Setting, participants, and study design
The study was conducted at Sinai Health in Toronto, Canada. Sinai Health is comprised of two facilities, an acute teaching hospital and a rehabilitation hospital, with a combined staff of more than 6,000 people. All hospital employees over the age of 18, including hospital staff, physicians, learners, volunteers, and third-party employees (e.g., retail store employees), will be distributed quarterly through posters and emails from the hospital beginning in fall 2020. Participants were invited to participate in a longitudinal study. The survey will be conducted eight times in total until spring 2022 and then in spring 2023.
The survey was conducted using online software (Alchemer, Louisville, Colorado) that complies with the Privacy Standards of Ontario, Canada (Personal Health Information Protection Act). All participants completed measures of emotional exhaustion and psychological distress at all time points and measures of posttraumatic (PTSD) symptoms at T1, T3, T5, T7, and T8. Measures of depersonalization and personal accomplishment were also completed at all time points, but only by 50% of randomly selected participants in the longitudinal version of the study. Depersonalization and personal achievement scores were only included in the analysis for healthcare professionals (nurses, physicians, members of other regulated healthcare professions and their students). This is because non-expert participants requested the “not applicable” option for these scale items after the T1 survey. , I used this option frequently after that. For the first five surveys, participants received a gift card worth US$15 in Canadian currency at the end of each completed survey. In studies 6 to 8, the value of the gift card was increased to US$20.
This study was approved by the Sinai Health Research Ethics Board (20-0084-E). All study participants provided informed consent. All procedures were performed in accordance with relevant guidelines and regulations.
During the recruitment phase, 884 potential participants agreed to take the survey. Of these, 538 (61%) responded to the first survey (T1, conducted from September 21 to November 15, 2020), which included a baseline measure of emotional exhaustion. These 538 individuals formed the cohort for further follow-up. Participation rates at subsequent time points were T2: 485/538 (90%), T3: 424/538 (79 %), T4: 409/538 (76%), T5: 395/538 (73%), T6: 372/538 (69%), T7: 350/538 (65%), T8: 289/538 (54 %). The latter 289 participants were included in the current analysis.
musical instrument
Emotional exhaustion, depersonalization, and personal accomplishment were measured in the Maslach Burnout Study: Human Services Survey for Healthcare Professionals25. Emotional exhaustion (9 items), depersonalization (5 items), and personal accomplishment (8 items) were each calculated as the sum of items scored from 0 to 6. Cronbach’s alpha across time points ranged from 0.94 to 0.96 (emotional exhaustion, n = 289), 0.84 to 0.90 (depersonalization, n = 82), and 81 to 0.89 (personal accomplishment, n = 82).
Psychological distress, consisting of depressive and anxiety symptoms, was measured with the Kessler K6. The Kessler K6 had six items scored from 0 to 4, yielding a range of 0 to 24 (27). The K6 strongly discriminates between community cases and non-cases of psychiatric disorders diagnosed by structured interviews (27), with acceptable sensitivity and specificity (28). In this cohort, Cronbach’s alpha at each time point ranged from 0.85 to 0.90 (n = 289).
Posttraumatic symptoms were measured using the Impact Assessment Scale-Revised (IES-R) (29), a 22-item scale that assesses hyperarousal, avoidance, and intrusions caused by the traumatic event. Respondents were asked to identify a stressful life event (in this case, “working during COVID-19”) and rate the extent to which 22 types of hardships had bothered them in the past seven days. (scores from 0 to 4 for each). . Full-scale Cronbach alphas at each time point at which this measure was used (T1, T3, T5, T7, T8) ranged from 0.94 to 0.96 (n = 289).
analysis
Descriptive statistics were used to characterize the sample. Participants were categorized into four job categories as previously described 24: nurses, other health care professionals, other personnel with patient contact, and other personnel without patient contact. Contact with patients was determined by participants’ endorsement of the statement, “In the past month, my job has brought me into direct contact with patients (within 2 meters for 15 minutes or more).”
To allow direct comparison of scales for different measures, we converted scores for all measures at all time points into standardized scores (0 = all group mean at T1, units = standard deviation from the T1 mean ).
Changes over time, differences in scores by occupational group, and interactions of these variables were determined using a repeated-measures analysis of variance (ANOVA), excluding participants who did not provide valid measurements at each time point. Tested by. The Greenhouse-Geisser correction was applied to tests for within-subject effects when Mauchly’s sphericity test indicated that sphericity could not be assumed. To interpret significant results from the ANOVA, standardized scores were plotted by occupational group at each time point.
The Spring 2023 (T8) value for each indicator differs from the T7 indicator (representing potential improvement due to lower case rates and relaxation of public health measures) or T1 (represents potential improvement from the early effects of the pandemic). Difference scores were calculated to test whether the results were different from those in the T8–T7 (representing improvement) and T8–T1. Confidence intervals for the difference scores were calculated to determine whether they were different from zero and to indicate change over time. All analyzes were performed using IBM SPSS Statistics 28 (Armonk, NY).