Suicidal Ideation of Healthcare Workers During COVID-19: An Ecological Momentary Assessment

Main Article Content

Christine Genest
https://orcid.org/0000-0002-2897-7003
Nicolas Bergeron
https://orcid.org/0000-0002-3373-3871
Émilie Provost-Tremblay
https://orcid.org/0000-0002-6566-5092
Marie-Michèle Dufour
https://orcid.org/0000-0003-4293-9246
Stéphane Guay
https://orcid.org/0000-0001-9638-3242
Steve Geoffrion
https://orcid.org/0000-0001-6514-2980

Abstract

Introduction: The COVID-19 pandemic had an impact on the psychological health of healthcare workers (HCWs). Cross-sectional studies report suicidal ideation in this population during this period, but no longitudinal study has examined the evolution of these ideas over time.


Objectives: To assess the evolution of suicidal ideation of HCWs during the first two waves of the COVID-19 pandemic among Quebec (Canada) HCWs and to identify the risk factors involved.


Methods: A longitudinal study among Quebec (Canada) HCWs using ecological momentary assessment was conducted between May 8, 2020, and March 31, 2021 (corresponding to the second half of the first wave to the end of the second). Participants (n=865) answered weekly questions related to anxiety (GAD-7), depression (PHQ-9), suicidal ideation (PHQ-9 Q.9), exposure to COVID-19, exposure to COVID-19-related deaths, their infection status and that of their co-workers and loved ones, as well as the amount of time they spent consuming news related to COVID-19.


Results: Proportion of suicidal ideation increased from May to June 2020 (second half of the first wave) peaking at 18% before declining up to March 2021. Anxiety and depression symptoms severity increased those ideations as well as having a colleague confirmed positive to COVID-19. Social support does not appear to be a protective factor for suicidal ideation. Suicidal thoughts are associated with media consumption and appear to be mediated by the presence of clinical distress expressed as depressive or anxiety states.


Discussion and conclusion: Media consumption in a pandemic context is associated with anxiety and depression, the more severe states of which may express suicidal ideation. Without inferring causality relationship, it seems advisable for HCWs to limit their media exposure during a disaster such as a pandemic.

Article Details

How to Cite
Genest, C., Bergeron, N., Provost-Tremblay, Émilie, Dufour, M.-M., Guay, S., & Geoffrion, S. (2022). Suicidal Ideation of Healthcare Workers During COVID-19: An Ecological Momentary Assessment. Science of Nursing and Health Practices, 5(2), 89–100. https://doi.org/10.7202/1095201ar
Section
Empirical research articles

References

Al-Humadi, S., Bronson, B., Muhlrad, S., Paulus, M., Hong, H., & Caceda, R. (2021). Depression, Suicidal Thoughts, and Burnout Among Physicians During the COVID-19 Pandemic: a Survey-Based Cross-Sectional Study. Acad Psychiatry, 45(5), 557-565. https://doi.org/10.1007/s40596-021-01490-3

Alonso, J., Vilagut, G., Mortier, P., Ferrer, M., Alayo, I., Aragón-Peña, A., Aragonès, E., Campos, M., Cura-González, I. D., & Emparanza, J. I. (2021). Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey. Revista de psiquiatria y salud mental, 14(2), 90-105. https://doi.org/10.1016/j.rpsm.2020.12.001

Amsalem, D., Lazarov, A., Markowitz, J. C., Naiman, A., Smith, T. E., Dixon, L. B., & Neria, Y. (2021). Psychiatric symptoms and moral injury among US healthcare workers in the COVID-19 era. BMC Psychiatry, 21(1), 546. https://doi.org/10.1186/s12888-021-03565-9

Awan, S., Diwan, M. N., Aamir, A., Allahuddin, Z., Irfan, M., Carano, A., Vellante, F., Ventriglio, A., Fornaro, M., Valchera, A., Pettorruso, M., Martinotti, G., Di Giannantonio, M., Ullah, I., & De Berardis, D. (2021). Suicide in Healthcare Workers: Determinants, Challenges, and the Impact of COVID-19. Front Psychiatry, 12, 792925. https://doi.org/10.3389/fpsyt.2021.792925

Bendau, A., Petzold, M. B., Pyrkosch, L., Mascarell Maricic, L., Betzler, F., Rogoll, J., Große, J., Ströhle, A., & Plag, J. (2021). Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany. European archives of psychiatry and clinical neuroscience, 271(2), 283-291. https://doi.org/10.1007/s00406-020-01171-6

Bentley, K. H., Franklin, J. C., Ribeiro, J. D., Kleiman, E. M., Fox, K. R., & Nock, M. K. (2016). Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clinical psychology review, 43, 30-46. https://doi.org/10.1016/j.cpr.2015.11.008

Bismark, M., Scurrah, K., Pascoe, A., Willis, K., Jain, R., & Smallwood, N. (2022). Thoughts of suicide or self-harm among Australian healthcare workers during the COVID-19 pandemic. Australian & New Zealand Journal of Psychiatry, 56(12), 1555-1565. https://doi.org/10.1177/00048674221075540

Buselli, R., Corsi, M., Veltri, A., Baldanzi, S., Chiumiento, M., Marino, R., Caldi, F., Perretta, S., Foddis, R., Cristaudo, A., & Guglielmi, G. (2022). Suicidal ideation and suicide commitment in Health Care Workers during COVID-19 pandemic: a review of the literature. International Journal of Occupational Safety and Health, 12(2), 117-124. https://doi.org/10.3126/ijosh.v12i2.40500

Cabarkapa, S., Nadjidai, S. E., Murgier, J., & Ng, C. H. (2020). The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain, behavior, & immunity-health, 8, 100144. https://doi.org/10.1016/j.bbih.2020.100144

Cai, C. Z., Lin, Y. L., Hu, Z. J., & Wong, L. P. (2021). Psychological and mental health impacts of COVID-19 pandemic on healthcare workers in China: A review. World Journal of Psychiatry, 11(7), 337-346. https://doi.org/10.5498/wjp.v11.i7.337

Chong, M.-Y., Wang, W.-C., Hsieh, W.-C., Lee, C.-Y., Chiu, N.-M., Yeh, W.-C., Huang, T.-L., Wen, J.-K., & Chen, C.-L. (2004). Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. The British journal of psychiatry, 185(2), 127-133. https://doi.org/10.1192/bjp.185.2.127

Costa, E., Macatangay, C., Balubar, N., & Narvaez, R. A. (2022). Pandemic Fatigue: A Concept Analysis. Health Notions, 6(6), 247-257.

Cyr, S., Marcil, M.-J., Marin, M.-F., Tardif, J.-C., Guay, S., Guertin, M.-C., Rosa, C., Genest, C., Forest, J., & Lavoie, P. (2021). Factors associated with burnout, post-traumatic stress and anxio-depressive symptoms in healthcare workers 3 months into the COVID-19 pandemic: an observational study. Frontiers in psychiatry, 1039. https://doi.org/10.3389/fpsyt.2021.668278

Domaradzki, J. (2021). The Werther effect, the Papageno effect or no effect? A literature review. International Journal of Environmental Research and Public Health, 18(5), 2396. https://doi.org/10.3390/ijerph18052396

Dufour, M.-M., Bergeron, N., Guay, S., & Geoffrion, S. (2022). Assessment of Psychological Distress in Health Care Workers During the First two Waves of COVID-19: A Follow-up of a Canadian Longitudinal Study. Chronic Stress, 6. https://doi.org/10.1177/24705470221108144

Dufour, M.-M., Bergeron, N., Rabasa, A., Guay, S., & Geoffrion, S. (2021). Assessment of psychological distress in health-care workers during and after the first wave of COVID-19: A canadian longitudinal study: Évaluation de la détresse psychologique chez les travailleurs de la santé durant et après la première vague de la COVID-19: Une étude longitudinale canadienne. The Canadian Journal of Psychiatry, 66(9), 807-814. https://doi.org/10.1177/07067437211025217

Giri, S. P., & Maurya, A. K. (2021). A neglected reality of mass media during COVID-19: Effect of pandemic news on individual's positive and negative emotion and psychological resilience. Personality and Individual Differences, 180, 110962. https://doi.org/10.1016/j.paid.2021.110962

Hagan, C. R., Podlogar, M. C., Chu, C., & Joiner, T. E. (2015). Testing the interpersonal theory of suicide: The moderating role of hopelessness. International Journal of Cognitive Therapy, 8(2), 99-113. https://doi.org/10.1521/ijct.2015.8.2.99

Holman, E. A., Garfin, D. R., Lubens, P., & Silver, R. C. (2020). Media exposure to collective trauma, mental health, and functioning: does it matter what you see? Clinical Psychological Science, 8(1), 111-124. https://doi.org/10.1177/2167702619858300

Kivelä, L., van der Does, W. A. J., Riese, H., & Antypa, N. (2022). Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research. Frontiers in Digital Health, 4, 876595. https://doi.org/10.3389/fdgth.2022.876595

Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2010). The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. General hospital psychiatry, 32(4), 345-359. https://doi.org/10.1016/j.genhosppsych.2010.03.006

Kroenke, S., Spitzer, R. L., & Janet, B. (2001). Williams. The PHQ-9. Journal of general internal medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Mortier, P., Vilagut, G., Ferrer, M., Serra, C., Molina, J. D., Lopez-Fresnena, N., Puig, T., Pelayo-Teran, J. M., Pijoan, J. I., Emparanza, J. I., Espuga, M., Plana, N., Gonzalez-Pinto, A., Orti-Lucas, R. M., de Salazar, A. M., Rius, C., Aragones, E., Del Cura-Gonzalez, I., Aragon-Pena, A.,… Group, M. W. (2021). Thirty-day suicidal thoughts and behaviors among hospital workers during the first wave of the Spain COVID-19 outbreak. Depress Anxiety, 38(5), 528-544. https://doi.org/10.1002/da.23129

Pfefferbaum, B., Newman, E., Nelson, S. D., Nitiéma, P., Pfefferbaum, R. L., & Rahman, A. (2014). Disaster media coverage and psychological outcomes: descriptive findings in the extant research. Current psychiatry reports, 16(9), 1-7. https://doi.org/10.1007/s11920-014-0464-x

Québec, I. n. d. s. p. d. (23 novembre 2022). Données COVID-19 par vague selon l’âge et le sexe au Québec. https://www.inspq.qc.ca/covid-19/donnees/age-sexe

Robles, R., Rodríguez, E., Vega-Ramírez, H., Álvarez-Icaza, D., Madrigal, E., Durand, S., Morales-Chainé, S., Astudillo, C., Real-Ramírez, J., Medina-Mora, M.-E., Becerra, C., Escamilla, R., Alocer-Castillejos, N., Ascencio, L., Diaz, D., Gonzalez, H., Barron-Velazquez, E., Fresan, A., Rodriguez-Bores, L.,… Reyes-Reran, G. (2020). Mental health problems among healthcare workers involved with the COVID-19 outbreak. Brazilian Journal of Psychiatry, 43, 494-503. https://doi.org/10.1590/1516-4446-2020-1346

Salman, M., Raza, M. H., Mustafa, Z. U., Khan, T. M., Asif, N., Tahir, H., Shehzadi, N., & Hussain, K. (2020). The psychological effects of COVID-19 on frontline healthcare workers and how they are coping: a web-based, cross-sectional study from Pakistan. MedRxiv. https://doi.org/10.1101/2020.06.03.20119867

Smallwood, N., Harrex, W., Rees, M., Willis, K., & Bennett, C. M. (2022). COVID‐19 infection and the broader impacts of the pandemic on healthcare workers. Respirology, 27(6), 411-426. https://doi.org/10.1111/resp.14208

Spitzer, R., Kroenke, K., & Williams, J. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092-1097. https://doi.org/10.1001/archinte.166.10.1092

Su, Z., McDonnell, D., Wen, J., Kozak, M., Abbas, J., Šegalo, S., Li, X., Ahmad, J., Cheshmehzangi, A., & Cai, Y. (2021). Mental health consequences of COVID-19 media coverage: the need for effective crisis communication practices. Globalization and health, 17(1), 1-8. https://doi.org/10.1186/s12992-020-00654-4

Turecki, G., & Brent, D. A. (2016). Suicide and suicidal behaviour. The Lancet, 387(10024), 1227-1239. https://doi.org/10.1016/S0140-6736(15)00234-2

Vizheh, M., Qorbani, M., Arzaghi, S. M., Muhidin, S., Javanmard, Z., & Esmaeili, M. (2020). The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. Journal of Diabetes & Metabolic Disorders, 19(2), 1967-1978. https://doi.org/10.1007/s40200-020-00643-9

Wilbiks, J. M., Best, L. A., Law, M. A., & Roach, S. P. (2021). Evaluating the mental health and well-being of Canadian healthcare workers during the COVID-19 outbreak. Healthcare Management Forum, 34(4), 205-210. https://doi.org/ 10.1177/08404704211021109