Fluctuations of stress and resilience in healthcare workers during the COVID-19 pandemic : Insights and recommendations

Background
Healthcare workers (HCW) have faced unprecedented challenges during the COVID-19, with significant impact on their well-being. We aimed to monitor stress-related symptoms and resilience in HCW over time in relation to various factors during the COVID-19 pandemic.

Methods
Between June 2020 and May 2022, data was collected among HCW of Leiden University Medical Centre (LUMC) through a digital self-monitoring application. The application included a 14-items self-monitoring tool (i.e., 7-items on Supporting factors, 7-items on Stressful burden), and a set of validated questionnaires (i.e., the Copenhagen Burnout Inventory (CBI), Impact of Event Scale – Revised (IES-R), Resilience Evaluation Scale (RES), and Depression Anxiety and Stress Scale (DASS-21).

Results
The self-monitoring tool and validated questionnaires were completed by 1070 and 413 participants respectively. Mean stress-related symptom scores (as measured by the self-monitoring, CBI, IES-R, and DASS-21) exhibited significant changes over time (all p’s < 0.001), which correlated with the waves of COVID-19 patients admitted and the national COVID-19 mortality rate (all p’s < 0.005). Resilience, as measured by the RES, showed a significant decrease from the start of data collection onwards (p = 0.001), whereas supporting factors showed significant decreases the first few months, followed by fluctuations after January 2021 (p = 0.02).

Limitations
Selection bias may have arisen as those participating may have been more concerned with the burden on mental wellbeing.

Conclusions
The current study underscores the need for active psychosocial support for all HCW particularly during periods of increased admissions due to pandemics.

Highlights

•  The current study found an increase in stress-related symptoms in HCWs during the beginning phases of the pandemic and the peaks of the waves that followed.

•  Active monitoring of wellbeing and offering psychosocial support is needed to mitigate the impact of psychological burden.

•  The Stress Buddy may serve as a less time-consuming screener of mental wellbeing as compared to conventional questionnaires.