Global vascular surgeons' experience, stressors, and coping during the coronavirus disease 2019 pandemic

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges for health care systems globally. We designed and administered a global survey to examine the effects of COVID-19 on vascular surgeons and explore the COVID-19-related stressors faced, coping strategies used, and support structures available.

Methods: The Pandemic Practice, Anxiety, Coping, and Support Survey for Vascular Surgeons was an anonymous cross-sectional survey sponsored by the Society for Vascular Surgery Wellness Task Force. The survey analysis evaluated the effects of COVID-19-related stressors on vascular surgeons measured using the Generalized Anxiety Disorder 7-item scale. The 28-item Brief Coping Orientation to Problems Experienced inventory was used to assess the active and avoidant coping strategies. Survey data were collected using REDCap (Research Electronic Data Capture) from April 14, 2020 to April 24, 2020 inclusive. Additional qualitative data were collected using open-ended questions. Univariable and multivariable analyses of the factors associated with the anxiety levels and qualitative analysis were performed.

Results: A total of 1609 survey responses (70.5% male; 82.5% vascular surgeons in practice) from 58 countries (43.4% from United States; 43.4% from Brazil) were eligible for analysis. Some degree of anxiety was reported by 54.5% of the respondents, and 23.3% reported moderate or severe anxiety. Most respondents (∼60%) reported using active coping strategies and the avoidant coping strategy of "self-distraction," and 20% used other avoidant coping strategies. Multivariable analysis identified the following factors as significantly associated with increased self-reported anxiety levels: staying in a separate room at home or staying at the hospital or a hotel after work (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.08-1.79), donning and doffing personal protective equipment (OR, 1.81; 95% CI, 1.41-2.33), worry about potential adverse patient outcomes due to care delay (OR, 1.47; 95% CI, 1.16-1.87), and financial concerns (OR, 1.90; 95% CI, 1.49-2.42). The factors significantly associated with decreased self-reported anxiety levels were hospital support (OR, 0.83; 95% CI, 0.76-0.91) and the use of positive reframing as an active coping strategy (OR, 0.88; 95% CI, 0.81-0.95).

Conclusions: Vascular surgeons globally have been experiencing multiple COVID-19-related stressors during this devastating crisis. These findings have highlighted the continued need for hospital systems to support their vascular surgeons and the importance of national societies to continue to invest in peer-support programs as paramount to promoting the well-being of vascular surgeons during and after the COVID-19 pandemic.

Keywords: Brief COPE Survey; COVID-19; Coping strategies; Financial stress; GAD-7 scale; Personal protective equipment.

Fig 1

Magnitude of stress reported by vascular surgeons toward occupational and personal coronavirus disease 2019-related stressors. PPE, Personal protective equipment.

Fig 2

Coping strategies used by vascular surgeons in practice and training (n = 1366) as measured using the Brief Coping Orientation to Problems Experienced inventory.

Fig 3

Most hospital support structures were associated with a reduction in self-reported anxiety levels among vascular surgeons as measured using the Generalized Anxiety Disorder 7-item scale while virtual social media based support platforms association to anxiety levels was mixed. COVID-19, Coronavirus disease 2019; PPE, personal protective equipment; SVS, Society for Vascular Surgery.

Supplementary Fig 1 (online only)

Map showing the geographic distribution of the 1609 survey respondents across the world.

Supplementary Fig 2 (online only)

Bar graph showing the responses to the Generalized Anxiety Disorder 7-item scale (n = 1518).

Supplementary Fig 3 (online only)

Bar graph showing the number of respondents for each Generalized Anxiety Disorder 7-item scale scores and the interpretation of the scores as degrees of anxiety (no, mild, moderate, and severe anxiety).

Supplementary Fig 4 (online only)

Bar graph showing the degree of self-reported anxiety (no, mild, moderate, and severe anxiety) associated with coronavirus disease 2019-related modifications of home routine after work (n = 1518). The difference in self-reported anxiety degree was statistically significant (P < .001).

Supplementary Fig 5 (online only)

The degree of stress associated with coronavirus disease 2019-related financial concerns by vascular surgeons (n = 1314). The difference in self-reported stress level was statistically significant by type of practice (P < .001).