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Please use this identifier to cite or link to this item: https://doi.org/10.25540/DAX0-K3ZF
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dc.titleHealthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective stud
dc.contributor.authorENG AI IRENE TEO
dc.contributor.authorCHAY JUNXING
dc.coverage.spatialSingapore
dc.date.accessioned2021-09-29T03:56:46Z
dc.date.available2021-09-29
dc.date.issued2021-09-29
dc.identifier.citationENG 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>
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/201509
dc.identifier.urihttps://doi.org/10.25540/DAX0-K3ZF
dc.description.abstract<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: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-bidi-font-family: Vrinda; mso-ansi-font-weight: bold;">Aim:</span></strong><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-bidi-font-family: Vrinda;"> The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout.</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: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-bidi-font-family: Vrinda; mso-ansi-font-weight: bold;">Method:</span></strong><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-bidi-font-family: Vrinda;"> A convenience sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N=2744) was recruited from four tertiary hospitals. Data was gathered between March-August 2020, which includes a 2-month lockdown period. HCWs completed monthly web-based surveys consisting of validated measurements of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale). </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: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-bidi-font-family: Vrinda; mso-ansi-font-weight: bold;">Results: </span></strong><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-bidi-font-family: Vrinda;"> The majority of the sample were nurses (60%) and female (81%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout.</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: 10pt; mso-spacerun: 'yes'; mso-fareast-font-family: Calibri; mso-bidi-font-family: Vrinda; mso-ansi-font-weight: bold;">Conclusions:</span></strong><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-bidi-font-family: Vrinda;"> Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs.  </span></p> <p> </p>
dc.rightsAttribution-NonCommercial 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subjectCOVID-19
dc.subjectHealthcare workers
dc.subjectPsychological well-being
dc.typeDataset
dc.contributor.departmentDUKE-NUS MEDICAL SCHOOL
dc.description.doidoi:10.25540/DAX0-K3ZF
dc.grant.idFRGR02PNDM20
dc.grant.fundingagencySGH Health Development Fund
dc.type.dataset.dta
dc.description.methods<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>
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