Keywords
COVID-19 pandemic
Health care workers
Italy
Abstract
Introduction: The COVID-19 pandemic has posed significant challenges for healthcare workers worldwide, potentially affecting their sense of coherence (SOC) and overall well-being. This study aimed to identify factors associated with different levels of SOC among healthcare workers. Methods: A cross-sectional study was conducted among 628 healthcare workers. SOC scores were assessed using a standardized questionnaire, and data on demographic characteristics, length of service, geographic location, and pandemic-related experiences were collected. Statistical analyses were performed to identify associations between these factors and SOC. Results: Healthcare workers had a lower average SOC score (mean: 57.1) compared to the national average in Italy (mean: 60.3). Younger age and shorter length of service were associated with a higher risk of low SOC (p<0.0001). Healthcare workers in the northwestern regions of Italy had an increased risk of low SOC compared to their counterparts in the northeastern regions (p=0.0336). Adverse pandemic-related experiences and worsening social relationships were also associated with a higher risk of low SOC (p<0.0001). Conclusions: This study highlights the unique challenges and stressors faced by healthcare workers during the COVID-19 pandemic and their impact on SOC. Age, length of service, geographic location, and social were significant factors influencing SOC levels. Targeted interventions are needed to enhance SOC and well-being, particularly for younger and newly employed healthcare workers. Strategies promoting social connections, work-life balance, and psychological support services are crucial to support healthcare workers' resilience and coping abilities.
References
Conversano, C, Marchi, L, Miniati, M. Psychological Distress Among Healthcare Professionals Involved in the Covid-19 Emergency: Vulnerability and Resilience Factors. Clin Neuropsychiatry 2020, 17 (2), 94–96. doi: 10.36131/CN20200212.
Tahara, M, Mashizume, Y, Takahashi, K. Coping Mechanisms: Exploring Strategies Utilized by Japanese Healthcare Workers to Reduce Stress and Improve Mental Health during the COVID-19 Pandemic. Int J Environ Res Public Health 2020, 18 (1), 131.
Epicentro, ISS. Available online: https://www.epicentro.iss.it/coronavirus/sars-cov-2-gestione-stress-operatori (accessed June 6, 2023).
Robertson, E, Hershenfield, K, Grace, S. L, et al. The Psychosocial Effects of Being Quarantined Following Exposure to SARS: A Qualitative Study of Toronto Healthcare workers. Can J Psychiatry 2004, 49, 403–407. doi: 10.1177/070674370404900612.
Giorgi, G, Lecca, L. I, Alessio, F, et al. COVID-19-Related Mental Health Effects in the Workplace: A Narrative Review. Int J Environ Res Public Health 2020, 17 (21), 7857. doi: 10.3390/ijerph17217857.
Barnett, J. E, Baker, E. K, Elman, N. S, et al. In Pursuit of Wellness: The Self-Care Imperative. Prof Psychol 2007, 38 (6), 603–612. doi: 10.1037/0735-7028.38.6.603.
Van der Colff, J. J, Rothmann, S, et al. Occupational Stress, Sense of Coherence, Coping, Burnout and Work Engagement of Registered Nurses in South Africa. SA J Ind Psychol 2009, 35 (1), 1–10. doi: 10.4102/sajip.v35i1.423.
Streb, M, Häller, P, Michael, T. PTSD in Paramedics: Resilience and Sense of Coherence. Behav Cogn Psychother 2014, 42, 452–463. doi: 10.1017/S1352465813000337.
Mittelmark, M. B, Sagy, S, Eriksson, M, et al., Eds. The Handbook of Salutogenesis; Springer: Cham, Switzerland, 2017.
Eriksson, M, Lindström, B. Antonovsky's Sense of Coherence Scale and the Relation with Health: A Systematic Review. J Epidemiol Community Health 2006, 60 (5), 376–381. doi: 10.1136/jech.2005.041616.
Antonovsky, A. Unraveling the Mystery of Health: How People Manage Stress and Stay Well; American Psychological Association: Worcester, MA, USA, 1987; Volume 218.
Experimental Center for Health Promotion and Health Education (CeSpes), Salutogenesis. Available at: http://cespes.unipg.it/salutogenesi.htm.
Gilbar O. Relationship between burnout and sense of coherence in health social workers. Soc Work Health Care 1998, 26, 39–49, doi: 10.1300/J010v26n03_03.
Levert T, Lucas M, Ortlepp K. Burnout in psychiatric nurses: contributions of the work environment and a sense of coherence. S Afr J Psychol 2000, 30, 36–43, doi: 10.1177/008124630003000205.
Tselebis A, Moulou A, Ilias I. Burnout versus depression and sense of coherence: study of Greek nursing staff. Nurs Health Sci 2001, 3, 69–71, doi: 10.1046/j.1442-2018.2001.00074.x.
Pahkin K, Väänänen A, Koskinen A, et al. Organizational change and employees' mental health: the protective role of sense of coherence. J Occupat Environ Med 2011, 53, 118–23.
Schäfer SK, Becker N, King L, Horsch A, Michael T. The relationship between sense of coherence and post-traumatic stress: a meta-analysis. Eur J Psychotraumatol 2019, 10(1), 1562839, doi: 10.1080/20008198.2018.1562839.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H, Kang L, Yao L, Huang M, Wang H, Wang G, Liu Z, Hu S. Factors Associated With Mental Health Outcomes Among Healthcare workers Exposed to Coronavirus Disease 2019. JAMA Netw Open 2020, 3(3), e203976, doi: 10.1001/jamanetworkopen.2020.3976.
Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare professionals during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020, doi: 10.1016/j.bbi.2020.05.026.
Masanotti GM, Paolucci S, Abbafati E, Serratore C, Caricato M. Sense of Coherence in Nurses: A Systematic Review. Int J Environ Res Public Health 2020, 17(6), 1861, doi: 10.3390/ijerph17061861.
Kowitlawkul Y, Yap SF, Makabe S, Chan S, Takagai J, Tam WW S, Nurumal MS. Investigating nurses' quality of life and work-life balance statuses in Singapore. Int Nurs Rev 2018, 66, 61–69, doi: 10.1111/inr.12457.
Braun-Lewensohn O, Abu-Kaf S, Kalagy T. Hope and resilience during a pandemic among three cultural groups in Israel: The second wave of COVID-19. Front Psychol 2021, 12, 340.
Eriksson M, Lindström B. Antonovsky's sense of coherence scale and the relation with health: A systematic review. J Epidemiol Commun Health 2006, 60, 376–381.
Questionario dell’OMS (in 5 domande) sullo stato di benessere (versione del 1998). Available at: https://www.psykiatri-regionh.dk/who-5/Documents/WHO5_Italian.pdf.
Antonovsky A. The structure and properties of the sense of coherence scale. Soc Sci Med 1993, 36, 725–733, doi: 10.1016/0277-9536(93)90033-Z.
Sardu C, Mereu A, Sotgiu A, Andrissi L, Jacobson MK, Contu P. Antonovsky's Sense of Coherence Scale: Cultural Validation of Soc Questionnaire and Socio-Demographic Patterns in an Italian Population. Clin Pract Epidemiol Ment Health 2012, 8, 1–6, doi: 10.2174/1745017901208010001.
Galletta M, Cherchi M, Cocco A, Lai G, Manca V, Pau M, Tatti F, Zambon G, Deidda S, Origa P, Massa E, Cossu E, Boi F, Contu P. Sense of coherence and physical health-related quality of life in Italian chronic patients: The mediating role of the mental component. BMJ Open 2019, 9, e030001, doi: 10.1136/bmjopen-2019-030001.
Mialhe FL, de Oliveira Júnior AJ, Junior MFS, Jamieson L, Neiva A, Soares GH. Oral health literacy, sense of coherence, and associations with poor school performance. J Sch Health 2022, doi: 10.1111/josh.13223, Epub ahead of print, PMID: 35883209.
Schäfer SK, Sopp MR, Schanz CG, Staginnus M, Göritz AS, Michael T. Impact of COVID-19 on public mental health and the buffering effect of a sense of coherence. Psychother Psychosom 2020, 89, 386–392, doi: 10.1159/000510752.
Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China. Med Sci Monit 2020, 26, doi: 10.12659/MSM.924171.
Huang L, Xu FM, Liu HR. Emotional responses and coping strategies of nurses and nursing college students during COVID-19 outbreak. MedRxiv 2020, doi: 10.1101/2020.03.05.20031898.
Xing J, Sun N, Xu J, Geng S, Li Y. Study of the mental health status of medical personnel dealing with new coronavirus pneumonia. PLoS ONE 2020, 15 (5), doi: 10.1371/journal.pone.0233145.
Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Res 2020, 288, doi: 10.1016/j.psychres.2020.112936.
Braun-Lewensohn O, Abu-Kaf S, Kalagy T. Hope and resilience during a pandemic among three cultural groups in Israel: The second wave of COVID-19. Front Psychol 2021, 12, 637349, doi: 10.3389/fpsyg.2021.637349.
Eriksson M, Lindström B. Validity of Antonovsky's sense of coherence scale: A systematic review. J Epidemiol Community Health 2005, 59, 460–466, doi: 10.1136/jech.2003.018085.
Richardson JTE. Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev 2011, 6, 135–147, doi: 10.1016/j.edurev.2010.12.001.
Hochwälder J. Negative life events and mental ill-health among women: A prospective study of the main, moderating, and mediating effect of sense of coherence. J Happiness Stud 2013, 14, 1739–1750, doi: 10.1007/s10902-012-9407-6.
Thoits PA. Stress, coping, and social support processes: Where are we? What next?. J Health Soc Behav 1995, 53–79, doi: 10.2307/2626957.
Kawachi I, Berkman LF. Social ties and mental health. J Urban Health 2001, 78, 458–467, doi: 10.1093/jurban/78.3.458.
Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry 2020, 63 (1), e32, doi: 10.1192/j.eurpsy.2020.35.
Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare professionals: Rapid review and meta-analysis. BMJ 2020, 369, m1642, doi: 10.1136/bmj.m1642.
Atri A, Sharma M, Cottrell R. Role of social support, hardiness, and acculturation as predictors of mental health among international students of Asian Indian origin. Int Q Community Health Educ 2007, 27, 59–73, doi: 10.2190/IQ.27.1.e.
Cobb S. Social support as a moderator of life stress. Psychosom Med 1976, 38, 300–314, doi: 10.1097/00006842-197609000-00003.
Caplan G. The family as social support, in Support Systems and Mutual Help: Multidisciplinary Explorations, Caplan G, Killilea M, Eds, Grune & Stratton: New York, NY, 1976, pp 19–36.