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Peñacoba-Puente C, García-Hedrera FJ, Gómez-Del-Pulgar García-Madrid M, Carmona-Monge FJ, Gil-Almagro F. Psychological Care in Spanish Nurses at the Frontline of the COVID-19 Pandemic: A Prospective Study on Symptoms, Burnout and Psychological Variables. Healthcare (Basel) 2025; 13:1108. [PMID: 40427945 DOI: 10.3390/healthcare13101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2025] [Revised: 04/24/2025] [Accepted: 05/06/2025] [Indexed: 05/29/2025] Open
Abstract
(1) Background: Previous studies have highlighted the emotional symptoms experienced throughout the COVID-19 pandemic by nurses and their consequences. It would be of interest to analyze the extent to which healthcare workers (HCWs), in the context of the psychological health crisis, have sought (and received) psychological care. Likewise, it would be highly relevant to analyze the profile of these professionals, both in terms of the sociodemographic and occupational characteristics as well as the emotional symptoms they presented, and the percentage of nurses who requested psychological help during the COVID-19 pandemic, their sociodemographic and occupational characteristics as well as their levels of associated symptoms. Additionally, one could study the associated psychological personality variables, including both risk factors and protective variables, as this is of special interest for the design of appropriate interventions. (2) Methods: An observational, descriptive, prospective longitudinal study with three data collection periods was carried out. At the first time point, anxiety, insomnia, self-efficacy, resilience and social support were assessed. Anxiety, insomnia, fear of COVID-19, cognitive fusion and burnout syndrome were assessed at the second time point. Finally, at the third time point, we assessed anxiety, insomnia and burnout syndrome. During the second and third time points, the nurses' requests for psychological help were assessed. (3) Results: Overall, 33.1% of the final sample requested psychological support, and 20.5% of them had sought psychological support by the first time point, of which 7.3% continued to in the final time measure. The request for psychological help was significantly related to higher means for anxiety (p = 0.003), insomnia (p = 0.001) and burnout (p < 0.05), as well as high levels of cognitive fusion (p = 0.001) and low levels of resilience (p = 0.009). Requests for psychological help were not significantly related to social support (p = 0.222) or fear of COVID-19 (p = 0.625). (4) Conclusions: The data suggest the need to promote measures for the implementation of psychological help among nurses aimed not only at reducing the consequences of the psycho-emotional affectation derived from a stressful work situation but also strengthening health-promoting traits such as self-efficacy or resilience.
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Affiliation(s)
- Cecilia Peñacoba-Puente
- Health Sciences Faculty, Department of Psychology, Psychology, Rey Juan Carlos University, Av. de Atenas, s/n, 28922 Alcorcón, Madrid, Spain
| | - Fernando José García-Hedrera
- Nurse Intensive Care Unit, Hospital Universitario Fundación Alcorcón, Budapest, 1, 28922 Alcorcón, Madrid, Spain
| | | | - Francisco Javier Carmona-Monge
- Anesthesia Department, Hospital Universitario Santiago de Compostela, Rúa da Choupana, s/n, 15706 Santiago de Compostela, A Coruña, Spain
| | - Fernanda Gil-Almagro
- Nurse Intensive Care Unit, Hospital Universitario Fundación Alcorcón, Budapest, 1, 28922 Alcorcón, Madrid, Spain
- Department of Simulation, Francisco de Vitoria University in Pozuelo, M-515, km 1, 800, 28223 Pozuelo de Alarcón, Madrid, Spain
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Zasada M, van Even S, Maben J, Oates J, Taylor C. Team Time as a wellbeing intervention for NHS staff: a qualitative evaluation of implementation during the COVID-19 pandemic. BMC Health Serv Res 2024; 24:1622. [PMID: 39695659 DOI: 10.1186/s12913-024-12046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 12/02/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Support for NHS staff was vital during the COVID-19 pandemic and Team Time was developed as an adaptation of Schwartz Rounds™ - a well-evidenced, facilitated group intervention. Building on the existing evidence base for Schwartz Rounds implementation, this study aims to understand the key factors associated with Team Time implementation and sustainability in this context. METHODS Twenty semi-structured interviews were conducted within 10 NHS acute, community and mental health organisations that ran Team Time during the pandemic: six with no prior experience of Schwartz Rounds and four that ran Schwartz Rounds prior to the pandemic. Additionally, three Team Time mentors who provided support to these organisations were also interviewed. Data analysis was underpinned by the Consolidated Framework for Implementation Research (CFIR). Data were analysed thematically, and key implementation factors were mapped onto CFIR constructs using the Framework method to explore patterns. RESULTS Implementation of Team Time was challenging in organisations that did not run Schwartz Rounds previously. Facilitating factors included having incentives in the outer setting (wider context of the organisation), the adaptability of the intervention, and wide ownership across the organisation. However, barriers to implementation were the perception that the intervention was complex and resource intensive and an unsupportive organisational culture and communication difficulties which hindered engagement. In those organisations which already ran Schwartz Rounds the burden of setting up the organisational infrastructure for Team Time was smaller and the implementation climate more supportive. CONCLUSIONS Similar to Schwartz Rounds, Team Time needed broad and sustained organisational support for implementation to become embedded in organisations and deliver benefits. Implementing it as an entirely new and stand-alone online intervention during the pandemic was challenging. Team Time should therefore be considered as an addition to Schwartz Rounds and as part of a long-term organisational investment in staff psychological wellbeing, not as a short-term intervention in a period of crisis.
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Affiliation(s)
- Magdalena Zasada
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, GU2 7YS, UK.
| | - Suzanne van Even
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, GU2 7YS, UK
| | - Jill Maben
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, GU2 7YS, UK
| | - Jennifer Oates
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, GU2 7YS, UK
| | - Cath Taylor
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, 30 Priestley Road, Surrey Research Park, Guildford, Surrey, GU2 7YS, UK
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Holmberg J, Rosendahl I, Andersson R, Kemani MK, Holmström L, Öst LG, Wicksell RK. Improving mental health among intensive care unit staff with communication skills training. Front Psychol 2024; 15:1454702. [PMID: 39469242 PMCID: PMC11513591 DOI: 10.3389/fpsyg.2024.1454702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 09/30/2024] [Indexed: 10/30/2024] Open
Abstract
Purpose Intensive Care Unit (ICU) staff report that a large part of the work-related distress they experience is related to communication situations with colleagues, patients, and relatives. Based on these findings, the aim of the present study was to preliminary evaluate the effects of a novel Communication Skills Training (CST) program on mental health among ICU staff. Methods The CST program was delivered to the entire work force of an ICU at a Swedish hospital and was evaluated as an uncontrolled clinical trial with three repeated measures. 100 participants were eligible and included in the analyses. The theoretical framework for the program was learning theory and cognitive behavioral therapy. The program was delivered by two psychologists and included one full-day lecture and three subsequent two-hour supervision sessions. Changes in mental health was evaluated with self-report questionnaires measuring perceived stress, general mental health, work engagement, and psychological flexibility. Results Analyses of three repeated measures showed significant improvements with 1.3 points lower perceived stress and 2.0 points lower general mental health after the intervention. No differences were seen in measures of work engagement or psychological flexibility. Conclusion Findings of the study supports the utility of the CST program as an intervention to target perceived stress and general mental health within intensive care. These findings should be further validated in trials with improved design.
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Affiliation(s)
- Johan Holmberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Rebecca Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | - Mike K. Kemani
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Holmström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lars-Göran Öst
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Rikard K. Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Pain Clinic, Capio St Göran Hospital, Stockholm, Sweden
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4
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Taxén M, Tolf S, Appelbom S, Sjöström-Bujacz A, Baresso N, Herber K, Johansson A, Keita M, Ramstedt L, Bringby AW, Stenfors T, Mazzocato P. Development, implementation and usefulness of an intervention to support psychological resilience during the COVID-19 pandemic: a study from a Swedish hospital based on interviews, documents and a survey. BMJ Open 2024; 14:e081095. [PMID: 39117405 PMCID: PMC11404210 DOI: 10.1136/bmjopen-2023-081095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES A range of interventions to support psychological resilience among healthcare workers were provided in hospitals during the COVID-19 pandemic. Most research has focused on the content and experience of these interventions, but less is known about their implementation. The aim of this study was to increase understanding of the development, implementation and perceived usefulness of an intervention to support psychological resilience among healthcare workers at a Swedish hospital during the pandemic. DESIGN This study employs interviews and documents to explore the development and implementation of support activities and a survey to assess the usefulness of the activities (on a scale from 1 to 5). Qualitative content analysis was used to analyse the interview data and documents. Descriptive statistics were used to analyse the survey data. SETTINGS A tertiary hospital in the outskirts of Region Stockholm. PARTICIPANTS Eight individual interviews were conducted with actors involved in developing the intervention. 286 healthcare workers answered the survey. RESULTS Support activities were developed and implemented by an internal multidisciplinary group who continuously identified and adapted activities to the needs of staff. The strategy of involving existing resources to jointly develop and continuously adapt staff support activities was beneficial for the implementation and longevity of the intervention. Scheduling difficulties were one of the challenges. The mean ratings of the activities ranged from 2.27 for one-on-one counselling to 3.25 for physical activity. Licensed practical nurses generally valued the activities higher than other professional groups. CONCLUSIONS The provision of activities to support psychological resilience in a crisis is facilitated by the ability of an organisation to use current resources in the face of a crisis, which is a sign of organisational resilience. Leaders who act quickly and create the conditions to test and learn under uncertainty can contribute to developing effective responses to a crisis.
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Affiliation(s)
- Mariel Taxén
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden, Karolinska Institutet, Stockholm, Sweden
| | - Sara Tolf
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden, Karolinska Institutet, Stockholm, Sweden
| | - Sophia Appelbom
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden, Karolinska Institutet, Stockholm, Sweden
| | - Aleksandra Sjöström-Bujacz
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - My Keita
- Södertälje Hospital, Södertälje, Sweden
| | | | | | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden, Karolinska Institutet, Stockholm, Sweden
| | - Pamela Mazzocato
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden, Karolinska Institutet, Stockholm, Sweden
- Södertälje Hospital, Södertälje, Sweden
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Carbonara N, Pellegrino R, De Luca C. Resilience of hospitals in an age of disruptions: a systematic literature review on resources and capabilities. Health Syst (Basingstoke) 2024; 13:192-228. [PMID: 39175496 PMCID: PMC11338213 DOI: 10.1080/20476965.2024.2365144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/02/2024] [Indexed: 08/24/2024] Open
Abstract
Hospitals play a critical role in ensuring continuous and effective healthcare delivery, especially during crises. However, the COVID-19 pandemic exposed vulnerabilities in hospital systems, prompting a need to enhance resilience-the ability to withstand, absorb, respond to, recover from, and learn from disasters. A systematic literature review, grounded in the resource-based view, identified organizational characteristics, in terms of resources and capabilities, and their synergistic effects that bolster hospital resilience. The results demonstrate that digital technologies impact on anticipation and adaptation abilities, organizational capabilities to reorganize roles, tasks, and spaces enhance adaptability, and Inter-organizational collaborations increase the responsiveness of the hospitals. The study provides substantial theoretical and practical contributions. It expands knowledge of hospital resilience in light of recent disruptive events and promotes integration capabilities as determinants for the majority of resilience dimensions. All organisational and inter-organisational collaboration, cooperation, and coordination are deemed crucial for hospital resilience.
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Affiliation(s)
- Nunzia Carbonara
- Department of Mechanics Mathematics and Management, Polytechnic University of Bari, Bari, Italy
| | - Roberta Pellegrino
- Department of Mechanics Mathematics and Management, Polytechnic University of Bari, Bari, Italy
| | - Cristina De Luca
- Department of Mechanics Mathematics and Management, Polytechnic University of Bari, Bari, Italy
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6
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Foo BMY, Sharpe L, Clayton JM, Wiese M, Menzies RE. The role of psychologists in supporting illness-related dying and death: A systematic mixed studies review. Clin Psychol Rev 2024; 110:102393. [PMID: 38615491 DOI: 10.1016/j.cpr.2024.102393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 04/16/2024]
Abstract
Psychologists remain underrepresented in end-of-life care, and there is limited understanding of their role among healthcare professionals, patients, and caregivers. This systematic mixed-studies review, prospectively registered on PROSPERO (CRD42020215775), explored the role of psychologists, and the facilitators and barriers they experience, in supporting clients with illness-related dying and death. A search of six research databases was conducted in October 2023. Fifty-one studies, mainly qualitative and from the perspectives of psychologists, met inclusion criteria. Thematic synthesis highlighted how psychologists provided expertise across various contexts. They supported clients with preparing for death, and adjusting to dying, provided professional consultancy and support, and undertook leadership in enhancing psychological end-of-life care. Results illustrated the sustaining factors and ongoing challenges working in end-of-life care, namely, the unique nature of navigating the death space, recognition and awareness of psychologists' contribution, and the support, training and development required. Given the universality of dying and death, this review is relevant to psychologists working within and beyond more traditional end-of-life care contexts, such as employee assistance programs, private practice, schools, and other psychological services. Policy, clinical and research implications are discussed, including the need for greater engagement and training of psychologists in the dying and death space.
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Affiliation(s)
- Baby M Y Foo
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Josephine M Clayton
- The Palliative Centre, HammondCare, Greenwich Hospital, Sydney, Australia; Northern Clinical School, The University of Sydney, Australia.
| | - Michele Wiese
- School of Psychology, Western Sydney University, Penrith, New South Wales 2751, Australia.
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
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7
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Vasiliou VS, Philia I, Drosatou C, Mitsi E, Tsakonas I. LeadinCare: A Qualitative Informed Digital Training Platform Development to Increase Physicians' Soft Communication Skills After COVID-19. PSYCHOL HEALTH MED 2024; 29:39-54. [PMID: 37131299 DOI: 10.1080/13548506.2023.2206144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
The post-COVID-19 pandemic era has placed new demands on physicians. One of these demands is the need to use targeted knowledge and soft communication skills, to address the psychosocial problems (e.g. vaccine hesitancy, fears) of individuals with Chronic Physical Illnesses (CPIs). Focusing on training physicians in targeted soft communication skills can help health care systems to address psychosocial-type problems. Yet, such training programs are rarely implemented, effectively.This study aimed to (a) understand physicians' implementation challenges when using soft communication skills during the COVID-19 pandemic; (b) identify beliefs, barriers, and facilitators that can influence physicians' behaviours to use soft communication skills; and (c) inform the content of the LeadinCare; a new digital training platform, designed to improve physicians' soft communication skills, by leveraging the TDF Theoretical Domain Framework (TDF).We conducted 14 in-depth semi-structured interviews with physicians in Greece, supporting non-COVID-19 cases with CPIs. We analyzed their data using inductive and deductive approaches.Physicians highlighted time, inability to see patients in person, absence of space for non-COVID-19 cases, and poor organizational procedures as barriers to using soft communication skills. Five TDF domains (beliefs) were identified as the most salient to inform the LeadinCare platform: (1) practical and well-organized knowledge; (2) skills that support patients and their relatives; (3) physicians' beliefs about capabilities to use the skills; (4) beliefs about consequences of using the skills (job satisfaction); and (5) the use of digital, interactive, and on-demand platforms (environmental context & resources). We mapped the domains in six narrative-based practices that informed the content of the LeadinCare.Physicians need skills that go beyond talking and towards cultivating resilience and flexibility.
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Affiliation(s)
- Vasilis S Vasiliou
- Postdoctoral Research Associate in Clinical and Health Psychology, Cardiff University, Cardiff, UK
- Clinical Psychologist & Postdoctoral Mixed Methods Research Associate, University of Oxford, Oxford, UK
| | - Issari Philia
- Department of Psychology, Laboratory for Qualitative Research in Psychology and Psychosocial Well-Being, National and Kapodistrian University of Athens, Athens Greece
| | - Constantina Drosatou
- Department of Psychology, Laboratory for Qualitative Research in Psychology and Psychosocial Well-Being, National and Kapodistrian University of Athens, Athens Greece
| | - Efi Mitsi
- Department of Psychology, Laboratory for Qualitative Research in Psychology and Psychosocial Well-Being, National and Kapodistrian University of Athens, Athens Greece
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Hovland IS, Skogstad L, Stafseth S, Hem E, Diep LM, Ræder J, Ekeberg Ø, Lie I. Prevalence of psychological distress in nurses, physicians and leaders working in intensive care units during the COVID-19 pandemic: a national one-year follow-up study. BMJ Open 2023; 13:e075190. [PMID: 38135308 PMCID: PMC10897841 DOI: 10.1136/bmjopen-2023-075190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To report and compare psychological distress as symptoms of anxiety, depression and post-traumatic stress among intensive care units' (ICU) nurses, physicians and leaders at 12 months after the baseline survey (spring 2020), during the COVID-19 pandemic in Norway. Furthermore, to analyse which baseline demographic and COVID ICU-related factors have a significant impact on psychological distress at 12 months. DESIGN Prospective, longitudinal, observational cohort study. SETTING Nationwide, 27 of 28 hospitals with COVID ICUs in Norway. PARTICIPANTS Nurses, physicians and their leaders. At 12 month follow-up 287 (59.3%) of 484 baseline participants responded. PRIMARY AND SECONDARY OUTCOME MEASURES Symptoms of anxiety and depression using the Hopkins Symptoms Checklist-10 (HSCL-10). Symptoms of post-traumatic stress using the post-traumatic stress disease checklist for the Diagnostic and Statistical Manual of Mental Disorders 5 (PCL-5).Demographics (included previous symptoms of anxiety and depression) and COVID ICU-related factors (professional preparations, emotional experience and support) impacting distress at 12 months. RESULTS Psychological distress, defined as caseness on either or both HSCL-10 and PCL-5, did not change significantly and was present for 13.6% of the participants at baseline and 13.2% at 12 month follow-up. Nurses reported significantly higher levels of psychological distress than physicians and leaders. Adjusted for demographics and the COVID ICU-related factors at baseline, previous symptoms of depression and fear of infection were significantly associated with higher levels of anxiety and depression at 12 months. Previous symptoms of depression, fear of infection and feeling of loneliness was significantly associated with more symptoms of post-traumatic stress. CONCLUSION One year into the COVID-19 pandemic 13.2% of the ICUs professionals reported psychological distress, more frequently among the nurses. Fear of infection, loneliness and previous symptoms of depression reported at baseline were associated with higher levels of distress. Protective equipment and peer support are recommended to mitigate distress. TRIAL REGISTRATION NUMBER ClinicalTrials.gov. Identifier: NCT04372056.
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Affiliation(s)
- Ingvild Strand Hovland
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of the Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Laila Skogstad
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Siv Stafseth
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Department of MEVU, Lovisenberg Diaconal University College, Oslo, Norway
| | - Erlend Hem
- Department of the Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institue of Studies of the Medical Profession, Oslo, Norway
| | - Lien M Diep
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Johan Ræder
- Department of Anesthesiology, Intitute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Øivind Ekeberg
- Psychosomatic and CL psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Irene Lie
- Centre for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology, Gjøvik, Norway
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9
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Sheehan KA, Schulz-Quach C, Ruttan LA, MacGillivray L, McKay MS, Seto A, Li A, Stewart DE, Abbey SE, Berkhout SG. "Don't Just Study our Distress, Do Something": Implementing and Evaluating a Modified Stepped-Care Model for Health Care Worker Mental Health During the COVID-19 Pandemic. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:43-53. [PMID: 35854421 PMCID: PMC9301355 DOI: 10.1177/07067437221111372] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Throughout the COVID-19 pandemic, there have been concerns about the mental health of health care workers (HCW). Although numerous studies have investigated the level of distress among HCW, few studies have explored programs to improve their mental well-being. In this paper, we describe the implementation and evaluation of a program to support the mental health of HCW at University Health Network (UHN), Canada's largest healthcare network. METHODS Using a quality improvement approach, we conducted a needs assessment and then created and evaluated a modified stepped-care model to address HCW mental health during the pandemic. This included: online resources focused on psychoeducation and self-management, access to online support and psychotherapeutic groups, and self-referral for individual care from a psychologist or psychiatrist. We used ongoing mixed-methods evaluation, combining quantitative and qualitative analysis, to improve program quality. RESULTS The program is ongoing, running continuously throughout the pandemic. We present data up to November 30, 2021. There were over 12,000 hits to the UHN's COVID mental health intranet web page, which included self-management resources and information on group support. One hundred and sixty-six people self-referred for individual psychological or psychiatric care. The mean wait time from referral to initial appointment was 5.4 days, with an average of seven appointments for each service user. The majority had moderate to severe symptoms of depression and anxiety at referral, with over 20% expressing thoughts of self-harm or suicide. Post-care user feedback, collected through self-report surveys and semistructured interviews, indicated that the program is effective and valued. CONCLUSIONS Development of a high-quality internal mental health support for HCW program is feasible, effective, and highly valued. By using early and frequent feedback from multiple perspectives and stakeholders to address demand and implement changes responsively, the program was adjusted to meet HCW mental health needs as the pandemic evolved.
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Affiliation(s)
- Kathleen A Sheehan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Christian Schulz-Quach
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, 7989University Health Network, Toronto, Ontario, Canada
| | - Lesley A Ruttan
- 7961Toronto Rehabilitation Institute, 7989University Health Network, Toronto, Ontario, Canada.,Graduate Department of Psychological Clinical Science, 33530University of Toronto, Scarborough, Ontario, Canada
| | - Lindsey MacGillivray
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Martha S McKay
- 7961Toronto Rehabilitation Institute, 7989University Health Network, Toronto, Ontario, Canada
| | - Alison Seto
- Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Adrienne Li
- 7961Toronto Rehabilitation Institute, 7989University Health Network, Toronto, Ontario, Canada.,7991York University, Toronto, Ontario, Canada
| | - Donna E Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Susan E Abbey
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Suze G Berkhout
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
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10
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Carvalho-Alves MO, Petrilli-Mazon VA, Brunoni AR, Malbergier A, Fukuti P, Polanczyk GV, Miguel EC, Corchs F, Wang YP. Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital: A factor analytical study. World J Psychiatry 2022; 12:843-859. [PMID: 35978972 PMCID: PMC9258270 DOI: 10.5498/wjp.v12.i6.843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for public health and has caused the loss of millions of lives worldwide. Hospital workers play a key role in averting the collapse of the health system, but the mental health of many has deteriorated during the pandemic. Few studies have been devoted to identifying the needs of workers on frontline duty. AIM To investigate dimensions of common emotional symptoms and associated predictors among Brazilian workers in a COVID-19 reference hospital. METHODS This is an observational study of the mental health of professionals in a COVID-19 hospital in the city of São Paulo. We invited all hospital employees to respond to an online survey between July and August 2020, during the first peak of the pandemic. Data of 1000 participants who completed the survey were analyzed (83.9% were women and 34.3% were aged 30 to 40). Hospital workers self-reported the presence of symptoms of depression, anxiety, trauma-related stress, and burnout through the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised and the Mini-Z Burnout Assessment respectively. Responses were assembled and subjected to exploratory factor analysis to reveal workers' core emotional distress. Multiple linear regression models were subsequently carried out to estimate the likelihood of dimensions of distress using questions on personal motivation, threatening events, and institutional support. RESULTS Around one in three participants in our sample scored above the threshold of depression, anxiety, post-traumatic stress disorder, and burnout. The factor analysis revealed a three-factor structure that explained 58% of the total data variance. Core distressing emotional domains were avoidance and re-experience, depression-anxiety, and sleep changes. Regression analysis revealed that institutional support was a significant protective factor for each of these dimensions (β range = -0.41 to -0.20, P < 0.001). However, participants' personal motivation to work in healthcare service was not associated with these emotional domains. Moreover, the likelihood of presenting the avoidance and re-experience dimension was associated with having a family member or close friend be hospitalized or die due to COVID-19 and having faced an ethical conflict. CONCLUSION Distressing emotional domains among hospital workers were avoidance and re-experience, depression and anxiety, and sleep changes. Improving working conditions through institutional support could protect hospital workers' mental health during devastating public health crises.
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Affiliation(s)
- Marcos O Carvalho-Alves
- Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
- Program in Neuroscience and Behavior, Department of Experimental Psychology, Institute of Psychology, University of Sao Paulo, Sao Paulo 01060-970, Brazil
| | - Vitor A Petrilli-Mazon
- Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
| | - Andre R Brunoni
- Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
| | - Andre Malbergier
- Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
| | - Pedro Fukuti
- Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
| | - Guilherme V Polanczyk
- Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
| | - Euripedes C Miguel
- Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo 05403-010, Brazil
| | - Felipe Corchs
- Program in Neuroscience and Behavior, Department of Experimental Psychology, Institute of Psychology, University of Sao Paulo, Sao Paulo 01060-970, Brazil
- Department of Psychiatry, University of Sao Paulo, Sao Paulo 05403-010, Brazil
| | - Yuan-Pang Wang
- Department of Psychiatry, School of Medicine, University of Sao Paulo, Sao Paulo 05403-010, Brazil
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11
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Rosen B, Preisman M, Read H, Chaukos D, Greenberg RA, Jeffs L, Maunder R, Wiesenfeld L. Providers' perspectives on implementing resilience coaching for healthcare workers during the COVID-19 pandemic. BMC Health Serv Res 2022; 22:780. [PMID: 35701756 PMCID: PMC9194890 DOI: 10.1186/s12913-022-08131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background The COVID-19 pandemic severely exacerbated workplace stress for healthcare workers (HCWs) worldwide. The pandemic also magnified the need for mechanisms to support the psychological wellbeing of HCWs. This study is a qualitative inquiry into the implementation of a HCW support program called Resilience Coaching at a general hospital. Resilience Coaching was delivered by an interdisciplinary team, including: psychiatrists, mental health nurses allied health and a senior bioethicist. The study focuses specifically on the experiences of those who provided the intervention. Methods Resilience Coaching was implemented at, an academic hospital in Toronto, Canada in April 2020 and is ongoing. As part of a larger qualitative evaluation, 13 Resilience Coaches were interviewed about their experiences providing psychosocial support to colleagues. Interviews were recorded, transcribed, and analyzed for themes by the research team. Interviews were conducted between February and June 2021. Results Coaches were motivated by opportunities to support colleagues and contribute to the overall health system response to COVID-19. Challenges included finding time within busy work schedules, balancing role tensions and working while experiencing burnout. Conclusions Hospital-based mental health professionals are well-positioned to support colleagues’ wellness during acute crises and can find this work meaningful, but note important challenges to the role. Paired-coaches and peer support among the coaching group may mitigate some of these challenges. Perspectives from those providing support to HCWs are an important consideration in developing support programs that leverage internal teams.
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Affiliation(s)
- Benjamin Rosen
- Sinai Health, Toronto, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Mary Preisman
- Sinai Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Heather Read
- Sinai Health, Toronto, Canada. .,Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada.
| | - Deanna Chaukos
- Sinai Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Rebecca A Greenberg
- Sinai Health, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Lianne Jeffs
- Sinai Health, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | - Robert Maunder
- Sinai Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Lesley Wiesenfeld
- Sinai Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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12
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Stafseth SK, Skogstad L, Ræder J, Hovland IS, Hovde H, Ekeberg Ø, Lie I. Symptoms of Anxiety, Depression, and Post-Traumatic Stress Disorder in Health Care Personnel in Norwegian ICUs during the First Wave of the COVID-19 Pandemic, a Prospective, Observational Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7010. [PMID: 35742259 PMCID: PMC9222786 DOI: 10.3390/ijerph19127010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2022]
Abstract
Background: The COVID-19 pandemic has induced demanding work situations in intensive care units (ICU). The objective of our study was to survey psychological reactions, the disturbance of social life, work effort, and support in ICU nurses, physicians, and leaders. Methods: From May to July 2020, this cross-sectional study included 484 ICU professionals from 27 hospitals throughout Norway. Symptoms of anxiety and depression were measured on Hopkins Symptom Checklist-10 (HSCL-10). Symptoms of post-traumatic stress disorder (PTSD) were measured on the PCL-5. Results: The study population were highly educated and experienced professionals, well prepared for working with COVID-ICU patients. However, 53% felt socially isolated and 67% reported a fear of infecting others. Probable cases of anxiety and depression were found in 12.5% of the registered nurses, 11.6% of the physicians, and 4.1% of the leaders. Younger age and <5 years previous work experiences were predictors for high HSCL-10 scores. Reported symptom-defined PTSD for nurses 7.1%; the leaders, 4.1%; and 2.3% of physicians. Conclusions: ICU health care professionals experienced talking with colleagues as the most helpful source of support. The COVID-ICU leaders reported a significantly higher mean score than physicians and nurses in terms of pushing themselves toward producing high work effort.
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Affiliation(s)
- Siv Karlsson Stafseth
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, 0424 Oslo, Norway
- MEVU, Lovisenberg Diaconal University College, 0456 Oslo, Norway
| | - Laila Skogstad
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, 9019 Tromsø, Norway;
| | - Johan Ræder
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, 0424 Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
| | - Ingvild Strand Hovland
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, 0424 Oslo, Norway;
| | - Haakon Hovde
- The Norwegian Association for Critical Care Nurses, 0152 Oslo, Norway;
| | - Øivind Ekeberg
- Psychosomatic and Consultation-Liaison Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway;
| | - Irene Lie
- Centre for Patient-Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, 0424 Oslo, Norway;
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, 2815 Gjøvik, Norway
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13
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Lungulescu CV, Turcu-Stiolica A, Lungulescu C, Dumitrescu EA, Turcu-Stiolica RA, Croitoru VM, Cazacu IM, Gheorghe AS, Stanculeanu DL, Sur D. How Much Burnout and Coping Influence Quality of Life among Young Oncology Providers in Romania during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5508. [PMID: 35564906 PMCID: PMC9102177 DOI: 10.3390/ijerph19095508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022]
Abstract
This study aims to investigate the correlations between burnout, coping strategies, and quality of life among young oncology healthcare workers in Romania during the COVID-19 pandemic. We collected the data using an online questionnaire consisting of sociodemographic questions, the Maslach Burnout Inventory, the COPE questionnaire, and the 15D instrument. A total of 122 healthcare providers responded to our survey. We evaluated the differences in the scores among the three groups of healthcare workers in oncology under 40 years old: medical oncologists (n = 87), radiation oncologists (n = 11), and oncology nurses (n = 24). Finally, we conducted a correlation analysis between the dimensions of burnout, coping, and quality of life. Overall, the medical oncologists exhibited much higher burnout levels than nurses in the COVID-19 pandemic outbreak, having statistically significant higher levels of emotional exhaustion, depersonalization, and lack of personal achievement. Some factors were inversely associated with burnout: active approach, planning, positive interpretation and growth, and acceptance. Our findings illustrated a very good level of health-related quality of life (average = 0.93, SD = 0.06), and no statistically significant differences were found in the quality of life between the three groups. This study was the first to identify the profile of young oncology providers in Romania. Our findings may be relevant in creating preventive strategies for burnout and increasing the quality of life in Romanian young oncology providers in future crises.
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Affiliation(s)
- Cristian-Virgil Lungulescu
- Oncology Department, University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Str., 200349 Craiova, Romania;
| | - Adina Turcu-Stiolica
- Pharmacoeconomics Department, University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Str., 200349 Craiova, Romania
| | - Cristina Lungulescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Str., 200349 Craiova, Romania;
| | - Elena-Adriana Dumitrescu
- Institute of Oncology, Prof. Dr. Alexandru Trestioreanu, Șoseaua Fundeni, 022328 Bucharest, Romania; (E.-A.D.); (A.-S.G.); (D.-L.S.)
| | | | - Vlad-Mihai Croitoru
- Department of Oncology, Fundeni Clinical Institute, 258 Fundeni Str., 022238 Bucharest, Romania; (V.-M.C.); (I.-M.C.)
| | - Irina-Mihaela Cazacu
- Department of Oncology, Fundeni Clinical Institute, 258 Fundeni Str., 022238 Bucharest, Romania; (V.-M.C.); (I.-M.C.)
| | - Adelina-Silvana Gheorghe
- Institute of Oncology, Prof. Dr. Alexandru Trestioreanu, Șoseaua Fundeni, 022328 Bucharest, Romania; (E.-A.D.); (A.-S.G.); (D.-L.S.)
| | - Dana-Lucia Stanculeanu
- Institute of Oncology, Prof. Dr. Alexandru Trestioreanu, Șoseaua Fundeni, 022328 Bucharest, Romania; (E.-A.D.); (A.-S.G.); (D.-L.S.)
| | - Daniel Sur
- 11th Department of Medical Oncology, University of Medicine and Pharmacy Iuliu Hatieganu, 400012 Cluj-Napoca, Romania;
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14
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Ethical Lessons from an Intensivist's Perspective. J Clin Med 2022; 11:jcm11061613. [PMID: 35329939 PMCID: PMC8949962 DOI: 10.3390/jcm11061613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Intensive care units (ICUs) around the world have been hugely impacted by the SARS-CoV-2 pandemic and the vast numbers of patients admitted with COVID-19, requiring respiratory support and prolonged stays. This pressure, with resulting shortages of ICU beds, equipment, and staff has raised ethical dilemmas as physicians have had to determine how best to allocate the sparse resources. Here, we reflect on some of the major ethical aspects of the COVID-19 pandemic, including resource allocation and rationing, end-of-life decision-making, and communication and staff support. Importantly, these issues are regularly faced in non-pandemic ICU patient management and useful lessons can be learned from the discussions that have occurred as a result of the COVID-19 situation.
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15
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Abhiram K, Tan BYQ, Tan M, Tan L, Sia CH, Chua YX, Lim LJH, Suppiah CM, Sim K, Chan YH, Ooi SBS. The Effect of COVID-19 Endemicity on the Mental Health of Health Workers. J Am Med Dir Assoc 2022; 23:405-413.e3. [PMID: 35219506 PMCID: PMC8863564 DOI: 10.1016/j.jamda.2022.01.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
Objectives A major surge in COVID-19 cases despite Singapore's high vaccination has strained the health care system in October 2021. Our aim was to assess and compare Healthcare Worker (HCW) mental well-being in 2021 against a previously published cohort in 2020. Design Cross-sectional survey study. Setting and Participants HCWs from 4 public hospitals and a primary health care system over a 4-week duration in 2021 coinciding with a major surge compared with a similar period in 2020. Methods A survey comprising of the Oldenburg Burnout Inventory (OLBI), Hospital Anxiety and Depression Scale (HADS), and Safety Attitudes Questionnaire (SAQ) was distributed via email. Primary endpoints were the proportion meeting OLBI thresholds for both disengagement and exhaustion and being at risk for both Anxiety and Depression using HADS. Multivariate analysis identified significant predictors among demographic, workplace, and SAQ data. Subgroup analysis of overseas HCWs was performed. Results We surveyed 1475 HCWs. Significantly more HCWs met primary outcomes using OLBI and HADS than in 2020 (84.1% and 39.6% vs 68.2% and 23.3%, respectively; P < .001). Burnout levels were uniformly high. A HADS score ≥8 in either subscale was significantly associated with meeting burnout thresholds (P < .001). Overseas HCWs (P = .002), South Asian ethnicity (P = .004), preuniversity educational qualifications (P = .026), and longer shift workhours of 8 to <12 (P = .015) and ≥12 (P = .001) were significantly associated with meeting HADS thresholds. Among overseas HCWs (n=407), seeing family more than a year ago was significantly associated with worse OLBI disengagement scores and a greater proportion meeting HADS thresholds vs seeing them within a year or being local HCWs (47.2% vs 37.2% and 35.6%, respectively; P = .001). Conclusions and Implications HCW mental health has objectively worsened between 2020 and 2021 in the pandemic’s second year. Avoiding prolonged shifts, adopting preventive mental health strategies, improving patient safety, and attention to HCWs of minority ethnicity, from overseas, and with preuniversity education may help.
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Affiliation(s)
- Kanneganti Abhiram
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Benjamin Y Q Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore.
| | - Melanie Tan
- Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore
| | - Lifeng Tan
- Division of Healthy Ageing, Alexandra Hospital, Singapore
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore
| | - Ying Xian Chua
- Pioneer Polyclinic, National University Polyclinics, National University Health System, Singapore
| | - Lucas J H Lim
- Psychiatry Residency Programme, National Healthcare Group, Singapore
| | | | - Kang Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; West Region, Institute of Mental Health, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shirley B S Ooi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Emergency Medicine Department, National University Hospital, Singapore
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