Need for psychological support and disability management programs during and after the COVID-19 pandemic in Italy: Preliminary findings from a hospital-based occupational health surveillance program

Introduction: Since the beginning of COVID-19 pandemic, healthcare workers (HCWs) have undoubtedly experienced overwhelming levels of strain associated with social and occupational stressors. This study aimed to investigate the potential psychological effects experienced by hospital workers and HCWs and their associated demographical and occupational characteristics during the COVID-19 pandemic. Methods: A cross-sectional study was carried out in a public hospital in Rome, Italy, from June 2020 to July 2021. 635 hospital workers (HCWs, administrative and technicians) were enrolled in the study. The “Psychological Injury Risk Indicator” questionnaire was used. Statistical analyses have been made using Student’s T test for categorical binomial variables and analysis of variance for multi-categorical variables. Logistic regression analysis was then performed. Results: 30.6% of the sample was at risk for general psychological impairment; reduced energy recovery was found in 48.0% and sleep problems in 44.7% of them. Female workers reported a two-fold risk for potential psychological impairment compared to male colleagues. Nurses presented a three-fold risk while physicians a two-fold risk for the overall score. Additionally, physicians had a four-fold risk to develop a lack of energy recovery and a three-fold risk for chronic fatigue. Technicians showed a significant double risk for sleep problems and chronic fatigue as well as a three-fold risk for reduced energy recovery. Administrative personnel reported a tendency on sleep problems. Interestingly, agile working was a two-fold protecting factor. No-night shifters have a half risk for reporting problems in energy recovery. Discussion and Conclusion: The measure of agile working is effective to mitigate the impacts of COVID-19 on mental health by protecting and promoting the psychological wellbeing of HCWs during and after the outbreak. Journal of Health and Social Sciences 2021; 6,3:367-378 The Italian Journal for Interdisciplinary Health and Social Development 368 INTRODUCTION Since the beginning of COVID-19 pandemic, healthcare workers (HCWs) have undoubtedly been experiencing overwhelming levels of strain associated with social and occupational stressors [1–3]. Psychological impact of pandemics has been widely observed in the past, particularly for frontline HCWs who particularly feel the extreme pressure of being victim of the virus or the main source of SARS-CoV-2 transmission for their families as well as for users [4]. In disaster medicine, uncontrolled emotional distress has been reported to cause acute stress, which may lead to post-traumatic stress disorder (PTSD) in a relatively short term [4]. PTSD has been described in 10% of survivors after flood or pipeline explosion [5, 6], in 20% of the population facing a fire disaster [7] and up to 30-50% after health disasters such as pandemics [8]. To date, after over one year and a half from the COVID-19 outbreak, psychiatric illnesses have been observed growing up worldwide in the workplace, including anxiety, depression and burnout syndrome [3, 9–14]. Recently, an in-depth characterization of COVID-associated PTSD highlighted the mediating role of hyperarousal rather than avoidance in the relationship between intrusive thoughts and mental health disorders [15]. Current evidence from literature highlights the relevance of some determinant factors for PTSD experienced during COVID-19 pandemic, including exposure level, working role, years of work experience, social and work support, job organization, quarantine, young age, gender, marital status, and coping styles [16]. Beyond the threat of occupational exposure to the virus, other elements affect mental health (e.g., longer shifts, increased workload and a general lack of sufficient communication and updated information), which are extremely important especially during pandemics [17]. These factors are crucial in health care settings, because they can influence the quality of Competing interests none declared. Copyright © 2021 Reparata Rosa Di Prinzio et al. Edizioni FS Publishers This is an open access article distributed under the Creative Commons Attribution (CC BY 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. See http:www.creativecommons.org/licenses/by/4.0/. Cite this article as: Di Prinzio RR, Bondanini G, De Falco F, Vinci MR, Camisa V, Santoro A, Mucci N, Dalmasso G, Giorgi G, Magnavita N, Zaffina S. Need for psychological support and disability management programs during and after the COVID-19 pandemic in Italy: Preliminary findings from a hospital-based occupational health surveillance program. J Health Soc Sci. 2021;6(3):367-378 Author Contributions: Conceptualization: RRDP, NMa, SZ. Methodology: FDF, GB. Data collection: FDF, GB, MRV, VC, AS. Formal analysis: RRDP, NMa, NMu. Writing-original draft preparation: RRDP, GB. Writing-review and editing: FDF, GD, GG, NMu, NMa, SZ. All authors have read and agreed to the published version of the manuscript. TAKE-HOME MESSAGE This study showed some differences in the occurrence of potential psychological effects among HCWs in terms of gender and professional category. As part of COVID-19-specific disability management program, agile working may be a protecting factor for mental health during the COVID-19 pandemic. Further studies are required to better clarify these aspects. Received: 01/09/2021 Accepted: 14/09/2021 Published Online: 15/09/2021 DOI 10.19204/2021/ndfr7 Journal of Health and Social Sciences 2021; 6,3:367-378 The Italian Journal for Interdisciplinary Health and Social Development 369 care and assistance for the community as well as increasing absenteeism [18, 19]. In a Spanish cohort, the profile of a HCW with higher levels of PTSD symptoms has been outlined in a woman who was concerned about her cohabitant’s high risk of infection [20]. Furthermore, a common perception is that sleep problems among the general population as well as among workers have worsened during the COVID-19 pandemic, more than during the MERS outbreak [21]. As shown in a Turkish population study, the current risk profile for poor sleep quality was being a poorly-educated, unmarried subject with COVID-19-related occupational problems (e.g., losing job during the epidemic period, working in the health sector, not being employed) [22]. No different proportions have been found between nurses and physicians who directly face COVID-19 patients (around 40%) [23]. In addition, being female has been found to be a moderator in a meta-analysis, as it seems associated with fewer sleep disorders [24]. Therefore, this study aimed to investigate the potential psychological injury experienced by hospital workers including HCWs and their demographical and occupational characteristics during the COVID-19 pandemic in Italy. METHODS Study population and setting A cross-sectional study was set in a public hospital in Rome from June 2020 to July 2021. Dependent workers of the hospital were randomly invited to participate to the study prior the health surveillance visit through the fulfilment of a self-administered questionnaire. A sampling of 635 subjects were selected over 2,800 (22.7% of the entire hospital working population). None of the participants were previously diagnosed with SARS-CoV-2 infection (four of them get infected after the considered period). The Questionnaire The “Psychological Injury Risk Indicator” (PIRI) is a 26-item questionnaire, which investigates mental health and work-related psychological injury [25]. Each question is graded on a Likert (0–6) point scale. The Italian version was used [26]. Reliability analysis of PIRI and its subscales showed a Cronbach’s alpha of .928 for this study. Given the mandatory abstention from alcohol at work for HCWs by Italian legislation [27], four of the original five subscales were considered, including sleep problems (6 items), energy recovery (5 items), PTSD symptoms (10 items), and chronic fatigue (5 items). The total score is computed as the sum of each subscale score and then standardized into a 0–100 scale. According to the original guidelines, overall scores major than 25 corresponds to potential psychological injury, while higher scores indicated a greater risk of injury [25]. Questionnaires with missing data were excluded from the study. Study variables Beyond demographic variables (age and gender), occupational variables were considered, including seniority, professional categories (nurses, physicians, technicians, and administrative personnel), commuting, night shifts, and agile working. The latter concerns the opportunity to work at home for more susceptible workers who are at high risk of serious sequelae and mortality in the event of SARS-CoV-2 infection because of a chronic disabling disease (the so called ‘frail health status’). This further measure belongs to the COVID-19 specific disability management program carried in the hospital during the pandemic. Ethical aspects Our study follows the principles of the Declaration of Helsinki. According to the guidelines on Italian observational retrospective studies, an independent Ethics Committee (EC) approved the study (protocol number 2000/2019). Informed consent was obtained from all the participants. Data analysis Statistical analyses have been made using Student’s T test for categorical binomial Journal of Health and Social Sciences 2021; 6,3:367-378 The Italian Journal for Interdisciplinary Health and Social Development 370 variables and Analysis of Variance (ANOVA) for multi-categorical variables. Logistic regression analysis was then performed assessing the extent of the impact of the considered variables on PIRI scores (both total and subscales). Two models were proposed for each score, evaluating the contribution of agile working in the score prediction for the second model. Data were analysed using the IBM Statistical