TÜRK DİYALİZ SAĞLIK ÇALIŞANLARINDA COVID-19’A BAĞLI GÖRÜLEN RUHSAL TEPKİLER

Öz

Amaç: COVID-19, sağlık çalışanları için psikolojik sorunların başlamasına veya kötüleşmesine yol açmıştır. Hastaların enfeksiyon, semptom şiddeti ve ölüm riskinin daha yüksek olması nedeniyle COVID-19, diyaliz çalışanları üzerinde ek bir stres oluşturmuştur. Bu çalışmada, salgının erken döneminde Türk diyaliz çalışanlarındaki psikolojik zorlanma ve ilişkili etmenleri araştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya Türkiye’deki özel ve kamu diyaliz merkezlerinden doktor, hemşire ve yardımcı sağlık personelleri katılmıştır. Katılımcılar, COVID-19’la ilişkili sorular, Depresyon Anksiyete Stres Ölçeği-21 (DASÖ-21) ve Çok Boyutlu Algılanan Sosyal Destek Ölçeği’ni (ÇBASDÖ) içeren çevrimiçi bir anket doldurmuşlardır. Ki-Kare, Fisher’s exact, Mann-Whitney-U, Kruskal Wallis, Spearman korelasyon ve lojistik regresyon analizleri uygulanmıştır. Bulgular: Çoğunluğu hemşireler (n=465; %48,8) olmakla birlikte, yardımcı sağlık personeli (n=402; %42,2) ve doktoların (n=86; %9) yanıtlarından eksiksiz olan toplam 953 yanıt analize alınmıştır. Enfekte olmak ve COVID-19’u çevresindekilere bulaştırmak en büyük endişe kaynakları olarak saptanmıştır. DASÖ-21 puanları bekar, çocuğu olmayan, koruyucu ekipman bulmakta güçlük çeken veya ileride bulma kaygısı yaşayan, COVID-19(+) kişilerle temas halinde olan; sigara ve alkol kullanımını artıran; yeni başlayan uyku, iştah ve somatik sorunlar bildiren katılımcılarda daha yüksek bulunmuştur. Enfeksiyonu kapmak (%94,6) vs. (%90,6) vs. (%84,7); p<0,001] ve ekipman sorunuyla ile ilgili endişeler [(%52,9) vs. (%29,4) vs. (%26,3); p<0,001], uyku [(%62,2) vs.(%43,5) vs. (%34); p<0,001, sırasıyla] ve somatik sorunlar [(%58,4) vs. (%50) vs. (%28,2); p<0,001] ve DASÖ-21 puanları [(5-21) vs. (3-15) vs. (0-12); p<0,001] hemşirelerde doktor ve sağlık çalışanlarına göre daha yüksektir. Sonuç: Salgına yönelik endişeler ve yaşam şekli değişiklikleri psikolojik zorluklarla ilişkili saptanmış olup, yeterli bilgi düzeyi, bulaştan korunma ve sosyal desteğin sağlık çalışanları için önemli konular olduğu görülmektedir. Sağlık çalışanlarının endişelerini yakınları, meslektaşları ve amirlerine/yöneticileriyle paylaşması önerilirken; kurumların da personelin psikolojik durumuna dikkat göstermesi ve gereğinde hızlı girişimler sağlaması önemlidir.

Anahtar Kelimeler

• COVID-19
• Diyaliz
• Sağlık Çalışanları
• Ruhsal Tepki

TURKISH DIALYSIS HEALTHCARE PROVIDERS’ PSYCHOLOGICAL RESPONSE TO COVID-19

Öz

Objective: COVID-19 has been a stressful experience for healthcare providers (HCPs) and created additional distress for dialysis HCPs due to patients’ higher risk of infection, symptom severity, and death. This study aims to investigate Turkish dialysis HCPs’ levels of psychological difficulties during COVID-19’s initial outbreak. Materials and Methods: The study has recruited physicians, nurses, and healthcare workers in dialysis centers. The participants completed an online survey that includes the screening questionnaire, Depression Anxiety Stress Scale-21 (DASS21), and Multidimensional Scale of Perceived Social Support (MSPSS). The study conducts the chi-square test, Fisher’s exact test, Mann-Whitney U test, Kruskal Wallis H test, Spearman correlation, and linear regression analyses. Results: The study involves 953 respondents, with nurses making up the majority (n=465, 48.8%), followed by healthcare workers (n=402; 42.2%) and physicians (n=86; 9%). HCPs’ most significant concerns were getting infected with COVID-19 and transmitting the disease to their loved ones. Single participants, those without children, those who had trouble finding equipment, and those worried about being able to find equipment in the future, being in contact with COVID-19 (+) people, those whose tobacco and alcohol use increased, and those who declared sleep, appetite, and/or somatic problems had higher DASS-21 scores. When compared respectively to healthcare workers and physicians, nurses were found to be more worried about getting COVID-19 (94.6% compared to 90.6% and 84.7%; p < 0.001), experience equipment shortages (52.9% compared to 29.4% and 26.3%; p<0.001), have sleep (62.2% compared to 43.5% and 34%; p<0.001) and somatic problems (58.4% compared to 50% and 28.2%; p<0.001), and higher DASS-21 scores (Range=5-21 compared to 3-15 and 0-12; p<0.001). Conclusion: Worries and lifestyle changes associated with the outbreak are seen to have been be related to psychological difficulties. An adequate level of knowledge, self-protection, and social support are essential issues for HCPs. While this study recommends that HCPs express and share their worries, institutions should also focus on the psychological status of their staff and provide immediate interventions.

Anahtar Kelimeler

• COVID-19
• dialysis
• healthcare providers
• psychological response

Teşekkür

We are thankful to Fresenius Medical Care Türkiye, for helping us to reach the majority of the dialysis physicians, nurses and other personnel.

Kaynakça

1. 1. World Health Organization. Novel Coronavirus (2019-nCoV) SITUATION REPORT - 1. [cited 2021 Feb 13]. Available from: https://www.who.int/docs/default-source/ coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4 google scholar
2. 2. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. [cited 2020 5 July]. Available from: https:// www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 google scholar
3. 3. Koffman J, Gross J, Etkind SN, Selman L. Uncertainty and COVID-19: how are we to respond? J R Soc Med 2020;113(6):211-6. [CrossRef] google scholar
4. 4. Sasangohar F, Sasangohar F, Jones SL, Masud FN, Vahidy FS, Kash BA. Provider Burnout and Fatigue during the COVID-19 Pandemic: Lessons Learned from a High-Volume Intensive Care Unit. Anesth Analg 2020;131(1):106-11. [CrossRef] google scholar
5. 5. Li J, Xu G. Lessons from the Experience in Wuhan to Reduce Risk of COVID-19 Infection in Patients Undergoing LongTerm Hemodialysis. Clin J Am Soc Nephrol 2020;15(5):717-19. [CrossRef] google scholar
6. 6. Kilincel S, Tuncer Issi Z, Kilincel O, Akpinar Aslan E, Ay R, Erzin G, et al. Effects of coronavirus (COVID-19) pandemic on health anxiety levels of healthcare professionals. J Contemp Med 2020;10(3):312-8. [CrossRef] google scholar
7. 7. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:901-7. [CrossRef] google scholar
8. 8. 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;88:559-65. [CrossRef] google scholar

9. 9. Klersy C, Callegari A, Martinelli V, Vizzardi V, Navino C, Malberti F, et al. burnout in health care providers of dialysis service in Northern Italy - A multicentre study. Nephrol Dial Transplant 2007;22(8):2283-90. [CrossRef] google scholar
10. 10. Agrawal V, Plantinga L, Abdel-Kader K, Pivert K, Provenzano A, Soman S, et al. burnout and emotional well-being among nephrology fellows: A national online survey. J Am Soc Nephrol 2020;31:675-85. [CrossRef] google scholar
11. 11. Karakoc A, Yilmaz M, Alcalar N, Esen B, Kayabasi H, Sit D. Burnout syndrome among hemodialysis and peritoneal dialysis nurses. Iran J Kidney Dis 2016;10(6):395-404. google scholar
12. 12. Argentero P, Dell’Olivo B, Ferretti MS. Staff Burnout and Patient Satisfaction With the Quality of Dialysis Care. Am J Kidney Dis 2008;51(1):80-92. [CrossRef] google scholar
13. 13. Kliger AS, Silberzweig J. Mitigating risk of COVID-19 in dialysis facilities. Clin J Am Soc Nephrol 2020;15(5):707-9. [CrossRef] google scholar
14. 14. Ma Y, Diao B, Lv X, Zhu J, Chen C, Liu L, et al. Epidemiological, clinical, and immunological features of a cluster of COVID-19-contracted hemodialysis patients. Kidney Int Rep 2020;5(8):1333-41. [CrossRef] google scholar
15. 15. Hall LH, Johnson J, Watt I, Tsipa A, O’Connor DB. Healthcare staff well-being, burnout, and patient safety: a systematic review. PloS one 2016;11(7):e0159015. [CrossRef] google scholar
16. 16. Janes G, Mills T, Budworth L, Johnson J, Lawton R. The Association Between Health Care Staff Engagement and Patient Safety Outcomes: A Systematic Review and MetaAnalysis. J Patient Saf 2021;17(3):207-16. [CrossRef] google scholar
17. 17. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33(3):335-43. [CrossRef] google scholar
18. 18. Sarıçam H. The Psychometric Properties of Turkish Version of Depression Anxiety Stress Scale-21 (DASS-21) in Community and Clinical Samples. J Cogn Psychother Res 2018;7(1):19-30. [CrossRef] google scholar
19. 19. Gratz KL, Roemer L. Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess 2004(26);41-54. [CrossRef] google scholar
20. 20. Eker D, Arkar H, Yaldiz H. Factorial structure, validity, and reliability of revised form of the multidimensional scale of perceived social support. Turk J Psychiatry 2001;12(1):17-25. [CrossRef] google scholar
21. 21. Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Res 2020;290:113130. [CrossRef] google scholar
22. 22. Hacimusalar Y, Kahve AC, Yasar AB, Aydin MS. Anxiety and hopelessness levels in COVID-19 pandemic: A comparative study of healthcare professionals and other community sample in Turkey. J Psychiatr Res 2020;129:181-8. [CrossRef] google scholar
23. 23. Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, et al. Psychological impact of COVID-19 on medical care workers in China. Infectious diseases of poverty 2020;9(1):1-13. [CrossRef] google scholar
24. 24. Brooks SK, Dunn R, Amlot R, Rubin GJ, Greenberg N. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occup Environ Med 2018;60(3):248-57. [CrossRef] google scholar
25. 25. Kim MS, Taeshik K, Lee D, Yook JH, Hong YC, Lee SY, et al. Mental disorders among workers in the healthcare industry: 2014 national health insurance data. Ann. Occup. Environ Med. 2018;30(1):31. [CrossRef] google scholar
26. 26. Du J, Dong L, Wang T, Yuan C, Fu R, Zhang L et al. Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan. Gen Hosp Psychiatry 2020;67:144-5. [CrossRef] google scholar
27. 27. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Can Med Assoc J 2003:168(10);1245-51. google scholar
28. 28. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395(10227):912-20. [CrossRef] google scholar
29. 29. Şahin MK, Aker S, Şahin G, Karabekiroğlu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020;45(6): 1168-77. [CrossRef] google scholar
30. 30. Karataş A, Canakci E, Kaya Y, Bostan, S., Özturan A, et al. Impact ofThe Covid-19 Pandemic onAnxiety andDepression Levels of The Dialysis Center Employees. Middle Black Sea Journal of Health Science 2020;6(2): 240-8. [CrossRef] google scholar
31. 31. Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Netw Open 2020;3:e2010185. [CrossRef] google scholar
32. 32. Centers of Disease Control and Prevention (CDC). Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19) [Internet]. [cited 2021 13 February]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html google scholar
33. 33. Marinaci T, Carpinelli L, Venuleo C, Savarese G, Cavallo P. Emotional distress, psychosomatic symptoms and their relationship with institutional responses: A survey of Italian frontline medical staff during the Covid-19 pandemic. Heliyon 2020;6(12):e05766. [CrossRef] google scholar
34. 34. Marjanovic Z, Greenglass ER, Coffey S. The relevance of psychosocial variables and working conditions in predicting nurses’ coping strategies during the SARS crisis: An online questionnaire survey. Int J Nurs Stud 2007;44(6):991-8. [CrossRef] google scholar
35. 35. Chigwedere OC, Sadath A, Kabir Z, Arensman E. The Impact of Epidemics and Pandemics on the Mental Health of Healthcare Workers: A Systematic Review. Int J Environ Res Public Health 2021;18(13):6695. [CrossRef] google scholar
36. 36. Muller AE, Hafstad EV, Himmels JPW, Smedslund G, Flottorp S, Stensland S0, et al. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Res 2020;293:113441. [CrossRef] google scholar
37. 37. Kılınç T, Sis Çelik A. Relationship between the social support and psychological resilience levels perceived by nurses during the COVID-19 pandemic: A study from Turkey. Perspect Psychiatr Care 2020;57(3):1000-8. [CrossRef] google scholar
38. 38. 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. [CrossRef] google scholar
39. 39. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 epidemic in China: A web-based cross-sectional survey.Psychiatry Res 2020;288:112954. [CrossRef] google scholar
40. 40. Jahrami H, BaHammam AS, AlGahtani H, Ebrahim A, Faris MAI, AlEid K, et al. The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19. Sleep Breath 2021;25:503-11. [CrossRef] google scholar
41. 41. Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attina A, Cinelli G, et al. Eating habits and lifestyle changes during COVID-19 lockdown: An Italian survey. J Transl Med 2020;18:229. [CrossRef] google scholar
42. 42. Haug TT, Mykletun A, Dahl AA. The association between anxiety, depression, and somatic symptoms in a large population: The HUNT-II study. Psychosom Med 2004;66(6):845-51. [CrossRef] google scholar
43. 43. Yach D. Tobacco Use Patterns in Five Countries During the COVID-19 Lockdown. Nicotine Tob Res 2020;22(9):1671-2. [CrossRef] google scholar
44. 44. Rodriguez LM, Litt DM, Stewart SH. Drinking to cope with the pandemic: The unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women. Addict Behav 2020;110:106532. [CrossRef] google scholar
45. 45. Çıtak N. Dünyada ve Türkiyede Pandeminin Seyri. Pandeminin İkinci Yılı Değerlendirme Raporu. TürkTabipleri Birliği Yayınları Ankara. 2022.p: 19-40. google scholar