0.05 (-0.01 to 0.11)	0.02 (-0.04 to 0.09)	0.08 (0.02 to 0.13)b	0.02 (-0.04 to 0.09)	0.03 (-0.03 to 0.08)	-0.02 (-0.08 to 0.05)
Previous psychiatric or psychological treatment (self-reported)	0.33 (0.2 to 0.46)c	0.33 (0.21 to 0.46)c	0.38 (0.27 to 0.5)c	0.38 (0.26 to 0.49)c	0.26 (0.13 to 0.38)c	0.25 (0.12 to 0.38)c
Had COVID-19 (self-reported)	0.14 (0.02 to 0.26)a	0.09 (-0.03 to 0.21)	-0.03 (-0.14 to 0.08)	-0.07 (-0.18 to 0.04)	0.09 (-0.03 to 0.21)	0.05 (-0.07 to 0.17)
Close family or friend hospitalized or who died due to COVID-19	0.14 (0.03 to 0.26)a	0.13 (0.02 to 0.25)a	0.06 (-0.06 to 0.16)	0.06 (-0.04 to 0.17)	0.14 (0.02 to 0.26)a	0.13 (0.01 to 0.24)a
Ethical conflict	0.21 (0.03 to 0.39)a	0.26 (0.08 to 0.44)b	0.08 (-0.09 to 0.25)	0.12 (-0.04 to 0.29)	0.02 (-0.16 to 0.2)	0.03 (-0.15 to 0.21)
Personal motivation	-0.03 (-0.11 to 0.04)	-0.02 (-0.09 to 0.06)	-0.03 (-0.1 to 0.04)	-0.02 (-0.09 to 0.05)	-0.01 (-0.09 to 0.06)	0.01 (-0.07 to 0.08)
Institutional support	-0.26 (-0.34 to -0.18)c	-0.26 (-0.33 to -0.18)c	-0.41 (-0.49 to -0.33)c	-0.41 (-0.48 to -0.34)c	-0.2 (-0.28 to -0.12)c	-0.2 (-0.28 to -0.13)c

¹Adjusted for age, gender, marital status, educational level, and occupation.

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

All models were statistically significant (P < 0.001). CI: Confidence interval.