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Vol. 14. Issue 2.
Pages 90-105 (April - June 2021)
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Vol. 14. Issue 2.
Pages 90-105 (April - June 2021)
Original article
DOI: 10.1016/j.rpsmen.2021.05.003
Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey
Impacto en la salud mental del personal sanitario español de la primera ola de la pandemia COVID-19: un amplio estudio transversal
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Jordi Alonsoa,b,c,
Corresponding author
jalonso@imim.es

Corresponding author.
, Gemma Vilaguta,b, Philippe Mortiera,b,*, Montse Ferrera,b,d, Itxaso Alayoa,b, Andrés Aragón-Peñae,f, Enric Aragonèsg,h, Mireia Camposi, Isabel D. Cura-Gonzálezj,k,f, José I. Emparanzal,b, Meritxell Espugam, Maria João Forjazn,o, Ana González-Pintop,q, Josep M. Harod,q,r, Nieves López-Fresneñas, Alma D. Martínez de Salázart, Juan D. Molinau,v,w,q, Rafael M. Ortí-Lucasx, Mara Parelladas,q, José Maria Pelayo-Terány, Aurora Pérez-Zapataz, José I. Pijoanaa,b, Nieves Planaz,b, Maria Teresa Puigab,ac,d,ad, Cristina Riusae,b,q,af, Carmen Rodríguez-Blázquezn,af, Ferran Sanzag,c,ah, Consol Serraai,aj,b, Ronald C. Kesslerak, Ronny Bruffaertsal, Eduard Vietaam,q, Víctor Pérez-Solàai,d,q, MINDCOVID Working group 1
a Health Services Research Unit, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
b CIBER Epidemiología y Salud Pública (CIBERESP), Spain
c Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
d Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
e Epidemiology Unit, Regional Ministry of Health, Community of Madrid, Madrid, Spain
f Fundación Investigación e Innovación Biosanitaria de Atención Primaria, Comunidad de Madrid, Madrid, Spain
g Institut d’Investigació en Atenció Primària IDIAP Jordi Gol, Barcelona, Spain
h Atenció Primària Camp de Tarragona, Institut Català de la Salut, Spain
i Service of Prevention of Labor Risks, Medical Emergencies System, Generalitat de Catalunya, Spain
j Research Unit, Primary Care Management, Madrid Health Service, Madrid, Spain
k Department of Medical Specialities and Public Health, King Juan Carlos University, Madrid, Spain
l Hospital Universitario Donostia, San Sebastián, Spain
m Occupational Health Service, Hospital Universitari Vall d’Hebron, Barcelona, Spain
n National Center of Epidemiology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
o Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
p Hospital Universitario Araba-Santiago, Vitoria-Gasteiz, Spain
q CIBER Salud Mental (CIBERSAM), Madrid, Spain
r Parc Sanitari Sant Joan de Déu, Barcelona, Spain
s Hospital General Universitario Gregorio Marañón, Madrid, Spain
t UGC Salud Mental, Hospital Universitario Torrecárdenas, Almería, Spain
u Villaverde Mental Health Center, Clinical Management Area of Psychiatry and Mental Health, Psychiatric Service, Hospital Universitario 12 de Octubre, Madrid, Spain
v Research Institute Hospital 12 de Octubre (i+12), Madrid, Spain
w Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain
x Hospital Clínic Universitari, Valencia, Spain
y Hospital El Bierzo, León, Spain
z Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
aa Hospital Universitario Cruces/OSI EEC, Bilbao, Spain
ab Department of Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
ac Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
ad CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
ae Agència de Salut Pública de Barcelona, Barcelona, Spain
af CIBER Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
ag Research Progamme on Biomedical Informatics (GRIB), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
ah Instituto Nacional de Bioinformatica - ELIXIR-ES, Barcelona, Spain
ai Parc de Salut Mar PSMAR, Barcelona, Spain
aj CiSAL-Centro de Investigación en Salud Laboral, IMIM/UPF, Barcelona, Spain
ak Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
al Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven, Leuven, Belgium
am Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain
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Tables (3)
Table 1. Prevalence of current probable mental disorders among Spanish healthcare workers, according to individual characteristics, COVID-19 exposure, and prior lifetime disorders. MINCOVID study (N=9138) (absolute numbers and weighted proportions).
Table 2. Bivariate associations between individual characteristics, COVID-19 exposure, and pre-pandemic lifetime (LT) mental disorders with any probable current mental disorders and current disabling. Spanish healthcare workers, MINDCOVID study (N=9138).
Table 3. Multivariable associations between individual characteristics, COVID-19 exposure, and prior lifetime (LT) mental disorders with probable current mental disorders and current disabling mental disorders. Spanish healthcare workers, MINDCOVID study (N=9138).
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Abstract
Introduction

Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain.

Methods

All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 – September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder –PTSD- [PCL-5≥7]; and Substance Use Disorder –SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable “disabling” current mental disorders.

Results

9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring “all of the time” for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95).

Conclusions

One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.

Keywords:
COVID-19 pandemic
Healthcare Workers
Mental Disorders
Need for Care
Disability
Adverse Mental Health
Resumen
Introducción

Los profesionales sanitarios son vulnerables al impacto negativo en salud mental de la pandemia COVID-19. Evaluamos la prevalencia de trastornos mentales y factores asociados durante la primera oleada de la pandemia en sanitarios españoles.

Métodos

Se invitó a todos los trabajadores de 18 instituciones sanitarias españolas (6 CCAA) a encuestas en línea evaluando características individuales, estado de infección y exposición a COVID-19 y salud mental (5 Mayo – 7 Septiembre, 2020). Reportamos: probables trastornos mentales actuales (Trastorno depresivo mayor TDD [PHQ-8≥10], Trastorno de ansiedad generalizada TAG [GAD-7≥10], Ataques de pánico, Trastorno de estrés postraumático TEP [PCL-5≥7]; y Trastorno por uso de sustancias TUS [CAGE-AID≥2]. La interferencia funcional grave (Escala de Discapacidad de Sheehan) identificó los probables trastornos “discapacitantes”.

Resultados

Participaron 9.138 sanitarios. Prevalencia de cribado positivo: 28,1% TDD; 22,5% TAG, 24,0% Pánico; 22,2% PTE; y 6,2% TUS. En general, el 45,7% presentó algún trastorno mental actual y el 14,5% algún trastorno discapacitante. Los sanitarios con trastornos mentales previos tuvieron el doble de prevalencia que aquellos sin patología mental previa. Ajustando por todas las variables, el trastorno mental incapacitante se asoció positivamente con: trastornos previos (TUS: OR=5.74; 95%CI 2.53-13.03; Ánimo: OR=3.23; 95%CI:2.27-4.60; Ansiedad: OR=3,03; IC 95%: 2,53-3,62); edad 18-29 años (OR=1,36; IC 95%: 1,02-1,82); atender “siempre” a pacientes COVID-19 (OR=5,19; IC 95%: 3,61-7,46), género femenino (OR=1,58; IC 95%: 1,27-1,96) y haber estado en cuarentena o aislado (OR=1,60; IC 95%: 1,31-1,95).

Conclusiones

Uno de cada 7 sanitarios españoles presentaron un probable trastorno mental discapacitante durante la primera oleada de COVID-19. Aquéllos con trastornos mentales alguna vez antes de la pandemia, los que están expuestos con frecuencia a pacientes con COVID-19, los infectados o en cuarentena / aislados, las mujeres y las enfermeras auxiliares deben considerarse grupos que necesitan seguimiento y apoyo de su salud mental.

Palabras clave:
Pandemia de COVID-19
Trabajadores de la salud
Trastornos mentales
Necesidad de atención
Discapacidad
Salud mental adversa

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