Work and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic

Santos Junior, Darci Francisco dos; Bittencourt, Marina Nolli; Marcheti, Priscila Maria; Pena, José Luís da Cunha; Chaves, Suellen Cristina da Silva; Gonçalves, Angélica Martins de Souza; Domingos, Alessandra Matheus; Nóbrega, Maria do Perpétuo do Socorro de Sousa

doi:10.1590/0034-7167-2022-0792

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 76 (6) • 2023 • https://doi.org/10.1590/0034-7167-2022-0792 copy

Work and Mental Distress among Nurses in the Amazon Region of Brazil during the COVID-19 Pandemic

Trabajo y malestar mental entre las enfermeras en la región amazónica de Brasil durante la pandemia de COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To assess the relationship between psychopathological symptoms and the social, clinical, and occupational profile of nurses in the Amazon region of Brazil during the COVID-19 pandemic.

Methods:

A descriptive cross-sectional online study was conducted in 2020 with 261 nurses. The Symptom Assessment Scale-40 was utilized.

Results:

The presence of pre-existing conditions before the pandemic was associated with psychotism (p=0.044). Experiencing constraints and/or violence at work during the pandemic was associated with somatization (p=0.025), and working hours were associated with anxiety (p=0.025). Nurses predominantly exhibited symptoms related to fear (33.7%), tension (34.5%), and a sense that something is wrong in the mind (22.6%).

Conclusions:

A significant association was observed between working hours and anxiety symptoms, the experience of constraints and/or violence at work during the COVID-19 pandemic and somatization symptoms, as well as between pre-existing conditions and psychotism symptoms related to COVID-19.

Descriptors:
COVID-19; Mental Health; Nursing; Amazonian Ecosystem; Psychic Symptoms

	Extremely Concerned	Not Concerned	Slightly Concerned
	n(%)	n(%)	n(%)
Psychoticism
Weakness or dizziness	51(19.5)	127(48.7)	83(31.8)
Heart or chest pain	55(21.1)	126(48.3)	80(30.7)
Fear in open spaces or on the streets	74(28.4)	105(40.2)	82(31.4)
Suicidal thoughts	10(3.8)	222(85.1)	29(11.1)
Sudden unexplained fear	58(22.2)	122(46.7)	81(31.0)
Fear of going out alone	34(13.0)	163(62.5)	64(24.5)
Back and hip pain	82(31.4)	94(36.0)	85(32.6)
Feeling of insignificance	60(23.0)	134(51.3)	67(25.7)
Fear	88(33.7)	69(26.4)	104(39.8)
Nausea. queasiness. or upset stomach	59(22.6)	130(49.8)	72(27.6)
Obsessive-Compulsivity
Muscle aches (body pain)	87(33.3)	76(29.1)	98(37.5)
Feeling observed and subject to comments by others	32(12.3)	171(65.5)	58(22.2)
Fear of taking buses. subways. or trains	65(24.9)	135(51.7)	61(23.4)
Difficulty breathing	40(15.3)	135(51.7)	86(33.0)
Episodes of hot or cold sensations	42(16.1)	138(52.9)	81(31.0)
Need to avoid certain things. places. or activities that trigger fear	75(28.7)	113(43.3)	73(28.0)
Mental lapses or momentary inability to think or recall information	70(26.8)	110(42.1)	81(31.0)
Numbness or tingling in specific body parts	44(16.9)	157(60.2)	60(23.0)
Sense of hopelessness regarding the future	58(22.2)	102(39.1)	101(38.7)
Somatization
Difficulty concentrating	82(31.4)	78(29.9)	101(38.7)
Feeling weakness in certain body parts	46(17.6)	125(47.9)	90(34.5)
Feeling tense or stuck	90(34.5)	81(31.0)	90(34.5)
Experiencing heaviness in the arms and legs	53(20.3)	136(52.1)	72(27.6)
Feeling uncomfortable when being observed or talked about by others	46(17.6)	153(58.6)	62(23.8)
Having to repeat the same actions. such as touching. counting. or washing	56(21.5)	125(47.9)	80(30.7)
Having urges to break or destroy things	25(9.6)	189(72.4)	47(18.0)
Feeling excessively self-conscious or overly concerned about others	60(23.0)	122(46.7)	79(30.3)
Feeling that everything requires an excessive amount of effort	54(20.7)	123(47.1)	84(32.2)
Anxiety
Waves of terror or panic	36(13.8)	164(62.8)	61(23.4)
Frequently getting involved in arguments	26(10.0)	178(68.2)	57(21.8)
Feeling nervous when left alone	28(10.7)	176(67.4)	57(21.8)
Feeling lonely even in the company of others	41(15.7)	136(52.1)	84(32.2)
Feeling excessively restless and unable to stay still	44(16.9)	152(58.2)	65(24.9)
Engaging in spinning or throwing objects	16(6.1)	212(81.2)	33(12.6)
Fear of fainting in public	14(5.4)	216(82.8)	31(11.9)
Persistent sense of detachment from others	23(8.8)	183(70.1)	55(21.1)
Feelings of guilt	46(17.6)	157(60.2)	58(22.2)
Belief that something is wrong with your mind	59(22.6)	143(54.8)	59(22.6)

	Mean	Standard Deviation	Cronbach's Alpha if the item is excluded
Psychoticism
Weakness or dizziness	2.123	0.707	0.707
Heart or chest pain	2.096	0.714	0.702
Feeling fear in open spaces or on the streets	2.031	0.774	0.695
Thoughts of suicide	2.073	0.380	0.716
Sudden onset of fear without reason	2.088	0.726	0.675
Fear of going out alone	2.115	0.603	0.696
Back and hip pain	2.011	0.801	0.662
Feeling of insignificance	2.027	0.698	0.692
Feeling afraid	2.061	0.857	0.686
Nausea. queasiness. or upset stomach	2.050	0.708	0.696
Obsessive-Compulsivity
Muscle soreness (body pain)	2.042	0.842	0.689
Feeling under surveillance and subject to scrutiny by others	2.100	0.580	0.685
Compulsive checking and rechecking of tasks	2.192	0.719	0.690
Fear of using buses. subways. or trains	1.985	0.696	0.695
Difficulty breathing	2.176	0.673	0.690
Episodes of sudden heat or cold sensations	2.149	0.671	0.672
Necessity to avoid specific things. places. or activities that provoke fear	1.992	0.754	0.684
Temporary cognitive lapses or memory lapses	2.042	0.761	0.702
Numbness or tingling sensations in body parts	2.061	0.629	0.686
Experiencing a sense of hopelessness regarding the future	2.165	0.764	0.708
Somatization
Difficulty concentrating	2.073	0.836	0.701
Feeling weakness in certain body parts	2.169	0.703	0.689
Feeling tense or trapped	2.000	0.832	0.684
Experiencing heaviness in the arms and legs	2.073	0.690	0.701
Feeling uncomfortable when being observed or talked about by others	2.061	0.642	0.712
Having to repeat the same actions. such as touching. counting. or washing	2.092	0.717	0.726
Having urges to break or destroy objects	2.084	0.519	0.735
Feeling excessively self-conscious or concerned about others	2.073	0.728	0.715
Feeling restless in crowded places. while shopping. or at the cinema	1.989	0.731	0.717
Feeling that everything requires excessive effort	2.115	0.719	0.706
Anxiety
Feeling nervous when left alone	2.111	0.561	0.734
Feeling lonely even when surrounded by others	2.165	0.673	0.750
Feeling restless to the point of being unable to sit still	2.080	0.642	0.745
Engaging in spinning or throwing objects	2.065	0.429	0.758
Fear of fainting in public	2.065	0.411	0.767
Persistent sense of emotional distance from others	2.123	0.534	0.742
Experiencing feelings of guilt	2.046	0.631	0.730
Belief that something is wrong with your mind	2.000	0.674	0.727

Variable	Psychoticism		Obsessive-Compulsivity		Somatization		Anxiety
Variable	Mean ± SD	p value	Mean ± SD	p value	Mean ± SD	p value	Mean ± SD	p value
Age Group		0.829² 2 Kruskal-Wallis test.		0.469² 2 Kruskal-Wallis test.		0.642² 2 Kruskal-Wallis test.		0.496² 2 Kruskal-Wallis test.
20-39 years	2.05±0.39		2.08±0.37		2.07±0.35		2.07±0.34
40-59 years	2.09±0.36		2.11±0.39		2.11±0.35		2.11±0.32
≥60 years	2.20±0.26		1.93±0.15		2.05±0.09		2.00±0.00
Gender		0.391¹ 1 Mann-Whitney U test;		0.391¹ 1 Mann-Whitney U test;		0.810¹ 1 Mann-Whitney U test;		0.206¹ 1 Mann-Whitney U test;
Female	2.06±0.37		2.08±0.38		2.08±0.35		2.08±0.33
Male	2.10±0.38		2.12±0.34		2.08±0.31		2.01±0.31
Total Monthly Income		0.127² 2 Kruskal-Wallis test.		0.915² 2 Kruskal-Wallis test.			0.833² 2 Kruskal-Wallis test.	0.732² 2 Kruskal-Wallis test.
< 1 minimum wage (MW)	2.12±0.31		2.06±0.17		2.09±0.25		2.08±0.18
1-3 MW	2.02±0.39		2.08±0.38		2.06±0.36		2.06±0.32
4-6 MW	2.06±0.37		2.09±0.38		2.09±0.34		2.07±0.36
7-9 MW	2.13±0.35		2.05±0.45		2.05±0.39		2.06±0.33
≥ 10 MW	2.24±0.33		2.20±0.34		2.18±0.29		2.19±0.30
Pre-existing Diseases		0.044¹ 1 Mann-Whitney U test;		0.104¹ 1 Mann-Whitney U test;			0.536¹ 1 Mann-Whitney U test;	0.298¹ 1 Mann-Whitney U test;
Yes	1.98±0.42		2.02±0.44		2.04±0.41		2.02±0.37
No	2.10±0.35		2.12±0.34		2.10±0.31		2.11±0.31
Weekly Workload		0.411² 2 Kruskal-Wallis test.		0.664² 2 Kruskal-Wallis test.			0.076² 2 Kruskal-Wallis test.	0.052² 2 Kruskal-Wallis test.
Over 44 hours per week	2.01±0.41		2.00±0.45		1.96±0.42		1.98±0.46
40 hours per week	2.10±0.37		2.12±0.37		2.11±0.34		2.09±0.31
20 hours per week	2.11±0.29		2.11±0.31		2.13±0.34		2.03±0.33
36 hours per week	2.03±0.30		2.08±0.34		2.11±0.25		2.17±0.22
Weekly Workload
44 hours per week	2.23±0.53		2.19±0.40		2.17±0.43		2.11±0.36
Not applicable	2.08±0.41		2.12±0.34		2.11±0.34		2.12±0.22
Experienced constraints and/or violence in the workplace during the COVID-19 pandemic		0.596² 2 Kruskal-Wallis test.		0.286² 2 Kruskal-Wallis test.		0.025² 2 Kruskal-Wallis test.		0.279² 2 Kruskal-Wallis test.
Yes	2.03±0.44		2.02±0.46		2.00±0.41		2.05±0.42
Not	2.10±0.31		2.12±0.33		2.12±0.30		2.10±0.26
Not applicable	2.03±0.45		2.15±0.32		2.13±0.32		2.14±0.28
Received psychological/emotional support from their workplace during the COVID-19 context		0.218¹ 1 Mann-Whitney U test;		0.578¹ 1 Mann-Whitney U test;		0.207¹ 1 Mann-Whitney U test;		0.656¹ 1 Mann-Whitney U test;
Yes	2.15±0.29		2.13±0.31		2.15±0.29		2.14±0.27
No	2.05±0.39		2.08±0.39		2.07±0.35		2.08±0.34

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[1] Corresponding author: Maria do Perpétuo do Socorro de Souza Nóbrega , E-mail: perpetua.nobrega@usp.br