COVID-19 pandemic in São Paulo
a quantitative study on clinical practice and mental health among medical residency specialties
Keywords:
Medical specialties, Coronavirus disease 2019, Mental hygiene, Medical residencyAbstract
BACKGROUND: 2020 was a challenging year for all healthcare professionals worldwide. In São Paulo, Brazil, the virus SARS-CoV-2 took 47,222 lives up to December 29, 2020. The front line of medical professionals in São Paulo was composed of many residents, who were transferred from their rotations to cover the needs of the pandemic. OBJECTIVE: To identify medical residents’ mental health and clinical issues, regarding symptoms of burnout, depression and anxiety during the pandemic, and to compare them among specialties. DESIGN AND SETTING: Quantitative study using a convenience sample of medical resident volunteers who responded to an anonymous online survey that was available during April 2020. METHODS: This investigation collected sociodemographic information and used the Oldenburg Burnout Inventory (OLBI) to measure burnout, the Patient Health Questionnaire (PHQ-9) to measure depression and the General Anxiety Disorder (GAD-7) scale to measure anxiety symptoms. This study also developed a COVID-19 Impact Questionnaire (CIQ-19) to assess the residents’ beliefs and clinical practices relating to COVID-19 patients. RESULTS: The sample comprised 1,392 medical residents in São Paulo, Brazil. Clinical specialty physicians showed the highest rates of anxiety symptoms (52.6%) and burnout (51.2%), among the specialties. CONCLUSION: Clinical specialty residents are at higher risk of anxiety, depression and burnout. The symptoms of anxiety and depression have worsened during the COVID-19 pandemic. There is a general need for mental health support interventions for medical resident physicians, which requires reinforcement during this worldwide crisis.
Downloads
References
Imperial College London. Report 21 - Estimating COVID-19 cases and reproduction number in Brazil. Available from: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-21-brazil/ Accessed in 2021 (May 13).
World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int Accessed in 2021 (May 13).
Emanuel EJ, Persad G, Upshur R, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. N Engl J Med. 2020;382(21):2049-55. PMID: 32202722; https://doi.org/10.1056/NEJMsb2005114
Vergano M, Bertolini G, Giannini A, et al. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic. Crit Care. 2020;24(1):165. PMID: 32321562; https://doi.org/10.1186/s13054-020-02891-w
Dunn M, Sheehan M, Hordern J, Turnham HL, Wilkinson D. Your country needs you: the ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19. J Med Ethics. 2020;46(7):436-440. PMID: 32409625; https://doi.org/10.1136/medethics-2020-106284
Gully PR. Pandemics, regional outbreaks, and sudden-onset disasters. Healthc Manage Forum. 2020;33(4):164-9. PMID: 32022584; https://doi.org/10.1177/0840470420901532
Agarwal S, Sabadia S, Abou-Fayssal N, et al. Training in neurology: Flexibility and adaptability of a neurology training program at the epicenter of COVID-19. Neurology. 2020;94(24):e2608-14. PMID: 32385187; https://doi.org/10.1212/WNL.0000000000009675
Fong ZV, Qadan M, McKinney R Jr, et al. Practical Implications of Novel Coronavirus COVID-19 on Hospital Operations, Board Certification, and Medical Education in Surgery in the USA. J Gastrointest Surg. 2020;24(6):1232-6. PMID: 32314235; https://doi.org10.1007/s11605-020-04596-5
Scheffer M, Cassenote A, Guerra A, et al. Demografia médica no Brasil 2020. São Paulo: FMUSP, CFM, 2020. Available from: https://www.fm.usp.br/fmusp/conteudo/DemografiaMedica2020_9DEZ.pdf Accessed in 2021 (May 13).
Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214-36. PMID: 27923088; https://doi.org/10.1001/jama.2016.17324
Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015;314(22):2373-83. PMID: 26647259; https://doi.org/10.1001/jama.2015.15845
Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. Gen Hosp Psychiatry. 2013;35(1):45-9. PMID: 23123101; https://doi.org/10.1016/j.genhosppsych.2012.08.005
Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ. 2020;369:m1642. PMID: 32371466; https://doi.org/10.1136/bmj.m1642
Gallagher TH, Schleyer AM. We Signed Up for This! - Student and Trainee Responses to the Covid-19 Pandemic. N Engl J Med. 2020;382(25):e96. PMID: 32268020; https://doi.org/10.1056/NEJMp2005234
Gelinas L, Pierce R, Winkler S, et al. Using Social Media as a Research Recruitment Tool: Ethical Issues and Recommendations. Am J Bioeth. 2017;17(3):3-14. PMID: 28207365; https://doi.org/10.1080/15265161.2016.1276644
Schuster MDS, Dias VDV. Oldenburg Burnout Inventory - validação de uma nova forma de mensurar Burnout no Brasil [Oldenburg Burnout Inventory - validation of a new way to measure Burnout in Brazil]. Cien Saude Colet. 2018;23(2):553-62. PMID: 29412413; https://doi.org/10.1590/1413-81232018232.27952015
Santos IS, Tavares BF, Munhoz TN, et al. Sensibilidade e especificidade do Patient Health Questionnaire-9 (PHQ-9) entre adultos da população geral [Sensitivity and specificity of the Patient Health Questionnaire-9 (PHQ-9) among adults from the general population]. Cad Saude Publica. 2013;29(8):1533-43. PMID: 24005919; https://doi.org/10.1590/0102-311x00144612
Moreno AL, DeSousa DA, Souza AMFLP, et al. Factor structure, reliability, and item parameters of the Brazilian-Portuguese version of the GAD-7 questionnaire. Temas Psicol. 2016;24(1):367-76. http://dx.doi.org/10.9788/TP2016.1-25
Pereira-Lima K, Loureiro SR. Burnout, anxiety, depression, and social skills in medical residents. Psychol Health Med. 2015;20(3):353-62. PMID: 25030412; https://doi.org/10.1080/13548506.2014.936889
Lai X, Wang M, Qin C, et al. Coronavirus Disease 2019 (COVID-2019) Infection Among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China. JAMA Netw Open. 2020;3(5):e209666. PMID: 32437575; https://doi.org/10.1001/jamanetworkopen.2020.9666
Felice C, Di Tanna GL, Zanus G, Grossi U. Impact of COVID-19 Outbreak on Healthcare Workers in Italy: Results from a National E-Survey. J Community Health. 2020;45(4):675-83. PMID: 32440724; https://doi.org/10.1007/s10900-020-00845-5
Lebares CC, Guvva EV, Ascher NL, et al. Burnout and Stress Among US Surgery Residents: Psychological Distress and Resilience. J Am Coll Surg. 2018;226(1):80-90. PMID: 29107117; https://doi.org/10.1016/j.jamcollsurg.2017.10.010
Greenberg N, Thomas S, Iversen A, et al. Do military peacekeepers want to talk about their experiences? Perceived psychological support of UK military peacekeepers on return from deployment. J Ment Health. 2003;12(6):565-73. https://doi.org/10.1080/09638230310001627928
Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-20. PMID: 32112714; https://doi.org/10.1016/S0140-6736(20)30460-8
Pereira-Lima K, Loureiro SR, Crippa JA. Mental health in medical residents: relationship with personal, work-related, and sociodemographic variables. Braz J Psychiatry. 2016;38(4):318-24. PMID: 27192216; https://doi.org/10.1590/1516-4446-2015-1882
Oreskovich MR, Kaups KL, Balch CM, et al. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012;147(2):168-74. PMID: 22351913; https://doi.org/10.1001/archsurg.2011.1481