Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud

doi:10.25540/DAX0-K3ZF

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Bibliographic Details
Main Authors:	ENG AI IRENE TEO, CHAY JUNXING
Other Authors:	DUKE-NUS MEDICAL SCHOOL
Published:	2021
Subjects:	COVID-19 Healthcare workers Psychological well-being
Online Access:	https://scholarbank.nus.edu.sg/handle/10635/201509 https://doi.org/10.25540/DAX0-K3ZF
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Institution:	National University of Singapore

id	sg-nus-scholar.10635-201509
record_format	dspace
institution	National University of Singapore
building	NUS Library
continent	Asia
country	Singapore Singapore
content_provider	NUS Library
collection	ScholarBank@NUS
topic	COVID-19 Healthcare workers Psychological well-being
spellingShingle	COVID-19 Healthcare workers Psychological well-being ENG AI IRENE TEO CHAY JUNXING Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud
description	doi:10.25540/DAX0-K3ZF
author2	DUKE-NUS MEDICAL SCHOOL
author_facet	DUKE-NUS MEDICAL SCHOOL ENG AI IRENE TEO CHAY JUNXING
author	ENG AI IRENE TEO CHAY JUNXING
author_sort	ENG AI IRENE TEO
title	Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud
title_short	Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud
title_full	Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud
title_fullStr	Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud
title_full_unstemmed	Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud
title_sort	healthcare worker stress, anxiety and burnout during the covid-19 pandemic in singapore: a 6-month multi-centre prospective stud
publishDate	2021
url	https://scholarbank.nus.edu.sg/handle/10635/201509 https://doi.org/10.25540/DAX0-K3ZF
_version_	1720446954920476672
spelling	sg-nus-scholar.10635-2015092021-12-28T07:13:27Z Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud ENG AI IRENE TEO CHAY JUNXING DUKE-NUS MEDICAL SCHOOL COVID-19 Healthcare workers Psychological well-being doi:10.25540/DAX0-K3ZF <p style="margin: 1em 0px 8pt; line-height: 200%;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 16pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-ansi-font-weight: bold;">Study design</span></strong></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">This study used the convenience sampling method to prospectively follow HCWs from four tertiary hospitals in Singapore that provided care to COVID-19 patients during the pandemic. Recruitment occurred throughout the duration of the study. The self-reported data was collected from 12 March - 31 August 2020, which included the peak of the pandemic that year and the nationwide lockdown period that occurred between April 7-June 1, 2020. </span></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 16pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-ansi-font-weight: bold;">Participants & data collection</span></strong></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">Doctors, nurses, allied health professionals, administrative and operations staff from several institutions (Singapore General Hospital, KKH Women’s & Children’s Hospital, Changi General Hospital, Sengkang General Hospital) within the largest public healthcare group in Singapore were invited through work email and/or staff portals to participate. There were no exclusion criteria. Participation was voluntary and those who were interested accessed the study through a web link or QR code. Participants provided their consent online before completing the initial survey and monthly follow-ups which took 15 and 10 minutes to complete, respectively. Follow-up survey links were sent directly to participants’ email address, which served as a way to link the responses over time. No other personal identifying information was collected. Research assistants who managed the data collection on the Qualtrics platform were not involved in data analyses. The survey was administered in English. The study was approved by the National University of Singapore IRB (S-20-081) and exempted from review by the SingHealth Centralized IRB (2020/2160). </span></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 16pt; mso-spacerun: 'yes'; mso-ansi-font-weight: bold;">Measures</span></strong></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><em style="mso-bidi-font-style: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-ansi-font-style: italic;">Study outcomes.</span></em><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;"> Stress was measured using the 4-item Perceived Stress Scale (PSS-4) </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[12]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">. A summed score ranging from 0-16 was calculated, and a median score threshold of ≥ 8 was used to indicate stress. Anxiety was measured using the 7-item Generalized Anxiety Disorder (GAD-7) scale </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[13]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">. A summed score ranging from 0-21 was calculated and t</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes';">he recommended threshold score of ≥ 10 was used. Job burnout was measured using a one-item burnout question from the Physician Work Life Scale where a score ≥ 3 indicated presence of job exhaustion </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes';">[14]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes';">. The measure has been used with a range of HCWs including doctors, nurses, and administrative personnel </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes';">[14]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes';">. Higher scores on all study outcomes indicated greater severity.</span></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><em style="mso-bidi-font-style: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-bidi-font-weight: bold; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-ansi-font-style: italic;">Objective job characteristics. </span></em><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-bidi-font-weight: bold; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">Participants reported their number of working years in healthcare. The responses to the following questions were coded “yes”/ “no”: whether they had a supervisory role</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">, experienced the 2003 SARS outbreak as a HCW, worked </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-bidi-font-weight: bold; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">night-shifts in the past month and worked longer than usual hours in the past month. Exposure to COVID-19 was assessed by “How often does your job require you to come in contact with suspected/ confirmed COVID-19 patients/ specimens?” with the response options being “not at all”, “occasionally”, and “daily”. </span></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><em style="mso-bidi-font-style: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-ansi-font-style: italic;">HCW-perceived job factors.</span></em><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;"> Perceived job risk was assessed using the item “I feel that my job puts me at great risk of exposure to COVID-19” where responses ranged from “strongly agree” to “strongly disagree” on a 6-point scale which was later recoded into a binary variable (high risk vs. low risk) </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[15]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">. Effective COVID-19 communication in the workplace was assessed using three items: availability/ timeliness of updates, trustworthiness of information, and clarity of policies and protocols. Teamwork was assessed via the statement “My work team has been working well together”. The response options were “yes”, “neutral”, and “no”. These workplace support questions were considered to have face validity and adapted from a previous SARS outbreak study </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[16]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">. Job dedication was measured using the subscale from the Utrecht Work Engagement Scale-9 </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[17]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">, where a higher summed score indicated higher job dedication, which consisted of feelings of enthusiasm, inspiration and pride for one’s job. Feeling appreciated was assessed by the statement “I feel appreciated by my department/ hospital/ employer” where the responses were coded into a binary variable: “never”/ “rarely” vs. “sometimes”/ “always”. </span></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><em style="mso-bidi-font-style: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-ansi-font-style: italic;">Personal resources. </span></em><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">The 4-item short forms of the Patient-Reported Outcomes Measurement Information System (PROMIS) </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[18]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;"> measures of emotional support </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[19]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;"> and general self-efficacy </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[20]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;"> were used. </span><span style="color: #000000; line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">The Emotional Support scale assesses perceived feelings of being cared for and valued as a person, while the General Self-efficacy scale measures confidence in exerting control over one’s situation. Both measures were rated to on a 5-point scale, with higher scores indicating increase in the construct measured. Summed scores were converted into T-scores. </span></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><em style="mso-bidi-font-style: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-ansi-font-style: italic;">Health.</span></em><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;"> Presence of a chronic health condition was assessed by the question “In your lifetime, have you ever been diagnosed by a physician as having a chronic disease or medical condition?” with the response options “yes”, “no” and “neutral”. Whether a participant had been quarantined during the duration of the study was coded as </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-bidi-font-weight: bold; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">“yes”/ “no”</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">.</span></p> <p style="margin: 1em 0px 8pt; line-height: 200%;"><strong style="mso-bidi-font-weight: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 16pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-ansi-font-weight: bold;">Data analysis</span></strong></p> <p style="margin: 1em 0px 0pt; line-height: 200%;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">A random-intercept logistic regression model, which is robust when missingness depends only on observed data (i.e., missing at random [MAR]), was used to investigate two questions: (1) whether rates of stress, anxiety, and job burnout among HCWs were increasing over time, and (2) what were the predictors of stress, anxiety, and job burnout among HCWs. To address the first question, we regressed the psychological outcomes of interest on calendar month. Calendar months were initially specified as a categorical variable to visualize trends, and later as a continuous variable to test for any statistically significant linear or quadratic trends. </span></p> <p style="margin: 1em 0px 0pt; line-height: 200%;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;"> </span></p> <p style="margin: 1em 0px 0pt; line-height: 200%;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">To address the second question, we regressed the psychological outcomes of interest on potential predictors, while controlling for calendar month, demographic factors (age, gender, marital status, presence of a chronic health condition and living with children, elderly, or vulnerable persons), and placement on quarantine related to COVID-19. Predictors considered include objective job characteristics, HCW-perceived job factors and personal resources which were described earlier. Regression models omitting HCW-perceived job factors and personal resources were also estimated to investigate how predictive objective job characteristics are of the outcomes in the absence of information on subjective factors. </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">Analyses were conducted using Stata version 15·1 </span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">[21]</span><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;"> and statistical inference were based on cluster-robust standard errors (</span><em style="mso-bidi-font-style: normal;"><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-ansi-font-style: italic;">SE</span></em><span style="line-height: 200%; font-family: 'Times New Roman'; font-size: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri;">s) and the 5% significance level.</span></p> <p> </p> 2021-09-29T03:56:46Z 2021-09-29 2021-09-29 ENG AI IRENE TEO, CHAY JUNXING (2021-09-29). Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud. ScholarBank@NUS Repository. [Dataset]. <a href="https://doi.org/10.25540/DAX0-K3ZF" target="_blank">https://doi.org/10.25540/DAX0-K3ZF</a> https://scholarbank.nus.edu.sg/handle/10635/201509 https://doi.org/10.25540/DAX0-K3ZF Singapore

Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud

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