Depression Among Nurses in COVID-19 Wards

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Abstract

The COVID-19 pandemic has been a major health crisis globally. This is particularly the case among healthcare workers in hotspot regions such as North-East of England. Healthcare workers, including nurses working in the hard-hit North-East of England, had to cope with stress, anxiety, and post-traumatic stress disorder, among other associated mental health issues arising from the pandemic. With this in mind, prevailing literature on the COVID-19 pandemic in various health databases relating to mental health has been identified. The classification of articles was performed in accordance with their general themes and then summarized. Based on the key findings, among nurses working in COVID-19 care units, anxiety and depressive states were noted as common factors in self-reported stress, as well as disturbed sleep. The available literature shows the prevalence in only the North-East of England designated wards and may not fully demonstrate the experience that nurses and healthcare workers in other areas in the country or globally face. The findings are of great significance to researchers and governments and can indicate the prevalence of anxiety and depression among nurses working in COVID-19 wards in the North-East of England during the pandemic.

The world health organization (WHO) acknowledged the COVID-19 pandemic on March 11, 2020. With little known regarding the virus, its high mortality rate, and the fast pace of global spreading, people were increasingly anxious. Generally, the population experienced anxiety, and healthcare workers (HCWs) were at the frontline. They were more frequently and directly exposed to the virus and thus had to cope with heightened emotional responses, thereby spending extra energy on recovery after heavy shifts (Salazar de Pablo et al., 2020). HCWs additionally encountered more difficulties – job stress as a result of increased demands of their work, challenges in the accessibility of proper personal protective equipment (PPE) supplies, and risks of getting infected. The research proposal under consideration is aimed at identifying the relationship between nursing staff’s work in COVID-19 wards and the development of depression and anxiety as mental disorders.

Problem Background

Though it is problematic to quantify the global numbers, some figures are accessible. The statistics indicate that by May 2020, more than 152,888 HCWs globally had been infected with the virus, and over 1,413 deaths were reported (De Kock et al., 2021). England’s HCWs represented a significant population in this global numbers. This mortality and morbidity risk linked to COVID-19 has mental health consequences (Yuan et al., 2020). The consequences are even worse in hotspot regions (Vizheh, 2020). Previously witnessed epidemics, including Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), were reported to have precipitated and exacerbated mental health issues among HCWs.

However, as opposed to these former epidemics, the coronavirus infection is different. High HCWs mortality rates, along with extensive coverage by the media, have had a substantial contribution to the high COVID-19 anxiety level (Firew et al., 2020). The statistics from the previous epidemics show high anxiety risks causing mental exhaustion and burnout (Arnetz et al., 2020). Previous studies also documented the development of post-traumatic stress symptoms and post-traumatic stress disorder symptoms several weeks after exposure to SARS and MERS.

Multiple primary studies accompanied by systematic reviews have been conducted to establish HCWs’ mental wellness in the course of the COVID-19 pandemic. While systematic reviews have been formerly done, they have had their limitations. Among the hard-hit regions, some researchers highlight the North-East of England (Muller et al., 2020). This paper’s objective is to perform a review of the existing literature with the aim of identifying anxiety and depression among nurses that worked in designated COVID-19 wards in the North-East of England during the pandemic. As Zhang et al. (2020) argue, this may contribute to studying the interventions targeted to lessen the emotional drain among HCWs, with particular attention to nurses. Thus, the analysis of academic literature is the optimal approach to searching and synthesizing relevant findings.

Literature Review

Among current academic sources, one can highlight a wide range of recent research on the topic under consideration. According to Xiao et al. (2020) and Armocida et al. (2020), healthcare systems and healthcare workers have been immensely burdened by the COVID-19 pandemic. An extremely high burden lying on HCWs has been stressed by the World Health Organization (Xiao et al., 2020). The agency has proceeded to call for action to address the required measures and immediate needs to prevent the serious impact on nurses’ mental and physical health and to ensure lives are saved (Rajkumar, 2020). Xiao et al. (2020) sought to compare the effects of previous outbreaks with those of COVID-19. The scholars note that former virus outbreaks indicated that non-frontline and frontline workers faced negative mental health outcomes (Xiao et al., 2020). As a result, the problem in question confirms its relevance.

There have been various reviews on the mental health of HCWs during the COVID-19 pandemic, which focused on HCWs’ mental health as a direct outcome of excessive burden and constant job stress. Vizheh (2020) acknowledged several studies that indicated prevalence rates and demonstrated specific correlations between burden and stress. The author combined them and stated that over one in every five HCWs suffered from depression and anxiety, and almost two in five presented insomnias (Vizheh, 2020). Muller et al. (2020), in turn, present several studies of subgroups analysis of HCWs and their descriptive summary and come to the conclusion that HCWs report more depression, anxiety, and sleep problems than the general population. This fact is a reliable confirmation of the problem’s persistence.

Health system sustainability is often viewed from the perspective of helping not only patients but also the staff involved. According to Adhikari et al. (2020), the effectiveness of adequate personnel management policies largely depends on the ability to safeguard the health of HCWs. So far, the findings of psychological distress among HCWs could be an indicator of an inability of the healthcare system to help HCWs effectively. A specific focus on hotspot areas and a particular group of HCWs is lacking (Shaukat, Ali, and Razzak, 2020). Thus, a more comprehensive and umbrella review of systematic reviews with a particular focus on Northwest of England Darlington and Durham counties has been conducted in this paper.

Methodology

As a methodological basis for the study, a mixed type is presented. The task is to identify the negative effects of excessive workload on nurses in a specific region from the perspective of the impact on their mental health. Therefore, to obtain creditable results, both qualitative data must be collected by using the responses of direct participants in the study and quantitative data by summing up the outcomes obtained in numerical correlations. This methodology allows for obtaining a comprehensive picture of the situation and describing the problem accurately and without bias.

Study Design

A systematic review is a convenient design to analyze the available academic literature, identify the main issues raised, synthesize useful findings, and relate the results to the topic under consideration. From the date when WHO announced the COVID-19 pandemic, relevant articles have been searched in various databases, including Web of Science, SCOPUS, and PubMed. Only articles written in English have been sought and analyzed. A keyword search has been applied to find relevant academic sources. They include “nurses,” “pandemic,” “stress,” “mental health,” “depression,” and some others. In addition, the temporal relevance of publications has been taken into account as an essential criterion for analysis.

Selection Criteria and Participants

The relevant articles have been selected by the following criteria:

The selected articles are case-control, cross-sectional, or cohort studies.
The publications are written in the English language.
The participants are nurses working in the North-East of England.
The articles are peer-reviewed and published in specialized academic journals.
The publications have sufficient data to calculate the degree of anxiety or depression among practicing nurses.

Ethical Approvals

The guidelines offered by the Preferred Reporting Items for Systematic Reviews and Meta- Analysis, or PRISMA, were taken into account. The personal consent of the participants involved in the processing of data obtained during the study was obtained. The study members received confirmation that their responses would only be used as background for the research analysis, and confidentiality was guaranteed. No conflicts of interest arose in the course of work.

Materials and Equipment

As the materials needed for the study, a standard digital program for compiling statistical correlations can be used, as well as ready-made questionnaires for the participants. Through communication with the target members, answers to pre-prepared questions should be compiled, and statistical totals can be calculated, for instance, in Excel. Additional tools are not needed because the key objective is based on identifying relationships between the variables involved, namely, work with COVID-19 patients and mental problems, rather than developing experimental methods of assistance.

Data Collection and Procedure

The involved participants can complete the questionnaires related to the specifics of their work in COVID-19 wards. As the criteria to take into account, such characteristics of the sample should be taken into account as age, gender, place of work, marital status, as well as experience with mental illness. Once qualitative data are obtained, they should be analyzed digitally to obtain relevant results and draw the necessary conclusions regarding the prevalence of the problem.

Data Analysis

Research Strategy Evaluation

Meta-analytic methods were used to calculate the pooled prevalence of anxiety and depression among the participants involved. To account for heterogeneity between the articles, restricted maximum likelihood (REML) and modeling with random effects were used. To examine the influence of various characteristics of anxiety and depression on the participants’ mental health, a meta-regression algorithm was performed. To assess potential publication bias possibility, the Egger test was utilized.

Plan for Implementation

To realize the goal of improving the situation, the plan for intervention may include the following steps:

Reporting the results of the study to managers and senior nurses.
Engaging additional stakeholders, such as health authorities, to review nursing staff’s work practices in COVID-19 wards.
Disseminating the research results in the academic community through publications in relevant sources.
Building a more flexible strategy of nurses’ work through shifts in their schedules.
Engaging psychologists as mentors for a vulnerable group of nurses.
Assessing the mental state of participants after several months of psychological assistance.

Ethical and Legal Dimensions

From an ethical perspective, no controversy arises within the framework of the proposed study. Nurses’ voluntary participation is a factor that eliminates research bias, and the objectives of the work are based on the promotion of positive changes that contribute to employees’ increased productivity and improved mental well-being. With regard to legal dimensions, appropriate changes in the load-sharing policy can be made. Excessive workload on nurses can be one of the causes of anxiety and depression, and to help junior medical employees, an appropriate legal framework should be developed to optimize nursing work-life balance.

Reference List

Adhikari, S. P. et al. (2020) ‘Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review’, Infectious Diseases of Poverty, 9(1), pp. 1-12.

Armocida, B. et al. (2020) ‘The Italian health system and the COVID-19 challenge’, The Lancet Public Health, 5(5), p. 1.

Arnetz, J. E. et al. (2020) ‘Nurse reports of stressful situations during the COVID-19 pandemic: qualitative analysis of survey responses’, International Journal of Environmental Research and Public Health, 17(21), p. 8126.

De Kock, J. H. et al. (2021) ‘A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being’, BMC Public Health, 21(1), pp. 1-18.

Firew, T. et al. (2020) ‘Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers’ infection and psychological distress during the COVID-19 pandemic in the USA’, BMJ Open, 10(10), p. e042752.

Muller, A. E. et al. (2020) ‘The mental health impact of the COVID-19 pandemic on healthcare workers, and interventions to help them: a rapid systematic review’, Psychiatry Research, 293, p. 113441.

Rajkumar, R. P. (2020) ‘COVID-19 and mental health: a review of the existing literature’, Asian Journal of Psychiatry, 52(102066), p. 102066.

Salazar de Pablo, G. et al. (2020) ‘Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis’, Journal of Affective Disorders, 275, pp. 48–57.

Shaukat, N., Ali, D. M. and Razzak, J. (2020) ‘Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review’, International Journal of Emergency Medicine, 13(1), pp. 1-8.

Vizheh, M. (2020) ‘The mental health of healthcare workers in the COVID-19 pandemic: a systematic review’, Journal of Diabetes & Metabolic Disorders, pp. 1-12.

Xiao, H. et al. (2020) ‘Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China’, Medical Science Monitor, 26, p. e923921.

Yuan, S. et al. (2020) ‘Comparison of the indicators of psychological stress in the population of Hubei province and non-endemic provinces in China during two weeks during the coronavirus disease 2019 (COVID-19) outbreak in February 2020’, Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 26, p. e923767.

Zhang, S. X. et al. (2020) ‘At the height of the storm: healthcare staff’s health conditions and job satisfaction and their associated predictors during the epidemic peak of COVID-19’, Brain, Behavior, and Immunity, 87, pp. 144-146.

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