Profissionais da Atenção Primária à Saúde no contexto da pandemia de COVID-19: saúde mental, qualidade de vida, estratégias de enfretamento (coping), valores básicos de vida, e percepções e práticas quanto às medidas preventivas contra a COVID-19

Abstract

Introduction: In pandemic situations, one of the main challenges is avoiding the health system's saturation. In this aspect, the effective performance of Primary Health Care (PHC) would be essential for the success of actions in the health care network. However, in the Brazilian scenario, there was a greater emphasis on the organization of the tertiary care network, with many primary health care units still dedicated to the exclusive care of flu-like illnesses or had their profile changed to emergency care units or inpatient centers, as well as many professionals from the APS were transferred to care centers for people with COVID-19. Thus, the pandemic situation associated with the change in the professional routine of the PHC health professionals may have had a direct impact on their mental health. Objective: To assess the mental health of PHC health professionals in the context of the COVID-19 pandemic, as well as the association between changes in mental health and quality of life, sleep quality, coping, and their human values. Methods: Cross-sectional study using an electronic questionnaire applied to health professionals from the PHC of Recanto das Emas, Distrito Federal, between November/2020 and October/2021. The following instruments were applied: sociodemographic and individual aspects questionnaire related to the pandemic by COVID-19, Self-Assessment of Behavior Inventory for Adults (ASR), Basic Values Questionnaire (QVB), Brief Coping Scale (BRIEF-COPE), World Health Organization Quality of Life Assessment - short version (WHO-QoL-BREEF) and Jenkins Sleep Scale. Results: 105 professionals were included: 13 doctors (12.4%), 18 nurses (17.1%), 7 dentists (6.7%), 12 other higher education professionals (11.4%), 20 technicians. nursing (19.0%), six other technical assistance professionals (5.7%), 22 community health agents (21.0%), and seven administrative technicians (6.7%). Of these, 64 thought that the COVID-19 pandemic was affecting their mental health (61.0%), 43 had already presented COVID-19 (41.0%), 74 reported fear of having COVID-19 (70.5%), and 100 of passing it on to a family member or close friend. Values above normal in the depressive symptoms scale of the ASR were observed in 50 professionals (47.6%) and the depressive or somatic symptoms scales in 14 of affective personality in 15 (9.3%), with 55 professionals showing alterations in at least one of the scales of symptoms of mental disorders (52.4%). Eighty-five professionals had sleep disorders (81.0%). Less than a fifth of health professionals (n=19, 18.1%) classified their quality of life as good and none as very good. The coping set focused on "Problem Solving" was the preponderant strategy (median: 75.0, IQ25-75%; 62.5-87.5) and strategies focused on "Avoidance" the lowest scored (median: 45, 0, IQ25-75%: 40.0-52.5). Female professionals (83.3% versus 60.0%, p = 0.009) and professionals that reported being afraid of transmitting COVID-19 to a close family member (100.0% versus 90.9%, p = 0.029) had the highest incidence of altered values in anxiety symptoms. The multivariate analysis showed that "Self-blame" (OR: 22.757; 95% CI: 1.410-367.254, p = 0.028) and the Jenkins Sleep Scale (OR: 1.137; 95% CI: 1.014-1.275, p = 0.028) are independently associated with an increased occurrence of a change in these symptoms. For depression or somatic symptoms, technical-level professionals who worked direct health care assistance and were not nursing technicians had a higher incidence of changes (21.4% versus 4.4%, p = 0.017). On the contrary, professionals with a higher education level showed reduced depression or somatic symptoms (57.1% versus 81.9%, p = 0.037). The multivariate analysis showed that "Self-blame" (OR: 1.529; 95%CI: 1.062-2.203, p = 0.022) was independently associated with an increased occurrence of the change in these symptoms, while the improvement in quality of life was associated with a reduction (OR: 0.939; 95%CI: 0.888-0.994, p = 0.030). Conclusion: A high degree of psychological distress and symptoms of mental disorders was observed in professionals working in PHC during the COVID-19 pandemic, with more than half of the professionals presenting symptoms of mental disorders, with anxiety symptoms being the most common. A minority of professionals had their quality of life classified as good and none as very good, in addition to presenting a high prevalence of sleep disorders. Professionals who adopted stress coping strategies related to avoidance or social support were the most likely to have impaired mental health, especially when these strategies were related to blaming themselves for the situation they experienced.