Resilience is the ability to reduce the effects of a distressing event by anticipation and preparation, in other words to “bounce back” once it has occurred . In this study, we analyzed resilience, anxiety, depression and coping strategies among non-local medical workers sent to Wuhan to support local staff in treating patients infected with COVID-19. The most important and significant finding of this study is that resilience was related to active coping, depression, anxiety, as well as training and support from the hospital. Resilience of non-local medical workers in this study was negatively associated with depression and anxiety. Our results suggest the potential usefulness of selecting more resilient medical workers to support the front line in major public health emergencies, and of creating resilience-building interventions to strengthen and preserve the mental health of medical staff working under challenging circumstances.
Our results suggest that resilience can protect a participant from feelings of anxiety and depression, which may help preserve mental health. Resilience helps medical workers recover better from trauma, which may help explain why resilient medical workers have lower anxiety and depression in the face of public health emergencies. Consistent with our study, analysis of more than 1000 nurses in Greece suggested that greater resilience was associated with lower anxiety . In a study of Toronto-based health care workers who continued to work in hospitals one to 2 years after the SARS outbreak, incidence of new episodes of psychiatric disorders were similar to or lower than community incidence rates . This may indicate a high level of resilience among these workers.
We also found a positive association between resilience and positive coping strategies. Consistent with our results, a survey of the psychological status of Chinese medical workers during the SARS outbreak in 2003 showed that they tended to adopt active forms of coping . A study of US medical workers suggests that, during times of change in the workplace, encouraging nurses to use positive coping strategies may lead to higher levels of resilience . A study in China suggested that new nurses with high levels of resilience could buffer the negative influence of workplace incivility by using a positive coping style . Our data suggest that developing a training course on effective coping strategies would prove highly beneficial to improve individual’s resilience. For example, medical workers could be encouraged to share their troubles with colleagues and retain a sense of humor while working with patients and colleagues during a pandemic.
Our study found an inverse association of levels of anxiety and depression with level of training received from the hospital employment prior to dispatch to Wuhan. Similarly, a perception of being adequately trained and supported by the hospital showed an inverse association with level of psychological distress after the SARS outbreak [23, 27]. This suggests that hospital-provided training to workers can improve their resilience and help protect their mental health as they respond to a pandemic.
The respondents in this study had a mean CD-RISC score of 67.04 ± 13.22, scoring higher for resilience than Chinese medical workers analyzed in the non-epidemic period (59.50 ± 12.77) . The higher score in our study may reflect a selection bias, since medical workers of higher resilience may have volunteered or been selected by their managers to take part in the challenging Wuhan mission. It is also possible that the higher resilience reflects the increased attention paid to mental health in China since the outbreak of SARS in 2003 and the Wenchuan earthquake in 2008 .
Nurses in our study scored lower on resilience than doctors or other support staff. Their score around 65 in our study is comparable to the score around 58 of nurses who survived the 2008 Wenchuan earthquake . Nurses typically show higher psychiatric morbidity than administrative staff or doctors during pandemics [8, 31], which may lead to longer recovery time from stress. Research is needed to clarify to what extent this is due to less resilience and whether it can be prevented by appropriate interventions to boost resilience.
Feelings of being adequately prepared and confident to complete tasks was associated with resilience in bivariate analysis, but not regression analysis after controlling for covariates. Future research should investigate more samples to analyze whether adequate preparation and confidence in completing tasks affect the resilience of non-local health workers during a pandemic.
The health system could develop a training intervention that provides information about the status of the epidemic and infectious disease prevention to medical personnel before sending them to the front line, which may ease their fear and anxiety, thereby improving their resilience. Resilience may also be maintained by providing support(i.e financial, childcare, psychological counseling) to the families of front-line health workers. In addition, our study indicates that more time should be devoted to worker preparation, which could directly benefit a worker’s confidence to complete tasks. Due to the sudden nature of the outbreak, most supporting medical workers had very limited time from receipt of information to departure. In other words, our data show that the resilience of medical workers can be heavily influenced and maintained by appropriate organizational support strategies and pre-emptive planning.
Since questionnaires were filled out electronically at the participant’s convenience, we cannot exclude the possibility that factors in the survey environment (such as other people present) may have influenced participants’ responses. Moreover, due to time and place limitations, this study measured only end-point resilience. Future research should employ a longitudinal design to assess changes in resilience during a pandemic and how they may affect subsequent mental health. We were unable to assess effects of education level on resilience, anxiety or depression because nearly 75% of our respondents had bachelor’s degrees. Lastly, our study examined only non-local medical workers. Future studies should compare the mental health status and risk factors between local and non-local workers.