Poor physical and mental health was common among Brazilian health workers employed in the public sector during the COVID-19 pandemic, according to a study by researchers at the Federal University of São Carlos (UFSCar) in the state of São Paulo, brazil The study showed that 86% reported burnout and 81% suffered from stress. They slept badly, suffered from depression and complained of pain. On the other hand, most said they were happy to provide meaningful services to society.
The study is still ongoing. An analysis of the initial findings is published in an article published in the journal Healthcare. The initiative as a whole has the support of FAPESP and is now in the final phase of data collection and analysis.
“The paper provides a snapshot of the situation, and we cannot blame the pandemic for all the problems we encountered, but we believe that the particularly severe effects of COVID-19 in Brazil contributed to these very negative results,” he said. Tatiana de Oliveira. Sato, professor of physical therapy at the School of Biological and Health Sciences (CCBS) of the UFSCar.
“Overwork, difficult decisions and dramatic experiences were intensified due to the pandemic, which affected all healthcare workers, but especially those on the front lines,” Sato said. According to the article, Brazil has had more healthcare workers die from COVID-19 than any other country.
“The original idea for the survey came just before the pandemic. Even outside the context of the pandemic, healthcare workers have to deal with a big schedule and a burden of responsibility. We wanted to assess the effects of everything that on their physical and mental health. However, when the pandemic hit, we decided to measure the impact of the public health emergency on the well-being of these workers,” said Sato.
change of course
The researchers initially planned to interview volunteers at work. They would all be health workers of the SUS, Brazil’s public health service, in São Carlos. However, the procedures needed to prepare the survey (permits, questionnaires, etc.) became irrelevant between late 2020 and early 2021, when the pandemic was taking place throughout Brazil and vaccine rollout was still incipient
“Instead, we created an online form and expanded the search for respondents nationwide,” Sato explained. “The inclusion criteria were working for the SUS, being over 18 years old and being directly involved in patient care.”
The form was publicized through social media, emails and newspapers. It contained five questionnaires, each designed to quantify an aspect of the respondent’s life. They include the Copenhagen Psychosocial Questionnaire, the Pittsburgh Sleep Quality Index, the Nordic Musculoskeletal Questionnaire, and the Beck Depression Inventory.
The form had 10 pages. “We estimated that it took 20-30 minutes to answer all the questions. Questionnaires were only included in the analysis if they were completely filled out,” said Sato. Local respondents also used equipment to measure the amount of physical activity for inclusion in the survey.
Finally, 125 healthcare workers participated in the study. The first phase of data collection ran from June 2021 to April 2022. The data published so far is a baseline and does not yet cover physical activity, but the project calls for four more steps that three, six, nine and 12 months later. the first collection.
“We called this cohort HEROES. We put a lot of thought into the name because we didn’t want it to be understood that healthcare workers are superhuman and never get tired or down. The name is meant to be a tribute. We also wanted to draw attention to the need to value healthcare workers, who were disproportionately affected by the pandemic,” Sato said. About 60 respondents participated in all stages.
Initial findings
Data presented in the article show a high prevalence of musculoskeletal symptoms: 64% reported neck pain, 62% shoulder pain, 58% back pain, and 61% pain lumbar
For Sato, all this was largely due to the long hours, standing most of the time, lifting patients and working without problems. “But mental stress can also trigger this type of pain because of the tension it creates in the body,” he noted.
The frequency of psychosocial problems is surprising, according to the authors, with stress affecting 81% of participants and 86% suffering from burnout. Symptoms of mild depression were detected in 22%, moderate depression in 16% and severe depression in 8%. In addition, 74.4% said they slept poorly.
It is still necessary to analyze the evolution of the indicators over time, however. According to Sato, prevalence levels tend to be lower in studies of other populations. For example, five meta-analyses cited in the article found attrition rates ranging from 25% to 37%, while nine such studies found attrition rates ranging from 17% to 57% of respective samples suffered from stress. These proportions are much lower than those reported in the study by UFSCar researchers.
Working climate
Other psychosocial factors were assessed using the Copenhagen questionnaire, with a large majority of respondents giving negative ratings to the emotional demands of their work (75%), its pace and intensity (61%) and its unpredictability (47%) . These were the psychosocial factors with the worst ratings in the survey.
Proportions reporting offensive behavior were also surprisingly high: 15% said they had been the subject of unwanted sexual attention or harassment, while 26% had been threatened, 17% harassed and 9% assaulted physically
“This is deplorable. All these numbers should be zero. Such occurrences in any workplace are unacceptable,” Sato said. Sexual harassment was reported more by younger women, she noted. Threats of violence came mainly from patients and their relatives, while co-workers were more often bullies than supervisors.
On the positive side, more than 90% said they felt their work was very meaningful and 80% said they were engaged in their work despite the stress.
Limitations and implications
For Sato, the relatively small number of respondents in the first form (125) and the even smaller number (about 60) remaining in the last stage of the survey were a limitation because they prevented extrapolation and data analysis for other regions. “However, the survey was valuable for its depth,” he said.
The information obtained, he added, is sufficient to pressure the senior management of the SUS and the authorities to improve working conditions. Professionals with physical and mental problems cannot always provide the best patient care.
“This must lead to increased staffing, better pay, less grueling hours and proper training,” Sato said. Simple matters such as training staff on the best ways to lift and transport patients without injuring themselves could lead to significant improvements in musculoskeletal terms. Similarly, building support networks would help nursing staff and others cope with the emotional toll. “Health workers need a lot of support. They are people too,” he said.
About the São Paulo Research Foundation (FAPESP)
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Research topic
people
Title of the article
Poor health conditions among Brazilian healthcare workers: study design and baseline characteristics of the HEROES cohort
Publication date of the article
October 20, 2022