Research carried out in the United States along with fourteen other countries suggested high rates of depression, anxiety, and acute stress reactions in healthcare workers during the COVID-19 pandemic. The healthcare workers were found to suffer from high levels of stress as they had to face increased clinical demands during this time and were cut off from essential sources of support.
“The psychological impact of the pandemic on this population was first observed in healthcare workers in Wuhan, China, where 45-50% reported depression and anxiety and 71% reported increases in emotional distress,” says Nicole DeTore and the research team from Massachusetts General Hospital and Harvard Medical School.
Similar episodes of increase in stress levels among healthcare workers were also seen during the H1N1 epidemic in 2008. However, evidence from previous research showed that the development of certain resilience training tools helped in the management of stress levels.
This study involves a non-randomized test to determine whether the resilience levels improved in healthcare workers who took the course compared to those who did not.
A pre-print version of the research paper is available on the medRxiv* server while the article undergoes peer review.
What is the Resilience Training Course?
Resilience is defined as the ability to recover from highly stressful or challenging life events quickly. The Resilience Training (RT) course for healthcare workers included 12-20 minutes videos that included information, exercises, and testimonials from healthcare workers. This helped to increase and maintain emotional resilience, which includes mentalization, self-compassion and mindfulness.
What did the study involve?
The online RT for healthcare workers involves pre-recorded videos of testimonials of healthcare workers and experienced clinicians who talked about their experiences during the pandemic and how the skills taught in the course helped them.
The course consisted of three sessions. Session 1 involved the concept of mindfulness and resilience, Session 2 involved enhancement of cognitive flexibility via mentalization and cognitive behavior, and Session 3 involved the development of self-compassion.
Participants undergoing the study had to complete a survey questionnaire on three separate occasions, before taking the course, one month after it, and two months after it. The questionnaire helped assess emotional distress, resilience, COVID-19 related anxiety, loneliness, burn-out, and self-compassion.
Statistical analysis, which included paired sample t-test and ANOVA was done to examine the effect of the RT course on resilience and emotional distress.
What did the study find?
Participants who completed all three surveys did not show any change in resilience levels in the first month, but resilience levels were found to improve after two months. Also, a significant decrease in emotional distress was found in the first month, which further improved after two months.
Among patients who took the RT course and those who did not, the ANOVA test results showed improved resilience after two months compared to those who did not take the test. Similarly, ANOVA test also revealed an improvement in emotional distress levels in participants who took the RT course compared to those who did not.
What did the authors conclude?
“In addition, in the intervention portion of the study, which by necessity used a pragmatic, non-randomized design, improvements in resilience and decreases in emotional distress were observed in healthcare employees who chose to participate in the brief resilience training course,” says the team.
The results of this study replicated with the other mental healthcare studies of healthcare workers during the previous pandemics.
However, it was found that exposure to COVID-19 patients did not correlate with emotional distress. This suggests that the participants had felt the psychological impact of the pandemic even if they have not been exposed to patients directly.
“Given the increased social isolation experienced by many during the COVID-19 pandemic, including healthcare workers who have been often required to work long hours in masks and other protective equipment while maintaining “social distance” from others, augmenting capacities that may lead to more meaningful connections with others may help to preserve well-being during this unusual period and its aftermath, as well as during other times of adversity” they add.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.