The impact of the Covid-19 pandemic on the mental health of workers in health services: building resilience in post-conflict territories

COVID-19于3月11日被世卫组织宣布为全球大流行。尽管哥伦比亚在大流行早期（3月17日）宣布全国进入紧急状态，并采取了其他缓解措施，但感染已蔓延到全国各地。就病例数量而言，哥伦比亚在世界上排名第十一。疫情期间的一个重大关切是对卫生服务的高需求超出了服务能力。对于这些苛刻的医疗需求，COVID-19大流行可能会影响医护人员（包括临床和非临床人员）的身心健康。在此疫情期间，由于长时间工作、职能转变及对疾病的恐惧，医务人员承受高度压力。此外，医务工作者可能面临病人死亡、绝望和道德困境。这些压力源可能会增加发展心理健康问题的风险。在哥伦比亚研究这一问题的最重要原因是，保健工作者精神问题的风险很高，保健服务资源缺乏，以及武装冲突造成的暴力历史，这意味着保健工作者甚至在大流行病到来之前就受到了高度压力。因此，我们建议：研究哥伦比亚和地区发展方案（PDET）的一些地区的卫生工作者的心理健康，并评估心理健康问题如何根据个人暴力史和弹性水平而变化。在第一次测量以及3个月、6个月和12个月的随访3中，评估来自COVID-19大流行的压力源与卫生工作者心理健康之间的关联。探索武装冲突暴露史如何改变COVID-19大流行的压力源对心理健康的影响。目的：设计基于电子健康的干预措施，以预防医务人员抑郁和焦虑症状，提高其心理弹性，并评估其可行性和满意度。方法：1）对3,000名医务人员（临床和非临床人员，包括行政人员和支持人员）进行横断面调查，估计心理健康压力源的患病率和分布。将通过卫生机构、医疗协会、医院和社交网络方便取样。在横断面研究中，我们还将包括来自佛罗里达、普拉德拉、阿帕塔多和图尔博的卫生工作者的特定样本（n = 150），并将比较国家一级与这些地区（优先考虑为冲突后）的具体数据之间的心理健康问题比例。2)队列研究：我们将纳入来自波哥大、麦德林和卡利等城市的医护人员（n= 3，100），他们将在首次测量后-3、-6和-12个月接受随访。这些信息将用于评估大流行压力源对心理健康的中期影响以及心理健康的保护和风险因素3）设计和评估基于电子健康的干预措施，以便发现和预防抑郁和焦虑，并提高卫生工作者的复原力。4)知识的社会占有的组成部分，包括研究成果的传播战略，预防卫生工作者心理健康问题的电子卫生干预。此外，我们将设计视频和信息图表教育材料，以促进卫生工作者的心理健康，并举办论坛，介绍结果，以及为决策者编写简短报告。

COVID-19 was declared a global pandemic by WHO on March 11. Even though Colombia declared a national emergency early in the pandemic (March 17) and has taken other mitigation measures, the infection has spread across the country. Colombia is the eleventh highest in the world in terms of the number of cases. One of the significant concerns during the pandemic is the high demand for health services that exceed the service capacities. For these demanding healthcare needs, COVID-19 pandemic can affect the physical and mental health of healthcare workers (HWs) (including clinical and non-clinical staff). During this pandemic, HWs are exposed to high levels of stress due to long working hours, changes in their functions, and fear of the disease. In addition, HWs can be exposed to the death of patients, hopelessness, and ethical dilemmas. These stressors can increase the risk of developing mental health problems. The most important reasons to study this problem in Colombia are the high risk of mental problems in HW, lack of resources in health services, and the history of violence due to the armed conflict which has meant that HWs were highly stressed even before the pandemic arrived. We therefore propose to: 1. To study the mental health of health workers in Colombia and some regions of the Development Programs with a Territorial Approach (PDET), and to assess how mental health problems vary according to the personal history of violence and resilience levels2. To assess the association between stressors derived from the COVID-19 pandemic and mental health in the health workers in a first measurement, and at 3, 6 and 12 months of follow-up 3. To explore how a history of exposure to armed conflict modifies the effects of the stressors from the COVID-19 pandemic on mental health.4. To design and evaluate the feasibility and satisfaction of an eHealth-based intervention to prevent symptoms of depression and anxiety, and increase resilience in health workersMethods: 1) Cross-sectional study of 3,000 health workers (clinical and non-clinical personnel including administrative personnel and support personnel) to estimate the prevalence and distribution of mental health stressors. Sampling will be convenient through health institutions, medical associations, hospitals and social networks. In the cross-sectional study, we will also include a specific sample of health workers from Florida, Pradera, Apartado and Turbo (n = 150) and will compare the proportions of mental health problems between the national level with the specific data of these regions (prioritized as post-conflict). 2) Cohort study: we will include healthcare workers (n=3,100) from the cities of Bogota, Medellin and Cali who will be followed up -3, -6, and -12 months after the first measurement. This information will be used to assess the medium-term impacts of the pandemic stressors on mental health as well as the protective and risk factor for mental health 3) Design and evaluation of an intervention based on eHealth that allows the detection and prevention of depression and anxiety and promotion of resilience in health workers. 4) component of social appropriation of knowledge that includes dissemination strategies of research results, eHealth intervention for prevention of mental health problems in health workers. In addition, we will design educational material in videos and infographics to promote the mental health of health workers, and conduct forums with the presentation of the results, as well as produce short reports for decision makers.