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Distress of nurses and midwives during COVID-19 laid bare

PTSD, stress and anxiety were all found in frontline staff during the first wave of the pandemic



“Extremely concerning” levels of psychological distress were seen among the UK’s nurses and midwives during the COVID-19 pandemic, new research has revealed. 

From information collected at three points during the first wave of the pandemic in 2020, high levels of distress were found, including experiences consistent with post-traumatic stress disorder (PTSD), stress and anxiety. 

A combination of pre-existing workforce challenges, rapid changes to professional life and ways of working, high patient mortality rates, risk of illness to both the individual and their family, and the way in which healthcare organisations responded to the pandemic, may all have had significant impact, the research found. 

“We know that even prior to the pandemic, the UK nursing and midwifery workforce was under significant strain due to high levels of attrition and ongoing recruitment challenges,” said Dr Keith Couper, assistant professor in emergency and critical care at the University of Warwick and project lead. 

“Our study clearly highlights that staff experiences during the COVID-19 pandemic has had significantly exacerbated this strain. 

“The findings of our research show that the psychological impact of the pandemic on the UK nursing and midwifery workforce has been extremely concerning. The ongoing challenges during subsequent pandemic waves have likely exacerbated this impact.”

The Impact of COVID-19 on the Nursing and Midwifery workforce (ICON) study is a longitudinal national survey which aimed to assess the mental health effects of the pandemic over time on the nursing workforce and identify the personal and workplace factors associated with wellbeing to inform the response to the current pandemic and support preparation for future pandemics.

Key findings include:

  • A significant proportion of participants were identified as having probable PTSD. While this declined over the three surveys, almost 29.3 per cent continued to report experiences indicative of a probable post-traumatic stress disorder diagnosis three months after the first pandemic peak
  • Severe or extreme stress was reported by almost 17.5 per cent of respondents three months after the first pandemic peak
  • 40 per cent reported that they lacked confidence in infection prevention and control training that they had received, or that training had not been received
  • Six per cent felt that the correct personal protective equipment was not always available
  • Prevalence of some psychological issues decreased following the first pandemic peak, but a significant proportion of participants continued to experience negative psychological effects during the pandemic recovery phase.

The surveys were taken at three time points between 2-14 April 2020, 28 April-12 May 2020 and 30 July-20 August 2020 and provide insight into psychological impact of the pandemic during the first wave and into the recovery period.

The ICON study was developed by the Royal College of Nursing Research Society and led by the University of Warwick and King’s College London, with collaborators including Barts Health NHS Trust, City University of London, University of Nottingham, Cardiff University, University of Plymouth, and University of Surrey.

All members of the UK nursing and midwifery workforce were eligible to complete the survey, including registered nurses, registered midwives, student nurses, healthcare support workers, nursing associates, and trainee nursing associates. The survey was distributed by social media, the Royal College of Nursing, and other key professional organisations.

Across the three surveys, a total of 7,840 analysable responses were received.

These findings can inform how healthcare organisations should respond to staff wellbeing needs both during the current pandemic, and in planning for future pandemics, said the researchers. 

The study concluded that healthcare organisations should urgently implement evidence-based strategies to support the wellbeing of members of the nursing and midwifery workforce affected by the pandemic, and develop robust workforce plans in preparation for future pandemics.

Ruth Harris, professor of health care for older adults in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London, added: “Our findings should drive healthcare employers throughout the world to address shortcomings in their organisational response to COVID-19, and future health emergencies, to both prevent psychological issues developing and ensure that those affected receive timely high-quality evidence-based support during the pandemic and as needed thereafter.”


Girls and boys vary in negative experience of social media

The age at which each sex is most vulnerable to the negative impact differs, new data reveals



Girls and boys might be more vulnerable to the negative effects of social media use at different times during their adolescence, according to new research.

UK data shows that girls experience a negative link between social media use and life satisfaction when they are 11-13 years old and boys when they are 14-15 years old. 

This suggests sensitivity to social media use might be linked to developmental changes, possibly changes in the structure of the brain, or to puberty, which occurs later in boys than in girls. 

But, for both, social media use at the age of 19 years was again associated with a decrease in life satisfaction. 

At this age, say the researchers, it is possible social changes – such as leaving home or starting work – may make us vulnerable.

The team – including psychologists, neuroscientists and modellers from the Universities of Cambridge and Oxford, and the Donders Institute for Brain, Cognition and Behaviour – analysed two UK datasets comprising some 84,000 individuals between the ages of ten and 80 years old. 

These included longitudinal data – that is, data that tracks individuals over a period of time – on 17,400 young people aged 10-21 years old.

Social media has fundamentally changed how young people spend time, share information and talk to others. 

This has led to widespread concern about its potential negative impact. 

Yet, even after years of research, there is still considerable uncertainty about how social media relates to wellbeing. 

The team looked for a connection between estimated social media use and reported life satisfaction and found key periods of adolescence where social media use was associated with a subsequent decrease in life satisfaction.

The researchers also found teens who have lower than average life satisfaction later use more social media.

Dr Amy Orben, from the University of Cambridge, who led the study, said: “The link between social media use and mental wellbeing is clearly very complex. 

“Changes within our bodies, such as brain development and puberty, and in our social circumstances appear to make us vulnerable at particular times of our lives.

“I wouldn’t say that there is a specific age group we should all be worried about. 

“We should all be reflecting on our social media use and encouraging those conversations but we need to understand what is driving these changes across the age groups and between genders.

Professor Andrew Przybylski, of the Oxford Internet Institute, said: ‘To pinpoint which individuals might be influenced by social media, more research is needed that combines objective behavioural data with biological and cognitive measurements of development. 

“We therefore call on social media companies and other online platforms to do more to share their data with independent scientists, and, if they are unwilling, for governments to show they are serious about tackling online harms by introducing legislation to compel these companies to be more open.”

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Mental health impact of pandemic on older people revealed

Those who were shielding were almost twice as likely to experience depressive symptoms, research shows



Older people who were shielding throughout the COVID-19 pandemic were nearly twice as likely to experience depressive symptoms, new research has revealed. 

The study – the first to look at the mental wellbeing of older people in England – adds further evidence that isolation and shielding are strongly associated with depression, anxiety and lower quality of life. 

Lead author, Dr Giorgio Di Gessa, of UCL Institute of Epidemiology & Health Care, said: “When restrictions came into place in March 2020, around 3.8million (six per cent) people in the UK were ordered to shield, 74 per cent of whom were aged over 50. 

“Our study is the first of its kind to look at the effect shielding had on the mental wellbeing of older people in England. 

“We know from previous studies that the pandemic and policies restricting human interaction have posed a greater risk to mental health and well-being, especially among specific people in socioeconomic adversity, those with pre-existing poorer health, and those feeling lonely. 

“In our study we therefore took all these factors into account to understand if shielding and staying at home were additional factors contributing to poorer mental health among older people.”

The research team, from UCL and the University of Manchester, used data from over 5,000 adults aged over 50 who are part of the English Longitudinal Study of Ageing (ELSA) to investigate the link between shielding and mental health, after controlling for sociodemographic characteristics, pre-pandemic physical and mental health, and social isolation measures. 

The data was collected during the first eight to nine months of the pandemic, two of which were characterised by ongoing lockdowns.

Dr Di Gessa explained: “Our analysis supports the idea that shielding itself has been harmful, over and above other known vulnerabilities.

“One reason for this could be the psychological impact of being told so starkly of your own vulnerability and mortality and the policing of your own behaviour, and resulting anxiety and stress.”

Respondents were asked whether in April, June/July, and November/December 2020 they shielded (not going out of the house for any reasons), stayed at home (leaving only for very limited purposes, such as shopping for food, exercise, or essential work) or neither. 

Their mental health was then assessed by asking questions about depressive symptoms, anxiety, wellbeing and quality of life.

About 28 per cent of respondents reported that they shielded at least once, with five per cent shielding throughout the first eight to nine months of the pandemic. 

About a third reported staying at home all the time whereas 37 per cent neither shielded nor stayed at home. 

Among those adults who shielded at all times, in November and December 2020, 42 per cent reported elevated depressive symptoms compared to 23 per cent among those who never shielded nor stayed at home. 

Older people shielding throughout the period studied also reported the lowest life satisfaction and quality of life scores.

The researchers were able to account for pre-pandemic mental and physical health as well as for social contacts with family and friends and loneliness during the pandemic to better understand if the relationships observed between shielding and poorer mental health was driven by pre-existing conditions or reduced social interactions and higher loneliness during the pandemic.

“Policy makers need to be aware of adverse consequences for the mental health and well-being of those advised to shield or stay at home,” said Professor Debbie Price, co-author of the study, from the University of Manchester.

“If the long-term health and social wellbeing of older people is to be safeguarded, there must be careful thought given to addressing the mental health and wider needs of individuals at higher risk from COVID-19 variants, or future pandemics.”

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Arts and culture ‘can reduce anti-social behaviour’

The positive impact of taking part in such activities can last for up to two years, research reveals



Teenagers who take part in arts and cultural activities are less likely to engage in anti-social and criminal behaviour for up to two years later, new research has revealed. 

Researchers looked at data from more than 25,000 teenagers in the United States who had filled out questionnaires over several years.

They measured the teenagers’ overall engagement with arts activities based on a wide range of factors, from involvement in school clubs, orchestras, choirs, and arts classes outside school, to whether they had visited museums or been to concerts, or read on their own.

The team, from UCL and the University of Florida, found that the more of these activities the teenagers were involved in, the less likely they were to report being engaged in anti-social behaviour – ranging from misbehaving at school, to getting into fights, to criminalised behaviour such as stealing and selling drugs – both at the time of the first survey and when they were asked again about anti-social behaviour one and two years later.

The team also found that teenagers and young people who were more engaged in the arts were likely to have better self-control scores and view anti-social behaviour negatively. These outcomes have previously been found to make young people less likely to engage in anti-social and criminalised behaviours.

Senior author Dr Daisy Fancourt, of UCL Institute of Epidemiology & Health Care, said: “Past research has shown that getting involved in the arts can have a big impact on teenagers’ mental health and wellbeing.

Our study adds to evidence about the wide-ranging benefits that arts and culture can have for young people, demonstrating a positive link between the arts and a lower prevalence of anti-social behaviour.

“Notably these findings remained, even when taking into account factors such as children’s age, gender, ethnicity, socio-economic background, their parents’ educational background, where they lived, and their previous patterns of antisocial behaviours.”

Lead author Dr Jess Bone, also of UCL’s Institute of Epidemiology & Health Care, said: “Our definition of arts and cultural engagement was very broad. It included dancing and acting in school clubs, reading, going to cinemas, museums, concerts, and music classes, as well as other hobbies that teenagers took part in regularly.

“Finding ways to reduce antisocial behaviour among teenagers is important because these behaviours may become established and continue into adulthood, affecting someone’s whole life.

“Our findings demonstrate the importance of making arts and cultural activities available for all young people, particularly in the wake of the COVID-19 pandemic, which has limited access to and funding for these resources.”

Researchers looked at data from two US-based longitudinal studies, the National Longitudinal Study of Adolescent to Adult Health and the National Education Longitudinal Study of 1988, whose participants were nationally representative. 

The research team analysed questionnaires filled in by teenagers and their parents between 1988 and 2002. The average age of participants at the start of these studies was 14 to 15 years.

In one of the cohorts, about half of adolescents reported engaging in anti-social and criminalised behaviours in the last 12 months. The average number of times participants engaged in these behaviours over the year was 1.6.

Although the researchers found that arts engagement was linked to fewer positive perceptions of anti-social behaviour and better self-control scores, they could not conclude that these factors were causally responsible for the association between arts engagement and antisocial behaviour as the study was observational.

Nonetheless, in considering mechanisms through which the arts could reduce antisocial behaviour, the researchers cited previous studies showing improvements from arts engagement including increased empathy, more prosocial behaviour, reduced boredom and improved self-esteem, as well as better emotion regulation.

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