DOI QR코드

DOI QR Code

The Effect of Stress on Anxiety and Depressed Mood and the Mediating Effect of Resilience in Medical Residents and Interns During Coronavirus Disease-19 Event

코로나바이러스감염증-19 사태에 따른 전공의 및 수련의의 스트레스 인지도가 불안 및 우울에 미치는 영향과 회복탄력성의 매개효과

  • Cho, Ho-Young (Department of Psychiatry, Konyang University Hospital) ;
  • Kim, Seung-Jun (Department of Psychiatry, Konyang University Hospital) ;
  • Kim, Ji-Woong (Department of Psychiatry, Konyang University Hospital) ;
  • Oh, Hong-Seok (Department of Psychiatry, Konyang University Hospital) ;
  • Im, Woo-Young (Department of Psychiatry, Konyang University Hospital) ;
  • Lee, Na-Hyun (Department of Psychiatry, Konyang University Hospital)
  • 조호영 (건양대학교병원 정신건강의학과) ;
  • 김승준 (건양대학교병원 정신건강의학과) ;
  • 김지웅 (건양대학교병원 정신건강의학과) ;
  • 오홍석 (건양대학교병원 정신건강의학과) ;
  • 임우영 (건양대학교병원 정신건강의학과) ;
  • 이나현 (건양대학교병원 정신건강의학과)
  • Received : 2022.05.16
  • Accepted : 2022.06.22
  • Published : 2022.06.30

Abstract

Objectives : In this study, we evaluate psychological stress, symptoms of anxiety and depressed mood and resilience which medical residents and interns perceived during COVID-19 event, then investigate the associations between stress and the symptoms and mediating effect of resilience on the associations. Methods : In this study, we made a self-reporting form to evaluate psychological stress with perceived stress scale (PSS), symptoms of anxiety and depressed mood with Hospital anxiety and depression scale (HAD), and resilience with Conner-Davidson Resilience Scale (CD-RISC). Medical residents and interns, who worked in a hospital during COVID-19 event, filled the self-reporting forms from july, 2020 to august, 2020. We conducted a Pearson correlation coefficient and a multiple regression to confirm association between psychological stress and symptoms of anxiety and depressed mood, then mediating effect of resilience. Results : The higher stress perceived, the more symptoms of anxiety and depressed mood were reported by medical residents and interns. The higher resilience is associated with lower stress and less symptoms of anxiety and depressed mood, which resilience is proven to mediate partially the association between stress and symptoms of depressed mood. Conclusions : This study shows that resilience has a partial mediating effects on the association between stress and psychological pathology especially depressed mood, given that medical residents and interns were under psychological distress during COVID-19 event. This suggests that resilience is the key for medical trainees to overcome the future crisis like COVID-19 event.

연구목적 본 연구는 코로나바이러스감염증-19 대유행 중 전공의 및 수련의의 스트레스와 불안 및 우울 간 상관관계를 파악하고 회복탄력성의 매개효과를 평가하고자 한다. 방 법 코로나바이러스감염증-19 대유행 기간 중 일개 대학병원에서 근무한 전공의 및 수련의를 대상으로 자가보고식 설문 조사를 통해 스트레스 인지도, 불안 및 우울, 회복탄력성 정도를 평가하였다. 이후 각 변인 간 상관관계를 평가하고 회복탄력성의 매개효과 검증절차를 시행하였다. 결 과 총 74명의 참여자에게서 스트레스 평균 18.79점, 불안 총점 평균 6.24점, 우울 총점 평균 7.81점으로 나타났고, 불안과 우울의 고위험군은 각각 28명(37.8%), 41명(55.4%)로 나타났다. 스트레스 총점이 높을수록 불안과 우울의 총점이 높게 나타났으며, 회복탄력성 총점이 높을수록 스트레스 총점, 불안 및 우울 총점 모두 낮게 나타났다. 회복탄력성의 매개효과는 스트레스와 우울 총점 간 상관관계에서만 통계적으로 유의했다. 결 론 코로나 바이러스 감염증-19 유행 기간 중 전공의 및 수련의에게서 높은 수준의 스트레스를 보였고, 이들 중 상당수가 불안 및 우울장애의 고위험군으로 확인되었다. 스트레스는 우울 및 불안을 증가시키며 이중 우울은 회복탄력성에 의해 완화될 수 있음을 보였다.

Keywords

References

  1. World Health Organization. [Origin of SARS-CoV-2 virus]. [updated 2021 March 30;cited 2022 May 1]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/origins-of-the-virus.
  2. Korea Disease Control and Prevention Agency. [Latest updates in coronavirus disease-19, Republic of Korea]. [updated 2022 May 1;cited 2022 May 1]. Available from: http://ncov.mohw.go.kr/.
  3. Chung MJ. Infectious disease, safety, state: history of infectious disease prevention and MERS situation. Critical Studies on Modern Korean History 2015;34:517-542.
  4. Meredith LS, Eisenman DP, Tanielian T, Taylor SL, Basurto-Davila R, Zazzali J, Diamond D, Cienfuegos B, Shields S. Prioritizing "psychological" consequences for disaster preparedness and response: a framework for addressing the emotional, behavioral, and cognitive effects of patient surge in largescale disasters. Disaster Med Public Health Prep 2011;5:73-80. https://doi.org/10.1001/dmp.2010.47
  5. World Health Organization. Pandemic influenza preparedness and response: a WHO guidance document. Geneva: World Health Organization; 2009.
  6. Pappas G, Kiriaze IJ, Giannakis P, Falagas ME. Psychosocial consequences of infectious diseases. Clin Microbiol Infect 2009;15:743-747. https://doi.org/10.1111/j.1469-0691.2009.02947.x
  7. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, Zandi MS, Lewis G, David AS. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry 2020;7:611-627. https://doi.org/10.1016/S2215-0366(20)30203-0
  8. Cheng SK, Wong CW, Tsang J, Wong KC. Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS). Psychol Med 2004;34:1187-1195. https://doi.org/10.1017/S0033291704002272
  9. Mak IW, Chu CM, Pan PC, Yiu MG, Chan VL. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry 2009;31:318-326. https://doi.org/10.1016/j.genhosppsych.2009.03.001
  10. Shin J, Park HY, Kim JL, Lee JJ, Lee H, Lee SH, Shin HS. Psychiatric morbidity of survivors one year after the outbreak of Middle East respiratory syndrome in Korea, 2015. J Korean Neuropsychiatr Assoc 2019;58:245-251. https://doi.org/10.4306/jknpa.2019.58.3.245
  11. Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma AS, Muana AT, Hann K, Eaton J, Martin S, Nellums LB. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ 2016 94:210-214. https://doi.org/10.2471/blt.15.158543
  12. Gomez-Ochoa SA, Franco OH, Rojas LZ, Raguindin PF, Roa-Diaz ZM, Wyssmann BM, Guevara SLR, Echeverria LE, Glisic M, Muka T. COVID-19 in health-care workers: a living systematic review and meta-analysis of prevalence, risk factors, clinical characteristics, and outcomes. Am J Epidemiol 2021;190:161-175. https://doi.org/10.1093/aje/kwaa191
  13. Maunder RG, Lancee WJ, Rourke S, Hunter JJ, Goldbloom D, Balderson K, Petryshen P, Steinberg R, Wasylenki D, Koh D, Fones CS. Factors associated with the psychological impact of severe acute respiratory syndrome on nurses and other hospital workers in Toronto. Psychosom Med 2004;66:938-942. https://doi.org/10.1097/01.psy.0000145673.84698.18
  14. Ho SM, Kwong-Lo RS, Mak CW, Wong JS. Fear of severe acute respiratory syndrome (SARS) among health care workers. J Consult Clin Psychol 2005;73:344-349. https://doi.org/10.1037/0022-006X.73.2.344
  15. Wong TW, Yau JK, Chan CL, Kwong RS, Ho SM, Lau CC, Lau FL, Lit CH. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med 2005;12:13-18. https://doi.org/10.1097/00063110-200502000-00005
  16. Bai Y, Lin CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv 2004;55:1055-1057. https://doi.org/10.1176/appi.ps.55.9.1055
  17. Nickell LA, Crighton EJ, Tracy CS, Al-Enazy H, Bolaji Y, Hanjrah S, Hussain A, Makhlouf S, Upshur RE. Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. CMAJ 2004;170:793-798. https://doi.org/10.1503/cmaj.1031077
  18. Maunder R. The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: lessons learned. Philos Trans R Soc Lond B Biol Sci 2004;359:1117-1125. https://doi.org/10.1098/rstb.2004.1483
  19. Verma S, Mythily S, Chan YH, Deslypere JP, Teo EK, Chong SA. Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore. Ann Acad Med Singap 2004 ;33:743-748.
  20. Um DH, Kim JS, Lee HW, Lee SH. Psychological effects on medical doctors from the Middle East Respiratory Syndrome (MERS) Outbreak: a comparison of whether they worked at the MERS occurred hospital or not, and whether they participated in MERS diagnosis and treatment. J Korean Neuropsychiatr Assoc 2017;56:28-34. https://doi.org/10.4306/jknpa.2017.56.1.28
  21. Schneider JM. Finding my way: healing and transformation through loss and grief. Colfax, WI; Seasons Press;1994.
  22. Connor KM. Assessment of resilience in the aftermath of trauma. J Clin Psychiatry 2006;67 Suppl 2:46-49.
  23. Charney DS. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry 2004;161:195-216. https://doi.org/10.1176/appi.ajp.161.2.195
  24. Rutter M. Resilience in the face of adversity. Protective factors and resistance to psychiatric disorder. Br J Psychiatry 1985;147:598-611. https://doi.org/10.1192/bjp.147.6.598
  25. Dyer JG, McGuinness TM. Resilience: analysis of the concept. Arch Psychiatr Nurs 1996;10:276-82. https://doi.org/10.1016/S0883-9417(96)80036-7
  26. Kwon HM, Kim TH, Choi MR, Kim BJ, Kim HW, Song OS, Eun HJ. The Effects of Middle East Respiratory Syndrome (MERS) Event on the Psychosocial Wellbeing of Healthcare Workers and the Public with the Mediating Effect of Resilience. Korean J Psychosom Med 2017;25:111-119. https://doi.org/10.22722/KJPM.2017.25.2.111
  27. Khoodoruth MAS, Al-Nuaimi SK, Al-Salihy Z, Ghaffar A, Khoodoruth WNC, Ouanes S. Factors associated with mental health outcomes among medical residents exposed to COVID-19. BJPsych Open 2021;7:e52. https://doi.org/10.1192/bjo.2021.12
  28. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-396. https://doi.org/10.2307/2136404
  29. Hong GR, Kang HK, Oh E, Park Y, Kim H. Reliability and Validity of the Korean Version of the Perceived Stress Scale-10 (K-PSS-10) in Older Adults. Res Gerontol Nurs 2016;9:45-51. https://doi.org/10.3928/19404921-20150806-72
  30. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
  31. Oh SM, Min KJ, Park DB. A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups. J Korean Neuropsychiatr Assoc 1999;38:289-296.
  32. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003;18:76-82. https://doi.org/10.1002/da.10113
  33. Baek HS, Lee KU, Joo EJ, Lee MY, Choi KS. Reliability and Validity of the Korean Version of the Connor-Davidson Resilience Scale. Psychiatry Investig 2010;7:109-115. https://doi.org/10.4306/pi.2010.7.2.109
  34. Baron RM, Kenny D. The moderator-mediator variable distinction in social psychological research. Journal of Personality and Social Psychology 1986;51:1173-1182. https://doi.org/10.1037/0022-3514.51.6.1173
  35. Chua SE, Cheung V, Cheung C, McAlonan GM, Wong JW, Cheung EP, Chan MT, Wong MM, Tang SW, Choy KM, Wong MK, Chu CM, Tsang KW. Psychological effects of the SARS outbreak in Hong Kong on high-risk health care workers. Can J Psychiatry 2004;49:391-393. https://doi.org/10.1177/070674370404900609
  36. Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The social psychology of health: Claremont Symposium on Applied Social Psychology. Newbury Park (CA): Sage Publications, Inc; 1988.
  37. National Center of Mental Health. National Mental Health Survey 2021. Korea Ministry of Health and Welfare: KyungSung;2021. p54-107.
  38. Muller AE, Hafstad EV, Himmels JPW, Smedslund G, Flottorp S, Stensland SO, Stroobants S, Van de Velde S, Vist GE. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: a rapid systematic review. Psychiatry Res 2020;293:113441. https://doi.org/10.1016/j.psychres.2020.113441
  39. Liang Y, Wu K, Zhou Y, Huang X, Zhou Y, Liu Z. Mental health in frontline medical workers during the 2019 novel coronavirus disease epidemic in China: a comparison with the general population. Int J Environ Res Public Health 2020;17:6550. https://doi.org/10.3390/ijerph17186550
  40. Dyer JG, McGuinness TM. Resilience: analysis of the concept. Arch Psychiatr Nurs 1996;10:276-282. https://doi.org/10.1016/S0883-9417(96)80036-7
  41. Rapp CA, Wintersteen R. The strengths model of case management: Results from twelve demostrations. Psychosocial Rehabilitation Journal 1989;13:23-32. https://doi.org/10.1037/h0099515