Impacto emocional en la población causado por la pandemia de COVID-19validación psicométrica de la escala AMICO para su uso como herramienta de valoración enfermera

Resumo

In December 2019, the first case of pneumonia caused by SARS-CoV-2 was detected in Wuhan being the cause of a disease called COVID-19, causing highly variable symptomatology, from mild fever and dry cough to death in some cases. This new virus is characterized by an extremely high infection rate and relatively high mortality. COVID-19 spread rapidly throughout the world and was declared a pandemic on March 11, 2020. In response, many governments around the world have implemented exceptional emergency measures, imposing severe confinement, quarantine and social isolation. During the pandemic, nurses have been overwhelmed by heavy workloads, forced to prevent infection under adverse conditions. Organizationally, all care units have had to be restructured to cope with the disease, coupled with a lack of material resources. In this pandemic context, many health care workers suffer somatic symptoms such as cardiovascular, respiratory, neurological and gastrointestinal, as well as psychological symptoms such as depression, fear, anxiety and stress. Given the new context of the emotional impact on the population, the need arises to create new validated tools that specifically measure the impact of COVID-19 at the level of mental health. In Spain, a research team designed the COVID-19 Fear and Anxiety Scale (AMICO). Unlike the FCV-19 scale, the AMICO scale incorporated eight new items that also measure the presence of COVID-19 specific anxiety, becoming a good prevention tool to detect the needs of the population at the mental health level. In this context, the aim of the present study is to assess the presence of anxiety and fear of Covid-19 in the general population of the United Kingdom. Objective The aim of this study was to develop and evaluate a psychometric assessment tool from the point of view of the mental health nurse specialist. Hypothesis In the assessment phase of the nursing process, the use of scales makes it possible to know the health status of a user without the need to provide invasive procedures or high economic cost. It also makes it possible to systematize the information, unifying criteria and diagnoses in order to evaluate the user objectively, thus shortening the evaluation time. Given the new context of the emotional impact on the population, the need arises to create new validated tools that specifically measure the impact of COVID-19 at the mental health level. In Spain, a research team designed the Anxiety and Fear of CO-vid-19 (AMICO) assessment scale. The use of this scale by health professionals and more specifically by the mental health nurse specialist would be useful to identify the extent to which COVID-19 has affected the mental health of the population in order to offer specific interventions for a problem that has affected the world's population and is still being discussed today. Methodology The research study developed in this thesis was organized in two phases. In the first, a systematic review was carried out with the aim of analyzing the impact on the mental health of nurses providing care to patients during the SARS-CoV-2 pandemic. Subsequently, in the second phase, a cross-sectional descriptive study based on a self-administered AMICO questionnaire in the nursing population of Spain, a psychometric validation study of the AMICO scale in the United Kingdom and another cross-sectional descriptive study based on a self-administered AMICO_UK questionnaire in the general population of the United Kingdom were carried out. Results In the systematic review, 18 studies were selected. The main dimensions measured in the studies in addition to anxiety and fear, were depression, stress and others such as insomnia or certain coping strategies. The only specific tool to measure fear in the selected studies was the Fear of COVID-19 Scale (FCV-19). Many of the selected articles jointly measured anxiety, stress and depression through the 21-item Depression, Anxiety and Stress Scale (DASS-21). It showed a high prevalence of anxiety, depression and stress among the women. Another instrument used was the Generalized Anxiety Disorder Scale (GAD-7), with the percentage range of nurses suffering from anxiety being between 30% and 40%, with severe anxiety ranging from 1.2% to 2.4%. In a sample of nurses residing in Spain, bivariate analysis revealed that for the total AMICO variable, statistically significant differences were found in the mean scale score and sex, educational level, m2housing variables and area of work. Nurses working in emergency and critical care, hospital care and maternal and child care had the highest AMICO scale scores. Discussion The main fear complaints of the nurses were related to the fear of infecting their family or friends and the fear of death of one of them. No specific scale to measure COVID-19 anxiety was found in the selected articles. However, it is known that there is a specific scale to measure fear and anxiety about COVID-19 in Spain. Probably, one of the reasons why this scale has not been used in the selected articles is because it has so far only been validated in Spain. In order to be able to use the AMICO scale in other countries so that they can benefit from its advantages, construct validation of the AMICO scale was carried out in the United Kingdom to assess the presence of fear and anxiety in this population group in relation to COVID-19. The results obtained have provided optimal results in the goodness-of-fit indices for the construct validation of the scale and its overall corrected reliability. In the case of the validation of the AMICO_UK scale, the regression study showed that women who reported not earning enough money to make ends meet, who had not self-confirmed and who had been vaccinated with only one dose presented higher levels of anxiety and fear of COVID-19. Most of the articles reviewed identify symptoms related to mental health problems in the general population in the face of COVID-19. Regarding the sex variable, it is worth mentioning that in all the articles reviewed the level of anxiety and, in general, mental health problems, as in the present study, were higher in women than in men. With respect to income, which was also significant in the present study, an analysis conducted in the UK revealed that the restrictions also had an impact on the socioeconomic position of individuals, with an increase in poverty. The results confirm the need to be concerned not only with protecting the physical health of health professionals, but also with the effects on their mental health, something that has been confirmed by a large number of studies. In the general UK population, bivariate analysis revealed statistically significant differences in relation to the variables sex, income level at the end of the month, health status score, self-confinement, amount of information received, vaccination, and vaccine side effects relative to the AMICO_UK mean. For the validation of the AMICO scale in the UK, the scores obtained on the AMICO_UK scale did not follow a normal distribution. Bivariate analysis revealed statistically significant differences in relation to the variables sex, income level at the end of the month, health status score, self-confinement, amount of information received, vaccination and vaccine side effects in relation to the AMICO_UK mean. An exploratory factor analysis (EFA) was performed, a Kaiser-Meyer-Olkin measure of 0.961 and a significance level of 0.000 in the Barlett's test of sphericity were obtained. With these results, the EFA was implemented, under the criteria of principal axial factorization and promax rotation, which yielded a factorial solution of 2 dimensions and 16 items. This factorial solution explained 68% of the variance. The sample of UK residents, bivariate analysis revealed statistically significant differences in relation to the variables sex, income at the end of the month, health status score, self-confinement, amount of information received, vaccination and side effects of the vaccine, in relation to the mean scores on the AMICO_UK scale. Conclusions The AMICO scale may allow the screening of mental health problems in nurses and may even allow the follow-up of these problems, seeking to facilitate the necessary support. The AMICO_UK scale has been shown to have adequate construct validity as an instrument to measure the presence of COVID-19 related anxiety and fear in the UK population. The AMICO_UK scale shows statistically significant differences with the variables sex, level of income at the end of the month, health status score, self-confinement, amount of information received and side effects of the vaccine. The results have provided optimal results on goodness-of-fit indices for construct validation of the AMICO_UK scale and its overall reliability. The majority of the UK population had low levels of anxiety and fear at the time the scale was administered. Because of the strong relationship between the impact of the COVID-19 pandemic and the social characteristics of the population, there is a need to assess specific population groups with the AMICO_UK scale with the aim of providing more targeted programs and helping to improve and restore the mental health of the UK population.