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Stigma on First Responders During COVID-19

18 Sep 2020 9:26 AM | AIMHI Admin (Administrator)

From APA PsycNet | Comments Courtesy of Matt Zavadsky

Very interesting findings – Summary statements:

 

First responders have a unique position as first-line response to COVID-19 patients, which results in an increased likelihood for exposure to the virus. Because of this position, mental health problems, such as anxiety, depression, insomnia, and stress, have been revealed in this population.

 

During the COVID-19 pandemic, health care workers and first responders described experiencing stigma in their communities. Amid this crisis, a qualitative phenomenological study was conducted to understand the experiences of first responders during the pandemic; this is the first study of its kind to review the effects of stigma on first responders in any pandemic. This study used a convenience sampling of first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) who discussed their personal experiences during the pandemic.

Solutions to this problem could include real-time and urgent information being conveyed to the public while being mindful of untoward exposure to the media (Garfin et al., 2020). The goal is to reduce hysteria and mitigate the transmission of misinformation.

 

Conclusion

Facing stigma is often invisible, in that the effects are not often recognized; despite the inability to see it, experiencing stigma can be dangerous to health while also diminishing the value of a person through discrimination and loss of status by being devalued, rejected, and excluded (Link et al., 2006). The compounding adverse mental health effects in an essential population used to fight the pandemic turns an already challenging situation dire.

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Stigma on First Responders During COVID-19

Tara Rava Zolnikov email the author, Frances Furio

Zolnikov, T. R., & Furio, F. (2020).

 

http://dx.doi.org/10.1037/sah0000270

 

Abstract

During the pandemic, first responders were at an increased risk of being stigmatized because of their direct exposure to COVID-19; stigmatization is an undesirable stereotype that can contribute to a myriad of adverse effects, including, but not limited to, anxiety, depression, devaluing, rejection, stress, health problems, exposure to risks, and limiting protective factors. The objectives of this research were to understand stigma on first responders during the COVID-19 pandemic as well as the consequences of stigma on first responder’s mental health. A qualitative phenomenological study used semistructured interviews to understand the experiences of first responders during the pandemic. This study included a convenience sampling of 31 first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) located worldwide. First responders reported feelings of isolation, lack of support and understanding by family or friends, decreased or forced removal in immediate social interaction (e.g., within family and friend circles), sentiments of being infected or dirty, increased feelings of sadness and anxiety, and reluctance to ask for help or get treatment (e.g., self-approval of being isolated). By answering these research questions, this information highlighted additional challenges that may be faced by first responders aside from being a frontline worker during a pandemic, which is equally stressful. By understanding the role of stigma, public health practitioners during pandemics or emergency situations can seek to diminish it.

 

On March 11, 2020, the World Health Organization (2020) characterized the newly emerging respiratory illness, coronavirus 2019 (COVID-19), as a global pandemic. COVID-19 had rapidly spread across the world, creating a surge of cases in countries like Italy, Iran, South Korea, and the United States. Pandemics and disease outbreaks pose significant threats to human health as well as contribute to adverse mental health effects because of drastic life changes along with the inability to predict daily events (Pike, Tomaney, & Dawley, 2010). Anxiety, stress, and fear felt by people during the coronavirus pandemic was real and overwhelming, resulting in strong emotional reactions in adults and children (Centers for Disease Control and Prevention, 2019). The culmination of these reactions could be directed at first responders, who were at the forefront of treating people affected by the disease and sequentially considered the most exposed population (Adhanom Ghebreyesus, 2020; Ehrlich, McKenney, & Elkbuli, 2020).

 

During the pandemic, first responders were at an increased risk of being stigmatized (Adhanom Ghebreyesus, 2020; Ehrlich et al., 2020), which is an undesirable stereotype that reduces an accepted person to a tainted one (Goffman, 1963). Stigma has several components, including stereotyping, discrimination, labeling, status loss, and separation (Link & Phelan, 2001). Stigmatization can negatively impact individuals faced with it, especially if stigma has become internalized (Drapalski et al., 2013). Stigmatization is problematic and can contribute to a myriad of adverse effects, including, but not limited to, anxiety, devaluing, rejection, exposure to risks, and limiting protective factors (Link & Phelan, 2006). Stigma has been shown to increase stress among the individuals who experience it (Major & O’Brien, 2005) as well as depression (Benoit, McCarthy, & Jansson, 2015). Stigma can impact an individual’s self-esteem and their overall achievements (Major et al., 2005). Studies have shown that low self-worth and negative health outcomes are both potential outcomes of stigma (Benoit et al., 2015).

 

During the COVID-19 pandemic, health care workers and first responders described experiencing stigma in their communities. Amid this crisis, a qualitative phenomenological study was conducted to understand the experiences of first responders during the pandemic; this is the first study of its kind to review the effects of stigma on first responders in any pandemic. This study used a convenience sampling of first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) who discussed their personal experiences during the pandemic.

 

Highlighted topics of discussion focused on treatment, stigma, feelings, and mental health. The expectation of this research was to upend aspects related to adverse mental health in a vital working population during the pandemic.

Method

 

A qualitative study was conducted to understand and explore the experiences of health care workers and first responders during the COVID-19 pandemic. This study used a descriptive phenomenological approach, which has been continuously described as a valuable research tool and strategy to understand the lived experiences of participants related to a phenomenon (Neubauer, Witkop, & Varpio, 2019; Marques & McCall, 2005; Husserl, 1980); the aim of this type of research is to identify the common themes, factors, or components related to a phenomenon to better understand the perspectives of those who have experienced it (Marques & McCall, 2005). A phenomenological study looks at both what was experienced and how it was experienced (Neubauer et al., 2019). This method was utilized for this study because first responder experiences offer a unique perspective during the pandemic, although they are not authorities on pandemic stigma, in general.

 

Health care workers and first responders were selected as the target population. This selection was due to the fact that these individuals have a unique position within this pandemic because they are likely the population most exposed to COVID-19 during this time. Inclusion criteria for this study was: above the age of 18 years, health care worker or first responder, and worked during the COVID-19 pandemic. Participants were recruited through convenience sampling, which used the Facebook platform; participants were then screened, selected, and interviewed via Zoom (per social distancing recommendations by the Centers for Disease Control and Prevention) in a private setting and format, during which questions reviewed challenges faced during the pandemic. After interviews, the data were then analyzed via hand coding, in which themes emerged and presented themselves through repetition. Themes were then made into a codebook, which were used to review all quotes related to the subject matter that directly correlated to answering the research questions. This thematic analysis followed the Moustakas (1994)–modified Van Kaam (1966) method.

 

All qualitative research must provide measures to ensure validity of the data in the research. In this case, the researchers established trustworthiness through credibility, multiple participant perspectives, peer debriefing and review, reflexive journaling, and field notes. Credibility was gained through triangulation of sources and member checking. Multiple participant perspectives were sought when female and males of various ages in different parts of the world working in different occupations were all included to participate in the interviews. Peer debriefing and review occurred before and after developing interview questions and analyzing themes in the data. Reflexive journaling and field notes occurred in a diary, which was used to report on questions related participant reactions and impressions of each interview. That said, limitations in all research exists. Limitations of this study included the possibility of nontransferable results to other first responders in the world, researcher personal bias (e.g., mental health researcher), and research participant bias.

 

The study protocol and ethics review were approved by California Southern University. All participants signed informed consent prior to the commencement of the interviews and audio recording. Codes were immediately assigned to every participant to ensure deidentified data collection.

 

Results

Participants’ answers concluded various challenges related to treatment, stigma, feelings, and mental health. Participants described factors that were associated with stigma, including feelings of isolation, lack of support and understanding by family or friends, decreased or forced removal of immediate social interaction (e.g., within family and friend circles), sentiments of being infected or dirty, increased feelings of sadness and anxiety, and reluctance to ask for help or get treatment (e.g., self-approval of being isolated).

 

Participants

A total of 31 health care workers and first responders were interviewed for this study. The mean age was 36.129 years, with a range between 23 and 57 years. In relation to gender, 18 participants identified as female, and 13 participants identified as male. Participants were located worldwide, including the United States (28), Kenya (one), Ireland (one), and Canada (one). Ethnicities included African/Kenyan, Arab/Palestinian, Caucasian, Caucasian/Russian, Caucasian/Iranian, and Caucasian/Irish. Of these, 18 of the participants were married, and 13 of the participants were single. Sixteen of the participants had children, with an average of 2.25 children per subject, a median of 2.5 children, and a range of one to four children.

 

The education levels of participants included high school (one), some college (four), associate degrees (six), bachelor degrees (13), graduate degrees (three), and medical school educations (four). All participants worked within roles as health care workers or first responders during the COVID-19 pandemic; there were physicians/doctors (three), nurses (14), a nurse tech, a behavioral therapist, an orthodontist, a dialysis technician, a technician in medical surgery, a data specialist, a paramedic, firefighters and paramedics (three), a firefighter and emergency medical technician, and police officers (three).

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