Symptoms of Anxiety, Depression, and Peritraumatic Dissociation in Critical Care Clinicians Managing Patients with COVID-19. A Cross-Sectional Study.
Symptoms of Anxiety, Depression, and Peritraumatic Dissociation in Critical Care Clinicians Managing Patients with COVID-19. A Cross-Sectional Study.
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DOI：
10.1164/rccm.202006-2568oc
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发表时间：
2020-11-15
影响因子：
24.7
通讯作者：
Kentish-Barnes N
中科院分区：
文献类型：
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作者：
Azoulay E;Cariou A;Bruneel F;Demoule A;Kouatchet A;Reuter D;Souppart V;Combes A;Klouche K;Argaud L;Barbier F;Jourdain M;Reignier J;Papazian L;Guidet B;Géri G;Resche-Rigon M;Guisset O;Labbé V;Mégarbane B;Van Der Meersch G;Guitton C;Friedman D;Pochard F;Darmon M;Kentish-Barnes N
理由：在冠状病毒病(新冠肺炎)大流行期间，一线医疗服务提供者(HCP)精神疾病的风险很高。目的：评估高血压病患者焦虑、抑郁和瘤周分离症状的发生率。方法：这是一项在2020年4月20日至2020年5月21日期间对法国21个ICU进行的横断面研究。采用《医院焦虑抑郁量表》和《瘤周分离体验问卷》进行评定。确定了与所报告的精神健康障碍症状独立相关的因素。测量和主要结果：应答率为67%，有1058名受访者(中位年龄33岁；71%的女性；68%的护理人员)。焦虑、抑郁和瘤周分离症状的发生率分别为50.4%、30.4%和32%，其中护士的发生率最高。多变量分析显示，男性患者的焦虑、抑郁和肿瘤周围分离症状发生率较低(优势比分别为0.58[95%可信区间0.42~0.79]、0.57[95%可信区间0.39~0.82]和0.49[95%可信区间0.34~0.72])。在非大学附属医院工作的HCP和护理助理有很高的焦虑症状和瘤周分离的风险。重要的是，我们确定了以下六个可改变的心理健康障碍症状决定因素：害怕被感染，无法休息，无法照顾家人，与艰难的情绪作斗争，对探视政策的限制感到遗憾，以及目睹匆忙的临终决定。结论：在新冠肺炎大流行期间，HCP经历了高水平的心理负担。医院、ICU主任和ICU工作人员必须制定策略，以克服不利精神疾病症状的可改变的决定因素。
Rationale: Frontline healthcare providers (HCPs) during the coronavirus disease (COVID-19) pandemic are at high risk of mental morbidity. Objectives: To assess the prevalence of symptoms of anxiety, depression, and peritraumatic dissociation in HCPs. Methods: This was a cross-sectional study in 21 ICUs in France between April 20, 2020, and May 21, 2020. The Hospital Anxiety and Depression Scale and the Peritraumatic Dissociative Experience Questionnaire were used. Factors independently associated with reported symptoms of mental health disorders were identified. Measurements and Main Results: The response rate was 67%, with 1,058 respondents (median age 33 yr; 71% women; 68% nursing staff). The prevalence of symptoms of anxiety, depression, and peritraumatic dissociation was 50.4%, 30.4%, and 32%, respectively, with the highest rates in nurses. By multivariable analysis, male sex was independently associated with lower prevalence of symptoms of anxiety, depression, and peritraumatic dissociation (odds ratio of 0.58 [95% confidence interval, 0.42–0.79], 0.57 [95% confidence interval, 0.39–0.82], and 0.49 [95% confidence interval, 0.34–0.72], respectively). HCPs working in non–university-affiliated hospitals and nursing assistants were at high risk of symptoms of anxiety and peritraumatic dissociation. Importantly, we identified the following six modifiable determinants of symptoms of mental health disorders: fear of being infected, inability to rest, inability to care for family, struggling with difficult emotions, regret about the restrictions in visitation policies, and witnessing hasty end-of-life decisions. Conclusions: HCPs experience high levels of psychological burden during the COVID-19 pandemic. Hospitals, ICU directors, and ICU staff must devise strategies to overcome the modifiable determinants of adverse mental illness symptoms.