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      The use of mental health promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: a prospective cohort study

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          Abstract

          Objectives

          To evaluate and compare nurses’ depression, anxiety and stress symptoms at the beginning of the COVID-19 pandemic and after six months; to evaluate and compare the frequency of use of mental health promotion strategies during the same period; and to identify the relationship between the frequency of use of mental health promotion strategies, during the same period, with nurses’ depression, anxiety and stress symptoms.

          Methods

          Data collection was carried out in two moments: at baseline and after six months. An online questionnaire was applied to nurses to assess the frequency of use of some mental health promotion strategies and their depression, anxiety, and stress symptoms (through the Depression Anxiety Stress Scales – short version (DASS-21)).

          Results

          The anxiety and stress symptoms significantly decreased over time. The physical activity increased, and a decrease was observed in the remote social contacts after six months. The stress, anxiety and depression scores were significantly lower in nurses who frequently or always used all strategies compared to participants who never or rarely used them, except for one strategy (rejecting information about COVID-19 from unreliable sources).

          Conclusions

          Mental health promotion strategies, such as physical activity, relaxation activity, recreational activity, healthy diet, adequate water intake, breaks between work shifts, maintenance of remote social contacts, and verbalization of feelings/emotions, are crucial to reduce nurses’ stress, anxiety and depression symptoms during the COVID-19 outbreak.

          Highlights

          • •

            Nurses’ stress and anxiety symptoms decreased six months after the lockdown due to COVID-19.

          • •

            Nurses increased the physical activity and reduced remote social contacts six months’ after the lockdown due to COVID-19.

          • •

            The use of mental health promotion strategies by nurses is important to reduce stress, anxiety, and depression symptoms.

          • •

            Caring for nurses’ mental health during the COVID-19 outbreak is a matter of public health concern.

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          Most cited references25

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          Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

          Cuiyan Wang, Riyu Pan, Xiaoyang Wan … (2020)
          Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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            Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

            Jianbo Lai, Simeng Ma, Ying Wang … (2020)
            Key Points Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
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              A Longitudinal Study on the Mental Health of General Population during the COVID-19 Epidemic in China

              Cuiyan Wang, Riyu Pan, Xiaoyang Wan … (2020)
              Highlights • A significant reduction in psychological impact 4 weeks after COVID outbreak. • The mean scores of respondents in both surveys were above PTSD cut-offs. • Female gender, physical symptoms associated with a higher psychological impact. • Hand hygiene, mask-wearing & confidence in doctors reduced psychological impact. • Online trauma-focused psychotherapy may be helpful to public during COVID-19.
              Article 0 comments Cited 1214 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Environ Res
                Journal ID (iso-abbrev): Environ Res
                Title: Environmental Research
                Publisher: Elsevier Inc.
                ISSN (Print): 0013-9351
                ISSN (Electronic): 1096-0953
                Publication date PMC-release: 4 February 2021
                Publication date (Electronic): 4 February 2021
                Electronic Location Identifier: 110828
                Affiliations
                [a ]S. João de Deus School of Nursing, University of Évora, Largo Do Sr. da Pobreza, 2B, 7000-811 Évora, Portugal
                [b ]Comprehensive Health Research Centre (CHRC), University of Évora, Largo Do Sr. da Pobreza, 2B, 7000-811 Évora, Portugal
                [c ]Abel Salazar Institute of Biomedical Sciences, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal
                [d ]“NursID: Innovation & Development in Nursing” Research Group, CINTESIS – Center for Health Technology and Services Research, Rua Dr. Plácido da Costa, S/n, 4200-450 Porto, Portugal
                [e ]Higher School of Health Fernando Pessoa, Rua Delfim Maia, 334, 4200-253 Porto, Portugal
                [f ]Nursing School of Porto, Rua Dr. António Bernardino de Almeida, 830, 844, 856, 4200-072 Porto, Portugal
                [g ]“AgeingC: AgeingCluster” Research Group, CINTESIS – Center for Health Technology and Services Research, Rua Dr. Plácido da Costa, S/n, 4200-450 Porto, Portugal
                Author notes
                [∗ ]Corresponding author. Lara Manuela Guedes de Pinho Tel.: +351 266 730 300 E-mail address: Mailing address: Comprehensive Health Research Centre (CHRC), University of Évora, Largo do Sr. da Pobreza, 2B, 7000-811 Évora, Portugal
                Article
                Publisher Item ID: S0013-9351(21)00122-5 Publisher ID: 110828
                DOI: 10.1016/j.envres.2021.110828
                PMC ID: 7857980
                PubMed ID: 33548294
                SO-VID: d8c5ad50-deca-45d9-8685-e205d2a43954
                Copyright © © 2021 Elsevier Inc. 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 : 14 January 2021
                Date revision received : 26 January 2021
                Date accepted : 29 January 2021
                Categories
                Subject: Article

                ScienceOpen disciplines: General environmental science
                Keywords: stress,anxiety,depression,nurses,mental health promotion strategies
                Data availability:
                ScienceOpen disciplines: General environmental science
                Keywords: stress, anxiety, depression, nurses, mental health promotion strategies

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