Bonzini Matteo, Comotti Anna, Fattori Alice, Cantù Filippo, Colombo Elisa, Tombola Valentina, Myslymi Eralda, Gatti Michele, Stucchi Giulia, Nava Carlo, Bordini Lorenzo, Riboldi Luciano, Brambilla Paolo
Occupational Medicine Unit, IRCCS Maggiore Policlinico Hospital Foundation, Milan, Italy.
School of Medicine, University of Milan, Milan, Italy.
Front Psychiatry. 2022 Mar 10;13:834753. doi: 10.3389/fpsyt.2022.834753. eCollection 2022.
Italy was the first Western country affected by the COVID-19 pandemic that still constitutes a severe challenge for healthcare workers (HCWs), with a deep impact on their mental health. Several studies confirmed that a considerable proportion of HCW developed adverse psychological impairment (PsI). To focus on preventive and rehabilitation measures, it is fundamental to identify individual and occupational risk factors. We systematically assessed possible PsI among all employees in a large university hospital in Italy, using validated psychometric scales in the context of occupational health surveillance.
In the period of July 2020 to July 2021, we enrolled 990 HCWs. For each subject, the psychological wellbeing was screened in two steps. The first-level questionnaire collected gender, age, occupational role, personal and occupational COVID-19 exposure, general psychological discomfort (GHQ-12), post-traumatic stress symptoms (IES-R), and anxiety (GAD-7). Workers showing PsI (i.e., test scores above the cutoff in at least one among GHQ-12, IES-R, and GAD-7) have been further investigated by the second-level questionnaire (psycho-diagnostic) composed by PHQ-9, DES-II, and SCL-90 scales. If the second-level showed clinically relevant symptoms, then we offered individual specialist treatment (third level).
Three hundred sixteen workers (32%) presented signs of PsI at the first-level screening questionnaire. Women, nurses, and subjects engaged in the COVID-19 area and with an infected family member showed significantly higher PsI risk. PsI prevalence was strongly associated with the pandemic trend in the region but sensibly decreased after January 2021, when almost all workers received the vaccination. A proportion of subjects with PsI presented clinically relevant symptoms (second-level screening) on PHQ-9 (35%), DES (20%), and SCL-90 (28%). These symptoms were associated neither to direct working experience with patients with COVID-19 nor to COVID-19 experience in the family and seemed not to be influenced by the pandemic waves or workers vaccination.
The evaluation of psychological wellbeing of all hospital workers, directly or indirectly exposed to pandemic consequences, constitutes a unique condition to detect individual, occupational, and non-occupational risk factors for PsI in situations of high stress and/or disasters, as well as variables associated with symptom chronicization.
意大利是首个受新冠疫情影响的西方国家，新冠疫情至今仍给医护人员带来严峻挑战，对他们的心理健康产生了深远影响。多项研究证实，相当一部分医护人员出现了不良心理损害（PsI）。为关注预防和康复措施，识别个体和职业风险因素至关重要。我们在职业健康监测背景下，使用经过验证的心理测量量表，对意大利一家大型大学医院的所有员工中可能存在的PsI进行了系统评估。
在2020年7月至2021年7月期间，我们招募了990名医护人员。对每个受试者的心理健康状况进行了两步筛查。一级问卷收集了性别、年龄、职业角色、个人和职业上接触新冠病毒的情况、一般心理不适（GHQ - 12）、创伤后应激症状（IES - R）和焦虑（GAD - 7）。表现出PsI（即GHQ - 12、IES - R和GAD - 7中至少一项测试分数高于临界值）的工作人员通过由PHQ - 9、DES - II和SCL - 90量表组成的二级问卷（心理诊断）进行进一步调查。如果二级问卷显示出临床相关症状，那么我们会提供个体专科治疗（三级）。
316名工作人员（32%）在一级筛查问卷中表现出PsI迹象。女性、护士以及在新冠疫情相关区域工作且有家庭成员感染的受试者显示出明显更高的PsI风险。PsI患病率与该地区的疫情趋势密切相关，但在2021年1月之后显著下降，当时几乎所有工作人员都接种了疫苗。一部分有PsI的受试者在PHQ - 9（35%）、DES（20%）和SCL - 90（28%）上表现出临床相关症状（二级筛查）。这些症状既与直接接触新冠患者的工作经历无关，也与家庭中的新冠经历无关，似乎不受疫情浪潮或工作人员接种疫苗的影响。
对所有直接或间接接触疫情后果的医院工作人员的心理健康进行评估，构成了一种独特的条件，可用于在高压力和/或灾难情况下检测PsI的个体、职业和非职业风险因素，以及与症状慢性化相关的变量。
