Cleper Rony, Hertz-Palmor Nimrod, Mosheva Mariela, Hasson-Ohayon Ilanit, Kaplan Rachel, Kreiss Yitshak, Afek Arnon, Pessach Itai M, Gothelf Doron, Gross Raz
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
The Chaim Sheba Medical Center, Ramat Gan, Israel.
Front Psychiatry. 2022 Apr 29;13:838825. doi: 10.3389/fpsyt.2022.838825. eCollection 2022.
To identify COVID-19 work-related stressors and experiences associated with sleep difficulties in HCW, and to assess the role of depression and traumatic stress in this association.
A cross-sectional study of HCW using self-report questionnaires, during the first peak of the pandemic in Israel (April 2020), conducted in a large tertiary medical center in Israel. Study population included 189 physicians and nurses working in designated COVID-19 wards and a comparison group of 643 HCW. Mean age of the total sample was 41.7 ± 11.1, 67% were female, 42.1% physicians, with overall mean number of years of professional experience 14.2 ± 20. The exposure was working in COVID-19 wards and related specific stressors and negative experiences. Primary outcome measurement was the Insomnia Severity Index (ISI). Secondary outcomes included the Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD-5); the Patient Health Questionnaire-9 (PHQ-9) for depression; the anxiety module of the Patient-Reported Outcomes Measurement Information System (PROMIS); Pandemic-Related Stress Factors (PRSF) and witnessing patient suffering and death.
Compared with non-COVID-19 HCW, COVID-19 HCW were more likely to be male (41.3% vs. 30.7%) and younger (36.91 ± 8.81 vs. 43.14 ± 11.35 years). COVID-19 HCW reported higher prevalence of sleep difficulties: 63% vs. 50.7% in the non-COVID group (OR 1.62, 95% CI 1.15-2.29, = 0.006), mostly difficulty maintaining sleep: 26.5% vs. 18.5% (OR 1.65, 95% CI 1.11-2.44, = 0.012). Negative COVID-19 work-related experiences, specifically witnessing patient physical suffering and death, partially explained the association. Although past psychological problems and current depression and PTSD were associated with difficulty maintaining sleep, the main association remained robust also after controlling for those conditions in the full model.
COVID-19 frontline HCW were more likely to report sleep difficulties, mainly difficulty maintaining sleep, as compared with non-COVID-19 HCW working at the same hospital. Negative patient-care related experiences likely mediated the increased probability for those difficulties. Future research is needed to elucidate the long-term trajectories of sleep difficulties among HCW during large scale outbreaks, and to identify risk factors for their persistence.
确定医护人员中与COVID-19工作相关的压力源及与睡眠困难相关的经历，并评估抑郁和创伤应激在这种关联中的作用。
在以色列新冠疫情首个高峰期（2020年4月），于以色列一家大型三级医疗中心，采用自填式问卷对医护人员进行横断面研究。研究人群包括189名在指定COVID-19病房工作的医生和护士以及643名医护人员组成的对照组。总样本的平均年龄为41.7±11.1岁，67%为女性，42.1%为医生，总体专业平均工作年限为14.2±20年。暴露因素为在COVID-19病房工作以及相关的特定压力源和负面经历。主要结局指标为失眠严重程度指数（ISI）。次要结局指标包括初级保健创伤后应激障碍筛查量表（PC-PTSD-5）；用于评估抑郁的患者健康问卷-9（PHQ-9）；患者报告结局测量信息系统（PROMIS）中的焦虑模块；大流行相关压力因素（PRSF）以及目睹患者痛苦和死亡情况。
与非COVID-19医护人员相比，COVID-19医护人员男性比例更高（41.3%对30.7%）且更年轻（36.91±8.81岁对43.14±11.35岁）。COVID-19医护人员报告的睡眠困难患病率更高：非COVID组为50.7%，COVID-19组为63%（OR=1.62，95%CI 1.15 - 2.29，P = 0.006），主要是难以维持睡眠：非COVID组为18.5%，COVID-19组为26.5%（OR=1.65，95%CI 1.11 - 2.44，P = 0.012）。与COVID-19工作相关的负面经历，尤其是目睹患者身体痛苦和死亡，部分解释了这种关联。尽管过去的心理问题以及当前的抑郁和创伤后应激障碍与难以维持睡眠有关，但在完整模型中对这些情况进行控制后，主要关联仍然显著。
与在同一家医院工作的非COVID-19医护人员相比，COVID-19一线医护人员更有可能报告睡眠困难，主要是难以维持睡眠。与患者护理相关的负面经历可能介导了这些困难发生概率的增加。需要进一步研究以阐明大规模疫情期间医护人员睡眠困难的长期轨迹，并确定其持续存在的风险因素。
