Psychische Ressourcen, Impfbereitschaft und Kündigungsabsichten von Mitarbeitenden im Gesundheitswesen während der COVID-19-Pandemie

Hintergrund und Ziele Die COVID-19-Pandemie belastet die Gesundheitssysteme weltweit, so auch in Deutschland. Für die Sicherung der Gesundheitsversorgung spielen die Beschäftigen im Gesundheitswesen eine Schlüsselrolle. Ihre Arbeitsfähigkeit bzw. Arbeitskraft hängen von ihrer psychischen und körperlichen Gesundheit ab. Außerdem hängt die Verfügbarkeit ihrer Arbeitskraft im Gesundheitsbereich von ihren Kündigungsabsichten ab. Hinsichtlich ihrer psychischen Gesundheit ist es wichtig, psychische Belastungen sowie damit assoziierte Risiko- und Schutzfaktoren im Kontext der COVID-19-Pandemie in Deutschland zu untersuchen. Außerdem kommt der Bereitschaft, sich gegen COVID-19 impfen zu lassen, eine große Bedeutung für die Bewahrung der körperlichen Gesundheit zu. Das Ausmaß dieser Impfbereitschaft des Gesundheitspersonals in Deutschland sowie damit assoziierte Faktoren sind von hoher Bedeutung, wenn es darum geht, die Auswirkungen der Pandemie auf die Beschäftigten im Gesundheitswesen zu verstehen. Ein Wegfall von Arbeitskraft durch Arbeitsunfähigkeit oder Kündigungen ist in Pflegeberufen, welche bereits einen Fachkräftemangel verzeichnen, besonders kritisch. Das Ausmaß der Kündigungsabsichten und Arbeitsunfähigkeitstage (AU-Tagen) sowie damit verbundene Faktoren bei Pflegekräften müssen beleuchtet werden, um sie möglichst gering halten zu können. Methode Die vorliegende Arbeit untersuchte im Zeitraum von April 2020 bis Juli 2021 mithilfe von drei Wellen einer Online-Befragung das psychische Befinden und die Impfbereitschaft des Gesundheitspersonals sowie Arbeitsunfähigkeitstage und Kündigungsabsichten von Pflegekräften in Deutschland. Die erste Befragung zwischen April und Juli 2020 erhob bei einer Stichprobe von 7765 Beschäftigten im deutschen Gesundheitswesen Symptome von Depression und generalisierter Angst mithilfe des PHQ-4 (Patient-Health-Questionnaire-4) sowie psychosoziale Ressourcen und Belastungen. Die zweite Befragung erfasste zwischen November 2020 und Januar 2021 die Impfbereitschaft gegen COVID-19 unter 6217 Beschäftigten des Gesundheitswesens in Deutschland. In der dritten Erhebung von Mai bis Juli 2021 wurden 757 Pflegekräfte in deutschen Krankenhäusern zu ihren Kündigungsabsichten und Arbeitsunfähigkeitstagen befragt. Zu allen drei Zeitpunkten wurden soziodemografische, berufliche, pandemiebezogene und psychosoziale Daten erfasst. Die Auswertung der Daten erfolgte mittels deskriptiver und inferenzstatistischer Verfahren. Ergebnisse Die erste Studie ergab, dass eine höhere soziale Unterstützung und stärkerer Optimismus mit niedrigeren Symptomausprägungen von Depression und generalisierter Angst einhergingen, wobei diese Ressourcen höhere Zusammenhänge zur psychischen Gesundheit zeigten als vermutete Risikofaktoren wie Geschlecht oder Kontakt zu Infizierten. Angst vor einer Ansteckung mit COVID-19 ging mit höheren Depressions- und generellen Angstsymptomen einher. Die zweite Untersuchung detektierte eine Impfbereitschaftsquote gegen COVID-19 von 65%. Mit einer höheren Impfbereitschaft assoziiert waren: männliches Geschlecht, Alter >40 Jahre, Zugehörigkeit zu einer COVID-19-Risikogruppe, die Berufsgruppe der Ärztinnen und Ärzte und die der Psychologinnen und Psychologen im Vergleich mit den Pflegekräften, ausreichende Informiertheit über COVID-19, wahrgenommener Schutz durch die Maßnahmen nationaler/lokaler Behörden und des Arbeitgebers sowie Angst vor einer COVID-19- Infizierung. Mit einer weniger wahrscheinlichen Impfbereitschaft assoziiert waren: Kinder zu haben, Migrationshintergrund, eine Tätigkeit in der direkten Patientenversorgung und Anzeichen einer Depression. Die dritte Studie deckte auf, dass 18,9% der befragten Pflegekräfte Kündigungsabsichten hatten. Geringere wahrgenommene Belohnung am Arbeitsplatz, ein Abteilungswechsel während der Pandemie, Teilzeit-Beschäftigung und stärkere Depressionssymptome gingen mit einer wahrscheinlicheren Kündigungsabsicht einher. Eine Infizierung mit COVID-19, eine Vorerkrankung, geringere wahrgenommene Belohnung, höhere Erschöpfungswerte, weniger Zustimmung dazu, dass ausreichend Personal eingesetzt ist, ein höherer wahrgenommener Verlass auf Kollegen und Kolleginnen, kein beruflicher Kontakt mit COVID-19-Infizierten und Angst vor einer Infizierung mit COVID-19 waren mit mehr AU-Tagen verbunden. Schlussfolgerungen und Diskussion Die Förderung psychosozialer Ressourcen wie sozialer Unterstützung und Optimismus unter Gesundheitspersonal scheint zum Schutz ihrer psychischen Gesundheit während der COVID� 19-Pandemie empfehlenswert. Informationen über COVID-19 und über die Impfung, vor allem für jüngere, weibliche und nichtärztliche Beschäftigte und jene mit Migrationshintergrund, angemessene Schutzmaßnahmen und die Prävention beziehungsweise Behandlung depressiver Symptome könnten die Impfbereitschaft des Gesundheitspersonals erhöhen. Ein hoher Anteil der Pflegekräfte plant, den medizinischen Bereich zu verlassen. Höhere wahrgenommene Belohnung bei der Arbeit könnte Kündigungsabsichten sowie AU-Tage verringern. Depressionsprävention, ein sorgfältiges Change-Management und Unterstützung für Teilzeit-Arbeitende könnten Kündigungsabsichten während der Pandemie ebenfalls entgegenwirken

Mindfulness and skills-based eHealth intervention to reduce distress in cancer-affected patients in the Reduct trial: Intervention protocol of the make it training optimized.

Introduction Cancer-affected patients experience high distress due to various burdens. One way to expand psycho-oncological support is through digital interventions. This protocol describes the development and structure of a web-based psycho-oncological intervention, the Make It Training optimized. This intervention is currently evaluated in the Reduct trial, a multicenter randomized controlled trial. Methods The Make It Training optimized was developed in six steps: A patient need and demand assessment, development and acceptability analysis of a prototype, the formation of a patient advisory council, the revision of the training, implementation into a web app, and the development of a motivation and evaluation plan. Results Through a process of establishing cancer-affected patients' needs, prototype testing, and patient involvement, the Make It Training optimized was developed by a multidisciplinary team and implemented in a web app. It consists of 16 interactive self-guided modules which can be completed within 16 weeks. Discussion Intervention protocols can increase transparency and increase the likelihood of developing effective web-based interventions. This protocol describes the process and results of developing a patient-oriented intervention. Future research should focus on the further personalization of web-based psycho-oncological interventions and the potential benefits of combining multiple psychotherapeutic approaches

The prevalence of effort-reward imbalance and its associations with working conditions, psychosocial resources and burden among health care workers during the COVID-19 pandemic: Results of the egePan-Voice study

ObjectiveThe association between a measure of effort-reward imbalance (ERI) and profession as well as gender in a sample of health care workers (HCW) during the first wave of the COVID-19 pandemic in Germany using the egePan-Voice study. In addition, we examined, which factors are associated with an effort-reward imbalance ratio (ERI ratio) &gt;1.MethodsIn a large sample of HCW (N = 6174) we assessed occupational stress with the short version of the effort-reward imbalance (ERI) questionnaire, working conditions, COVID-19-related problems and psychosocial resources (ENRICHD Social Support Inventory, ESSI; Sense of Coherence Scale, SOC-3 and optimism, SOP2).ResultsThe prevalence of a ERI ratio &gt;1 among HCW was 50.9%. The prevalence’s of an ERI ratio &gt;1 were statistically significant different between gender as well as the occupational profession. The proportion of women (51.8%) with ERI ratio &gt;1 was significantly higher than among men (47.8%). The highest ERI imbalance was found among nurses (62.8%), followed by medical technical assistants (MTA) (58.8%), while psychologists/psychotherapists revealed the lowest value (37.8%), followed by physicians (41.8%). In the total sample, most essential factors reported at this time for increased ERI ratio were: insufficient staff for the current work load, insufficient recovery, feeling insufficiently protected by measures taken by the hospital/the employer, high occupancy rate of the wards, insufficient trust in colleagues and being a nurse as compared with being a physician.ConclusionThe findings indicate a high proportion of HCW with effort-reward imbalance and substantial profession-related differences. Preventive interventions should be offered to vulnerable groups among the HCW to decrease the imbalance measured by work stress.</jats:sec

Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct

IntroductionMany patients with cancer experience severe psychological distress, but as a result of various barriers, few of them receive psycho-oncological support. E-mental health interventions try to overcome some of these barriers and the limitation of healthcare offers, enabling patients with cancer to better cope with psychological distress. In the proposed trial, we aim to assess the efficacy and cost-effectiveness of the manualised e-mental health intervention Make It Training- Mindfulness-Based and Skills-Based Distress Reduction in Oncology. Make It Training is a self-guided and web-based psycho-oncological intervention, which includes elements of cognitive behavioural therapy, mindfulness-based stress reduction and acceptance and commitment therapy. The training supports the patients over a period of 4 months. We expect the Make It Training to be superior to treatment as usual optimised (TAU-O) in terms of reducing distress after completing the intervention (T1, primary endpoint).Methods and analysisThe study comprises a multicentre, prospective, randomised controlled confirmatory interventional trial with two parallel arms. The proposed trial incorporates four distinct measurement time points: the baseline assessment before randomisation, a post-treatment assessment and 3 and 6 month follow-up assessments. We will include patients who have received a cancer diagnosis in the past 12 months, are in a curative treatment setting, are 18–65 years old, have given informed consent and experience high perceived psychological distress (Hospital Anxiety and Depression Scale ≥13) for at least 1 week. Patients will be randomised into two groups (Make It vs TAU-O). The aim is to allocate 600 patients with cancer and include 556 into the intention to treat analysis. The primary endpoint, distress, will be analysed using a baseline-adjusted ANCOVA for distress measurement once the intervention (T1) has been completed, with study arm as a binary factor, baseline as continuous measurement and study centre as an additional categorical covariate.Ethics and disseminationThe Ethics Committee of the Medical Faculty Essen has approved the study (21-10076-BO). Results will be published in peer-reviewed journals, conference presentations, the project website, and among self-help organisations.Trial registration numberGerman Clinical Trial Register (DRKS); DRKS-ID: DRKS00025213

Psychosocial burden and working conditions during the COVID-19 pandemic in Germany: The VOICE survey among 3678 health care workers in hospitals

Objective: The aim of this cross-sectional web-based study was to examine self-reported mental distress, psychosocial burdens, working conditions and potential risk and protective factors for depressive and anxiety symptoms during the COVID-19 pandemic in health care workers (HCW). Methods: In the largest survey on mental health of HCW conducted during the first wave of COVID-19 in Europe (N = 8071 HCW), we investigated depressive (Patient Health Questionnaire-2, PHQ-2), and anxiety symptoms (Generalized Anxiety Disorder-2, GAD-2), working conditions, and psychosocial burden of 3678 HCW of three health care professions in hospitals: physicians (n = 1061), nurses (n = 1275), and medical technical assistants (MTA, n = 1342). Results: The prevalence of clinically significant levels of depressive and anxiety symptoms was 17.4% and 17.8% for physicians, 21.6% and 19.0% for nurses, and 23.0% and 20.1% for MTA, respectively. All three professions demonstrated significantly elevated PHQ-2 and GAD-2 scores, when compared with general German population before the pandemic, but lower scores in relation to that during the pandemic. Multiple linear regression analyses revealed that higher levels of depressive symptoms were associated with insufficient recovery during leisure time, increased alcohol consumption, and less trust in colleagues in difficult situations at work. In addition, elevated anxiety scores were related to increased fear of becoming infected with COVID-19. Conclusion: During the pandemic HCW demonstrated a lower burden of mental distress compared to the general population. Nevertheless, a high percentage of HCW demonstrates psychosocial distress, so that the establishment of regular mental health screening and prevention programmes for HCW is indicated

Depressive and anxiety symptoms in the course of the COVID-19 pandemic among physicians in hospitals: results of the longitudinal, multicenter VOICE-EgePan survey over two years

Abstract Background This longitudinal, multicenter web-based study explored the trajectories of depressive and anxiety symptoms during the COVID-19 pandemic among physicians over two years. Methods At four measurement points between 4/2020 and 5/2022 depressive (Patient Health Questionnaire-2, PHQ-2) and anxiety symptoms (Generalized Anxiety Disorder Scale-2, GAD-2) among physicians in German hospitals were assessed. Time, gender and age effects were analyzed with linear mixed regression models. Comparisons with norm values for the German population during the COVID-19 pandemic were also performed and frequencies of probable depression and anxiety are reported. Results The physicians (N = 340) showed a significant increase of depressive symptoms from T1 (M = 1.35, SD = 1.33) to T4 (M = 1.64, SD = 1.34) (p  50 years, p = .003). As compared to the general population, the physicians reported significantly elevated PHQ-2 (T1: M = 1.35, SD = 1.33; T2: M = 1.53, SD = 1.37; T3: M = 1.55, SD = 1.40; T4: M = 1.64, SD = 1.34) and GAD-2 scores (T1: M = 1.35, SD = 1.42; T2: M = 1.59, SD = 1.43; T3: M = 1.61, SD = 1.57; T4: M = 1.49, SD = 1.46) for all measurement points (all p < .001). The frequencies of probable depression (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) were: 14.1% and 17.0% (T1), 16.5% and 21.9% (T2), 17.8% and 22.6% (T3) and 18.5% and 17.3% (T4), respectively. Conclusions Mental distress of physicians in German hospitals has increased in the course of the COVID-19 pandemic with gender and age-related differences. Possible causes should be explored and regular monitoring of mental health and prevention programmes for physicians should be established. Trial registration The study was registered on ClinicalTrials (DRKS-ID: DRKS00021268) on 9.4.2020

Sick Leave and Intention to Quit the Job among Nursing Staff in German Hospitals during the COVID-19 Pandemic

Background: Sick leave and turnover of nurses exacerbate an already existing nursing shortage during the COVID-19 pandemic in Germany and other countries. Frequency and associated factors of sick leave and intention to quit among nurses need to be examined to maintain healthcare. Methods: An online survey among nursing staff (N = 757) in German hospitals was conducted between May and July 2021. Sick leave days, intention to quit, working conditions, depression, anxiety and sleep disorder symptoms, effort-reward imbalance (ERI), COVID-19-related and sociodemographic variables were measured. Regression analyses were performed. Results: The intention to quit was present in 18.9%. One third (32.5%) reported sick leave of &ge;10 and 12.3% more than 25 days in 12 months. Significant predictors for &ge;10 sick leave days were infection with SARS-CoV-2, a pre-existing illness, exhaustion, trust in colleagues and fear of becoming infected. Higher ERI reward levels, perception of sufficient staff and contact with infected patients were associated with lower odds for &ge;10 sick leave days. Lower reward levels, having changed work departments during the pandemic, working part-time and higher depression levels significantly predicted turnover intention. Conclusion: Alarmingly, many nurses intend to quit working in healthcare. Perceived reward seems to buffer both sick leave and turnover intention. Enhancing protection from COVID-19 and reducing workload might also prevent sick leave. Depression prevention, improved change management and support of part-time workers could contribute to reducing turnover intention among nurses

Vaccination willingness against COVID-19 among healthcare workers in Germany Results from a University Medicine Network survey between November 2020 and January 2021

Background The COVID-19 pandemic is a continuing burden on society and the health system. The vaccination willingness among healthcare workers is of particular interest, as these groups play a key role in the pandemic response. Objectives The present study investigated how the willingness of healthcare workers in Germany to get vaccinated depends on sociodemographic, occupational, and COVID-19-specific characteristics, as well as mental health. Methods Between November 2020 and January 2021, 6217 employees in the German healthcare system were questioned about their vaccination willingness, sociodemographic, occupational, COVID-19-specific, and psychosocial characteristics using the online VOICE survey within the framework of the University Medicine Network (NUM). Results The vaccination willingness of the sample group was 65.3%. A higher vaccination willingness was associated with male gender; age > 40 years; having no children or no migration background; not working in direct patient care; belonging to a COVID-19 risk group or professional group of physicians and psychologists in comparison with nursing staff; feeling sufficiently informed about COVID-19 and protected by the measures of the national or local authorities and the employer; fear of infection; and lack of signs of depression. Physicians showed the highest willingness to get vaccinated. Conclusions During the study period, an overall moderate vaccination willingness against COVID-19 in the health sector was described. Information about the disease and vaccination, especially for younger people, females, and non-physicians, adequate protective measures and prevention of depressive symptoms could increase the vaccination willingness

Social Support and Optimism as Protective Factors for Mental Health among 7765 Healthcare Workers in Germany during the COVID-19 Pandemic: Results of the VOICE Study

Background: The COVID-19 pandemic is impacting mental health worldwide, particularly among healthcare workers (HCWs). Risk and protective factors for depression and generalized anxiety in healthcare workers need to be identified to protect their health and ability to work. Social support and optimism are known protective psychosocial resources, but have not been adequately studied in the context of the COVID-19 pandemic among healthcare workers in Germany. Methods: Within the first wave of the VOICE study (n = 7765), a longitudinal web-based survey study among healthcare workers in Germany, we assessed symptoms of depression (PHQ-2) and generalized anxiety (GAD-2), social support (ENRICHD Social Support Inventory; ESSI), and generalized optimism as well as sociodemographic, occupational, and COVID-19 related variables. Multiple linear regression analyses were conducted to examine associations between the constructs. Results: The analyses revealed that higher levels of social support and optimism were associated with lower levels of depression and generalized anxiety. They showed a higher association with depression and generalized anxiety than demographic or occupational risk factors such as female gender and direct contact with infected individuals. Conclusion: Psychosocial resources such as social support and optimism appear to contribute to successful coping with the COVID-19 pandemic and should be considered in future studies