Evaluation of anxiety, psychological resilience and codependency in nurses during the COVID-19 pandemic

Abstract

Aims: In this study, it was aimed to evaluate anxiety levels in nurses during the COVID-19 pandemic and to examine the relationship between psychological resilience and codependency levels and anxiety levels. Methods: The study was conducted on 152 nurses actively working in a pandemic hospital during the COVID-19 outbreak. Sociodemographic Information Form, Beck Anxiety Inventory, Spann-Fischer Codependency Scale, Brief Resilience Scale were used as data collection tools. Results: As a result of the study, anxiety and codependency scores of nurses working in high-risk pandemic units during the pandemic were higher and psychological resilience scores were lower than those working in low-risk units. When the relationship between anxiety, psychological resilience and codependency in the research group was examined; a negative and highly significant relation was found between psychological resilience and anxiety and between psychological resilience and codependency, and a positive and highly significant relation was found between anxiety and codependency (p<0.001 for all). According to the results of regression analysis, it was found that anxiety levels decreased as psychological resilience levels increased in nurses, and anxiety levels increased as codependency levels increased. Conclusion: It was concluded that the anxiety levels of nurses working in high-risk units during the COVID-19 pandemic were higher, and the levels of psychological resilience and codependency affected the level of anxiety experienced by nurses.Interventions to increase psychological resilience are important in order to protect nurses, who work with great devotion on the front line during disasters and pandemics, from anxiety and the development of codependency, which is an important problem that reduces the quality of care and decreases work performance.

Keywords

• COVID-19
• nurse
• anxiety
• resilience
• codependency

References

1. Lamb D, Gnanapragasam S, Greenberg N, et al. Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic. Occup Environ Med. 2021;78(11):801-808.
2. Labrague LJ, De Los Santos JAA. COVID-19 anxiety among front-line nurses: Predictive role of organisational support, personal resilience and social support. J Nurs Manag. 2020;28(7):1653-1661.
3. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3): e203976.
4. Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - a systematic review and meta-analysis. Psychiatry Res. 2020;291:113190.
5. Earvolino-Ramirez M. Resilience: a concept analysis. Nurs Forum. 2007;42(2):73-82.
6. Turner SB. Resilience of nurses in the face of disaster. Disaster Med Public Health Prep. 2015;9(6):601-604.
7. Cooper AL, Brown JA, Rees CS, Leslie GD. Nurse resilience: a concept analysis. Int J Ment Health Nurs. 2020;29(4):553-575.
8. Haddadi P, Besharat MA. Resilience, vulnerability and mental health. Procedia - Soc Behav Sci. 2010;5:639-642.

9. Shin YC, Kim SM, Kim H, et al. Resilience as a protective factor for depressive mood and anxiety among Korean employees. J Korean Med Sci. 2019;34(27):e188.
10. Fradelos EC, Alikari V, Vus V, et al. Assessment of the relation between religiosity, anxiety, depression and psychological resilience in nursing staff. Health Psychol Res. 2020;8(1):8234.
11. Ançel G. Karşılıklı bağımlılık kavramı hemşirelikle ilişkisi ve karşılıklı bağımlılığı belirleme araçları. Turk J Res Develop Nurs. 2012; 14(1):70-78.
12. Öz F. Bağlaşıklık ve hemşirelik. Codependency and nursing. Kriz Derg. 1998;6(1):67-73.
13. Biering P. "Codependency". A disease or the root of nursing excellence? J Holist Nurs. 1998;16(3):320-337.
14. Martsolf DS, Hughes-Hammer C, Estok P, Zeller RA. Codependency in male and female helping professionals. Arch Psychiatr Nurs. 1999;13(2):97-103.
15. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-897.
16. Ulusoy M, Sahin, NH, Erkmen H. Turkish version of the Beck anxiety inventory: psychometric properties. J Cogn Psychother. 1998;12(2):163-172.
17. Fischer J L, Spann L, Crawford DW. Measuring codependency. Alcohol Treat Q. 1991;8(1):87-100.
18. Tanhan F, Mukba G. “Spann-Fischer ilişki bağımlılığı ölçeği’nin Türkçe’ye uyarlama çalışmasına ilişkin psikometrik bir analiz”. Pamukkale Üniv Eğ Fak Der. 2014;36:179-190.
19. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194-200.
20. Doğan T. Kısa psikolojik sağlamlık ölçeği’nin Türkçe uyarlaması: geçerlik ve güvenirlik çalışması. J Happiness Well-Being. 2015;3(1):93-102.
21. Korkmaz SA, Yıldız A, Erdas MB, Karakaya O, Goka E. Mental health status of healthcare workers during the COVID-19 pandemic in Turkey: results from the vaccination phase. PBS. 2022;12(4):164-175.
22. Luthar SS, Cicchetti D. The construct of resilience: implications for interventions and social policies. Dev Psychopathol. 2000;12(4):857-885.
23. Barzilay R, Moore TM, Greenberg DM, et al. Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers. Transl Psychiatry. 2020;10(1):291.
24. Setiawati Y, Wahyuhadi J, Joestandari F, Maramis MM, Atika A. Anxiety and resilience of healthcare workers during COVID-19 pandemic in Indonesia. J Multidiscip Health. 2021;14:1-8.
25. Karabulak H, Kaya F. The relationship between psychological resilience and stress perception in nurses in Turkey during the COVID-19 pandemic. J Nurs Res. 2021;29(6):e175.
26. Bayat D, Polat Olca S. Covid 19 pandemisinin hemşirelerin psikolojik sağlamlık anksiyete ve depresyon düzeylerine etkisi. Sağlık Akademisyenleri Derg. 2023;10(1):146-154.
27. Cullen J, Carr A. Codependency: an empirical study from a systemic perspective. Contemp Fam Ther. 1999;21(4):505-526.
28. Yates JG, McDaniel JL. Are you losing yourself in codependency?. Am J Nurs. 1994;94(4):32-36.
29. Caffrey RA, Caffrey PA. Nursing: caring or codependent? Nurs Forum. 1994;29(1):12-17.
30. Knapek E, Balázs K, Ildikó KS.Resilience and early maladaptive schemas among codependent, borderline, and healthy individuals. Alkalmazott Pszıchológıa. 2015;15(1):111-127.
31. Faraji H, Utar K, Berfu Boran N. Relationship between early maladaptive schemas and psychological resilience. Asia Stud Acad Soc Stud. 2022; 6(19):203-214.
32. Jazayeri M, Vatan khah HR, badiei MM. The relationship between defense styles and early maladaptive schemas with resilience in boy students of high school in Tehran city. Thoughts Behav Clin Psychol. 2014;8(30):7-16.
33. Lin J, Ren Y, Gan H, Chen Y, Huang Y, You X. Factors influencing resilience of medical workers from other provinces to Wuhan fighting against 2019 novel coronavirus pneumonia. BMC Psychiatry. 2020;417:1-15.
34. Huffman EM, Athanasiadis DI, Anton NE, et al. How resilient is your team? Exploring healthcare providers' well-being during the COVID-19 pandemic. Am J Surg. 2021;221(2):277-284.
35. Saruç S, Kızıltaş A. An analysis of the healthcare personnel’s anxiety levels during the COVID-19 pandemic in terms of their psychological resilience and the problems they experienced. J Psychiatric Nurs. 2021;12(4):314-323.