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      Pre-pandemic burnout and its changes during the COVID-19 outbreak as predictors of mental health of healthcare workers: a lesson to be learned.

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          Abstract

          The aim of this study was to identify how previously existing burnout and its changes during the pandemic contributed to PTSD symptoms and psychological distress in a cohort of 388 healthcare workers (HCWs). Each HCW was surveyed in Sep 2019 (before COVID-19) and again in Dec 2020-Jan 2021 (during the pandemic) to assess burnout (MBI); and in the second wave only to assess PTSD (PCL-5-SF), psychological distress (GHQ-12) and resilience (CD-RISC-10). Changes in emotional exhaustion (EE) and depersonalisation (DEP) were stronger in HCWs with lower EE and DEP baseline values. HCWs with higher baseline poor personal accomplishment (PPA) improved more than those with lower baseline values. In multivariable-adjusted models, pre-pandemic EE and its changes were equally associated to both outcomes: standardised-βs of 0.52 and 0.54 for PTSD, respectively; and 0.55 and 0.53 for psychological distress. Changes in DEP were associated with PTSD only (0.10). Changes in PPA had a higher association with psychological distress (0.29) than pre-pandemic PPA (0.13). Resilience was associated with lower psychological distress (-0.25). Preventive actions aimed at reducing EE, e.g., addressing organisational dysfunctions, are needed to mitigate the impact of future crises, whereas improving personal accomplishment levels is a key target to protect HCWs from mental health disorders during a pandemic.

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          Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

          Kathryn M Connor, Jonathan Davidson (2003)
          Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.
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            The measurement of experienced burnout

            Christina Maslach, Susan Jackson (1981)
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              The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation.

              Christy Blevins, Frank W Weathers, Margaret T Davis … (2015)
              The Posttraumatic Stress Disorder Checklist (PCL) is a widely used DSM-correspondent self-report measure of PTSD symptoms. The PCL was recently revised to reflect DSM-5 changes to the PTSD criteria. In this article, the authors describe the development and initial psychometric evaluation of the PCL for DSM-5 (PCL-5). Psychometric properties of the PCL-5 were examined in 2 studies involving trauma-exposed college students. In Study 1 (N = 278), PCL-5 scores exhibited strong internal consistency (α = .94), test-retest reliability (r = .82), and convergent (rs = .74 to .85) and discriminant (rs = .31 to .60) validity. In addition, confirmatory factor analyses indicated adequate fit with the DSM-5 4-factor model, χ2 (164) = 455.83, p < .001, standardized root mean square residual (SRMR) = .07, root mean squared error of approximation (RMSEA) = .08, comparative fit index (CFI) = .86, and Tucker-Lewis index (TLI) = .84, and superior fit with recently proposed 6-factor, χ2 (164) = 318.37, p < .001, SRMR = .05, RMSEA = .06, CFI = .92, and TLI = .90, and 7-factor, χ2 (164) = 291.32, p < .001, SRMR = .05, RMSEA = .06, CFI = .93, and TLI = .91, models. In Study 2 (N = 558), PCL-5 scores demonstrated similarly strong reliability and validity. Overall, results indicate that the PCL-5 is a psychometrically sound measure of PTSD symptoms. Implications for use of the PCL-5 in a variety of assessment contexts are discussed.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Psychiatry Res
                Journal ID (iso-abbrev): Psychiatry Res
                Title: Psychiatry Research
                Publisher: Elsevier B.V.
                ISSN (Print): 0165-1781
                ISSN (Electronic): 1872-7123
                Publication date PMC-release: 12 June 2023
                Publication date (Electronic): 12 June 2023
                Electronic Location Identifier: 115305
                Affiliations
                [a ]EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
                [b ]Division of Psychiatry, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
                [c ]Occupational and Preventive Unit, ASST Lariana, Como, Italy
                [d ]Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
                [e ]Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, Italy
                [f ]Mediterranea Cardiocentro, Napoli, Italy
                [g ]Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
                Author notes
                [* ]Corresponding author: Marco M. Ferrario, EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
                Article
                Publisher Item ID: S0165-1781(23)00255-X Publisher ID: 115305
                DOI: 10.1016/j.psychres.2023.115305
                PMC ID: 10261975
                PubMed ID: 37331071
                SO-VID: aadf23a4-3305-450e-ad21-02d49696661b
                Copyright © © 2023 Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 22 February 2023
                Date revision received : 8 June 2023
                Date accepted : 11 June 2023
                Categories
                Subject: Article

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: ptsd,burnout,healthcare workers,psychological distress,covid-19
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: ptsd, burnout, healthcare workers, psychological distress, covid-19

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