Mental health and emotional distress among healthcare workers during the first wave of COVID-19 pandemic in Italy

Background: the novel coronavirus pandemic has had a considerable impact on public health all over the world causing global health crises, straining the resources of health systems and revealing their vulnerabilities with profound implications for health. Italy was one of the most affected countries, as the first European full-blown outbreak occurred there. The exposure of the Italian healthcare workers to COVID-19 may be an important risk factor for psychological distress and mental health. Aim: to describe worries, sleep disturbances and risk perception of being infected among Italian Health Care Workers (HCWs) during the first wave of the pandemic. Methods: a research protocol was prepared in order to be submitted to the reference Ethical committee. It reported the aim and the methods (data collection, statistical analysis, privacy etc.) of the study. The protocol has been prepared in accordance with the guidelines for observational studies (STROBE guidelines) and was developed by a multidisciplinary team including biostatisticians, psychiatrists and prevention technicians. A cross-sectional study – web based open survey was conducted. Data collection was carried out through an ad hoc questionnaire administered online using the Google platform “Form”. The study population included physicians, nurses, medical staff (radiologic technologists, rehabilitation technicians, physiotherapists and midwives), healthcare support and administrative personnel working in hospitals, nursing homes and therapeutic communities in Italy during the first wave of the pandemic period (February–May 2020). Trainee students, who had not obtained the qualification yet at the time of the interview, could not participate in the study. Data were summarized by descriptive statistics. Multivariable logistic regression was implemented to identify factors associated with sleep disturbances. To explore factors associated with risk perception of being infected a multinomial logistic regression was performed. Statistical significance level was set at p < 0.05. Results: respondents were 2103 but 2078 met the inclusion criteria. Females were 78.8% and mean age was 42.17±10.98. The highest percentage of respondents were physicians (40.75%) and nurses (32.15%), followed by medical (18.00%), healthcare support (4.50%) and administrative (4.60%) staff. In a score range between 0 (not worried) and 4 (very worried), our results showed that participants declared that they were worried about the Coronavirus infection with a median score of 3 (IQR 2-3). 16% reported having been infected with SARS-CoV-2, 56.96% of HCWs were worried about “The risk of infection for the surrounding people”. 63.43% of the sample reported having sleep disturbances; at the beginning of the pandemic, 59.19% reported perceiving a high risk of being infected. About psychological aspects, 83.85% of HCWs perceived need for psychological support but only 9.38% received it. Conclusion: the results concerning the high degree of worries and the presence of sleep disturbances firstly indicate that institutions need to be better prepared to deal with contingency plans, especially in the areas of mental health, workload and resource access. These fields in turn contain specific problems that cover other areas and affect HCWs. Our findings highlight the importance of psychological and psychiatric support services during the COVID-19 pandemic scenario. These services may be useful for health authorities and policy makers to ensure the psychological well-being of healthcare workers and to promote precautionary behaviors among them