History of contact with the SARS-COV-2 virus and the sense of coherence in the development of psychological distress in the occupational health professionals in Spain

Article SCIENCE PROGRESS Science Progress 2021, Vol. 104(2) 1–19 ÓThe Author(s) 2021 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/00368504211026121 journals.sagepub.com/home/sci History of contact with the SARS-COV-2 virus and the sense of coherence in the development of psychological distress in the occupational health professionals in Spain Juan Go ´mez-Salgado 1,2 ,Mo ´nica Ortega-Moreno 3 , Guillermo Soriano 4 ,Javier Fagundo-Rivera 5,6 , Regina Allande-Cusso ´ 7 and Carlos Ruiz-Frutos 1,2 1 Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain 2 Safety and Health Postgraduate Programme, Universidad Espı ´ritu Santo, Guayaquil, Ecuador 3 Department of Economy, Faculty of Labour Sciences, University of Huelva, Huelva, Spain 4 Spanish Association of Specialists in Occupational Medicine, Madrid, Spain 5 Health Sciences Doctorate School, University of Huelva, Huelva, Spain 6 Nursing Department, Atla ˆntica Health School, Barcarena, Portugal 7 Nursing Department, University of Seville, Seville, Spain Abstract The COVID-19 pandemic has affected the psychological well-being of healthcare professionals, among them, on medical and nursing occupational specialists. This study describes the psychological distress that this group has suffered, analyzing the effect that the sense of coherence related with the history of contact with infected people has generated in their mental health. Cross-sec- tional descriptive study using online questionnaires. Data were collected on a sample of 499 subjects, representing 42.0% and 38.8% of the associations of specialists in Occupational Medicine and Nursing, respectively. A univariate data analysis, independence test, and the CHAID multivariate method were carried out. The percentage of workers with high psychological distress was higher among women than among men; this was also higher in public sector workers than in the Corresponding author: Juan Go ´mez-Salgado, Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Avenida Tres de Marzo, s/n, Huelva, Huelva 21007, Spain. Email: [email protected] Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). private sector. No differences have been observed regarding psychological distress and educational level, coexistence, having children, working away from home, having a pet, or between being a physician or nurse. The most efficient measure to prevent psychological distress was acting regarding the comprehensibility dimension of the sense of coherence. Sex, contact with any infected person, age, living as a couple, working in public or private centers, the availability of diagnostic tests, and the correlation with the manageability dimension were modulating factors. Sense of coherence is an effective measure to prevent psychological distress due to contact with people affected by COVID-19 in Occupational Health professionals. Keywords Occupational practice, COVID-19, psychological distress, sense of coherence, occupational health professionals Background Healthcare professionals who were subjected to quarantine because of COVID-19, those who worked in COVID-19 intensive care units, or those who had family or friends infected with the SARS-CoV-2 virus developed considerably more anxiety, depression, frustration, and fear than those who had not experienced these conditions, 1–3 also causing the appearance of panic crisis and various psychic disorders. 1,4 To these we must add insomnia, 5,6 post-traumatic stress, 7 physical and mental exhaustion, or emotional disorders, 8 which generate frequent feelings of not being able to cope with the situation. Along the COVID-19 pandemic, different public health interventions have been implemented in the search for effective results on workers’ physical and mental health. 9 In the European Union, these regulations have reinforced the need for collaboration between the occupational and preventive health services of private companies and the occupational services of the National Health Systems for the diagnosis, treatment, and rehabilitation of work-related diseases. 10,11 However, these regulations have been limited to a scarce collaboration and procedures that have been issued to protect the rights of workers in periods of isolation during the pandemic. 11 The current lack of interventions has led researchers both in epidemiology and preventive medicine to require the occupational health research community to submit papers on workers’ health risks regarding the COVID-19 pandemic. 12 Although some studies have analyzed the mental health effects of COVID-19 on non-health workers, 13 there are not many publications focused on specific healthcare professionals, such as specialists in Occupational Medicine and Nursing, which are the subject of this study. It is known that Occupational Medicine and Nursing specialists have had to work longer hours and with limited human resources, with the subsequent effects on their mental health. 14 On the other hand, maintaining the psycho-emotional well-being of frontline healthcare workers and building their resilience is crucial in addressing and containing the COVID-19 disease, 15,16 as these negative effects on psychological health are often broader and longer-term than the effects on physical 2Science Progress health. 17 In this way, psychological distress (PD) is a widely used indicator of mental health status and the sense of coherence (SOC) is a competence that can help professionals cope with the work-related PD and may contribute to their well-being and health. 18 SOC was described as an ability to understand a situation, perceiving it as manageable, and provides a way to find meaning that motivates and allows the person to mobilize their resources and develop an effective coping response. 19,20 Several studies have shown that personality traits such as lower neuroticism and higher extraversion, open-mindedness to new experiences, and conscientiousness influence the SOC by promoting its development. 21,22 The SOC is acquired through training; health professionals with higher academic levels will have higher rates of SOC. 23 This study aims to know the influence that the history of contact with the SARS-COV-2 virus and the Sense of Coherence have had in the development of Psychological Distress in the collective of Occupational Physicians and Nurses in Spain during the first months of the pandemic. Methods Design Cross-sectional descriptive study using online questionnaires. Participants A non-probabilistic sampling was used. An invitation to participate in the study was sent to all members of the Spanish Association of Specialists in Occupational Medicine and of the Association of Specialists in Occupational Nursing. Professionals who did not have their residence in Spain at the time of the study or were not active (medical leave, jobless, or retired) were excluded. Data collection took place between 23 April and 24 June 2020. Instruments An ad hoc questionnaire was prepared based on published scientific evidence. For sociodemographic and work-related variables, age, sex, marital status, employment status, level of study, public or private nature of the workplace, years of experience in the specialty, level of care of the working activity, and variables related to working conditions were assessed. For the study of the ‘‘contact history’’ variable, history of contacts with possible positive cases of COVID-19, or suspected of being positive was also collected, as well as having performed sampling for COVID-19 diagnosis. In relation to the psychological distress variable, the Goldberg General Health Questionnaire 24 was used. This questionnaire consists of 12 items and 4 answer options, and an overall score in a range between 0 and 12 points. The scale achieved Go ´mez-Salgado et al. 3 a Cronbach’s areliability value of 0.97, and the internal consistency indexes presented by the dimensions ranged from a= 0.91 to a= 0.93. 25 The sense of coherence was measured through the Sense of Coherence-13 (SOC) scale in its Spanish version. 26 It is a self-administered questionnaire composed of 13 items with seven points. It assesses how often the participant lives certain experiences such as believing they are treated unfairly or whether they have very confusing feelings or ideas. The scale has a range of 13–91 points in its overall rating. It has three dimensions: (1) Meaningfulness, which measures the value that the person gives to experiences and motivation to fight against the adversities and challenges of life; (2) Comprehensibility, which measures the cognitive ability to understand and deal with difficult-to-solve situations; and (3) Manageability, which measures the ability to make effective use of the resources available to the person. The instrument as a whole obtained a Cronbach’s aindex of 0.824. The internal consistency indexes presented by the dimensions were a= 0.591 for meaningfulness, a= 0.690 for comprehensibility, and a= 0.611 for manageability. The scores obtained in each dimension of the SOC were categorized, distinguishing between low, medium, or high, where low grouped scores between the minimum and the 25th percentile; medium, central 50% of cases; and high, between the 75th percentile and the maximum value. Procedure A first draft of the questionnaire was analyzed by 10 experts consisting of specialists in clinical psychology, public health, epidemiologists, and Occupational physicians and nurses. Piloting was subsequently performed with the aim to identify the level of understanding and reliability of the questionnaire. Fifty-seven healthcare workers chosen through a sampling for convenience with approximately similar characteristics to the final target population were selected and accepted to participate. 50.90% were men and 49.10% were women, and the mean age was 41.87 years (SD = 11.86). Most of these participants were married (56.10%) and had postgraduate studies, either Master’s or Doctorate (57.90%). All of them completed the survey from different electronic devices (Tablet, laptop, and mobile). The questionnaire was accepted and no difficulty in the development, completion, or understanding of the items was found. Also, our scales achieved a Cronbach’s a reliability value of 0.867 in the GHQ and 0.831 in the SOC. Data were collected through an online questionnaire using the Qualtrics Ò survey and storage platform. The online questionnaire was distributed among the physicians of the Spanish Association of Specialists in Occupational Medicine and the nurses of the Spanish Association of Specialists in Occupational Nursing, who had agreed to be contacted for research purposes. To this end, both associations were contacted and collaborated with the dissemination of the link to the online questionnaire. From the presidency of both Associations, information on the study was sent to their associates and their participation was requested. By clicking a link, the participants could access the survey. Prior to starting the questionnaire, an 4Science Progress introductory page was displayed to inform about the study and its objectives, and the written consent for participation was requested at the end of it. Data analysis A descriptive statistical analysis was performed, with determination of absolute frequencies and percentages of variables that collect socio-labor information, contact history, and sense of coherence. To assess whether there was an association between these variables and the presence of psychological distress, the independence x 2 test was used, and the CHAID method determined which variables were most significant. The chosen predictors were those with lower adjusted p, as long as that value was less than or equal to the significance level set to 0.05. The analyses were carried out with the statistical software SPSS 26.0Ó(IBM, Armonk, NY, US) and R version 4.0.0Ó. 27 Ethical aspects This study had the favorable report of the Research Ethics Committee of Huelva, belonging to the Ministry of Health of Andalusia (PI 036/20) and complied with all the ethical principles contained in the Helsinki Declaration. All participants gave their permission to participate voluntarily and anonymously through the mandatory written informed consent before starting the online survey. Results Descriptive analysis The final sample was composed of 499 Occupational Health professionals, of which 402 were specialist physicians and 97 were nursing specialists. In absolute terms, 42% of physicians and 38.8% of nurses of both professional Associations answered the questionnaire. 65.73% of the total were women, 50% of them were over 51 years of age, and 55.51% had master’s or doctoral studies. 78.16% were married or living together as a couple, 79.56% had children, and 33.67% had a pet. All of them were actively working during the first months of the COVID-19 pandemic in Spain, and 69.96% were working away from home. Similarly, 36.67% worked in a public center. Of the total sample, 80.56% were Occupational Medicine specialists and 19.44% were Occupational Nursing specialists. The percentage of workers with high psychological distress (PD) was higher in women (72.87%) than in men (51.46%); it was also higher in those aged 51 or younger (70.28%) than in those over the age of 51 (60.46%), and higher in public sector workers (72.68%) than those in the private sector (61.39%). No statistically significant difference has been observed between PD and educational level, living as a couple, having children, working away from home, having a pet, or between being a physician or a nurse (Table 1). Go ´mez-Salgado et al. 5 Table 1. Socio-labor variables of the studied collective and psychological distress. Total GHQ \3 GHQ ˜3 No. cases %of total No. cases % line No. cases % line Statistical x 2 p-Value 499 100 172 34.47 327 65.53 Sex Male 171 34.27 83 48.54 88 51.46 22.797 \0.001 Female 328 65.73 89 27.13 239 72.87 Age* 51 or younger 249 50.00 74 29.72 175 70.28 5.116 0.024 Older than 51 249 50.00 98 39.36 151 60.64 Educational level Degree/ University degree 222 44.49 69 31.08 153 68.92 2.032 0.154 Postgraduate MSc or PhD 277 55.51 103 37.18 174 62.82 Marital status With a partner 390 78.16 142 36.41 248 63.59 2.979 0.084 Without a partner 109 21.84 30 27.52 79 72.48 Children No 102 20.44 32 31.37 70 68.63 .544 0.461 Yes 397 79.56 140 35.26 257 64.74 Having a pet No 331 66.33 111 33.53 220 66.47 .380 0.538 Yes 168 33.67 61 36.31 107 63.69 Working* From home 117 26.23 85 72.65 32 27.35 5.140 0.077 Away from home 312 69.96 191 61.22 121 38.78 Both from and away from home 17 3.81 12 70.59 5 29.41 Work center Public 183 36.67 50 27.32 133 72.68 6.534 0.011 Private or associated 316 63.33 122 38.61 194 61.39 Profile Occupational Health nurse 97 19.44 34 35.05 63 64.95 .018 0.893 Occupational Health physician 402 80.56 138 34.33 264 65.67 * Total cases do not correspond because information was not collected in all subjects. 6Science Progress Multivariate analysis Figure 1 shows the psychological distress (PD) segmentation tree obtained from the socio-labor variables listed in Table 1. The sex variable was profiled as the most significant, with a lower percentage of cases with PD among men. In women, the type of workplace was a mediating variable, with higher levels of PD among those working for a public company. Among those who did so in a private company, working from home in telework mode generated higher levels of PD. In relation to contacts that may lead to the disease, that was having been in contact for more than 15 min and with less than 2-m distance with an infected person, 61.3% claimed not to have experienced this situation. This percentage dropped to 45.9% when the participant had not been in casual contact with an infected person. Even lower was the percentage of those who claimed not to have had any contact with any person or material suspected of being infected (35.9%). 76.4% replied that no family member had been infected. In none of these contact situations, a statistically significant difference was found for generating higher percentages of PD (Table 2). The total mean score of the SOC-13 scale was 62.8 (SD = 12.02). Table 2 shows how, regarding the overall value of the sense of coherence (SOC), 88.5% of those who give a low value have PD, a percentage which was lower among those with intermediate SOC (67.2%), and even lower among those with a high SOC (38.0%). The same trend was seen in the three dimensions that make up the SOC. 90.5% of those with low comprehensibility have PD, lowering this percentage (63.7%) for those who have intermediate SOC levels and decreasing to 34.3% for those professionals with high levels of comprehensibility. Low manageability was also associated with a higher percentage of professionals showing PD (84.0%), while the lowest percentage was found among those with higher manageability levels (35.8%). Similarly, 80.7% of those with low meaningfulness levels have PD, lowering this percentage for those with intermediate levels of meaningfulness (67.2%), and even more (42.6%) for those with high meaningfulness levels. Sex distinction was presented as the most significant variable when studying sociodemographic variables and contact history together, with higher risk found among women than among men. For women who work in public centers, 80.4% have psychological distress (PD), this percentage decreases for those who work in private centers; when they do so in associated centers, PD was reduced to 79.7% when working from home and to 62.3% if they worked away from home or combining both ways. In men, having had a diagnostic test was presented as a mediating variable, and for those who had undergone the test, the percentage of PD reduced to 18.8% if they had a pet, and to 52.2% if they did not. Among men who had not been diagnosed, PD was higher (69%) in those with university studies than in those with postgraduate studies, being age the mediating variable in the latter case and decreasing the percentage to 64.5% in individuals aged 51 or younger, or to 52.4% in those over 51 years of age if they were working in a public center, and to 11.1% for those in private or associated centers (Figure 2). Go ´mez-Salgado et al. 7 Figure 1. Socio-labor variables in the genesis of psychological distress. 8Science Progress Table 2. Association of the history of contact and sense of coherence with the development of psychological distress. Total GHQ \3 GHQ ˜3 No. cases %of total No. cases % line No. cases % line Statistical x 2 p-Value 495 100 170 34.3 325 65.7 499 1.00 172 34.47 327 65.53 Contact record Contact upper to 15 min and \2 m with infected person No 306 61.3 106 34.6 200 65.4 .010 0.910 Yes/doesn’t know 193 38.7 66 34.2 127 65.8 Casual contact with infected person No 229 45.9 75 32.8 154 67.2 .553 0.457 Yes/doesn’t know 270 54.1 97 35.9 173 64.1 Any contact with a person or material suspected of being infected No 179 35.9 63 35.2 116 64.8 .065 0.798 Yes/doesn’t know 320 64.1 109 34.1 211 65.9 Infected family member No 380 76.4 135 35.5 245 64.5 .789 0.374 Yes/doesn’t know 119 23.8 37 31.1 82 68.9 Infected peer* No 137 30.7 46 33.6 91 66.4 .296 0.587 Yes/doesn’t know 309 69.3 112 36.2 197 63.8 Quarantined for having symptoms or having had risk contact* No 454 96.4 161 35.5 293 64.5 1.036 0.309 Yes 17 3.6 4 23.5 13 76.5 Diagnostic tests performed No 335 67.13 113 33.7 222 66.3 .246 0.620 Yes/doesn’t know 164 32.87 59 36.0 105 64.0 Sense of coherence Comprehensibility (SOC_C) Low 148 29.90 14 9.5 134 90.5 85.508 \.001 Intermediate 245 49.49 89 36.3 156 63.7 High 102 20.61 67 65.7 35 34.3 Manageability (SOC_M) Low 156 31.52 25 16.0 131 84.0 60.797 \.001 Intermediate 244 49.29 84 34.4 160 65.6 High 95 19.19 61 64.2 34 35.8 Meaningfulness (SOC_S) Low 140 28.28 27 19.3 113 80.7 39.819 \.001 Intermediate 247 49.90 81 32.8 166 67.2 High 108 21.82 62 57.4 46 42.6 SOC Low 130 26.26 15 11.5 115 88.5 71.241 \.001 Intermediate 244 49.29 80 32.8 164 67.2 High 121 24.44 75 62.0 46 38.0 *Total cases do not correspond because information is not collected in all subjects. Go ´mez-Salgado et al. 9 be asymptomatic carriers of COVID-19 or even with symptoms in their first state. In this way, sense of coherence is an effective measure to prevent psychological distress due to contact with people affected by Covid-19. Conclusions The results of this study were consistent with previous studies, such as higher PD in women or young people. But there were also different ones, such as not having found more PD in nurses than in practitioners. Likewise, nurses have been able to adapt better to teleworking than other health professionals, largely due to the low hospital percentage of teleworkers, and maybe because of the less exposure or contact with people affected by COVID-19. Comprehensibility and manageability are dimensions of the Sense of Coherence that have been related with the regulation of psychological distress in Occupational medical and nursing specialists. This study may lead to the convenience of segmenting studies on the effects of COVID-19 into subgroups of healthcare professionals. We believe that future studies should be carried out to analyze these differentiating group characteristics, which may justify a different development of PD level, and thereby could lead to identify measures for its prevention. Acknowledgements We would like to thank the members of the Spanish Association of Specialists in Occupational Medicine and those of the Association of Specialists in Occupational Nursing, without whose help this study would not have been possible. Declaration of conflicting interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. 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Mo ´nica Ortega-Moreno is a PhD in Statistical Sciences and lecturer of the Department of Economics, at the University of Huelva. Guillermo Soriano, PhD, MD, is a Specialist in Preventive Medicine and Public Health. Master in Clinical Analysis and Advanced Methods of Statistics. Occupational Medicine & Wellness by Work Coordinator at SGS. Javier Fagundo-Rivera, PhD, is a Nurse Specialist in Emergency and Critical Care. Master in Health Sciences Investigation Methodology. Lecturer at the University of Seville. Regina Allande-Cusso ´, PhD, RN, is a Lecturer at the Nursing Department of the University of Seville. Nurse in the Emergency Unit of the Virgen del Rocı ´o University Hospital (Seville). Accredited nstructor in Advanced Life Support (CPR). Carlos Ruiz-Frutos, PhD, MD, is a University professor of the Department of Preventive Medicine and Public Health at the University of Huelva. Master of Science in Occupational Medicine, University of London. Go ´mez-Salgado et al. 19