CONSEQUENCES OF THE COVID-19 PANDEMIC AND THE CURRENT MILITARY CONTEXT OVER THE STRESS OF HEALTHCARE PROFESSIONALS

Abstract

We conducted a cohort study regarding the impact of stress on healthcare professionals in the pandemic and military context of September 2022. Study group: active medical staff (N=147) aged <60 years, 88% female, 81.4% urban; doctors (40%), nurses (30%) and auxiliary staff (30%). More than half of the respondents reported a high level of stress at a professional level (53%), other forms of reported stress were at social (30%), physical (27%), psychological (20%) or economic level. The general level of post-pandemic stress experienced was mostly moderate to severe (score "5- 10/10",77.6%). Correlations between economic, social, pandemic and military stress showed that all of them are positively and statistically significantly correlated (p<0.001). Therefor, it is mandatory to prioritize the implementation of sustainable measures through medical management, as to prevent professional stress.

Headnote

Abstract: We conducted a cohort study regarding the impact of stress on healthcare professionals in the pandemic and military context of September 2022. Study group: active medical staff (N=147) aged <60 years, 88% female, 81.4% urban; doctors (40%>), nurses (30%>) and auxiliary staff (30'%>). More than half of the respondents reported a high level of stress at a professional level (53%>), other forms of reported stress were at social (307o), physical (27%>), psychological (20%>) or economic level. The general level of post-pandemic stress experienced was mostly moderate to severe (score "5-10/10",77'.6%). Correlations between economic, social, pandemic and military stress showed that all of them are positively and statistically significantly correlated (p<0.001). Therefor, it is mandatory to prioritize the implementation of sustainable measures through medical management, as to prevent professional stress.

Keywords: medical staff, stress, pandemic, COVID-19, war

Introduction

COVID-19 is a disease caused by a new type of coronavirus (SARS-CoV-2). It was first identified in China in December 2019 in Wuhan city, from where the infection spread rapidly to other regions in China and worldwide, with isolated cases in some EU Member States reported in January 2020. In late February 2020, Italy reported a significant increase in COVID-19 cases in the northern regions of the country. By March 2020, all EU Member States had reported cases of COVID-19. The World Health Organization (WHO) is coordinating the global response. On 11 March 2020, WHO declared COVID-19 a global pandemic1.

The Covid-19 pandemics had a major influence on the population and the healthcare professionals, both psychologically and physically2. The medical staff and the whole medical system were overwhelmed by the large volume of work, increased risks of infection, in special conditions (special medical costumes, the wearing of protection masks: protective masks on each ward, simple surgical masks or FFP 1, FFP 2, FFP 33, protective visors or glasses, frequent tests at the entrance on the ward of both patients and medical staff, isolation rooms, reorganization of circuits in medical units, new procedures, frequent, sometimes daily, administrative and professional regulations on diagnostic criteria, treatment, isolation rules, quarantine, issuing of sick leave, etc.).

The major psychological influence was represented by an increased level of stress both on a short term and on a medium and long term. According to the Romanian language dictionary, stress is a general term which is used for every element in nature (trauma, emotions, cold, heat etc.) capable to create in humans and animals a feeling of tension and an alarm reaction of the body, causing serious diseases4.

Stress can create emotions of the type fight or run, fear, fury, sadness, worry, dumbness or frustration5. Its influence manifests differently from one person to another. Some persons display light influences as changes of appetite, difficulties of concentration or decision taking, insomnia or as well as major influences on the body like the worsening of existing chronic problems, and thus altering the quality of life of the affected person6, worsening mental health, addiction to certain substances, skin rashes, etc. Therefore, identifying stress and recognizing its negative consequences is essential on one hand to understanding emotions, on the other hand to finding solutions to control emotions, either through self-awareness and individual effort, or through qualified help, an important role being played here by communication with the mental health specialist7.

Though the pandemic context seems to be ending, a new trigger appeared this year represented by the military context at the border with Ukraine which also contributes with major psychological implications, being an additional element of stress in the life of the medical staff: ,will we or will we not enter the war?'. ,If we enter the war, will it be necessary to send doctors on the battlefield?"etc.

The objective of this study is to analyze the impact of the last two and a half years' stress in the life of the healthcare proffesionals in the pandemic and present military context.

Material and methods

This study represents a cohort study made in September 2022 inside the medical community (N=147)

It was undertaken in the form of an online structured quiz, containing 11 questions, which was made using the Google formularies and spread among the healthcare professionals (doctors, nurses, auxiliary personnel) through social media, using the appropriate sample technique of the "snow ball"8.

The resulting data were analyzed through the IBM SPSS Statistics 20 and Excel from the program Microsoft Office Professional Plus 2013.

The quantitative variables are presented as average or medium +/-standard deviation, confidence interval 95%. Qualitative variables are presented as percentage or frequency. The Pearson test was used in order to measure the power of association between two quantitative variables.

The analyzed variables are: age, sex, environmental origin, professional activity, scales for the measurement of the stress level: scales from 1 to 10, "1" being minimum/no stress and "10" being maximum/ intense stress. It was agreed to interpret the scales as follows: 1-4 mild intensity, 5-7 moderate intensity, 8-10 high intensity.

Results and discussions

The study group was represented by active medical staff aged less than 60 years, (figure no. 1).

The age distribution by decades was: 36% between 20-29 years, 18% between 30-39 years, 30% between 40-49 years, 16% between 50-59 years.

86.4% of the respondents were of the feminine sex (figure no .2) and 81.6% came from an urban environment (figure no.3).

Regarding healthcare professionals, all respondents were working in the medical system when the study was made; the respondents were mainly doctors (resident, specialist, primary doctors) 40 % , nurses 30 %, the rest of the group being represented by under nurses and auxiliary personnel 30%. (figure n0.4)

To the question "thinking of the highest challenge in the last two years (since the pandemics started), on what level was it?", the respondents in more than 50% mentioned that it occurred on the professional level, (figure n0.5) This aspect underlines the importance of in-depth study of the effects of stress on healthcare staff, in order to identify the main sources of stress, the relationships between stressors; the results can be used as a research resource for developing programs to prevent the identified factors and professional stress in general.

On the physical level (at a somatic level, weight fluctuation) and on a psychological level, stress was reported by 1 of 3 and 1 of 5 respondents.

The consequences of the Covid-19 pandemics were also reported at a social and economic level. It is essential to underline that the current social stress was reported in 1 of 3 respondents, being reported as medium-increased, 72.1% having >5 out of 10 scores (figure no.6)

At an economic level, some studies belonging to specialized literature underline an increase of economic uncertainty during the pandemics9 caused both by a pressure generated by a potential loss of jobs and the uncertainty related to income.

In our study the stress reported on the economic level was mainly medium-severe in intensity, displaying scores between 5-10 out of 10, in a 68.7 percent (figure no.7)

The most vulnerable group at the level of economic stress was represented by the respondents of the second decade between 20 and 29 years of age, which reports in 42.9 percent a high intensity of stress with scores of 8-10 out of 10 (p. 0.477) (figure no.8). We draw attention to the fact that the major impact of post-pandemic economic stress has been on young people.

If we compare stress with the pandemics or the war, the results indicate very clearly a superiority of the stress brought by the pandemics in a unanimous way (40.8%) (figure no.9). Yet, an important number of respondents, 40.1% specified that both events, the pandemics and the potential war, increased the level of stress felt by them; 9.5 percent of the respondents mentioned that none of the two events increases their level of stress.

Quantifying the level of general stress felt after the two years of Covid-19 pandemics, it was mainly medium-severe, 77.6% of the respondents giving a score between 5 and 10 out of 10 (figure no.10)

Quantifying the level of general stress experienced after the COVID-19 pandemic in terms of intensity by age group, we find a higher impact of stress on young people, the latter reporting more frequently general stress and higher intensity than in other age groups, scoring between "5-10" out of 10 (figure no. 11).

Quantifying the level of stress felt because of a potential war, 40.8% of the respondents gave a medium score between 5 and 7 out of 10 (figure no.12)

Relating the level of economic, social stress in a pandemic and military context we can say that they are correlated in a positive and statistically significant way (p<0.001), having an ascendant trend (the Pearson test) (table nO.l)

Between the stress reported on economical issues and the stress reported on social issues there is also a positive and a statistically significant correlation (r=0.44, p<001). Consequently, we can say that the more the economic stress increases, the more the social stress increases too, which is also valid reciprocally.

There is a statistically significant positive correlation (r = 0.519, p < .001) between stress regarding the pandemic and stress regarding economic issues. Therefore, we can say that the more stress regarding the pandemic increases, the more stress regarding economic issues increases; the reverse is also true.

There is a statistically significant positive correlation (r = 0.696, p < .001) between stress regarding the pandemic and stress felt from a social point of view. Therefore, we can say that the more stress regarding the pandemic is increasing, the more stress felt from a social point of view is increasing; and vice versa.

Between the stress about a potential war and the social stress there is a statistically significant relation (r=0.492, p.<001). Consequently, we can say that the more the stress related to war increases, the more the social stress increases too, which is valid also reciprocally.

Between a stress about a potential war and the economic stress, there is a positive and statistically significant correlation (r=0.379, p<.001). Consequently, we can say that the more the stress linked to a potential war increases, the more increases the economic stress, which is valid also reciprocally, (figure no.13)

Between the stress related to a potential war and the stress linked to the pandemics there is a positive and statistically significant relation (r=0.613, p<001). Consequently, the more the stress related to a potential war increases the more increases the stress linked to the pandemics, which is valid also reciprocally, (figure no.13)

Our study is consistent with studies in the literature, showing that the COVID-19 pandemic posed a major challenge among healthcare professionals. The main consequences of the stress induced by the COVID-19 pandemic in health professionals were at the psychological level, with a large proportion of health staff showing increased values of depression, anxiety and stress10. Several studies have examined the impact of the pandemic and its influence on burnout syndrome and posttraumatic stress among medical staff11. Some studies revealed that poor working conditions during the pandemic were trigger factors for the onset of depression among young medical staff12, similar to the data presented by us.

Another important result of our study, which should be mentioned, is that a very high percentage of the surveyed health professionals (40.1%) do not know "if they would make the same choices" if a similar pandemic context were to be repeated (table no. 2). This aspect underlines the necessity and importance of medical management for optimizing and making the work at a medical system level more efficient and for providing early psychological support13.

Conclusions

This study draws attention to the increased prevalence of stress and its consequences among healthcare professionals due to the COVID-19 pandemic and the military context, a new issue both as a sociological phenomena and as a subject of research.

The general stress level experienced 2 and a half years after the pandemic was mostly moderate-severe (score "5-10/10", 77.6%) having a significant, negative influence on the lives of medical staff. Analyzing the level of economic, social, pandemic and military stress, we found that all of them were positively and statistically significantly correlated (p<0.001). Between stress regarding the possible war and stress experienced regarding the pandemic there was a statistically significant positive correlation (r= 0.613, p< .001). Consequently, the more stress regarding the possible war increases, the more stress regarding the pandemic increases; the reverse is also true.

Knowing the impact of professional stress on more than 50% of the respondents and the fact that a very high percentage of them do not know what choices they would make in a similar pandemic context, we believe that it is necessary to prioritize the implementation of sustainable measures that can prevent and combat professional stress at medical management level. In this way, further benefits can be designed to manage crisis situations in any global or territorial context. These measures can include early support provided by the medical institution, which can prepare employees for any possible situations. At the end of a post-pandemic or war crisis situation, medical staff should be given special time to reflect on their experiences, under the guidance of managers or psychologists, so that the experiences gained can be used constructively in the future in individual medical work, but more importantly, in the implementation of healthcare system-wide measures.

Footnote

**** Ruxandra Mihalache, corresponding author, university assistant, MD, PhD. student, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy "Carol Davila", Bucharest.

***** Translated by Andreea Maria Popescu, Associate Professor, PhD., Faculty of Foreign Languages and Literatures, University of Bucharest.

1 https://www.consilium.europa.eu/ro/policies/coronavirus/

2 G. Adhikari et al., Stress among Resident Doctors Working in Different Hospitals of Nepal in the Face of COVID-19 Pandemic: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2021 Jul 1; 59(238); p. 558-563.

3 Health and Safety Authority: A Guide to Respiratory Protective Equipment, Dublin, The Metropolitan Building, 2010, p. 3.

4 https://dexonhne.ro/definitie/stres

5 Centers for Disease and Prevention, Coping with Stress, 2022, p. 1.

6 M. Gurgu, E.F. Bleotu, A. Zamfirescu, H. Gurgu, M. Gurgu, M. Sporis, Association between Frailty and Pain: A Time Bomb. Innov Aging. 2017 Jun 30; l(Suppl 1); p. 388.

7 A. Popescu, A. Zamfirescu, Reconciling with the Shadow, Bucharest, Euromentor Journal; Vol. 11, Iss. 2, Qun 2020), p. 103-112.

8 S.W. Huck, Reading Statistic and Research. Pearson Education Inc, 2004.

9 X. Lu, Z. Lin, COVID-19, Economic Impact, Mental Health, and Coping Behaviors: A Conceptual Framework and Future Research Directions. Front Psychol. 2021 Nov 11; 12:759974.

10 S. Hummel et al., Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study. J Med Internet Res. 2021 Jan 18; 23(l):e24983.

11 J. Raudenska et al., Occupational burnout syndrome and post-traumatic stress among healthcare professionals during the novel coronavirus disease 2019 (COVID-19) pandemic, Best Practice & Research Clinical Anaesthesiology, Volume 34, Issue 3, 2020, p. 553-560.

12 A. Dunning, et al., Relationship between working conditions and psychological distress experienced by junior doctors in the UK during the COVID-19 pandemic: a cross-sectional survey study. BMJ Open, 2022, p. 1.

13 N. Greenberg et al., Managing mental health challenges faced by healthcare workers during Covid-19 pandemic, BMJ, 2020; p. 368.

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