Prevalence of post-traumatic symptomatology and anxiety among residential nursing and care home workers following the first COVID-19 outbreak in Northern Italy

Abstract

The current COVID-19 pandemic has been officially linked to the deaths of hundreds of thousands of people across the globe in just a few months. It is particularly lethal for the elderly in general, as well as for populations residing in long-term stay facilities. By this time, those working and caring for high-risk populations have been exposed to very intense and sudden levels of physical and psychological strain. The situation has taken a particularly tragic turn in residential nursing and care homes (NCH), which were hit hard by the pandemic. In residential NCH, neither residents nor workers tend to have immediate access to the same expertise, medication and equipment as in hospitals, which exacerbates an already tense situation. Among the mental health conditions related to exposure to potentially traumatic events, post-traumatic stress disorder and anxiety are the most prevalent and scientifically recognized. In this survey-based epidemiological study, we test the prevalence of anxiety and post-traumatic symptomatology in residential nursing and care home workers-a group of individuals that has been largely neglected but who nonetheless plays a very important and sensitive role in our society. We do this by focusing on the North of Italy, the most affected region during the first COVID-19 outbreak in Italy. Using a single-stage cluster design, our study returns an estimate for the prevalence of moderate-to-severe anxiety and/or post-traumatic symptomatology of 43% (s.e. = 3.09; 95% CI [37-49]), with an 18% (s.e. = 1.83; 95% CI [14-22]) prevalence of comorbidity among workers of Northern Italian NCH between 15 June and 25 July 2020 (i.e. 12-52 days after the end of national lockdown). Women and workers who had recently been in contact with COVID-19-positive patients/colleagues are more likely to report moderate-to-severe symptoms, with odds ratios of 2.2 and 1.7, respectively.

Keywords: COVID-19; anxiety; care home worker; mental health; nursing home worker; post-traumatic stress disorder.

Figure 1.

Official mortality rates by age group (percentage of people who died compared with the total registered positive cases in a given age group) as of 15 May 2020 [6]. About 94% of the deceased were aged 60 or over. Data source: Istituto Superiore di Sanità (ISS).

Figure 2.

Milestone events in the recent COVID-19 outbreak in Italy. From the beginning of March to 15 May 2020 the number of confirmed cases increased dramatically from 1694 to 223 885 [6]. According to official data from the ISS as of 15 May, COVID-19 had been related to 29 884 deaths (i.e. a mortality rate of about 13%) and 94% of the deceased were people aged above 60 [6]. We collected our data during the subacute-chronic phase, between mid-June and the end of July 2020. Although the country has entered Phase 2, more restrictive rules continue to be applied in NCH, where residents are particularly vulnerable to COVID-19.

Figure 3.

IASC pyramid of mental health and psychosocial support interventions in emergency settings [42]. Interventions across layers are intended to be complementary and not mutually exclusive. Interventions located at the top two levels of the pyramid (layers iii and iv) are the most specialized and focused on populations with high levels of symptomatology and/or mental disorders (e.g. psychotherapies, focused psychosocial interventions delivered by mental health specialists as psychologists). At the base of the pyramid, there are basic services and security (layer i), and general community support (layer ii), that are mainly focused on reinforcing and activating social networks and support [43].