Introduction
Materials and methods
Study design and participants
Measures
Sociodemographic data and working conditions
Moral distress
Depressive symptoms
Anxiety
Somatic symptom severity
Burnout
Pandemic stress load
Statistics
Results
Sample characteristics
Physicians | Nurses | |
---|---|---|
Gender | ||
Male n (%) | 69 (57.0) | 23 (18.4) |
Female n (%) | 51 (42.2) | 102 (81.6) |
Diverse n (%) | 1 (0.8) | 0 (0) |
Age | ||
Mean ± SD | 47.4 ± 10.6 | 43.7 ± 11.8 |
Years of work experience | ||
Mean ± SD | 19.9 ± 10.9 | 22.3 ± 12.2 |
Occupational field | ||
Inpatient n (%) | 69 (57.0) | 85 (68.0) |
Outpatient n (%) | 49 (40.5) | 32 (25.6) |
Other n (%) | 3 (2.5) | 8 (6.4) |
Mental burden moral distress and working conditions
n | Mean (± SD) | Median (IQR) | Range | |
---|---|---|---|---|
Moral distress | ||||
Physicians | ||||
Completed | 121 | 3.83 (± 2.36) | 3.00 | 10 |
Missing | 0 | – | – | – |
Nurses | ||||
Completed | 125 | 5.09 (± 2.26) | 5.0 | 9 |
Missing | 0 | – | – | – |
Depressive symptoms | ||||
Physicians | ||||
Completed | 120 | 6.14 (± 5.21) | 5.00 (5.00) | 26 |
Missing | 1 | – | – | – |
Nurses | ||||
Completed | 123 | 8.37 (± 5.00) | 7.00 (7.00) | 21 |
Missing | 2 | – | – | – |
Anxiety | ||||
Physicians | ||||
Completed | 117 | 5.14 (± 4.40) | 4.00 (5.00) | 20 |
Missing | 4 | – | – | – |
Nurses | ||||
Completed | 121 | 6.55 (± 4.40) | 5.00 (5.00) | 18 |
Missing | 4 | – | – | – |
Somatic symptoms | ||||
Physicians | ||||
Completed | 110 | 4.80 (± 4.27) | 4.00 (5.00) | 18 |
Missing | 11 | – | – | – |
Nurses | ||||
Completed | 111 | 9.79 (± 5.87) | 9.00 (9.00) | 26 |
Missing | 14 | – | – | – |
Burnout symptoms–emotional exhaustion | ||||
Physicians | ||||
Completed | 100 | 20.56 (± 11.92) | 19.00 (17.75) | 52 |
Missing | 21 | – | – | – |
Nurses | ||||
Completed | 103 | 21.98 (± 12.17) | 22.00 (19.00) | 49 |
Missing | 22 | – | – | – |
Burnout symptoms–depersonalization | ||||
Physicians | ||||
Completed | 100 | 6.41 (± 4.86) | 6.00 (6.75) | 21 |
Missing | 21 | – | – | – |
Nurses | ||||
Completed | 103 | 4.99 (± 4.53) | 4.00 (6.00) | 18 |
Missing | 22 | – | – | – |
Burnout symptoms–personal accomplishment | ||||
Physicians | ||||
Completed | 100 | 39.68 (± 5.64) | 41.00 (6.00) | 27 |
Missing | 21 | – | – | – |
Nurses | ||||
Completed | 103 | 37.55 (± 5.76) | 38.00 (7.00) | 23 |
Missing | 22 | – | – | – |
FACT-19: pre-pandemic risk factors | ||||
Physicians | ||||
Completed | 88 | 1.91 (± 1.71) | 1.00 (2.00) | 7.0 |
Missing | 33 | – | – | – |
Nurses | ||||
Completed | 92 | 2.55 (± 2.05) | 2.00 (3.00) | 9 |
Missing | 33 | – | – | – |
FACT-19: acute pandemic stress | ||||
Physicians | ||||
Completed | 88 | 6.06 (± 2.45) | 5.50 (3.38) | 13.5 |
Missing | 33 | – | – | – |
Nurses | ||||
Completed | 92 | 7.14 (± 2.71) | 6.75 (3.88) | 12.5 |
Missing | 33 | – | – | – |
FACT-19: acute pandemic stress source A (lethal threat) | ||||
Physicians | ||||
Completed | 88 | 0.22 (± 0.65) | 0.00 (0.00) | 3.5 |
Missing | 33 | – | – | – |
Nurses | ||||
Completed | 92 | 0.49 (± 1.15) | 0.00 (0.00) | 4.5 |
Missing | 33 | – | – | – |
FACT-19: acute pandemic stress source B (existential fear) | ||||
Physicians | ||||
Completed | 88 | 0.56 (± 0.66) | 0.00 (1.00) | 3.0 |
Missing | 33 | – | – | – |
Nurses | ||||
Completed | 92 | 0.58 (± 0.73) | 0.00 (1.00) | 3.0 |
Missing | 33 | – | – | – |
FACT-19: acute pandemic stress source C (isolation) | ||||
Physicians | ||||
Completed | 88 | 1.64 (± 0.90) | 2.00 (1.00) | 4.0 |
Missing | 33 | – | – | – |
Nurses | ||||
Completed | 92 | 1.83 (± 0.66) | 2.00 (0.00) | 3.0 |
Missing | 33 | – | – | – |
FACT-19: acute pandemic stress source D (fear dynamics) | ||||
Physicians | ||||
Completed | 88 | 2.55 (± 1.28) | 2.50 (2.00) | 5.5 |
Missing | 33 | – | – | – |
Nurses | ||||
Completed | 92 | 3.30 (± 1.40) | 3.25 (1.88) | 6.5 |
Missing | 33 | – | – | – |
Prevalence | 95% CI | |
---|---|---|
Physicians | ||
Mild depressive symptoms | 35.8% | 27–45% |
Moderate depressive sympotoms | 11.7% | 7–19% |
Moderately severe depressive symptoms | 4.2% | 1–10% |
Severe depressive symptoms | 3.3% | 1–8% |
Mild anxiety | 29.1% | 21–38% |
Moderate anxiety | 10.3% | 5–17% |
Severe anxiety | 4.3% | 1–10% |
Low somatic symptom severity | 28.2% | 20–38% |
Medium somatic symptom severity | 6.4% | 3–13% |
High somatic symptom severity | 6.4% | 2–13% |
Symptoms of burnout | 46.0% | 36–56% |
Nurses | ||
Mild depressive symptoms | 35.0% | 27–44% |
Moderate depressive symptoms | 27.6% | 20–36% |
Moderately severe depressive symptoms | 11.4% | 6–18% |
Severe depressive symptoms | 2.4% | 1–7% |
Mild anxiety | 41.3% | 32–51% |
Moderate anxiety | 17.4% | 11–25% |
Severe anxiety | 6.6% | 3–13% |
Low somatic symptom severity | 32.4% | 24–42% |
Medium somatic symptom severity | 24.3% | 17–33% |
High somatic symptom severity | 22.5% | 15–31% |
Symptoms of burnout | 46.6% | 37–57% |
Factors associated with mental burden and moral distress
B | SE | p | OR | 95% CI for OR | ||
---|---|---|---|---|---|---|
Age < 40 | 0.064 | 0.295 | 0.827 | 1.066 | 0.598 | 1.902 |
Being female/diverse | 0.577 | 0.301 | 0.055 | 1.781 | 0.988 | 3.211 |
Occupational setting | 0.930 | |||||
Hospital setting | –0.109 | 0.297 | 0.714 | 0.897 | 0.501 | 1.605 |
Other Setting | 0.000 | 0.672 | 1.000 | 1.000 | 0.268 | 3.733 |
Professional group nursing | 0.834 | 0.291 | 0.004 | 2.303 | 1.301 | 4.076 |
Constant | –0.847 | 0.302 | 0.005 | 0.429 |
B | SE | p | OR | 95% CI for OR | ||
---|---|---|---|---|---|---|
Age < 40 | 0.394 | 0.345 | 0.254 | 1.483 | 0.753 | 2.919 |
Being female/diverse | 1.320 | 0.414 | 0.001 | 3.744 | 1.664 | 8.427 |
Occupational setting | 0.705 | |||||
Hospital setting | 0.283 | 0.367 | 0.440 | 1.327 | 0.646 | 2.726 |
Other setting | 0.420 | 0.759 | 0.580 | 1.522 | 0.344 | 6.742 |
Professional group nursing | 0.225 | 0.360 | 0.531 | 1.253 | 0.618 | 2.538 |
Moral distress | 0.414 | 0.076 | < 0.001 | 1.512 | 1.303 | 1.756 |
Constant | –4.259 | 0.622 | < 0.001 | 0.014 |
B | SE | p | OR | 95% CI for OR | ||
---|---|---|---|---|---|---|
Age < 40 | 1.742 | 0.536 | 0.001 | 5.710 | 1.999 | 16.311 |
Being female/diverse | –0.206 | 0.452 | 0.649 | 0.814 | 0.335 | 1.975 |
Hospital/other setting | 0.017 | 0.446 | 0.970 | 1.017 | 0.424 | 2.436 |
Moral Distress | 0.108 | 0.089 | 0.225 | 1.114 | 0.936 | 1.327 |
Constant | –0.962 | 0.514 | 0.061 | 0.382 |
B | SE | p | OR | 95% CI for OR | ||
---|---|---|---|---|---|---|
Age < 40 | 1.104 | 0.597 | 0.064 | 3.017 | 0.936 | 9.721 |
Being female/diverse | –0.127 | 0.574 | 0.825 | 0.881 | 0.286 | 2.711 |
Hospital/other setting | 0.076 | 0.586 | 0.897 | 1.079 | 0.342 | 3.401 |
Moral distress | 0.325 | 0.116 | 0.005 | 1.384 | 1.102 | 1.738 |
Constant | –3.554 | 0.850 | < 0.001 | 0.029 |
B | SE | p | OR | 95% CI for OR | ||
---|---|---|---|---|---|---|
Age < 40 | 0.243 | 0.490 | 0.620 | 1.275 | 0.488 | 3.335 |
Being female/diverse | 1.826 | 0.763 | 0.017 | 6.210 | 1.391 | 27.728 |
Occupational setting | 0.773 | |||||
Hospital setting | 0.222 | 0.567 | 0.695 | 1.249 | 0.411 | 3.794 |
Other setting | 0.702 | 0.993 | 0.480 | 2.018 | 0.288 | 14.138 |
Number of COVID-19 cases in employees | –0.123 | 0.220 | 0.576 | 0.884 | 0.575 | 1.361 |
Number of COVID-19 cases in patients | 0.020 | 0.042 | 0.627 | 1.020 | 0.941 | 1.107 |
Increase in workload | 1.524 | 0.645 | 0.018 | 4.590 | 1.296 | 16.265 |
Sufficient access to protective clothing | 0.286 | 0.522 | 0.584 | 1.331 | 0.478 | 3.702 |
Feeling sufficiently protected from COVID-19 | 0.212 | 0.539 | 0.693 | 1.237 | 0.430 | 3.554 |
Staff shortages | 0.569 | 0.528 | 0.281 | 1.767 | 0.627 | 4.977 |
Difficulties in building relationships with patients | 0.430 | 0.470 | 0.360 | 1.537 | 0.612 | 3.861 |
Having been vaccinated at least once | 0.036 | 0.681 | 0.958 | 1.037 | 0.273 | 3.936 |
Moral distress | 0.321 | 0.125 | 0.010 | 1.379 | 1.079 | 1.762 |
Constant | –6.053 | 1.709 | < 0.001 | 0.002 |
B | SE | p | OR | 95% CI for OR | ||
---|---|---|---|---|---|---|
Age < 40 | 0.682 | 0.528 | 0.197 | 1.978 | 0.702 | 5.569 |
Being female/diverse | –0.682 | 0.697 | 0.328 | 0.505 | 0.129 | 1.982 |
Occupational setting | 0.413 | |||||
Hospital setting | –0.801 | 0.667 | 0.230 | 0.449 | 0.121 | 1.659 |
Other setting | 0.166 | 1.048 | 0.874 | 1.181 | 0.151 | 9.210 |
Number of COVID-19 cases in employees | –0.038 | 0.214 | 0.859 | 0.963 | 0.634 | 1.464 |
Number of COVID-19 cases in patients | 0.072 | 0.063 | 0.251 | 1.075 | 0.950 | 1.217 |
Increase in workload | 0.950 | 0.657 | 0.148 | 2.585 | 0.714 | 9.365 |
Sufficient access to protective clothing | –0.648 | 0.542 | 0.232 | 0.523 | 0.181 | 1.515 |
Feeling sufficiently protected from COVID-19 | –0.064 | 0.570 | 0.911 | 0.938 | 0.307 | 2.867 |
Staff shortages | 0.588 | 0.595 | 0.323 | 1.800 | 0.561 | 5.779 |
Difficulties in building relationships with patients | 0.367 | 0.528 | 0.487 | 1.443 | 0.513 | 4.059 |
Having been vaccinated at least once | 0.193 | 0.721 | 0.789 | 1.213 | 0.295 | 4.983 |
Moral distress | 0.316 | 0.148 | 0.032 | 1.372 | 1.027 | 1.832 |
Constant | –2.200 | 1.559 | 0.158 | 0.111 |
B | SE | p | OR | 95% CI for OR | ||
---|---|---|---|---|---|---|
Age < 40 | 0.188 | 0.471 | 0.690 | 1.207 | 0.479 | 3.036 |
Being female/diverse | 1.317 | 0.613 | 0.031 | 3.734 | 1.0124 | 12.404 |
Occupational setting | 0.972 | |||||
Hospital setting | –0.099 | 0.545 | 0.857 | 0.906 | 0.311 | 2.640 |
Other setting | 0.066 | 0.929 | 0.943 | 1.069 | 0.173 | 6.597 |
Number of COVID-19 cases in employees | 0.347 | 0.309 | 0.261 | 1.414 | 0.772 | 2.590 |
Number of COVID-19 cases in patients | 0.017 | 0.042 | 0.686 | 1.017 | 0.937 | 1.103 |
Increase in workload | 1.021 | 0.540 | 0.059 | 2.776 | 0.964 | 7.995 |
Sufficient access to protective clothing | –0.080 | 0.514 | 0.876 | 0.923 | 0.337 | 2.526 |
Feeling sufficiently protected from COVID-19 | –1.314 | 0.550 | 0.017 | 0.269 | 0.091 | 0.790 |
Staff shortages | 0.152 | 0.488 | 0.755 | 1.164 | 0.447 | 3.030 |
Difficulties in building relationships with patients | 0.618 | 0.455 | 0.175 | 1.854 | 0.760 | 4.522 |
Having been vaccinated at least once | 0.736 | 0.649 | 0.257 | 2.087 | 0.585 | 7.449 |
Constant | –1.531 | 1.326 | 0.248 | 0.216 |