The COVID-related mental health load of neonatal healthcare professionals: a multicenter study in Italy

  1. Luigi Gagliardi
  2. Serena Grumi
  3. Marzia Gentile
  4. Roberta Cacciavellani
  5. Giulia Placidi
  6. Angelina Vaccaro
  7. Claudia Maggi
  8. Beatrice Gambi
  9. Letizia Magi
  10. Laura Crespin
  11. Graziano Memmini
  12. Marcello DeFilippo
  13. Elena Verucci
  14. Liliana Malandra
  15. Laura Mele
  16. Angelo Azzarà
  17. Livio Provenzi

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Abstract

Background

The COVID-19 pandemic has dramatically affected healthcare professionals’ lives. We investigated the potential mental health risk faced by healthcare professionals working in neonatal units in a multicentre cross-sectional observational study.

Methods

We included all healthcare personnel of seven level-3 and six level-2 neonatal units in Tuscany, Italy. We measured the level of physical exposure to COVID-19 risk, self-reported pandemic-related stress, and mental health load outcomes (anxiety, depression, burnout, psychosomatic symptoms, and post-traumatic symptoms) using validated, self-administered, online questionnaires during the second pandemic wave in Italy (October 2020 to March 2021).

Results

We analyzed 314 complete answers. Scores above the clinical cutoff were reported by 91% of participants for symptoms of anxiety, 29% for post-traumatic symptoms, 13% for burnout, and 3% for symptoms of depression. Moreover, 50% of the participants reported at least one psychosomatic symptom. Pandemic-related stress was significantly associated with all the measured mental health load outcomes, with an Odds Ratio of 3.31 (95% confidence interval: 1.87, 5.88) for clinically relevant anxiety, 2.46 (1.73, 3.49) for post-traumatic symptoms, 1.80 (1.17, 2.79) for emotional exhaustion, and 2.75 (1.05, 7.19) for depression. Female health care professionals displayed a greater risk of anxiety, and male health care professionals and nurses, of depressive symptoms.

Conclusions

Despite the low direct clinical impact of COVID-19 in newborns, neonatal professionals, due to both living in a situation of uncertainty and personal exposure to contacts with parents and other relatives of the newborns, and having to carry out activities once routine and now fraught with uncertainty, displayed clear signs of mental health load outcomes. They must be considered a specific population at risk for psychological consequences during the pandemic.

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  1. Version published to 10.1186/s13052-022-01305-7
  2. ScreenIT

    SciScore for 10.1101/2021.06.23.21259414: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Those who participated in the survey provided an informed consent and anonymously filled in a series of questionnaires aimed at assessing their emotional stress response to the COVID-19 healthcare emergency as well as a series of potential mental health outcomes including emotional exhaustion (burnout), depression, anxiety, psychosomatic and post-traumatic symptoms.
    IRB: The study has been approved by the Ethics Committee of the participant parties.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The statistical analyses were conducted using R36 and IBM SPSS Statistics for Windows, ver. 26.0.37
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations. Firstly, the response rate of our survey (32.9%), though similar to that of another recent study,28 does not allow us to claim representativeness of our sample. Secondly, the cross-sectional study design does not allow to assess the causal directions of the relationship between the COVID-related stress and the professionals’ wellbeing. Moreover, the unavailability of pre-emergency data did not allow to disentangle the potential impact of COVID-related stress from that of the usual workload. Although data collection occurred by self-report questionnaires, we used well-validated tools, except for the ad-hoc measure used to assess COVID-19 exposures and response. Finally, participants were enrolled from hospitals located in only one Italian region that was not a primary hotspot of the virus spreading during the first lockdown, but that was hit during subsequent waves of the pandemic,40 as confirmed by the 10% of respondents who had experienced the death of at least one significant other and 30% of them who had indirect experience of a relative or close friend who needed intensive care hospitalization.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.06.23.21259414v1 on medRxiv