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Magnitude of stress reported by vascular surgeons towards occupational and personal COVID-19-related stressors.
Source publication
Background:
The COVID-19 pandemic has made a significant impact on all spheres of society. The objective of this study was to examine the impact of COVID-19 on the practices, finances, and social aspects of Brazilian vascular surgeons' lives.
Methods:
This is a descriptive analysis of the responses from Brazilian vascular surgeons to the cross-s...
Context in source publication
Context 1
... of becoming disabled or dying during the pandemic prompted 130 (30%) Brazilian vascular surgeons to review or make a living will, 89 (21%) to designate or re-discuss their medical power of attorney, 65 (15%) to review or to apply for disability/life insurance, and 145 (34%) to discuss dying with family or friends. Figure 1 summarizes the magnitude of stress reported by the respondents associated with occupational and personal COVID-19-related stressors. ...
Citations
... Таким образом, вместо реализации плановой каротидной эндартерэктомии, бедренно-подколенного шунтирования и т.д. на фоне абсолютно стабильного состояния эти операции стали реализовываться в у словиях Заболевания периферических артерий Peripheral artery disease двусторонней коронавирусной пневмонии, прогрессирования ишемии нижних конечностей, острого коронарного синдрома, острейшего периода инсульта [3][4][5]. Второй поток больных был обусловлен патогенезом течения коронавирусной инфекции. Неоднократно сообщалось, что эта патология сопровождается повышенной частотой тромбозов периферического русла [6][7][8]. ...
... Some previous studies on this topic have been limited to a single institution, 9 a single country [10][11][12] or a single surgical specialty with a sole focus on surgeons' mental health. 12 13 At present, the largest international study on the impact of workplace factors on the mental health of healthcare workers during the COVID-19 pandemic consists of 54.1% and 34.6% of responses from nurses and doctors, respectively, without a subgroup analysis of surgeons or surgical team members. 14 The British Medical Association (BMA) also found that 45% of doctors were suffering from 'depression, anxiety, stress, burnout or other mental health conditions' pertaining to, or exacerbated by, COVID-19 and has therefore published recommendations to develop a long-term strategy to protect the well-being of healthcare staff. ...
Objectives: To investigate the impact of COVID-19 on the well-being of surgeons and allied health professionals as well as the support provided by their institutions.
Design: This cross-sectional study involved distributing an online survey through medical organisations, social media platforms and collaborators.
Setting: It included all staff based in an operating theatre environment around the world.
Participants: 1590 complete responses were received from 54 countries between 15 July and 15 December 2020. The average age of participants was 30–40 years old, 64.9% were men and 32.5% of a white ethnic background. 79.5% were surgeons with the remainder being nurses, assistants, anaesthetists, operating department practitioners or classified other.
Main outcome measures: Participants that had experienced any physical illness, changes in mental health, salary or time with family since the start of the pandemic as well as support available based on published recommendations.
Results: 32.0% reported becoming physically ill. This was more likely in those with reduced access to personal protective equipment (OR 4.62; CI 2.82 to 7.56; p<0.001) and regular breaks (OR 1.56; CI 1.18 to 2.06; p=0.002). Those with a decrease in salary (29.0%) were more likely to have an increase in anxiety (OR 1.50; CI 1.19 to 1.89; p=0.001) and depression (OR 1.84; CI 1.40 to 2.43; p<0.001) and those who spent less time with family (35.2%) were more likely to have an increase in depression (OR 1.74; CI 1.34 to 2.26; p<0.001). Only 36.0% had easy access to occupational health, 44.0% to mental health services, 16.5% to 24/7 rest facilities and 14.2% to 24/7 food and drink facilities. Fewer measures were available in countries with a low Human Development Index.
Conclusions: This work has highlighted a need and strategies to improve conditions for the healthcare workforce, ultimately benefiting patient care.
... Some previous studies on this topic have been limited to a single institution, 9 a single country [10][11][12] or a single surgical specialty with a sole focus on surgeons' mental health. 12 13 At present, the largest international study on the impact of workplace factors on the mental health of healthcare workers during the COVID-19 pandemic consists of 54.1% and 34.6% of responses from nurses and doctors, respectively, without a subgroup analysis of surgeons or surgical team members. 14 The British Medical Association (BMA) also found that 45% of doctors were suffering from 'depression, anxiety, stress, burnout or other mental health conditions' pertaining to, or exacerbated by, COVID-19 and has therefore published recommendations to develop a long-term strategy to protect the well-being of healthcare staff. ...
ABSTRACT
Objectives To investigate the impact of COVID-19 on the
well-being of surgeons and allied health professionals as
well as the support provided by their institutions.
Design This cross-sectional study involved distributing an
online survey through medical organisations, social media
platforms and collaborators.
Setting It included all staff based in an operating theatre
environment around the world.
Participants 1590 complete responses were received
from 54 countries between 15 July and 15 December
2020. The average age of participants was 30–40 years
old, 64.9% were men and 32.5% of a white ethnic
background. 79.5% were surgeons with the remainder
being nurses, assistants, anaesthetists, operating
department practitioners or classified other.
Main outcome measures Participants that had
experienced any physical illness, changes in mental
health, salary or time with family since the start of the
pandemic as well as support available based on published
recommendations.
Results 32.0% reported becoming physically ill. This
was more likely in those with reduced access to personal
protective equipment (OR 4.62; CI 2.82 to 7.56; p<0.001)
and regular breaks (OR 1.56; CI 1.18 to 2.06; p=0.002).
Those with a decrease in salary (29.0%) were more
likely to have an increase in anxiety (OR 1.50; CI 1.19
to 1.89; p=0.001) and depression (OR 1.84; CI 1.40
to 2.43; p<0.001) and those who spent less time with
family (35.2%) were more likely to have an increase in
depression (OR 1.74; CI 1.34 to 2.26; p<0.001). Only
36.0% had easy access to occupational health, 44.0%
to mental health services, 16.5% to 24/7 rest facilities
and 14.2% to 24/7 food and drink facilities. Fewer
measures were available in countries with a low Human
Development Index.
Conclusions This work has highlighted a need and
strategies to improve conditions for the healthcare
workforce, ultimately benefiting patient care
... J o u r n a l P r e -p r o o f 11 During the COVID-19 pandemic, surveys of physicians in various surgical departments revealed a decrease in surgical volume, loss of revenue, reduction in operating room capacity, increased use of telehealth, and loss of income. [12][13][14][15][16][17][18][19] Pursuant to the recommended guidelines to suspend elective surgeries, private and university-based surgical specialties detailed their J o u r n a l P r e -p r o o f the authors' knowledge looking at the impact of the COVID-19 pandemic on a Department of Surgery at a large academic institution, with reporting of the real-world financial data. ...
Background
The COVID-19 pandemic resulted in sweeping shutdowns of surgical operations to increase hospital capacity and conserve resources. Our institution, following national and state guidelines, suspended non-essential surgeries from March 16 through May 4, 2020. This study examines the financial impact of this decision on our institution’s health system by comparing two waves of COVID-19 cases.
Methods
Total revenue was obtained for surgical cases occurring during the first wave of the pandemic between March 1, 2020 and July 31, 2020 and the second wave between October 1, 2020 and February 29, 2021 for all surgical departments. During the same time intervals, in the pre-pandemic year 2019, total revenue was also obtained for comparison. Net revenue and work relative value units (wRVUs) per month were compared to each respective month for all surgical divisions within the department of surgery.
Results
Comparing the 5-month first wave period in 2020 to pre-pandemic 2019 for all surgical departments, there was a net revenue loss of $99,674,376, which reflected 42% of the health system’s revenue loss during this period. The department of surgery contributed to a net revenue loss of $58,368,951, which was 24.9 percent of the health system’s revenue loss. Within the department of surgery, there was a significant difference between the net revenue loss per month per division of the first and second wave: first wave median -$636,952 [IQR -1,432,627, 26,111] and second wave median -$274,626 [-781,124, 396,570] (p=0.04). A similar difference was detected when comparing percent change in wRVUs between the two waves (Wave 1: Median -13.2% [IQR: -41.3%, -1.8%], Wave 2: Median -7.8% [IQR: -13.0%, 1.8%], p=0.003).
Conclusion
Stopping elective surgeries significantly decreased revenue for a health system. Losses for the health system totaled $234,839,990 during the first wave with lost surgical revenue comprising 42% of that amount. With elective surgeries continuing during the second wave of COVID-19 cases, the health system losses were substantially lower. The contribution surgery has to a hospital’s cash flow is essential in maintaining financial solvency. It is important for hospital systems to develop innovative and alternative solutions to increase capacity, offer comprehensive care to medical and surgical patients, and prevent shutdowns of surgical activity through a pandemic to maintain financial security.
... ; Civantos et al., 2020; Cortés-Álvarez et al., 2020; Dal'Bosco et al., 2020; DeBoni et al., 2020; Fernández et al., 2020;Giardino et al., 2020;Guiroy et al., 2020;Malgor et al., 2020;Martinez et al., 2020;Medeiros et al., 2020;Mier-Bolio et al., 2020;Monterrosa-Castro et al., 2020; Mora-Magaña et al., 2020;Passos et al., 2020;Paz et al., 2020;Samaniego et al., 2020;Schuch et al., 2020;Yáñez et al., 2020;Antiporta et al., 2021; Boluarte-Carbajal et al., 2021;Brito-Marques et al., 2021;Cayo-Rojas et al., 2021;Cénat et al., 2021; de Oliveira Andrade et al., 2021;Espinosa-Guerra et al., 2021; Esteves et al., 2021;Fernandez et al., 2021;Ferreira et al., 2021;Feter et al., 2021;Flores-Torres et al., 2021;García-Espinosa et al., 2021;Goularte et al., 2021;Landaeta-Díaz et al., 2021;Loret de Mola et al., 2021;Mautong et al., 2021;Mendonca et al., 2021;Mota et al., 2021;Nayak et al., 2021;Puccinelli et al., 2021;Ribeiro et al., 2021;Schmitt Jr et al., 2021; Scotta et al., 2021;Serafim et al., 2021;Torrente et al., 2021aTorrente et al., , 2021bVillela et al., 2021;Vitorino et al., 2021;Werneck et al., 2021;Zhang et al., 2021aZhang et al., , 2021c da Silva Júnior et al., 2021;Robles et al., 2021) ...
... ;Chen et al., 2020;Civantos et al., 2020; Cortés-Álvarez et al., 2020;Dal'Bosco et al., 2020;De Boni et al., 2020; Fernández et al., 2020;Malgor et al., 2020;Martinez et al., 2020;Medeiros et al., 2020;Mier-Bolio et al., 2020;Monterrosa-Castro et al., 2020; Mora-Magaña et al., 2020;Passos et al., 2020;Paz et al., 2020;Samaniego et al., 2020;Schuch et al., 2020;Yáñez et al., 2020; Boluarte-Carbajal et al., 2021;Cayo-Rojas et al., 2021;Cénat et al., 2021; de Oliveira Andrade et al., 2021;Espinosa-Guerra et al., 2021;Fernandez et al., 2021;Ferreira et al., 2021;Feter et al., 2021;Flores-Torres et al., 2021;García-Espinosa et al., 2021;Giardino et al., 2020;Goularte et al., 2021;Landaeta-Díaz et al., 2021;Loret de Mola et al., 2021;Mautong et al., 2021;Mendonca et al., 2021;Nayak et al., 2021;Puccinelli et al., 2021;Ribeiro et al., 2021;Serafim et al., 2021;Torrente et al., 2021aTorrente et al., , 2021bVitorino et al., 2021;Werneck et al., 2021;Zhang et al., 2021aZhang et al., , 2021bCaycho-Rodriguez et al., 2022;; da Silva Júnior et al., 2021;Robles et al., 2021) ...
Aims
There is a lack of evidence related to the prevalence of mental health symptoms as well as their heterogeneities during the coronavirus disease 2019 (COVID-19) pandemic in Latin America, a large area spanning the equator. The current study aims to provide meta-analytical evidence on mental health symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population and university students in Latin America.
Methods
Bibliographical databases, such as PubMed, Embase, Web of Science, PsycINFO and medRxiv , were systematically searched to identify pertinent studies up to August 13, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimise data entry errors.
Results
A total of 62 studies with 196 950 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress and insomnia was 35%, 35%, 32% and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (36% v . 28%, p < 0.001), in countries speaking Portuguese (40%) v. Spanish (30%). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers and students in Latin America was 37%, 34%, 33% and 45%, respectively.
Conclusions
The high yet heterogenous level of prevalence of mental health symptoms emphasises the need for appropriate identification of psychological interventions in Latin America.
... Some previous studies on this topic have been limited to a single institution, 9 a single country [10][11][12] or a single surgical specialty with a sole focus on surgeons' mental health. 12 13 At present, the largest international study on the impact of workplace factors on the mental health of healthcare workers during the COVID-19 pandemic consists of 54.1% and 34.6% of responses from nurses and doctors, respectively, without a subgroup analysis of surgeons or surgical team members. 14 The British Medical Association (BMA) also found that 45% of doctors were suffering from 'depression, anxiety, stress, burnout or other mental health conditions' pertaining to, or exacerbated by, COVID-19 and has therefore published recommendations to develop a long-term strategy to protect the well-being of healthcare staff. ...
Objectives To investigate the impact of COVID-19 on the
well-being of surgeons and allied health professionals as
well as the support provided by their institutions.
Design This cross-sectional study involved distributing an
online survey through medical organisations, social media
platforms and collaborators.
Setting It included all staff based in an operating theatre
environment around the world.
Participants 1590 complete responses were received
from 54 countries between 15 July and 15 December
2020. The average age of participants was 30–40 years
old, 64.9% were men and 32.5% of a white ethnic
background. 79.5% were surgeons with the remainder
being nurses, assistants, anaesthetists, operating
department practitioners or classified other.
Main outcome measures Participants that had
experienced any physical illness, changes in mental
health, salary or time with family since the start of the
pandemic as well as support available based on published
recommendations.
Results 32.0% reported becoming physically ill. This
was more likely in those with reduced access to personal
protective equipment (OR 4.62; CI 2.82 to 7.56; p<0.001)
and regular breaks (OR 1.56; CI 1.18 to 2.06; p=0.002).
Those with a decrease in salary (29.0%) were more
likely to have an increase in anxiety (OR 1.50; CI 1.19
to 1.89; p=0.001) and depression (OR 1.84; CI 1.40
to 2.43; p<0.001) and those who spent less time with
family (35.2%) were more likely to have an increase in
depression (OR 1.74; CI 1.34 to 2.26; p<0.001). Only
36.0% had easy access to occupational health, 44.0%
to mental health services, 16.5% to 24/7 rest facilities
and 14.2% to 24/7 food and drink facilities. Fewer
measures were available in countries with a low Human
Development Index.
Conclusions This work has highlighted a need and
strategies to improve conditions for the healthcare
workforce, ultimately benefiting patient care
... After removing the three largest influencing studies, pooled prevalence was 21.8% (95% CI 17.3-26.7%). Cumulative analysis revealed that heterogeneity only reached acceptability for a subset of ten studies (Civantos et al., 2020a,b;Fauzi et al., 2020;Imran et al., 2020;Malgor et al., 2021;Shalhub et al., 2021;Elhadi and Msherghi, 2021;Kannampallil et al., 2020), all with proportions falling within an 8.5% range (95% CI 15.2-23.6%). For these studies, heterogeneity was reduced to moderate (I 2 =58.054) and pooled prevalence was 20.9% (95% CI 19.5-22.4%). ...
Background:
This review provides an estimate of the global prevalence of depression and anxiety symptoms among doctors, based on analysis of evidence from the first year of the COVID-19 pandemic.
Methods:
A systematic review was conducted to identify suitable studies. Final searches were conducted on 3rd March 2021. Papers were initially screened by title and abstract, based on pre-agreed inclusion criteria, followed by full-text review of eligible studies. Risk of bias was assessed using the Joanna Briggs Checklist for Prevalence Studies. Data from studies rated as low or medium risk of bias were pooled using a random-effects meta-analysis. Sensitivity and subgroup analyses were conducted to explore heterogeneity.
Results:
Fifty-five studies were included after full-text review. Of these, thirty studies were assessed as low or medium risk of bias and were included in primary analyses. These comprised twenty-six studies of depression (31,447 participants) and thirty studies of anxiety (33,281 participants). Pooled prevalence of depression and anxiety was 20.5% (95% CI 16.0%-25.3%) and 25.8% (95% CI 20.4%-31.5%) respectively.
Interpretation:
Evidence from the first year of the pandemic suggests that a significant proportion of doctors are experiencing high levels of symptoms of depression and anxiety, although not conclusively more so than pre-pandemic levels. Differences in study methodology and variation in job demands may account for some of the observed heterogeneity.
Limitations:
Findings must be interpreted with caution due to the high heterogeneity and moderate risk of bias evident in the majority of included studies.
... In Italy, 20% of the health team became infected [12] and 154 doctors died [13]. Studies have shown that the presence of corona can cause a lot of stress to the staff [14][15][16]. At first, the treatment systems were not fully prepared to deal with this stress, but with the onset of the pandemic, basic measures were taken immediately, which were provided according to each country and region [17,18]. ...
... The risk of transmitting respiratory aerosols to the surgeon is high in the ENT group and ophthalmologists, while in the neurosurgery group the risk is moderate (high for surgery at base of skull or trans-sphenoidal) and in the orthopedic group this risk is low (22). Vascular surgeons who implanted Central Venous Catheter (CVC) identified themselves as at high risk for infection [14]. This is because the vascular surgeon appears to be in contact with both the patient's bloody secretions and the patient's breathing when placing dialysis access or CVC, which increases the risk of transmitting the disease to the vascular surgeon, and increases the risk when considering a large number of these patients. ...
... Vascular surgeons are an integral part of the hospital front line by performing complex vascular procedures or vascular complications or supporting other surgeries [14], and the surgeon as a team leader or manager is expected to always be in the best health [16]. Experienced and senior vascular surgeons should not be in constant contact with Covid patients so that we lose their help due to quarantine when necessary [28]. ...
... The effects of the COVID-19 pandemic upon clinical care, workforce environments and clinically generated revenue and compensation have been ubiquitous and with deep consequence for nearly all vascular surgeons within the United States 1-3 as well as those around the world [4][5][6] . ...
Introduction
: The novel coronavirus SARS-CoV-2 (COVID-19) has spread rapidly since it was identified. We sought to understand its effects on vascular surgery practices stratified by VASCON surgical readiness level and determine how these effects have changed during the course of the pandemic.
Methods
: All members of the Vascular and Endovascular Surgery Society were sent electronic surveys questioning the effects of COVID-19 on their practices in the early pandemic in April (EP) and four months later in the pandemic in August (LP) 2020.
Results
: Response rates were 206/731(28%) in the EP group and 108/731(15%) in the LP group (p<0.0001). Most EP respondents reported VASCON levels less than 3 (168/206,82%), indicating increased hospital limitations while 6/108(6%) in the LP group reported this level (p<0.0001). The EP group were more likely to report a lower VASCON level (increased resource limitations), and decreased clinic, hospital and emergency room consults. Despite an increase of average cases/week to pre-COVID-19 levels, 46/108(43%) of LP report continued decreased compensation, with 57% reporting more than 10% decrease. Respondents in the decreased compensation group were more likely to have reported a VASCON level 3 or lower earlier in the pandemic (p=0.018). 91/108(84%) of LP group have treated COVID-19 patients for thromboembolic events, most commonly acute limb ischemia (76/108) and acute DVT (76/108). While the majority of respondents are no longer delaying the vascular surgery cases, 76/108 (70%) feel that vascular patient care has suffered due to earlier delays, and 36/108 (33%) report a backlog of cases caused by the pandemic.
Conclusions
: COVID-19 had a profound effect on vascular surgery practices earlier in the pandemic, resulting in continued detrimental effects on the provision of vascular care as well as compensation received by vascular surgeons.
... Physicians reported the importance of having social support from friends, family, colleagues, and professionals (e.g., counsellors) in 29 studies [28,30,39,43,44,48,56,58,67,72,78,83,91,99,102,106,115,119,131,150,155,163,172,192,[202][203][204][205]. Several studies (n = 29) described positive personal coping strategies such as maintaining a positive attitude and resilience [37,46,83,100,106,108,136,202,205,206], practicing self-care (e.g., physical activity, eating well, resting, engaging in activities they enjoy) [30,35,56,65,70,91,102,103,117,119,129,131,150,151,207], and engaging with religious practices [39, 46, 131, 205] as a way to mitigate negative psychological outcomes. ...
... Physicians reported the importance of having social support from friends, family, colleagues, and professionals (e.g., counsellors) in 29 studies [28,30,39,43,44,48,56,58,67,72,78,83,91,99,102,106,115,119,131,150,155,163,172,192,[202][203][204][205]. Several studies (n = 29) described positive personal coping strategies such as maintaining a positive attitude and resilience [37,46,83,100,106,108,136,202,205,206], practicing self-care (e.g., physical activity, eating well, resting, engaging in activities they enjoy) [30,35,56,65,70,91,102,103,117,119,129,131,150,151,207], and engaging with religious practices [39, 46, 131, 205] as a way to mitigate negative psychological outcomes. In contrast, two studies reported that physicians engaged in avoidance coping strategies (e.g., screaming, crying, denial, self-blame, disengaging, substance abuse, etc.) [83,106,108,127,202,203,205]. ...
... Several studies (n = 29) described positive personal coping strategies such as maintaining a positive attitude and resilience [37,46,83,100,106,108,136,202,205,206], practicing self-care (e.g., physical activity, eating well, resting, engaging in activities they enjoy) [30,35,56,65,70,91,102,103,117,119,129,131,150,151,207], and engaging with religious practices [39, 46, 131, 205] as a way to mitigate negative psychological outcomes. In contrast, two studies reported that physicians engaged in avoidance coping strategies (e.g., screaming, crying, denial, self-blame, disengaging, substance abuse, etc.) [83,106,108,127,202,203,205]. ...
Background
Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout. The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health.
Methods
We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 17, 2020. Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers.
Results
From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review. Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries. Psychological symptoms of anxiety (14.3–92.3%), stress (11.9–93.7%), depression (17–80.5%), post-traumatic stress disorder (13.2–75.2%) and burnout (14.7–76%) were commonly reported among physicians, regardless of infectious disease outbreak or country. Younger, female (vs. male), single (vs. married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms.
Interpretation
Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist. Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19.
