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      Traumatic stress symptoms among Spanish healthcare workers during the COVID-19 pandemic: a prospective study

      research-article
      1 , 2 , 1 , 2 , 1 , 2 , 3 , 1 , 2 , 4 , 1 , 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 10 , 17 , 18 , 19 , 5 , 20 , 5 , 21 , 22 , 23 , 24 , 25 , 5 , 26 , 27 , 28 , 29 , 5 , 24 , 5 , 30 , 31 , 32 , 2 , 33 , 2 , 32 , 34 , 35 , 36 , 37 , 2 , 4 , 38 , 23 , 39 , 4 , 40 , 41 , 2 , 42 , 43 , 2 , 44 , 45 , 46 , 47 , 5 , 48 , 5 , 36 , 42 , 1 , 2 , 4 , 1 , 2 , , MINDCOVID Working Group
      Epidemiology and Psychiatric Sciences
      Cambridge University Press
      COVID-19, health personnel, prospective cohort study, traumatic stress

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          Abstract

          Aim

          To investigate the occurrence of traumatic stress symptoms (TSS) among healthcare workers active during the COVID-19 pandemic and to obtain insight as to which pandemic-related stressful experiences are associated with onset and persistence of traumatic stress.

          Methods

          This is a multicenter prospective cohort study. Spanish healthcare workers ( N = 4,809) participated at an initial assessment (i.e., just after the first wave of the Spain COVID-19 pandemic) and at a 4-month follow-up assessment using web-based surveys. Logistic regression investigated associations of 19 pandemic-related stressful experiences across four domains (infection-related, work-related, health-related and financial) with TSS prevalence, incidence and persistence, including simulations of population attributable risk proportions (PARP).

          Results

          Thirty-day TSS prevalence at T1 was 22.1%. Four-month incidence and persistence were 11.6% and 54.2%, respectively. Auxiliary nurses had highest rates of TSS prevalence (35.1%) and incidence (16.1%). All 19 pandemic-related stressful experiences under study were associated with TSS prevalence or incidence, especially experiences from the domains of health-related (PARP range 88.4–95.6%) and work-related stressful experiences (PARP range 76.8–86.5%). Nine stressful experiences were also associated with TSS persistence, of which having patient(s) in care who died from COVID-19 had the strongest association. This association remained significant after adjusting for co-occurring depression and anxiety.

          Conclusions

          TSSs among Spanish healthcare workers active during the COVID-19 pandemic are common and associated with various pandemic-related stressful experiences. Future research should investigate if these stressful experiences represent truly traumatic experiences and carry risk for the development of post-traumatic stress disorder.

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          Most cited references59

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation.

            The Posttraumatic Stress Disorder Checklist (PCL) is a widely used DSM-correspondent self-report measure of PTSD symptoms. The PCL was recently revised to reflect DSM-5 changes to the PTSD criteria. In this article, the authors describe the development and initial psychometric evaluation of the PCL for DSM-5 (PCL-5). Psychometric properties of the PCL-5 were examined in 2 studies involving trauma-exposed college students. In Study 1 (N = 278), PCL-5 scores exhibited strong internal consistency (α = .94), test-retest reliability (r = .82), and convergent (rs = .74 to .85) and discriminant (rs = .31 to .60) validity. In addition, confirmatory factor analyses indicated adequate fit with the DSM-5 4-factor model, χ2 (164) = 455.83, p < .001, standardized root mean square residual (SRMR) = .07, root mean squared error of approximation (RMSEA) = .08, comparative fit index (CFI) = .86, and Tucker-Lewis index (TLI) = .84, and superior fit with recently proposed 6-factor, χ2 (164) = 318.37, p < .001, SRMR = .05, RMSEA = .06, CFI = .92, and TLI = .90, and 7-factor, χ2 (164) = 291.32, p < .001, SRMR = .05, RMSEA = .06, CFI = .93, and TLI = .91, models. In Study 2 (N = 558), PCL-5 scores demonstrated similarly strong reliability and validity. Overall, results indicate that the PCL-5 is a psychometrically sound measure of PTSD symptoms. Implications for use of the PCL-5 in a variety of assessment contexts are discussed.
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              The PHQ-8 as a measure of current depression in the general population.

              The eight-item Patient Health Questionnaire depression scale (PHQ-8) is established as a valid diagnostic and severity measure for depressive disorders in large clinical studies. Our objectives were to assess the PHQ-8 as a depression measure in a large, epidemiological population-based study, and to determine the comparability of depression as defined by the PHQ-8 diagnostic algorithm vs. a PHQ-8 cutpoint > or = 10. Random-digit-dialed telephone survey of 198,678 participants in the 2006 Behavioral Risk Factor Surveillance Survey (BRFSS), a population-based survey in the United States. Current depression as defined by either the DSM-IV based diagnostic algorithm (i.e., major depressive or other depressive disorder) of the PHQ-8 or a PHQ-8 score > or = 10; respondent sociodemographic characteristics; number of days of impairment in the past 30 days in multiple domains of health-related quality of life (HRQoL). The prevalence of current depression was similar whether defined by the diagnostic algorithm or a PHQ-8 score > or = 10 (9.1% vs. 8.6%). Depressed patients had substantially more days of impairment across multiple domains of HRQoL, and the impairment was nearly identical in depressed groups defined by either method. Of the 17,040 respondents with a PHQ-8 score > or = 10, major depressive disorder was present in 49.7%, other depressive disorder in 23.9%, depressed mood or anhedonia in another 22.8%, and no evidence of depressive disorder or depressive symptoms in only 3.5%. The PHQ-8 diagnostic algorithm rather than an independent structured psychiatric interview was used as the criterion standard. The PHQ-8 is a useful depression measure for population-based studies, and either its diagnostic algorithm or a cutpoint > or = 10 can be used for defining current depression.
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                Author and article information

                Journal
                Epidemiol Psychiatr Sci
                Epidemiol Psychiatr Sci
                EPS
                Epidemiology and Psychiatric Sciences
                Cambridge University Press (Cambridge, UK )
                2045-7960
                2045-7979
                2023
                09 August 2023
                : 32
                : e50
                Affiliations
                [1 ]Health Services Research Unit, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques , Barcelona, Spain
                [2 ]CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III , Madrid, Spain
                [3 ]Asociación instituto de investigación en sistemas de salud Biosistemak , Barakaldo, País Vasco, España
                [4 ]Department of Medicine and Life Sciences, Universitat Pompeu Fabra , Barcelona, Spain
                [5 ]CIBER de Salud Mental, Instituto de Salud Carlos III , Madrid, Spain
                [6 ]Centre Fórum Research Unit, Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar , Barcelona, Spain
                [7 ]Department of Health Services Research Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques , Barcelona, Spain
                [8 ]Department for Psychiatry and Psychotherapy, Hospital of the Ludwig-Maximilians-University Munich , Germany
                [9 ]Epidemiology Unit, Regional Ministry of Health, Community of Madrid , Madrid, Spain
                [10 ]Fundación Investigación e Innovación Biosanitaria de AP, Comunidad de Madrid , Madrid, Spain
                [11 ]Department of Atenció Primària Camp de Tarragona, Institut d’Investigació en Atenció Primària IDIAP Jordi Gol , Barcelona, Spain
                [12 ]Atenció Primària Camp de Tarragona, Institut Català de la Salut , Spain
                [13 ]Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcala , Alcalá de Henares, Spain
                [14 ]Ramón y Cajal Institute of Sanitary Research (IRYCIS) , Madrid, Spain
                [15 ]Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, The City University of New York , New York, NY, USA
                [16 ]Service of Prevention of Labor Risks, Medical Emergencies System , Generalitat de Catalunya, Spain
                [17 ]Research Unit, Primary Care Management, Madrid Health Service , Madrid, Spain
                [18 ]Department of Medical Specialities and Public Health, King Juan Carlos University , Madrid, Spain
                [19 ]Occupational Health Service, Hospital Universitari Vall d’Hebron , Barcelona, Spain
                [20 ]BIOARABA, UPV-EHU, Hospital Universitario Araba-Santiago , Vitoria-Gasteiz, Spain
                [21 ]Department of Research and Development Unit, Parc Sanitari Sant Joan de Déu , Barcelona, Spain
                [22 ]Department Facultat de Medicina y Ciencias de la Salut, Universitat de Barcelona (UB) , Barcelona, Spain
                [23 ]National Center of Epidemiology, Instituto de Salud Carlos III , Madrid, Spain
                [24 ]Department Medicina Preventiva, Hospital General Universitario Gregorio Marañón , Madrid, Spain
                [25 ]UGC Salud Mental, Hospital Universitario Torrecárdenas , Almería, Spain
                [26 ]Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario 12 de Octubre , Madrid, Spain
                [27 ]Research Institute Hospital 12 de Octubre (i+12) , Madrid, Spain
                [28 ]Faculty of Health Sciences, Universidad Francisco de Vitoria , Madrid, Spain
                [29 ]Department of Preventive MedicineDepartment, Hospital Clínic Universitari , Valencia, Spain
                [30 ]Servicio de Psiquiatría y Salud Mental, Hospital el Bierzo, Gerencia de Asistencia Sanitaria del Bierzo (GASBI), Gerencia Regional de Salud de Castilla y Leon (SACYL) , Ponferrada, León, Spain
                [31 ]Area de Medicina Preventiva y Salud Pública, Universidad de León , León, Spain
                [32 ]Department Servicio de Prevención de Riesgos Laborales, Príncipe de Asturias University Hospital , Alcalá de Henares, Madrid, Spain
                [33 ]Department Clinical Epidemiology Unit, Hospital Universitario Cruces/OSI EEC , Bilbao, Spain
                [34 ]Department of Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau , Barcelona, Spain
                [35 ]Biomedical Research Institute Sant Pau (IIB Sant Pau) , Barcelona, Spain
                [36 ]Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public HealthDepartment, Universitat Autònoma de Barcelona (UAB) , Barcelona, Spain
                [37 ]CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III , Madrid, Spain
                [38 ]Agència de Salut Pública de Barcelona , Barcelona, Spain
                [39 ]CIBER de Enfermedades Neurodegenerativas, Instituto de Salud Carlos III , Madrid, Spain
                [40 ]Research Progamme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM) , Barcelona, Spain
                [41 ]Instituto Nacional de Bioinformatica – ELIXIR-ES (IMPaCT-Data-ISCIII) , Barcelona, Spain
                [42 ]Departament de Psiquiatria i Medicina Legal, Parc de Salut Mar PSMAR , Barcelona, Spain
                [43 ]CiSAL-Centro de Investigación en Salud Laboral, IMIM/UPF , Barcelona, Spain
                [44 ]Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Donostia University Hospital, Clinical Epidemiology Unit , San Sebastián, Spain
                [45 ]Clinical Epidemiology, Biodonostia Health Research Institute , San Sebastián, Spain
                [46 ]Department of Health Care Policy, Harvard Medical School , Boston, MA, USA
                [47 ]Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven , Leuven, Belgium
                [48 ]Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS , Barcelona, Catalonia, Spain
                Author notes
                Corresponding author: Philippe Mortier; Email: pmortier@ 123456imim.es
                [†]

                The MINDCOVID Working Group is formed by Jordi Alonso, Itxaso Alayo, Manuel Alonso, Mar Álvarez, Benedikt Amann, Franco F. Amigo, Gerard Anmella, Andres Aragón, Nuria Aragonés, Enric Aragonès, Ana Isabel Arizón, Angel Asunsolo, Alfons Ayora, Laura Ballester, Puri Barbas, Josep Basora, R. Bausà, Elena Bereciartua, Inés Bravo, Alberto Cotillas, Andres Cuartero, Concha de Paz, Isabel del Cura, Maria Jesus del Yerro, Domingo Diaz, Jose Luis Domingo, Jose I. Emparanza, Mireia Espallargues, Meritxell Espuga, Patricia Estevan, M. Isabel Fernandez, Tania Fernandez, Montse Ferrer, Yolanda Ferreres, Giovanna Fico, M. Joao Forjaz, Rosa Garcia Barranco, J. Manuel Garcia, Torrecillas C. Garcia-Ribera, Araceli Garrido, Elisa Gil, Marta Gomez, Javier Gomez, Ana Gonzalez Pinto, Josep Maria Haro, Margarita Hernando, Maria Giola Insigna, Milagros Iriberri, Nuria Jimenez, Xavi Jimenez, Amparo Larrauri, Fernando Leon, Nieves Lopez-Fresneña, Carmen Lopez, Mayte Lopez-Atanes Juan Antonio Lopez-Rodriguez, German Lopez-Cortacans, Alba Marcos, Jesus Martin, Vicente Martin, Mercedes Martinez-Cortés, Raquel Martinez-Martinez, Alma D. Martinez de Salazar, Isabel Martinez, Marco Marzola, Nelva Mata, Josep Maria Molina, Juan de Dios Molina, Emilia Molinero, Philippe Mortier, Carmen Muñoz, Andrea Murru, L. Navarro, Jorge Olmedo, Rafael M. Ortí, Rafael Padrós, Meritxell Pallejà, Raul Parra, Julio Pascual, Jose Maria Pelayo, Rosa Pla, Nieves Plana, Coro Perez Aznar, Beatriz Perez Gomez, Aurora Perez Zapata, Jose Ignacio Pijoan, Elena Polentinos, Beatriz Puertolas, Maria Teresa Puig, Alex Quílez, M. Jesus Quintana, Antonio Quiroga, David Rentero, Cristina Rey, Cristina Rius, Carmen Rodriguez-Blazquez, M. Jose Rojas, Yamina Romero, Gabriel Rubio, Mercedes Rumayor, Pedro Ruiz, Margarita Saenz, Jesus Sanchez, Ignacio Sanchez-Arcilla, Ferran Sanz, Consol Serra, Victoria Serra-Sutton, Manuela Serrano, Silvia Sola, Sara Solera, Miguel Soto, Alejandra Tarrago, Natividad Tolosa, Mireia Vazquez, Margarita Viciola, Eduard Vieta, Gemma Vilagut, Sara Yago, Jesus Yañez, Yolanda Zapico, Luis Maria Zorita, Iñaki Zorrilla, Saioa L. Zurbano, and Victor Perez-Solá.

                Author information
                https://orcid.org/0000-0001-7199-8339
                https://orcid.org/0000-0003-4831-2305
                https://orcid.org/0000-0001-8627-9636
                https://orcid.org/0000-0003-2113-6241
                Article
                S2045796023000628
                10.1017/S2045796023000628
                10465320
                37555258
                0d33c786-b311-4691-bcf1-9bd871db689b
                © The Author(s) 2023

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                : 02 September 2022
                : 06 March 2023
                : 24 June 2023
                Page count
                Tables: 3, References: 65, Pages: 13
                Categories
                Original Article

                covid-19,health personnel,prospective cohort study,traumatic stress

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