key: cord-0919898-5fikraas authors: Ozen, Gulsum; Zanfardino, Angela; Ozen, Gulsah; Acan, Burak; Piscopo, Alessia; Casaburo, Francesca; Gicchino, Francesca; Confetto, Santino; Troncone, Alda; Iafusco, Dario title: Comparison of emotional approaches of medical doctors against COVID‐19 pandemic: Eastern and Western Mediterranean countries date: 2021-10-21 journal: Int J Clin Pract DOI: 10.1111/ijcp.14973 sha: 34e0a6f189851f755eb7e4a0740c0a914e5a319e doc_id: 919898 cord_uid: 5fikraas BACKGROUND: Pandemics are states of disease that occur worldwide and sharply increase in populations. It causes life events which trigger anxiety, depression, anger, sleep deprivation, emotional distress and stress. World Health Organization (WHO) declared coronavirus disease 2019 (COVID‐19) a pandemic on March 11, pointing to the over 118,000 cases in over 110 countries. Many healthcare workers became ill during the pandemic and some among them died. In this study, we aimed to evaluate and compare level of stress against COVID‐19 pandemic among doctors from Turkey and Italy. METHODS: This research is a cross‐sectional study in which Perceived Stress Scale (PSS‐10) and Secondary Traumatic Stress Scale (STSS) are administered online via social networks. All data collection tools were delivered to individuals between 1 and 15 June 2020 and filled in online with Google Forms application. In total, 618 individuals were included in this study and all of them were medical doctors. RESULTS: Higher PS and STS levels were found related to female gender, being married, working in pandemic hospital and older ages. Stress levels were found statistically higher in Turkish doctors when compared to Italian doctors for both stress scales (Turkish/Italian PSS:20.18 ± 7.90/ 19.35 ± 6.71, STSS: 44.19 ± 13.29/ 38.83 ± 13.74). CONCLUSION: The number of doctors per 1000 of population is lower and per capita visits to a physician are higher in Turkey when compared to Italy. Besides pandemic, these heavier working conditions, increased weekly working hours can cause stress for Turkish doctors. Reporting information such this study is important and international collaborations are essential to plan future prevention strategies. We need to strengthen international ties and build more international collaborations rather than staying within our national silos. Additionally, interventions to promote mental well‐being in health care professionals exposed to COVID‐19 need to be immediately implemented. There are limited number of studies on the effects of COVID-19 pandemic on health professionals in literature. Most of these studies are typically based on cross-sectional study designs in one country, which cannot discern whether there is difference between the ways and levels of being affected by doctors from different countries. If international comparisons done carefully, they can play a major role in our learning what works best for COVID-19 pandemic. There needs to be more thoughtful and thorough analyses of country differences as it is probably the most important and most valid evidence for informing COVID-19 policy in real time. 8 This study is the first comparative study which evaluates the psychological effects of COVID-19 pandemic in both Turkey and Italy. In this study, we aimed to evaluate and compare the level of stress, emotional distress with COVID-19 pandemic among pediatricians from Turkey and Italy. This research is a cross-sectional study in which the scales are administered online via social networks and looked for the snowball effect in order to evaluate the state and trait stress levels and hopelessness levels of doctors in both countries. A stratified random sampling method was chosen to select the respondents. Perceived Stress Scale (PSS-10) and Secondary Traumatic Stress Scale (STSS) were created in Google Forms delivered to participants. • COVID-19 causes worries about one's own health and that of loved ones, economic disruption and losses, lifestyle disruptions, social isolation and loneliness. • Frontline health professionals against COVID-19 are considered particularly susceptible to development of psychiatric disorders because of lack of satisfactory personal protective equipment, staying away from their families, fear of being infected and infecting loved ones. • Together, these conditions could create a "perfect storm" for inducing emotional distress. • There are limited number of studies on the effects of COVID-19 pandemic on health professionals in literature. • Most of these studies are typically based on crosssectional study designs in one country, which cannot discern whether there is difference between the ways and levels of being affected by doctors from different countries. • If international comparisons done carefully, they can play a major role in our learning what works best for COVID-19 pandemic. • There needs to be more thoughtful and thorough analyses of country differences as it is probably the most important and most valid evidence for informing COVID-19 policy in real time. • This study is the first comparative study that evaluates the psychological effects of COVID-19 pandemic in both Eastern and Western Mediterranean countries. All data collection tools were delivered to individuals between 1 and 15 June 2020 and filled online with the Google Forms application. Only the forms in which socio-demographic data and scales were filled completely were evaluated. Missing or abandoned forms were not evaluated. In total, 632 individuals were included in this study and all of them were medical doctors. Three hundred and seventeen of them were from Turkey and 315 from Italy. After the elimination of missing or abandoned forms, 303 Turkish and 310 Italian doctors' data were evaluated and then proceeded with the assessment of PSS-10 and STSS. The questionnaire began with basic demographic information related to sex, age, marital status, working statues in pandemic hospital. PSS-10 is the most widely used 10-item self-report measure of global perceived stress (PS) and created by Cohen. 9 Items in the scale were designed to tap how unpredictable, uncontrollable and overloading respondents find their lives in the last month. A total score ranged from 0 to 40. Subscale scores were computed by Higher STSS total score indicating a higher frequency of symptoms. A total score below 28 corresponds to "little or no STS," a score between 28 and 37 means "mild STS," between 38 and 43 "moderate STS," between 44 and 48 "high STS," and beyond 49 "severe STS". In order to mention the presence of STS symptoms, the substance in question must be marked as "occasionally" (3), "often" (4) or "very often" (5); represented by items marked "never" (1) and "rarely" (2) is not accepted. At the same time, in order to legitimise of the presence of these PTS diagnostic criteria, at least one of the items measuring the intrusion, at least three of the items measuring the signs of avoidance and at least two of the items measuring the signs of arousal, should be marked as "occasionally" and above. 14 STSS; Turkish adaptation study was made by Yildirim et al 14 and was translated and validated in Italian in 2012 by Setti and Argentero. 15 Studies have consistently identified a two-factor structure with six negatively worded items (Items 1, 2, 3, 6, 9, 10) comprising the first factor and four positively worded items (Items 4, 5, 7, 8) comprising the second factor. Independent Samples T-Test was used to compare the averages of two independent groups with normal distribution and Mann-Whitney U test was used to compare the median of two independent groups with no normal distribution. Significance level was accepted if p-value was less than 0.05 (P < .05). The sample of this study consists of 303 Turkish and 310 Italian in total 613 participants. All participants were medical doctors. Socio-demographic attributes of the respondents are presented in Table 1 . Demographic attributes of the respondents were compared with their PSS and STSS points and the results are shown in Table 2 . For Turkish participants, there was significant difference between gender and PS level (P = .001). Additionally being married, working in pandemic hospital and older ages resulted in higher PSS and STSS scores but no significant difference was found (P > .05). For Italian participants, STSS scores of women, married ones, doctors who worked in pandemic hospital and elder were found significantly higher than men, single, doctors not working in the pandemic hospital and younger (P < .05). Although similar results were found for PS levels, only for gender and marital status statistically significant difference was found. (P = .00, .001, respectively). Participants between 45 and 54 years old had the highest scores for PSS and STSS; the lowest scores were in the youngest group (Table 2) . Turkish women and men doctors had higher scores when compared to Italians for both scales and Turkish were found related to scoring significantly higher points in the STSS (female P = .00, male P = .001; Table 3 ). Married and single Turkish doctors had higher scores than Italian doctors for PSS, STSS and statistically significant difference was found (P < .05). Turkish doctors who work in pandemic hospital had higher scores when compared to Italians for both scales but there was significant difference just for doctors who did not work in pandemic hospital in STSS (P = .00). Note: M ± SD = mean ± standard deviation. Studies showed that COVID-19 causes fear, anxiety, stress, worries about one's own health and that of loved ones, economic disruption and losses, lifestyle disruptions, social isolation and loneliness (Cacioppo, 2010) . Issues such as psychological and neuropsychiatric aspects, changed daily routines because of quarantine, socioeconomic problems and worries about future become more involved in their conversations. 16 Higher PS and STS levels were found related to being a woman as it was showed in previous studies. 17 Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. 18 Some doctors started to live apart from their families, some of them were living with high-risk groups at home and they were forced to work. In both countries, schools were closed. Note: M ± SD = mean ± standard deviation. Note: M ± SD = mean ± standard deviation. 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The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China Understanding, compliance and psychological impact of the SARS quarantine experience Haber Bülteni Comparison of emotional approaches of medical doctors against covid-19 pandemic: Eastern and Western Mediterranean countries Rocco Russo, Francesca Orlando, Fernanda Iafusco and all the members of the PediaVirus Network and Stefano Marseglia who participated with enthusiasm to the study. The authors declared no conflict of interest. All Authors critically reviewed and accepted the paper. GO conceived the study, collected data and drafted the paper. AZ, GO, BA, AP, FC, MFG, SC, DI critically revised the manuscript. GO collected data, conceived the study. DI drafted the paper, revised the manuscript and is the guarantor of the paper. Authors have no conflict of interest to declare. The study was approved by the Ethics Committee of University of