Protective Factors, Stress and Anxiety Effects on the Resilience Levels of Healthcare Workers During COVID-19 Pandemic

Yıl 2024, , 491 - 499, 31.08.2024

Ceren Türkdoğan Görgün , Elif Erbay

https://doi.org/10.54005/geneltip.1457311

Öz

Objective: This study investigated how protective factors, stress and anxiety levels affect the resilience levels of healthcare workers (HCWs) throughout the COVID-19 pandemic. Specific aims included examining whether resilience levels among HCWs vary significantly based on demographic variables.
Methods: A total of 303 HCWs from two training and research hospitals completed the survey. Protective Factors for Resilience Scale (PFRS), The Stress and Anxiety to Viral Epidemics–9 Items Scale, and Brief Resilience Scale were used as data collection tools. Confirmatory factor analysis, reliability analyses, construct validity analysis, discriminant validity analysis, structural equation modelling, t-test and ANOVA were conducted respectively.
Results: Only the impact of the individual sub-factor of PFRS on the resilience level of HCWs was positive and significant (b=.847, t= 8.670, p<.001); stress and anxiety levels of HCWs to viral epidemics on their resilience level were both insignificant (b= .039, t=-.468, p=.640; b= .095, t=1.073, p=.283). The resilience level of HCWs who were male (M=4.53, SD=.55), were married (M=4.50, SD=.55), had high school graduates (M=4.87, SD=.27), had 31 years and above experience (M=5.00, SD=.00), had children (M=4.54, SD=. 53), and exercised 2-3 days a week (M=4.54, SD=.46) had significantly higher levels of resilience.
Conclusion: This study pointed out that individual protective factors (such as healthy skills and abilities) effect resilience of HCWs positively and play a crucial for the mental health of HCWs. HCWs who were man, married, low educated, more experienced, had children and doing sports 2-3 days a week had significantly higher resilience.

Anahtar Kelimeler

resilience, stress, anxiety, protective factors, healthcare workers, pandemics

Etik Beyan

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Giresun University on 09.3.2022 with decision number E-50288587-050.01.04-80432.

Koruyucu Faktörler, Stres ve Anksiyetenin COVID-19 Pandemisi Sırasında Sağlık Çalışanlarının Psikolojik Dayanıklılık Düzeyleri Üzerindeki Etkileri

Öz

Amaç: Bu çalışma, koruyucu faktörlerin, stres ve kaygı düzeylerinin COVID-19 salgını boyunca sağlık çalışanlarının psikolojik dayanıklılık düzeylerini nasıl etkilediğini araştırmıştır. Özel amaçlar arasında, sağlık çalışanlarının psikolojik dayanıklılıklarının demografik değişkenlere göre anlamlı farklılık gösterip göstermediğinin incelenmesi de yer almaktadır.
Gereç ve Yöntem: İki eğitim ve araştırma hastanesinden toplam 303 sağlık çalışanı anketi tamamlamıştır. Veri toplama araçları olarak Psikolojik Dayanıklılık için Koruyucu Faktörler Ölçeği, Viral Salgınlara Karşı Stres ve Kaygı Ölçeği ve Kısa Dayanıklılık Ölçeği kullanılmıştır. Sırasıyla doğrulayıcı faktör analizi, güvenilirlik analizleri, yapı geçerliliği analizi, ayırıcı geçerlilik analizi, yapısal eşitlik modellemesi, t-testi ve ANOVA yapılmıştır.
Bulgular: Psikolojik Dayanıklılık için Koruyucu Faktörler Ölçeği’nin sadece Bireysel alt faktörünün sağlık çalışanlarının psikolojik dayanıklılık düzeyi üzerindeki etkisi pozitif ve anlamlıdır (b=.847, t= 8.670, p<.001); sağlık çalışanlarının viral salgınlara karşı stres ve kaygı düzeylerinin psikolojik dayanıklılık düzeyleri üzerindeki etkisi ise anlamsız bulunmuştur (b= .039, t=-.468, p=.640; b= .095, t=1.073, p=.283). Erkek (M=4.53, SD=.55), evli (M=4.50, SD=.55), lise mezunu (M=4.87, SD=.27), 31 yıl ve üzeri deneyime sahip (M=5.00, SD=.00), çocuk sahibi (M=4.54, SD=. 53) ve haftada 2-3 gün egzersiz yapan (M=4.54, SD=.46) sağlık çalışanlarının dayanıklılık düzeyleri anlamlı derecede daha yüksek çıkmıştır.
Sonuç: Bu çalışma, bireysel koruyucu faktörlerin (sağlıklı beceriler ve yetenekler gibi) sağlık çalışanlarının psikolojik dayanıklılığını olumlu yönde etkilediğini ve sağlık çalışanlarının psikolojik sağlığı için önemli bir rol oynadığını göstermiştir. Erkek, evli, düşük eğitimli, daha deneyimli, çocuk sahibi ve haftada 2-3 gün spor yapan sağlık çalışanlarının psikolojik dayanıklılıkları ise anlamlı düzeyde daha yüksektir.

Anahtar Kelimeler

Psikolojik dayanıklılık, Stres, Anksiyete, Koruyucu Faktörler, Sağlık Çalışanları, Pandemi

Kaynakça

• Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA 2020; 323(21):2133-2134. doi: 10.1001/jama.2020.5893. PMID: 32259193.
• Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, Chen-Li D, Iacobucci M, Ho R, Majeed A, McIntyre RS. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord 2020; 277:55-64. doi: 10.1016/j.jad.2020.08.001.
• Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020; 88:559-565. doi: 10.1016/j.bbi.2020.04.049.
• Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian J Psychiatr 2020; 51:102119. doi: 10.1016/j.ajp.2020.102119.
• Chen H, Sun L, Du Z, Zhao L, Wang L. A cross-sectional study of mental health status and self-psychological adjustment in nurses who supported Wuhan for fighting against the COVID-19. J Clin Nurs 2020; 29(21-22):4161-4170. doi: 10.1111/jocn.15444.
• Masten AS, Best KM, Garmezy N. Resilience and development: Contributions from the study of children who overcome adversity. Development and psychopathology 1990; 2(4): 425-444.
• Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003; 18(2):76-82. doi: 10.1002/da.10113.
• Luthar SS, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work. Child Dev 2000; 71(3):543-62. doi: 10.1111/1467-8624.00164.
• Rutter M. Psychosocial resilience and protective mechanisms. Am J Orthopsychiatry 1987; 57(3):316-331. doi: 10.1111/j.1939-0025.1987.tb03541.x.
• Labrague LJ. Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies. J Nurs Manag 2021; 29(7):1893-1905. doi: 10.1111/jonm.13336.
• Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, et al. Stress, Resilience, and Coping of Healthcare Workers during the COVID-19 Pandemic. J Prim Care Community Health 2021; 12:21501327211008448. doi: 10.1177/21501327211008448.
• Field A. Discovering statistics using SPSS (2nd ed.). London: Sage Publication, 2005.
• Nunnally JC. Psychometric Theory (2nd ed.). New York: McGraw-Hill, 1978.
• Harms C, Pooley JA, Cohen L. The Protective Factors for Resilience Scale (PFRS): Development of the scale. Cogent Psychology 2017; 4(1), Article 1400415. doi: 10.1080/23311908.2017.1400415
• Tanko Ç, Ekşi F, Hatun O, Ekşi H. Psikolojik Sağlamlık için Koruyucu Faktörler Ölçeği Türkçe formunun geçerlik ve güvenirliği. Ege Eğitim Dergisi 2021; 22(1):16-29. doi: 10.12984/egeefd.793597
• Chung S, Kim HJ, Ahn MH, Yeo S, Lee J, Kim K, et al. Development of the Stress and Anxiety to Viral Epidemics-9 (SAVE-9) Scale for Assessing Work-related Stress and Anxiety in Healthcare Workers in Response to Viral Epidemics. J Korean Med Sci 2021; 36(47):e319. doi: 10.3346/jkms.2021.36.e319.
• Uzun N, Akça ÖF, Bilgiç A, Chung S. The validity and reliability of the Stress and Anxiety to Viral Epidemics-9 items Scale in Turkish health care professionals. J Community Psychol 2022; 50(2):797-805. doi: 10.1002/jcop.22680.
• 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. doi: 10.1080/10705500802222972.
• Doğan T. Adaptation of the Brief Resilience Scale into Turkish: A validity and reliability study. The Journal of Happiness and Well-Being 2015; 3(1):93-102
• Kline RB. Principles and Practice of Structural Equation Modeling (4th ed.). New York: Guilford Press, 2015.
• Collier JE. Applied Structural Equation Modeling Using AMOS: Basic to Advanced Techniques. New York, Routledge, 2020.
• Hu LT, Bentler PM. Cutoff Criteria for Fit Indexes in Covariance Structure Analysis: Conventional Criteria versus New Alternatives. Structural Equation Modeling 1999; 6:1-55. doi: 10.1080/10705519909540118
• Hair J, Black W, Babin B, Anderson R. Multivariate Data Analysis, 7a. Editon, 2010.
• Bentler PM. Comparative fit indexes in structural models. Psychological Bulletin 1990; 107(2):238–246. doi: 10.1037/0033-2909.107.2.238
• Straub D, Boudreau M, Gefen D. Validation Guidelines for IS Positivist Research. Communications of the Association for Information Systems 2004; 13. doi: 10.17705/1CAIS.01324
• Nunnally JC, Bernstein IH. The Assessment of Reliability. Psychometric Theory 1994; 3:248-292.
• Gefen D, Straub D, Boudreau M. Structural Equation Modeling and Regression: Guidelines for Research Practice. Communications of the Association for Information Systems 2000; 4. doi: 10.17705/1CAIS.00407
• Bollen KA. Structural equations with latent variables. John Wiley & Sons, 1989. Doi:10.1002/9781118619179
• Bagozzi R, Yi Y. On the Evaluation of Structural Equation Models. J Acad Mark Sci 1988; 16:74-94. Doi: 10.1007/BF02723327
• Anderson JC, Gerbing DW. Structural equation modeling in practice: A review and recommended two-step approach. Psychological Bulletin 1988; 103(3):411–423. Doi: 10.1037/0033-2909.103.3.411
• Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research 1981; 18(1):39-50.
• Dyer JG, McGuinness TM. Resilience: analysis of the concept. Arch Psychiatr Nurs 1996; 10(5):276-82. doi: 10.1016/s0883-9417(96)80036-7.
• Jones Wood SC, Phillips RA. Building workforce resilience at the individual and organizational levels. NEJM Catalyst Innovations in Care Delivery 2022; 3(8), CAT-22.
• Schmuck J, Hiebel N, Kriegsmann-Rabe M, Schneider J, Matthias JK, Erim Y, Morawa E, et al. Individual Stress Burden and Mental Health in Health Care Workers during the COVID-19 Pandemic: Moderating and Mediating Effects of Resilience. Int J Environ Res Public Health 2022; 19(11):6545. doi: 10.3390/ijerph19116545.
• Hong Y, Lee J, Lee HJ, Kim K, Cho IK, Ahn MH, et al. Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era. Psychiatry Investig 2021; 18(4):357-363. doi: 10.30773/pi.2021.0019.
• Bahar A, Koçak HS, Samancıoğlu Bağlama S, Çuhadar D. Can Psychological Resilience Protect the Mental Health of Healthcare Professionals during the COVID-19 Pandemic Period?. Dubai Med J 2020; 3(4):133–139.
• Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, et al. The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence. Curr Psychiatry Rep 2020; 22(8):43. doi: 10.1007/s11920-020-01166-z.
• Liljestrand R, Martin S. Stress and Resilience Among Healthcare Workers During the COVID-19 Pandemic: Consideration of Case Studies. Rehabil Nurs 2021; 46(6):300-304. doi: 10.1097/RNJ.0000000000000344.
• Bozdağ F, Ergün N. Psychological Resilience of Healthcare Professionals During COVID-19 Pandemic. Psychol Rep 2021; 124(6):2567-2586. doi: 10.1177/0033294120965477.
• Coco M, Guerrera CS, Santisi G, Riggio F, Grasso R, Di Corrado D, et al. Psychosocial Impact and Role of Resilience on Healthcare Workers during COVID-19 Pandemic. Sustainability 2021; 13(13):7096. doi: 10.3390/su13137096
• Di Monte C, Monaco S, Mariani R, Di Trani M. From Resilience to Burnout: Psychological Features of Italian General Practitioners During COVID-19 Emergency. Front Psychol 2020; 11:567201. doi: 10.3389/fpsyg.2020.567201.
• Guo C, Li S, Chan SS. Long-term effects of disaster exposure on health care workers’ resilience: A comparison of the Wenchuan earthquake-exposed and unexposed groups. International Journal of Disaster Risk Reduction 2022; 67,102658. doi: 10.1016/J.IJDRR.2021.102658
• Parthasarathy S, Lalu JS. The Psychological Impact of COVID-19 Pandemic on Health Care Workers in the Andaman and Nicobar Islands. International Journal of Indian Psychology 2021; 9(3):1268-1279. doi: 10.25215/0903.119
• Safiye T, Vukčević B, Gutić M, Milidrag A, Dubljanin D, Dubljanin J, Radmanović B. Resilience, Mentalizing and Burnout Syndrome among Healthcare Workers during the COVID-19 Pandemic in Serbia. Int J Environ Res Public Health 2022; 19(11):6577. doi: 10.3390/ijerph19116577.
• Silva SMD, Baptista PCP, Silva FJD, Almeida MCDS, Soares RAQ. Resilience factors in nursing workers in the hospital context. Rev Esc Enferm USP 2020; 54:e03550. English, Portuguese. doi: 10.1590/S1980-220X2018041003550.
• Yusefi A R, Faryabi R, Bordbar S, Daneshi S, Nikmanesh P. Job Burnout Status and its Relationship with Resilience Level of Healthcare Workers during Covid-19 Pandemic: A Case of Southern Iran. Iran J Health Sci 2021; 9(3):1-11
• Wong EL, Qiu H, Chien WT, Wong CL, Chalise HN, Hoang HTX, et al. Comparison of Resilience Among Healthcare Workers During the COVID-19 Pandemics: A Multinational Cross-Sectional Survey in Southeast Asian Jurisdictions. Int J Public Health 2022; 67:1605505. doi: 10.3389/ijph.2022.1605505.
• Sull A, Harland N, Moore A. Resilience of health-care workers in the UK; a cross-sectional survey. J Occup Med Toxicol 2015; 10:20. doi: 10.1186/s12995-015-0061-x.
• Sánchez-Zaballos M, Mosteiro-Díaz MP. Resilience Among Professional Health Workers in Emergency Services. J Emerg Nurs 2021; 47(6):925-932.e2. doi: 10.1016/j.jen.2020.07.007.
• Türkdoğan Görgün C. The effect of psychological health levels of healthcare professionals on professional quality of life: COVID-19 pandemic (Doctoral dissertation). Ankara, Ankara University, 2022.
• Mantas-Jiménez S, Lluch-Canut MT, Roldán-Merino J, Reig-Garcia G, Juvinyà-Canal D. Resilience and job satisfaction among out-of-hospital emergency medical service professionals: A cross-sectional multi-centric study. J Nurs Manag 2022; 30(6):2084-2092. doi: 10.1111/jonm.13645.
• Matheson C, Robertson HD, Elliott AM, Iversen L, Murchie P. Resilience of primary healthcare professionals working in challenging environments: a focus group study. Br J Gen Pract 2016; 66(648):e507-15. doi: 10.3399/bjgp16X685285.
• Kaye-Kauderer H, Loo G, Murrough JW, Feingold JH, Feder A, Peccoralo L, et al. Effects of Sleep, Exercise, and Leadership Support on Resilience in Frontline Healthcare Workers During the COVID-19 Pandemic. J Occup Environ Med 2022; 64(5):416-420. doi: 10.1097/JOM.0000000000002460.
• Zhang SX, Liu J, Afshar Jahanshahi A, Nawaser K, Yousefi A, Li J, Sun S. 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 Behav Immun 2020; 87:144-146. doi: 10.1016/j.bbi.2020.05.010.
• Sobregrau Sangrà P, Aguiló Mir S, Castro Ribeiro T, Esteban-Sepúlveda S, García Pagès E, López Barbeito B, et al. Mental health assessment of Spanish healthcare workers during the SARS-CoV-2 pandemic. A cross-sectional study. Compr Psychiatry 2022; 112:152278. doi: 10.1016/j.comppsych.2021.152278.
• Maraqa B, Nazzal Z, Zink T. Palestinian Health Care Workers’ Stress and Stressors During COVID-19 Pandemic: A Cross-Sectional Study. J Prim Care Community Health 2020; 11:2150132720955026. doi: 10.1177/2150132720955026.
• Rogers HB. Mindfulness meditation for increasing resilience in college students. Psychiatric Annals 2013; 43(12):545-548.