During the early phases of the COVID-19 pandemic, the world initially focused on measures to suppress COVID-19 transmission and protect their populations by developing vaccines and drug treatments for the most vulnerable and a host of social actions, including implementing social distancing, working from home, travel restrictions, lockdowns, and face coverings. Nearly 2 years after the initial outbreak, at the time of writing this editorial, and through research conducted as part of this Research Topic, it is clear that the mental health impacts of COVID-19 on healthcare workers (HCW) are significant. There is an urgent need to understand and address these impacts (Greenberg et al., 2020). This is particularly true given the World Health Organisation has outlined a series of mental health and psychosocial considerations aimed explicitly at HCWs (World Health Organisation, 2020). The present Research Topic on Coronavirus Disease (COVID-19) and HCWs has added to the scientific knowledge in several main areas, including barriers and enablers to healthcare delivery, understanding HCWs' mental health and well-being, resilience, coordination and communication within the workforce, and specific interventions to promote mental health and well-being

Galli, F

Keyworth, C

Mitchell, AEP

Salas, E

Vegni, E

Frontiers in Psychology

PubMed

Mitchell, Andrew E. P.

Galli, Federica

Keyworth, Chris

Vegni, Elena

Salas, Eduardo

PubMed Central

Editorial: Coronavirus Disease (COVID-19): The Mental Health, Resilience, and Communication Resources for the Short- and Long-term Challenges Faced by Healthcare Workers

ChesterRep

EDITORIALpublished: 18 April 2022doi: 10.3389/fpsyg.2022.904328Frontiers in Psychology | www.frontiersin.org 1 April 2022 | Volume 13 | Article 904328Edited and reviewed by:Severi Luoto,The University of Auckland,New Zealand*Correspondence:Andrew E. P. Mitchella.mitchell@chester.ac.ukSpecialty section:This article was submitted toPsychology for Clinical Settings,a section of the journalFrontiers in PsychologyReceived: 25 March 2022Accepted: 31 March 2022Published: 18 April 2022Citation:Mitchell AEP, Galli F, Keyworth C,Vegni E and Salas E (2022) Editorial:Coronavirus Disease (COVID-19): TheMental Health, Resilience, andCommunication Resources for theShort- and Long-term ChallengesFaced by Healthcare Workers.Front. Psychol. 13:904328.doi: 10.3389/fpsyg.2022.904328Editorial: Coronavirus Disease(COVID-19): The Mental Health,Resilience, and CommunicationResources for the Short- andLong-term Challenges Faced byHealthcare WorkersAndrew E. P. Mitchell 1*, Federica Galli 2, Chris Keyworth 3, Elena Vegni 4 andEduardo Salas 51 Faculty of Health and Social Care, University of Chester, Chester, United Kingdom, 2Department of Dynamic and ClinicalPsychology, Sapienza University of Rome, Rome, Italy, 3 School of Psychology, University of Leeds, Leeds, United Kingdom,4Department of Health Sciences, University of Milan, Milan, Italy, 5Department of Psychology, Rice University, Houston, TX,United StatesKeywords: coronavirus disease (COVID-19), mental health, communication, resilience, health care workers(HCWs)Editorial on the Research TopicCoronavirus Disease (COVID-19): The Mental Health, Resilience, and CommunicationResources for the Short- and Long-Term Challenges Faced by Healthcare WorkersDuring the early phases of the COVID-19 pandemic, the world initially focused on measures tosuppress COVID-19 transmission and protect their populations by developing vaccines and drugtreatments for the most vulnerable and a host of social actions, including implementing socialdistancing, working from home, travel restrictions, lockdowns, and face coverings. Nearly 2 yearsafter the initial outbreak, at the time of writing this editorial, and through research conducted aspart of this Research Topic, it is clear that the mental health impacts of COVID-19 on healthcareworkers (HCW) are significant. There is an urgent need to understand and address these impacts(Greenberg et al., 2020). This is particularly true given theWorld Health Organisation has outlineda series of mental health and psychosocial considerations aimed explicitly at HCWs (World HealthOrganisation, 2020). The present Research Topic on Coronavirus Disease (COVID-19) and HCWshas added to the scientific knowledge in several main areas, including barriers and enablers tohealthcare delivery, understanding HCWs’ mental health and well-being, resilience, coordinationand communication within the workforce, and specific interventions to promote mental healthand well-being. The Research Topic yielded 42 articles with contributions from 240 authors. Thearticles within this Research Topic were published between the third quarter of 2020 and 2021. Themajority of studies were conducted in Europe (n = 26), with most conducted in Italy (n = 13),the United Kingdom (n = 3), and Spain (n = 3). There was also one study from each of Norway,Denmark, Romania, Turkey, Portugal, Austria and Switzerland. Asia included China (n= 6), India(n= 3), one study in Pakistan and Vietnam, one study conducted in Brazil, and four studies in theUnited States of America.Mitchell et al. Editorial: Coronavirus and Mental HealthThe heterogeneity of the studies in terms of location andpopulations further contributes to the Research Topic. The studydesigns can be dichotomised, with the majority of studies (n= 29) being cross-sectional. Most were questionnaire studiesin which a population is surveyed at one point in time todescribe characteristics. Other studies (n = 5) were broadlyqualitative and used interviews or focus groups. There weresystematic reviews (n = 5), mostly narrative reviews and oneexample involving meta-analysis (Dong et al.). There was onerandomised control trial reported within the Research Topic(Procaccia et al.). Finally, there was a mixed-method (Putrino etal.) and an opinion/commentary paper (Chapman et al.). Therewas a range of analysis techniques in the qualitative papers. Themost frequent method was to conduct interviews, with mostusing thematic and less frequently involving content analysis.Data analysis within the quantitative papers used descriptive anddispersion analysis, analysis of variance, regression analysis andfactor analysis to report the results. The submissions assessedvarious mental health outcomes, including anxiety and mooddisorders, post-traumatic stress disorder, obsessive-compulsivedisorder, and sleep disturbance.The different studies collected in the Research Topic maybe described according to four lines of research. Firstly, a partof the studies addressed the enablers and barriers in healthcaredelivery, both person-specific variables and resources to deliverhealthcare. Moreno-Jiménez et al. utilised the Job Demands-Resources model (JD-R; Bakker and Demerouti, 2017) andreported that high job demands by HCWs during the COVID-19 pandemic were related to a lack of appropriate resources,such as protective equipment in the healthcare environment. Thelimited supply or lack of Personal Protective Equipment (PPE)was related to adverse outcomes, including increased workloadand fear of contagion. The authors suggested that increasedresources such as PPE could reduce fear of contagion andemotional consequences. It has been found that COVID-19 canaffect team performance at four stressor levels: individual, team,organization, and work-life (Tannenbaum et al., 2021). Workingin healthcare settings during a pandemic has the potential riskto cause high levels of stress because of exposure to a range ofpotentially stressful situations.Some specific stressors for HCWs have included theinterpersonal aspects of practise, clinical environment, keepingup to date with current knowledge and dealing with patientconcerns (Mitchell, 2020a). A study by Del Piccolo et al.focused on individual, interpersonal and organisational resourcesto reduce stress. The authors suggested that the essentialaspects are the promotion of acceptance of negative emotionsand resilience to stressors at the individual level. At theinterpersonal level, peer support and daily sharing of experienceshelped. At the organisational level, the findings suggested thataccess to COVID-19-specific resources, such as PPE, enabledItalian obstetrics staff to undertake their work safely whilstreducing distress. Healthcare workers’ health and welfare areimportant resources and potential barriers. Individual well-being was described in two papers (Raza et al.; Testoni etal.) by investigating the lived experiences of health workersduring the COVID-19 pandemic. Both studies utilised qualitativeinterviews in different countries and found that frontline workersexperienced the highest personal distress when confrontedwith COVID-19.The second aspect of the Research Topic focused on articlesinvestigating HCWs’ mental health and well-being during thefirst 18 months of the COVID-19 pandemic. Galli et al. (2020)reported the likely risk of developing a psychiatric disorderfor healthcare workers during the pandemic. An article byChatterjee et al. found that 79.3% of the HCWs had moderate tosevere levels of perceived stress, and 47.9% had insomnia duringthe early phase of the pandemic in India. Huo et al. studiedthe determinates of burnout of HCWs during the COVID-19 pandemic in China. The authors indicated that 36.5% ofworkers experienced burnout. The findings highlighted personaland work-related factors were associated with burnout, suchas being less experienced HCW and younger. Another studyin the United States by Pearman et al. found that healthcareworkers were at an increased risk of experiencing mental healthissues such as depression and anxiety compared to a matchedgeneral population sample during the pandemic. Furthermore,the authors indicated that HCWs, on average, had a symptomprofile to reach a clinical diagnosis of depression. Pfefferbaumand North (2020) reported that HCWs are at risk due to job-specific attributes, i.e., exposure to disease and concerns abouttransmitting the infection. Early and mid-term consequences onHCWs’ physical, behavioural, and mental health were focused onby Khanji et al. by developing a study protocol (CoPE-HCP) tocompare HCWs and the general public. The authors hoped toimprove the delivery and design of support systems for HCWsand the public.A third aspect relates to articles addressing resilienceand communication themes. This aspect attracted researchinvestigating the adherence and understanding of clinicalguidelines and the impact of the pandemic on levels of emotionaldistress and resilience of HCWs. Outside of this Research Topic,Keyworth et al. (2021) investigated adherence to Governmentguidelines in the general population and reported that thepsychosocial effects could undermine long-term adherence.Riguzzi and Gashi examined the psychosocial lessons learntduring the first wave of COVID-19 and adherence to guidelinesin HCWs in Switzerland. The authors found a high level ofemotional distress, with 70% of the HCWs reporting emotionaldistress in the first pandemic wave. Fifty-two percent of HCWsfelt worried about passing the virus on to their family or friends.In contrast, 18% of HCWs felt worried about the same happeningto themselves. The findings also suggest an overestimation of theeffectiveness of standard hygiene procedures, with 36% falselybelieving standard hygiene measures would keep themselvesand others safe. Lenzo et al. focused on the relationshipbetween emotion regulation and its effect on depression andanxiety. The authors found that perceiving stressor contextcues was inversely associated with depression and anxiety.This finding suggests the possibility of using psychologicaltheories to support psychological interventions to help mitigatethe psychological consequence of depression and anxiety. Theauthors did not name a specific intervention but named a broadrange of third-wave cognitive and behavioural techniques such asFrontiers in Psychology | www.frontiersin.org 2 April 2022 | Volume 13 | Article 904328Mitchell et al. Editorial: Coronavirus and Mental Healthmindfulness-based interventions to decrease compassion fatigueand resilience amongst HCWs (Zhang et al.). The relationshipsbetween mindfulness and resilience have been studied byMitchell (2020b), finding that acceptance and attention withinmindfulness was important for HCWs’ resilience.The last main grouping of articles focused on specificinterventions to promote mental health. Callus et al. completeda rapid review to identify the most effective stress reductiontechniques for healthcare workers managing infected patientswith coronavirus (SARS, MERS, and COVID-19). The authorsidentified several studies focusing on interventions to supportHCWs. Still, most did not test user satisfaction or conduct afollow-up, which suggests a need for further research into stressreduction interventions to safeguard HCWs’ mental health. Thisarea of research is needed to protect staff from fatigue andburnout during high levels of acknowledged exposure to stressorsduring the pandemic (Leo et al., 2021). Callus et al. reportedon a digital package in which user satisfaction was measured(Blake et al., 2020). The evaluation of the online support packageindicated a high user satisfaction for content, usability and utilityamongst HCWs in the United Kingdom. In another study,Putrino et al. showed that after a single 15-min experience ina multisensory experience recharge room, healthcare workersshowed a 59.6% reduction in self-reported stress levels and ratedthe experience positively at 99.3%.Studies have also looked at service-level implementation byteams in response to COVID-19. A study by Cao di San Marcoet al. (2020) reported implementing a clinical psychology serviceand detailed two types of psychological support, decompressionrooms and small-group sessions, as beneficial. A similar service-level provision was reported by You et al. focussed on hotlinecounselling service, which was set up following the initialCOVID-19 outbreak to provide HCWs with psychologicalsupport. The authors devised a psychological hotline scale toassess skills and reported a good level of reliability and validity.The scale was designed to screen and evaluate the competenciesof counsellors providing hotline support. Aristizabal et al.reported on heart rate variability biofeedback to support HCWsat times of stress and anxiety. The authors highlighted thatdiaphragmatic breathing exercises could positively reduce stressand anxiety. Procaccia et al. investigated the benefits of expressivewriting compared to neutral writing on HCWs’ psychologicaladjustment during the COVID-19 pandemic after three writingsessions. The findings suggest a positive benefit in psychologicaladjustment to several psychological outcomes.CONCLUSIONIn summary, this Research Topic has gathered articles fromaround the world and focused on HCWs and the best evidence tosupport their mental health and well-being during the pandemic.The studies report from the meso-level of organisations to themicro-level of individual behaviour and cognitions. These articleshave contributed to the understanding of the needs of the HCWsto deliver health in the most effective and safe ways for thepatients whilst protecting themselves as an invaluable resource.This Research Topic has published studies addressing a rangeof topics relevant to understanding mental health, resilience,coordination and communication within the workforce, andspecific interventions to promote mental health for HCWsduring the COVID-19 pandemic. Coronavirus is likely to be achallenge for the foreseeable future regarding understanding itssequelae for the HCWs themselves. Future consideration of well-being and mental health is needed amongst frontline workers.There is a need to understand how to prevent distress and provideinterventions to support healthcare workers during such periods.This Research Topic is a valuable source for future work in thearea. Hopefully, this Research Topic will motivate more researchon this important worldwide topic.AUTHOR CONTRIBUTIONSAMwrote the initial draft. FG, CK, EV, and ES critically reviewedand provided valuable feedback on the final version of themanuscript. All authors approved the submitted version.ACKNOWLEDGMENTSThe editors would like to show their appreciation to allcontributors for their manuscripts. Two hundred and fortyauthors contributed forty-two original research and reviewarticles. Furthermore, the topic editors would like to thank thereviewers who helped us create an exciting and high-qualityresearch topic.REFERENCESBakker, A. B., and Demerouti, E. (2017). Job demands-resources theory:taking stock and looking forward. J. Occup. Health Psychol. 22, 273–285.doi: 10.1037/ocp0000056Blake, H., Bermingham, F., Johnson, G., and Tabner, A. (2020). Mitigatingthe psychological impact of COVID-19 on healthcare workers: adigital learning package. Intern. J. Environ. Res. Public Health 17, 2997.doi: 10.3390/ijerph17092997Cao di San Marco, E., Menichetti, J., and Vegni, E. (2020). COVID-19 emergencyin the hospital: How the clinical psychology unit is responding. Psychol. TraumaTheo. Res. Pract. Policy 12, S43–S44. doi: 10.1037/tra0000684Galli,. F., Pozzi, G., Ruggiero,. F., Mameli,. F., Cavicchioli,. M., Barbieri,. S., et al.(2020). A systematic review and provisional metanalysis on psychopathologicburden on health care workers of coronavirus outbreaks. Front. Psychiatry 11,568664. doi: 10.3389/fpsyt.2020.568664Greenberg, N., Docherty, M., Gnanapragasam, S., and Wessely, S. (2020).Managing mental health challenges faced by healthcare workersduring covid-19 pandemic. Br. Med. J. 368, m1211. doi: 10.1136/bmj.m1211Keyworth, C., Epton, T., Byrne-Davis, L., Leather, J. Z., and Armitage, C. J.(2021). What challenges do UK adults face when adhering to COVID-19-related instructions? Cross-sectional survey in a representative sample. PrevMed. 147, 106458. doi: 10.1016/j.ypmed.2021.106458Frontiers in Psychology | www.frontiersin.org 3 April 2022 | Volume 13 | Article 904328Mitchell et al. Editorial: Coronavirus and Mental HealthLeo, C. G., Sabina, S., Tumolo, M. R., Bodini, A., Ponzini, G., Sabato,E., et al. (2021). Burnout among healthcare workers in the COVID 19era: a review of the existing literature. Front. Public Health 9, 750529.doi: 10.3389/fpubh.2021.750529Mitchell, A. E. P. (2020a). The perceived psychological stressors and copingbehaviours in university students, on a pre-registration programme. J. Ment.Health Train. Educ. Pract. 15, 249–259. doi: 10.1108/JMHTEP-09-2019-0048Mitchell, A. E. P. (2020b). Resilience and mindfulness in nurse trainingon an undergraduate curriculum. Perspect. Psychiatr. Care 57, 1474–1481.doi: 10.1111/ppc.12714Pfefferbaum, B., and North, C. S. (2020). Mental health and the Covid-19 pandemic. N. Engl. J. Med. 383, 510–512. doi: 10.1056/NEJMp2008017Tannenbaum, S. I., Traylor, A. M., Thomas, E. J., and Salas, E. (2021). Managingteamwork in the face of pandemic: evidence-based tips BMJ Qual. Saf. 30,59–63. doi: 10.1136/bmjqs-2020-011447World Health Organisation (2020).Mental Health and Psychosocial ConsiderationsDuring the COVID-19 Outbreak. Geneva: WHO.Conflict of Interest: The authors declare that the research was conducted in theabsence of any commercial or financial relationships that could be construed as apotential conflict of interest.Publisher’s Note: All claims expressed in this article are solely those of the authorsand do not necessarily represent those of their affiliated organizations, or those ofthe publisher, the editors and the reviewers. Any product that may be evaluated inthis article, or claim that may be made by its manufacturer, is not guaranteed orendorsed by the publisher.Copyright © 2022 Mitchell, Galli, Keyworth, Vegni and Salas. This is an open-accessarticle distributed under the terms of the Creative Commons Attribution License (CCBY). The use, distribution or reproduction in other forums is permitted, providedthe original author(s) and the copyright owner(s) are credited and that the originalpublication in this journal is cited, in accordance with accepted academic practice.No use, distribution or reproduction is permitted which does not comply with theseterms.Frontiers in Psychology | www.frontiersin.org 4 April 2022 | Volume 13 | Article 904328

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Editorial: Coronavirus Disease (COVID-19): The Mental Health, Resilience, and Communication Resources for the Short- and Long-term Challenges Faced by Healthcare Workers

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