The impact of the Covid-19 pandemic on the mental health of workers in health services: building resilience in post-conflict territories

COVID-19 was declared a global pandemic by WHO on March 11. Even though Colombia declared a national emergency early in the pandemic (March 17) and has taken other mitigation measures, the infection has spread across the country. Colombia is the eleventh highest in the world in terms of the number of cases. One of the significant concerns during the pandemic is the high demand for health services that exceed the service capacities. For these demanding healthcare needs, COVID-19 pandemic can affect the physical and mental health of healthcare workers (HWs) (including clinical and non-clinical staff). During this pandemic, HWs are exposed to high levels of stress due to long working hours, changes in their functions, and fear of the disease. In addition, HWs can be exposed to the death of patients, hopelessness, and ethical dilemmas. These stressors can increase the risk of developing mental health problems. The most important reasons to study this problem in Colombia are the high risk of mental problems in HW, lack of resources in health services, and the history of violence due to the armed conflict which has meant that HWs were highly stressed even before the pandemic arrived. We therefore propose to:

1. To study the mental health of health workers in Colombia and some regions of the Development Programs with a Territorial Approach (PDET), and to assess how mental health problems vary according to the personal history of violence and resilience levels
2. To assess the association between stressors derived from the COVID-19 pandemic and mental health in the health workers in a first measurement, and at 3, 6 and 12 months of follow-up
3. To explore how a history of exposure to armed conflict modifies the effects of the stressors from the COVID-19 pandemic on mental health.
4. To design and evaluate the feasibility and satisfaction of an eHealth-based intervention to prevent symptoms of depression and anxiety, and increase resilience in health workers

Methods:
1) Cross-sectional study of 3,000 health workers (clinical and non-clinical personnel including administrative personnel and support personnel) to estimate the prevalence and distribution of mental health stressors. Sampling will be convenient through health institutions, medical associations, hospitals and social networks. In the cross-sectional study, we will also include a specific sample of health workers from Florida, Pradera, Apartado and Turbo (n = 150) and will compare the proportions of mental health problems between the national level with the specific data of these regions (prioritized as post-conflict).

2) Cohort study: we will include healthcare workers (n=3,100) from the cities of Bogota, Medellin and Cali who will be followed up -3, -6, and -12 months after the first measurement. This information will be used to assess the medium-term impacts of the pandemic stressors on mental health as well as the protective and risk factor for mental health

3) Design and evaluation of an intervention based on eHealth that allows the detection and prevention of depression and anxiety and promotion of resilience in health workers.

4) component of social appropriation of knowledge that includes dissemination strategies of research results, eHealth intervention for prevention of mental health problems in health workers. In addition, we will design educational material in videos and infographics to promote the mental health of health workers, and conduct forums with the presentation of the results, as well as produce short reports for decision makers.