美国 COVID-19 大流行期间医护人员心理健康结果的社会生态预测因素。
Socio-ecological predictors of mental health outcomes among healthcare workers during the COVID-19 pandemic in the United States.
机构信息
Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America.
出版信息
PLoS One. 2021 Feb 5;16(2):e0246602. doi: 10.1371/journal.pone.0246602. eCollection 2021.
BACKGROUND
Healthcare workers are at increased risk of adverse mental health outcomes during the COVID-19 pandemic. Studies are warranted that examine socio-ecological factors associated with these outcomes to inform interventions that support healthcare workers during future disease outbreaks.
METHODS
We conducted an online cross-sectional study of healthcare workers during May 2020 to assess the socio-ecological predictors of mental health outcomes during the COVID-19 pandemic. We assessed factors at four socio-ecological levels: individual (e.g., gender), interpersonal (e.g., social support), institutional (e.g., personal protective equipment availability), and community (e.g., healthcare worker stigma). The Personal Health Questionnaire-9, Generalized Anxiety Disorder-7, Primary Care Post-Traumatic Stress Disorder, and Alcohol Use Disorders Identification Test-Concise scales assessed probable major depression (MD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and alcohol use disorder (AUD), respectively. Multivariable logistic regression models were used to assess unadjusted and adjusted associations between socio-ecological factors and mental health outcomes.
RESULTS
Of the 1,092 participants, 72.0% were female, 51.9% were frontline workers, and the mean age was 40.4 years (standard deviation = 11.5). Based on cut-off scores, 13.9%, 15.6%, 22.8%, and 42.8% had probable MD, GAD, PTSD, and AUD, respectively. In the multivariable adjusted models, needing more social support was associated with significantly higher odds of probable MD, GAD, PTSD, and AUD. The significance of other factors varied across the outcomes. For example, at the individual level, female gender was associated with probable PTSD. At the institutional level, lower team cohesion was associated with probable PTSD, and difficulty following hospital policies with probable MD. At the community level, higher healthcare worker stigma was associated with probable PTSD and AUD, decreased satisfaction with the national government response with probable GAD, and higher media exposure with probable GAD and PTSD.
CONCLUSIONS
These findings can inform targeted interventions that promote healthcare workers' psychological resilience during disease outbreaks.
背景
在 COVID-19 大流行期间，医护人员面临着心理健康不良后果的风险增加。有必要进行研究，以检查与这些结果相关的社会生态因素，为未来疾病爆发期间支持医护人员的干预措施提供信息。
方法
我们在 2020 年 5 月期间对医护人员进行了一项在线横断面研究，以评估 COVID-19 大流行期间心理健康结果的社会生态预测因素。我们评估了四个社会生态层面的因素：个人（例如，性别）、人际（例如，社会支持）、机构（例如，个人防护设备的可用性）和社区（例如，医护人员的耻辱感）。使用个人健康问卷-9、广泛性焦虑症-7、初级保健创伤后应激障碍和酒精使用障碍识别测试简明量表分别评估可能的重度抑郁症（MD）、广泛性焦虑症（GAD）、创伤后应激障碍（PTSD）和酒精使用障碍（AUD）。使用多变量逻辑回归模型评估社会生态因素与心理健康结果之间的未调整和调整关联。
结果
在 1092 名参与者中，72.0%为女性，51.9%为一线工作人员，平均年龄为 40.4 岁（标准差=11.5）。根据截断分数，分别有 13.9%、15.6%、22.8%和 42.8%的人可能患有 MD、GAD、PTSD 和 AUD。在多变量调整模型中，需要更多的社会支持与更高的可能 MD、GAD、PTSD 和 AUD 的几率相关。其他因素的重要性因结果而异。例如，在个体层面上，女性性别与可能的 PTSD 相关。在机构层面上，团队凝聚力较低与可能的 PTSD 相关，而难以遵循医院政策与可能的 MD 相关。在社区层面上，较高的医护人员耻辱感与可能的 PTSD 和 AUD 相关，对国家政府应对措施的满意度降低与可能的 GAD 相关，而媒体接触度较高与可能的 GAD 和 PTSD 相关。
结论
这些发现可以为疾病爆发期间促进医护人员心理弹性的有针对性的干预措施提供信息。
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