Vicar Traumatization from Covid-19: Psychosocial Consequences for Healthcare Workers and General Population in China
The field of health sciences, in the fight against Coronavirus, today faces two emergencies and emergencies. If on the one hand we work tirelessly for the discovery of a vaccine, understanding the consequences on mental health of a global and unprecedented pandemic like the one we are experiencing is equally a priority.
Advertising message For this reason, universities and research institutes all over the world are working to collect, in the form of online surveys, data that investigate the effects and risks of quarantine on the psychological well-being of individuals. Currently 2.6 billion people live in a form of lockdown, or a third of the world population; the greatest psychosocial experiment that has ever been witnessed and whose toxic effects need to be mitigated, if you do not want to pay an even higher price.
Of great help, in understanding the psychosocial effects caused by the virus, is the scientific literature of previous epidemics, in particular the Lancet review (2020) which collects 24 studies investigating the psychosocial impact of quarantine on individuals.
Among the most common effects emerge: irritability and mood disorders, but also stress, insomnia, anxiety, anger, depression and post traumatic stress symptoms. This overview allows retrospective research to create models for predicting the consequences of the pandemic. But a fundamental reading key, as well as a chronological advantage, in the understanding of the current phenomenon, is played by the studies currently conducted in China.
With regard to the effects on the general Chinese population, it has emerged that a higher psychological impact is registered in the female gender, in the student category and in those suffering from particular physical symptoms. On the other hand, elements that suggest a greater psychological well-being are informed but thoughtful research on pandemic developments and the adoption of preventive measures (Wang et. Al., 2020).
With reference to the psychosocial effects on healthcare workers, as already highlighted in the Lancet review, research conducted in China also shows how the mental health of the medical staff is exposed to heavier and persistent risks over time. Specifically, the most affected category is the nursing staff, more than the medical one. In fact, the psychosocial effects of quarantine in healthcare personnel not only affect the personal sphere, but also affect the working sphere. Many healthcare professionals are witnessing a deterioration in work performance, avoidance behaviors, reluctance to do their job again and consideration of resignation. In addition, the manifestation of symptoms can extend or occur up to 3 years after the end of the traumatic event.
Advertising message A new and interesting effect is reported by the Nanjing Hospital, which made a comparison between first-line nurses (in close contact with patients infected by Covid) and non-front-line nurses and volunteers (involved in the emergency but not in close contact with Covid patients). The relevance of the study lies in having paid attention, among the various psychosocial consequences of the pandemic, to vicarious traumatization. The literature describes vicarious trauma as post-traumatic suffering, similar to the experiences of direct victims (Brady et al., 1999). The term, proposed by Pearlman, initially referred to the psychotherapeutic context, or to that phenomenon of empathic involvement, by the psychotherapist, in particular traumatic experiences of patients. This phenomenon allows the psychotherapist to experience mental symptoms similar to the patient’s psychological trauma. (Collins and Long, 2003). The definition of vicarious trauma was then extended to a large number of catastrophic events in which the severity of the damage exceeds people’s emotional and psychological tolerance, causing psychological anomalies generated by emotional and physical closeness with those who experience the trauma itself (Sinclair and Hamill , 2007). The main symptoms of vicarious traumatization are loss of appetite, sleep disturbance, physical decline, numbness, inattention, fear and despair. The relevant finding that emerged from the study at Nanjing Hospital is that staff not directly involved in the front line experienced higher stress related symptoms than those who operated on the front line,
The study involved 214 volunteers from the general population and 526 nurses (of which 234 on the front line and 292 not on the front line), for a total of 740 individuals. The study was conducted through an anonymous questionnaire structured using the “Sojump” app that users received via WeChat following informed consent. The questionnaire consisted of 38 items investigating physiological and psychological responses. Frontline nurses were found to have lower vicarious traumatization scores than nurses not directly involved. There were no significant differences, however, within the “not on the front line” category between the nurses and volunteers involved.
The reasons for this evidence can be traced back to two reasons: first of all, the fact that the nurses on the front lines volunteered for the role with adequate psychological preparation. In addition, the level of experience and practice of the frontline staff was highly qualified and relevant, coming mostly from intensive care units and internal medicine. These elements probably played from protective factors in a more severe development of vicarious traumatization. This is also demonstrated by the fact that, in frontline nurses, vicarious trauma resulted from empathizing with the Covid patients they cared for, while non-frontline and volunteer nurses extended their concern to frontline colleagues line.
The study certainly presents the limit of a sample made up mainly of nurses, who although constituting the largest portion of the population under study, do not fully represent the sample of the medical staff. However, the results obtained bring to light a psychological consequence of the pandemic on which attention had not yet been paid, both in medical personnel and in the general population, which should be investigated.
In conclusion, it is possible to say that a preventive intervention on vicarious traumatization and psychological stress in the populations mentioned, combined with correct and transparent information on the epidemic, can stem the psychological effects of Covid and facilitate its treatment.