Effects of working in vulnerable contexts on the mental health of primary healthcare professionals during the COVID-19 pandemic: a mixed-methods study

Kleverson Gomes de Miranda; Izabel Cristina Rodrigues da Silva; Rafaela M A Martins Fonseca; Andrea Donatti Gallassi

doi:10.1136/bmjopen-2023-073472

Effects of working in vulnerable contexts on the mental health of primary healthcare professionals during the COVID-19 pandemic: a mixed-methods study

BMJ Open. 2023 Nov 2;13(11):e073472. doi: 10.1136/bmjopen-2023-073472.

Authors

Kleverson Gomes de Miranda¹, Izabel Cristina Rodrigues da Silva¹, Rafaela M A Martins Fonseca¹, Andrea Donatti Gallassi^{2

3}

Affiliations

¹ Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Universidade de Brasilia (UnB), Brasilia, DF, Brazil.
² Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Universidade de Brasilia (UnB), Brasilia, DF, Brazil andrea.gallassi@gmail.com.
³ Centro de Referência sobre Drogas e Vulnerabilidades Associadas, Universidade de Brasilia (UnB), Brasilia, DF, Brazil.

Abstract

Objective: The objective of this study is to analyse the relationship and psychosocial issues between working during the COVID-19 pandemic in primary healthcare (PHC) facilities located in the most vulnerable health region (HR) of the Federal District of Brazil (FDB) compared with a lesser region.

Design: Mixed-method study data. The questionnaire was based on the World Health Survey and the Convid Behavioural Survey. Quantitative data were described in absolute and relative frequency. Pearson's χ² test verified differences according to the region (significance level <5%). A margin of error of 8% with 95% CI defined the sample. The content analysis (by Bardin) analysed the qualitative data.

Setting: A representative sample of PHC professionals working at the Western HR and Central HR of the FDB.

Participants: 111 women and 27 male PHC professionals, aged ≥ 18 years.

Outcome measures: Psychosocial variables-personal emotions towards the clients, social relationships and use of psychoactive substances (PAS).

Intervention: An online questionnaire (27 questions) and 1 open-ended question.

Results: The sample comprised 138 PHC professionals; 80.40% were female aged between 40 and 49 years old (27.3%); declared themselves as black/pardo (58.7%); were married (53.60%), and worked in family healthcare teams (47.80%). No association between working in the most vulnerable HR compared with the least one and presenting psychosocial issues, except for anger towards clients (p=0.043). 55.10% worked much more than usual, 60.80% reported being depressed, 78.20% anxious, 76.80% stressed, 77.50% had no empathy and 78.30% felt isolated from family/friends. Towards the clients, 59.40% reported empathy and 72.5% no affection/care. The consume of psychotropic medications was reported by 34.80%, and 14.50% increased alcohol/PAS use. Qualitative data leverage quantitative findings: work overload, the indifference of the Federal Government and distance from family/friends.

Conclusion: Working in the most vulnerable region and in the least one affects the psychosocial aspects of the PHC professionals equally.

Keywords: COVID-19; Health & safety; Latin America; MENTAL HEALTH; Primary Health Care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19* / epidemiology
Female
Health Personnel / psychology
Humans
Male
Mental Health
Middle Aged
Pandemics
Primary Health Care