Introduction
Exposure to COVID-19 and pandemic-related public health measures like lockdowns has been linked to mental health impacts in the general population.Reference Holzinger, Nierwetberg and Chung1 Healthcare professionals constitute a subgroup at high risk for repercussions from the COVID-19 pandemic. This population is already at risk for burnout and poor mental health.Reference Lai, Ma and Wang2, Reference Frajerman, Morvan, Krebs, Gorwood and Chaumette3 Notably, physicians are especially at a high risk of developing adverse mental health outcomes, including symptoms of depression, anxiety, sleep problems, and increased fatigue.Reference Lai, Ma and Wang2, Reference El-Hage, Hingray and Lemogne4, Reference O’Higgins, Rojas, Echeverria, Roselló-Jiménez, Benito and Haro5 The high level of psychological distress among physicians may be linked to the COVID-19-related workload that exceeded the usual health care system capacity.Reference El-Hage, Hingray and Lemogne4 This distress may have been intensified by the pervasive atmosphere of uncertainty, an influential factor for anxiety, changes in circadian rhythms, and the lack of knowledge regarding COVID-19, particularly in the first weeks after the outbreak.Reference El-Hage, Hingray and Lemogne4, Reference Temsah, Alenezi and Alarabi6, Reference Blume, Schmidt and Cajochen7 Importantly, healthcare professionals have faced substantial risks of contracting COVID-19, potentially subjecting them to the short- or long-term mental health consequences of COVID-19.Reference Spada, Biffi and Belotti8, Reference Taquet, Sillett and Zhu9
Data regarding the impact of the COVID-19 on mental health professionals are scarce.Reference Stefanatou, Xenaki and Karagiorgas10 Mental healthcare systems had to swiftly adapt following the first outbreak and during peaks of COVID-19, frequently struggling with resource shortages including protective equipment.Reference Alexiou, Steingrimsson and Akerstrom11 Challenges encompassed change of workplace or using telepsychiatry without prior experience or training.Reference Zangani, Ostinelli and Smith12–Reference Mucic and Hilty14 Furthermore, several treatment options like brain stimulation treatments and electroconvulsive therapy became significantly constrained or even paused when COVID-19 started.Reference Grover, Mehra and Sahoo15–Reference Takács, Asztalos, Ungvari and Gazdag17 Mental health professionals were relocated to join frontline management of COVID-19, where they were at higher risk of SARS-CoV-2 infection.Reference Alexiou, Steingrimsson and Akerstrom11, Reference Grover, Mehra and Sahoo15, Reference Rapisarda, Vallarino and Brousseau-Paradis18
Mental health professionals encountered levels of mental distress comparable to other medical specialtiesReference Brillon, Philippe, Paradis, Geoffroy, Orri and Ouellet-Morin19 but also showed a noticeable prevalence of burnout and sleep problems, with younger individuals being at higher risk of burnout.Reference Stefanatou, Xenaki and Karagiorgas10, Reference Rapisarda, Vallarino and Brousseau-Paradis18, Reference Pappa, Barnett, Berges and Tired20 A study in Saudi Arabia revealed a high incidence of burnout and depression symptoms among psychiatry trainees during the COVID-19 pandemic.Reference Alkhamees, Assiri, Alharbi, Nasser and Alkhamees21 As of now, the sole study investigating the preparedness and knowledge of early career psychiatrists during the pandemic has been conducted in Iran.Reference Eissazade, Shalbafan and Saeed13 The reports of early career psychiatrists working during the pandemic in different countries suggest that their experiences were similar to some extent, however, access to telepsychiatry and to personal protective equipment varied considerably between countries after the pandemic outbreak.Reference de Filippis, Soler-Vidal and Pereira-Sanchez22, Reference Pereira-Sanchez, Adiukwu and El Hayek23 It is suggested that the areas of psychiatric training that have been affected by the COVID-19 pandemic were quality of training, lack of diversified clinical exposure and practice, lack of research activities, use of technology for education, and effects on entrance and exit exams.Reference Nagendrappa, de Filippis and Ramalho24 Consequently, understanding the impact of the COVID-19 pandemic on ECPs in European countries is paramount.
The aim of the study has been to investigate the impact of the COVID-19 pandemic on education and professional development, working conditions, and wellbeing of early career psychiatrists in Europe, as well as their attitudes to telepsychiatry.
Methods
Study design
This was a cross-sectional international study among early-career psychiatrists. An online questionnaire (Supplementary Material) was developed by the Early Career Psychiatrists Committee (ECPC) of the European Psychiatric Association (EPA). The questionnaire included 24 items, and was structured in five sections: (1) socio-demographics, (2) COVID-19 knowledge and training, (3) workplace conditions, (4) wellbeing and support, and (5) telepsychiatry. Based on the survey, seven dependent variables were used in the analysis:
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1) Confidence in knowledge of COVID-19 symptoms and management,
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2) Confidence in managing patients with a comorbidity of COVID-19 and a mental disorder,
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3) Adherence to physical distancing and other recommendations related to COVID-19 prevention at the workplace,
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4) The impact of the COVID-19 pandemic on wellbeing,
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5) The impact of supervisors and/or co-workers on wellbeing,
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6) Satisfaction with the use of telepsychiatry during the pandemic,
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7) Likeliness to use telemedicine after the pandemic.
Data collection
Early career psychiatrists practicing in European countries were eligible to take part in this study. The EPA ECPC defines an “Early Career Psychiatrist” as a psychiatric trainee or a psychiatrist under 40 years of age or a psychiatrist less than 5 years after completing their specialty training (including both adult and child and adolescent psychiatrists).
In the beginning, participants confirmed that they met the study’s inclusion criteria and provided consent to participate in the study. The survey also included a question about professional status. Responses that did not fall into one of the following groups were excluded from this study: (1) trainee in general adult psychiatry, (2) trainee in child and adolescent psychiatry, (3) specialist in general adult psychiatry under 40 years of age or with less than 5 years of clinical practice after specialty, and (4) specialist in child and adolescent psychiatry under 40 years of age or with less than 5 years of clinical practice after specialty.
The questionnaire was administered online and information about the survey was distributed through websites, mailing lists, and social media of the EPA and the European Federation of Psychiatric Trainees (EFPT). Data were collected during the COVID-19 pandemic, from 16 June 2020 to 1 September 2021.
Statistical analysis
A series of multiple regression analyses were conducted to determine variables that could predict the dependent variables, such as (1) confidence in the knowledge on COVID-19 symptoms and management; (2) confidence in managing patients with comorbidity of COVID-19 and mental disorders; (3) impact of COVID-19 on the wellbeing; (4) impact of supervisors and co-workers on wellbeing; (5) satisfaction with the use of telepsychiatry during the pandemic; and (6) willingness to use telemedicine after the pandemic. These variables were included as dependent variables in the separate regression models.
The selected characteristics and work-related conditions were included as predictors in the regression models: (1) gender (men or women); (2) the category of the country in which one is currently working according to the World Bank Classification (WBC) (high income or lowest income); (3) professional status (trainee or specialist); (4) professional areas (general adult psychiatry or child and adolescent psychiatry); (5) main place of work during the pandemic (in-patient or out-patient and other settings) (6) specific recommendations for ECPs during the pandemic (yes or no); (7) additional educational activities (courses, workshops, local conferences) on COVID-19 offered for ECPs (yes or no); (8) providing online obligatory local training and educational activities for ECPs (courses, workshops, local conferences) (yes or no); (9) extending the duration of training (yes or no); (10) reducing the duration of training (yes or no); (11) preventing from taking the specialist exam as planned (yes or no); (12) obligation by the authorities to change the place of work (yes or no); (13) following the recommendations related to COVID-19 prevention (eg physical distancing) at the workplace (yes or no); (14) personal protective equipment provided for the ECPs (yes or no); (15) access to free COVID-19 tests at place of work (yes or no); (16) diagnosis of COVID-19 (yes or no); (17) access to free psychological counselling (yes or no); (18) recommendations how to proceed with telepsychiatry (yes or no); and (19) access to dedicated closed platform for audiovisual communication in telemedicine (yes or no).
To detect potential collinearity or multicollinearity among the predicting variables, we calculated variance inflation factors (VIF). The higher value of VIF indicates a more problematic amount of collinearity between predictors.Reference Hair, Black and Babin25 Values of more than 4 or 5 were considered as being moderate to high, with values of 10 or more being considered as very high.Reference Hair, Black, Babin and Anderson26, Reference Kim27 VIFs greater than 4 was also considered as indicator of possible problem with multicollinearity.Reference Hair, Black, Babin and Anderson26 In this study, the maximum value of VIF was 1.36 (see the VIFs in Table 6). These results allow us to assume no multicollinearity among the explanatory variables.
To run the series of multiple regressions, there were linearity as assessed by partial regression plots and a plot of studentized residuals against the predicted values. In each model, there was the independence of residuals, as assessed by the Durbin-Watson statistic. The Durbin-Watson statistic can range from 0 to 4. A value of approximately 2 indicates that there is no correlation between residuals.Reference Eyduran, Ozdemir and Alarslan28 The values in this study were very close to 2 (1.869–2.116), so it can be accepted that there was independence of errors (residuals) (see Table 1).
Participants’ Sociodemographic Data
a The “Total” column also includes those who identified their gender as non-binary or did not disclose their gender.
The bias-corrected and accelerated (BCa) bootstrap method using 2000 resamples was used as the recommended technique for computing confidence intervals for statistics that do not address the normality of the data.Reference Efron and Tibshirani29–Reference Haukoos and Lewis31
The variables measured on the ordinal scale (eg diagnosis of COVID-19) were recoded using the Dummy Coding method (coded variables: 0 = no, 1 = yes).Reference Hardy32
All statistical analyses were done with SPSS version 29 for Windows.33 The level of significance was set at p < 0.05 in all statistical tests.
Results
Participants
A total of 595 people completed the survey, of which 517 met the study inclusion criteria. The reasons for excluding responses from the survey are presented in the flowchart (Figure 1).
Flowchart.
Socio-demographics
Gender
Women (n = 330) accounted for 63.8% of the study’s participants, men (n = 184) 35.6%. One person identified as non-binary (0.2%), and two did not want to specify their gender (0.4%).
Country of work
The included participants lived in 39 different European countries. In total, 365 participants were from high-income countries (HIC) based on the World Bank classification, 151 participants from upper-middle-income countries (UMIC), one participant from a lower-middle income country (LMIC). Currently, there are no low-income countries (LIC) among the European countries. For the purpose of comparisons between groups according to the World Bank classification, participants from UMI and LMI countries were combined into one group.
Professional status
Trainees in general adult psychiatry (n = 205) accounted for 39.7% of participants, while early-career specialists in general adult psychiatry (n = 191) accounted for 36.9%. Trainees in child and adolescent psychiatry (n = 88) represented 17.0% of participants and early-career specialists in child and adolescent psychiatry (n = 33) represented 6.4%.
Main place of work during the pandemic
ECPs in Europe worked in a variety of settings during the pandemic. The largest group (n = 263, 50.9%) worked in inpatient psychiatric units and/or in emergency psychiatric units. A total of 171 (33.1%) ECPs worked in a public outpatient mental health care facility (psychiatric clinics, day wards, psychiatric rehabilitation facilities, or community mental health teams). Forty-two (8.1%) participants worked in individual private psychiatric practice. There were 28 (5.4%) participants who worked in dedicated inpatient or outpatient COVID-19 wards or clinics, whereas 13 (2.5%) ECPs worked in other settings (eg university or prison).
The results of the following sections of the survey are presented in Tables 2–5.
COVID-19 Knowledge and Training
a The ‘Total’ column also includes those who identified their gender as non-binary or did not disclose their gender.
Workplace Conditions
a The “Total” column also includes those who identified their gender as non-binary or did not disclose their gender.
Well-being and Support
a The “Total” column also includes those who identified their gender as non-binary or did not disclose their gender.
Telepsychiatry
a The “Total” column also includes those who identified their gender as non-binary or did not disclose their gender.
COVID-19 knowledge and training
The majority of the study participants reported being “confident” (46.2%) or “neutral” (35%) in their knowledge on COVID-19 symptoms and management. However, with regard to confidence in managing patients with a comorbidity of COVID-19 and a mental disorder, the largest proportion of survey participants reported being neutral (44.1%), while confident (29%) or very confident (3.3%) responses were given by only a third of respondents in total. Of note is the difference in the frequency of “confident” and “very confident” responses between women (28.2% in total) and men (39.7% in total). More than half (54%) of ECPs received specific recommendations in their country during the pandemic and 64.8% had additional educational activities (courses, workshops, and local conferences) on COVID-19. For the vast majority of ECPs (88.4%), at least some of the obligatory local training and educational activities (courses, workshops, and local conferences) have been replaced with online activities. A quarter of respondents experienced either a change in the duration of their training or prevented them from taking the exam as planned during the pandemic period.
Workplace conditions
More than a quarter of the participants (26.9%) have been obliged by the authorities to change the place of work because of the pandemic while almost three quarters of them (74.3%) “agreed” or “strongly agreed” that physical distancing and other recommendations related to the COVID-19 prevention were followed at their workplace. In total, 77.9% of the ECPs reported that personal protective equipment been sufficiently provided in their workplace. Two thirds of the participants (66.9%) had access to free COVID-19 tests at their place of work, while 71% have been tested for SARS-CoV-2. Almost one in ten (9.7%) of the ECPs have been clinically diagnosed with COVID-19, whereas one third (33.1%) have been quarantined.
Wellbeing and support
The majority (59.2%) of the study participants have declared that COVID-19 pandemic affects their well-being “negatively” or “very negatively.” The assessment of the impact of coworkers and supervisors on the well-being of ECPs varied: 31.3% rated it as either “rather positive” or “very positive,” 32.1% as either “rather negative” or “very negative,” while 32.3% specified that they had no significant impact. Less than half (43.5%) of the study participants had access to free psychological counselling.
Telepsychiatry
The vast majority (92.6%) of ECPs indicated that telepsychiatry was used in their countries during the pandemic. However, only about half of them had recommendations on how to proceed with telepsychiatry. The majority (62.5%) of the total number of participants in the study used various means of communication for telepsychiatry, with 17.4% of the participants only using non-video communication methods (“telephone or software for audio communication only” or “chat, text messages, or e-mail only”). Dedicated closed platforms for audiovisual communication in telemedicine were available to 23.4% of ECPs during the pandemic. Only 31.5% responded that they were “rather satisfied” or “very satisfied” with the use of telepsychiatry during the pandemic. Only 31.5% responded that they were “rather satisfied” or “very satisfied” with the use of telepsychiatry during the pandemic. However, half (49.7%) of the respondents assessed that it was “likely” or “very likely” that they were to use telemedicine after the pandemic.
Predictors of confidence in knowledge on COVID-19 symptoms and management among ECPs
The multiple regression was run to predict the confidence in the knowledge on COVID-19 symptoms and management among ECPs from the set of predictors. The multiple regression model statistically significantly predicted dependent variable (DV), F(19, 469) = 2.04, p = .006, adj. R2 = .04. Five variables added statistically significantly to the prediction (p < .05).
The analysis indicated that men showed higher confidence in knowledge of COVID-19 symptoms and management than women when all variables were included in the model (β = .10, t = 2.23; p = .022; 95% BCa CI: 0.02–0.33). The results also indicated that the specialists (β = .11, t = 2.37; p = .018; 95% BCa CI: 0.03–0.35) were more confident than trainees. Moreover, reducing the duration of the training (β = .10, t = 2.13; p = .031; 95% BCa CI: 0.01–0.54), following COVID-19-related recommendations (β = .13, t = 2.90; p = .006; 95% BCa CI: 0.03–0.20) and access to a dedicated platform for telemedicine (β = .11, t = 2.34; p = .028; 95% BCa CI: 0.03–0.39) were the significant predictors of a higher confidence in knowledge on COVID-19 symptoms and management among ECPs (see Table 6).
Predictors of Confidence in Knowledge on COVID-19 Symptoms and Management among ECPs (N = 508)
Note. Significant predictors are bold.
Abbreviation: WBC, World Bank Classification; HI, high-income; UMI, upper-middle-income; LMI, lower-middle income; 95% BCa CI, 95% bias-corrected and accelerated (BCa) bootstrap interval; ref., reference category.
Predictors of confidence in managing patients with comorbidity of COVID-19 and mental disorders among ECPs
The multiple regression model statistically significantly predicted confidence in managing patients with comorbidity of COVID-19 and mental disorders among ECPs, F(19, 488) = 4.49, p < .001, adj. R2 = .12. Thus, the model accounted for 12% of the variance of the dependent variable.
The analysis indicated that men showed higher confidence in managing patients with comorbidity of COVID-19 and mental disorders than women when all variables were included in the model (β = .12, t = 2.71; p = .009; 95% BCa CI: 0.06–0.35). The specialists (β = .12, t = 2.52; p = .018; 95% BCa CI: 0.05–0.36) were more confident than the trainees. Moreover, child and adolescent psychiatrists were less confident than general adult psychiatrists (β = −.09, t = −2.10; p = .030; 95% BCa CI: −0.35 to −0.03). Having specific recommendations (β = .12, t = 2.81; p = .003; 95% BCa CI: 0.07–0.36), access to additional educational activities for ECPs (β = .09, t = 2.12; p = .039; 95% BCa CI: 0.01–0.35), following COVID-19-related recommendations (β = .09, t = 2.09; p = .049; 95% BCa CI: 0.00–0.17) and access to a provided protective equipment (β = .12, t = 2.50; p = .016; 95% BCa CI: 0.05–0.43) were the significant predictors of a higher confidence in managing patients with comorbidity of COVID-19 and mental disorders among ECPs (see Table 7).
Predictors of Confidence in Managing Patients with Comorbidity of COVID-19 and Mental Disorders Among ECPs (N = 508)
Note. Significant predictors are bold.
Abbreviation: WBC, World Bank Classification; HI, high-income; UMI, upper-middle-income; LMI, lower-middle income; 95% BCa CI, 95% bias-corrected and accelerated (BCa) bootstrap interval; ref., reference category.
Predictors of the assessment of COVID-19 impact on the well-being among ECPs
Model 3 accounted for a significant amount of the variance in COVID-19 impact on the well-being among ECPs, F(19, 488) = 3.07, p < .001, adj. R 2 = .072, and explained 7.2% of the variation in the dependent variable.
The analysis indicated that following COVID-19-related recommendations (β = .14, t = 2.98; p = .002; 95% BCa CI: 0.05–0.21) and access to the dedicated platform for telemedicine (β = .14, t = 3.05; p = .003; 95% BCa CI: 0.11–0.51) were the significant predictors of assessing COVID-19 as less negative for well-being (see Table 8).
Predictors of Assessing COVID-19 Impact on the Well-being Among ECPs (N = 508)
Note. Significant predictors are bold.
Abbreviation: WBC, World Bank Classification; HI, high-income; UMI, upper-middle-income; LMI, lower-middle income; 95% BCa CI, 95% bias-corrected and accelerated (BCa) bootstrap interval; ref., reference category.
Predictors of the assessment of supervisors’ and co-workers’ impact on the well-being of ECPs
Regarding the assessment of supervisors’ and co-workers’ impact on the well-being of ECPs, the multiple regression indicates that the set of selected predictors contributed significantly to the regression model, F(19, 469) = 4.21, p < .001, adj R2 = .111) and accounted for 11.1% of the relevance of supervisors and co-workers for ECPs’ well-being.
In particular, the analysis indicated that additional educational activities for ECPs (β = .09, t = 2.03; p = .049; 95% BCa CI: 0.01–0.41), lack of possibility to take the exam on time (β = .09, t = 1.99; p = .023; 95% BCa CI: 0.05–0.69), following COVID-related recommendations (β = .25, t = 5.55; p < .001; 95% BCa CI: 0.18–0.38), diagnosis of COVID-19 (β = .08, t = 1.96; p = .035; 95% BCa CI: 0.03–0.56), and access to free psychological counselling (β = .16, t = 3.65; p < .001; 95% BCa CI: 0.15–0.52) predict the assessment of the impact of supervisors’ and co-workers’ on ECPs’ well-being as more positive (see Table 9).
Predictors of the Supervisors’ and Co-workers’ Impact on the Well-being of ECPs (N = 489)
Note. Significant predictors are bold.
Abbreviation: WBC, World Bank Classification; HI, high-income; UMI, upper-middle-income; LMI, lower-middle income; 95% BCa CI, 95% bias-corrected and accelerated (BCa) bootstrap interval; ref., reference category.
Predictors of satisfaction with the use of telepsychiatry during the COVID-19 pandemic among ECPs
The analysis indicated that the model, including the set of predictors, had explained a 15.1% variation in satisfaction with the use of telepsychiatry during the COVID-19 pandemic, F(19, 365) = 4.69; p < .001, adj. R2 = 0.151).
It turned out that the obligation by the authorities to change the place of work (β = −0.11, t = −2.07, p = .035; 95% BCa CI: −0.46 – −0.02) was a predictor of decreased satisfaction with telepsychiatry. Whereas, diagnosis of COVID-19 (β = 0.11, t = 2.24, p =. 022; 95% BCa CI: 0.04–0.73), having recommendations for telepsychiatry (β = 0.20, t = 4.02, p <. 001; 95% BCa CI: 0.22–0.63) as well as access to dedicated platform for telemedicine (β = 0.21, t = 4.09, p <. 001; 95% BCa CI: 0.26–0.67) were related to increased satisfaction with telepsychiatry (see Table 10).
Predictors of Satisfaction with the Use of Telepsychiatry During the COVID-19 pandemic Among ECPs (N = 395)
Note. Significant predictors are bold.
Abbreviation: WBC, World Bank Classification; HI, high-income; UMI, upper-middle-income; LMI, lower-middle income; 95% BCa CI, 95% bias-corrected and accelerated (BCa) bootstrap interval; ref., reference category.
Predictors of willingness to use telemedicine after the COVID-19 pandemic among ECPs
Model 6 accounted for a significant amount (10.6%) of the variance in the willingness to use telemedicine after the COVID-19 pandemic among ECPs, F(19, 443) = 3.90, p < .001, adj. R 2 = .106.
The analysis indicated that men showed a greater willingness to use telemedicine after the COVID-19 pandemic than women (β = 0.11, t = 2.31; p = .020; 95% BCa CI: 0.03–0.45). Moreover, additional educational activities for ECPs (β = 0.11, t = 2.33; p = .020; 95% BCa CI: 0.05–0.46), having recommendations for telepsychiatry (β =0.11, t = 2.20; p = .022; 95% BCa CI: 0.04–0.44), and access to the dedicated platform for telemedicine (β = 0.23, t = 4.84; p < .001; 95% BCa CI: 0.37–0.79) were the significant predictors of the greater willingness to use telemedicine after the COVID-19 pandemic, whereas the obligation by the authorities to change the place of work (β = −0.11, t = −2.32, p = .017; 95% BCa CI: −0.50 – −0.07) predict decreased willingness (see Table 11).
Predictors of Willingness to Use Telemedicine after the Pandemic Among ECPs (N = 463)
Note. Significant predictors are bold.
Abbreviation: WBC, World Bank Classification; HI, high-income; UMI, upper-middle-income; LMI, lower-middle income; 95% BCa CI, 95% bias-corrected and accelerated (BCa) bootstrap interval; ref, reference category.
Discussion
ECPs coped differently during the COVID-19 pandemic, contingent upon their work settings and conditions. A previously published article from Iran used the same questionnaire translated into Persian, which allows a direct comparison of the results with our study.Reference Eissazade, Shalbafan and Saeed13 In Europe overall we found slightly more participants being confident about their knowledge than in Iran. On the other hand, Iranian ECPs tended to be more confident in managing patients with a comorbidity of COVID-19 and a mental disorder.
The extent of COVID-19 knowledge may be associated with one’s undergraduate education. In Germany a study with medical students reported that 64% were dissatisfied with teaching on COVID-19 disease and 73% with teaching on COVID-19 vaccines.Reference Baessler, Zafar and Mengler34
The results, which reveal a higher self-assessment of their knowledge and competence among men compared to women could be attributed to a general tendency for men to overestimate their competence, as described in the literature.Reference Ring, Neyse, David-Barett and Schmidt35, Reference Lundeberg, Fox and Punćcohaŕ36 A study comprising healthcare workers and students from the Gulf Cooperation Council region demonstrated similar COVID-19 knowledge levels between genders, albeit with slightly higher raw scores for men.Reference Abdulwahab, Kamal, AlAli, Husain and Safar37 On the other hand, a review on healthcare professional experiences of women during outbreaks suggests that disparities affecting women include a higher risk of pathogen exposure and infection, poorer access to personal protective equipment, increased workload, and higher prevalence of mental health problems.Reference Morgan, Tan and Oveisi38
Compared to ECPs from Iran, a smaller proportion of ECPs working in Europe had specific recommendations introduced during the COVID-19 pandemic and were offered additional educational activities on COVID-19. Similarly, less participants from Europe had some or all of their obligatory local training and educational activities replaced with online activities than in Iran. However, the pandemic has affected the duration of the training of over one third of ECPs from Iran, while in European countries the duration of training of only a quarter of participants has been altered.Reference Eissazade, Shalbafan and Saeed13
Much more respondents from Europe, compared to Iran, agreed that the physical distancing and other recommendations related to COVID-19 prevention were followed at their workplace. The majority of participants in both Iran and Europe were sufficiently provided with personal protective equipment in their workplace. However, much more European ECPs had access to free COVID-19 tests in their place of work and were tested for SARS-CoV-2.Reference Eissazade, Shalbafan and Saeed13
A study on psychiatric trainees from 22 countries showed burnout is a common phenomenon among early career psychiatrists.Reference Jovanović, Podlesek and Volpe39 Severe burnout was experienced by over one third of trainees and it was significantly associated with long working hours, lack of supervision and not having regular time to rest. In a study from Saudi Arabia on a group of 150 psychiatry trainees, over a quarter showed symptoms of burnout, and the same proportion had depressive symptoms.Reference Alkhamees, Assiri, Alharbi, Nasser and Alkhamees21 Those who suffered from burnout were almost nine times more likely to show symptoms of depression. Trainees who were women, who were in the first 2 years of training or who have received any mental health help in the previous 2 years were more likely to show depressive symptoms. In the previously mentioned study,Reference Eissazade, Shalbafan and Saeed13 the majority of Iranian participants described that the pandemic had negatively affected their wellbeing. A similar percentage of ECPs in Europe were affected negatively, albeit they tended to be affected to a lesser extent. Interestingly, twice as many European participants reported negative effects of their supervisors and/or co-workers on their well-being in comparison to those from Iran. Access to free psychological counseling was more available for ECPs in Iran than to those in Europe. More participants from Europe were obliged by the authorities to change their place of work because of the pandemic. There was a substantial difference in the proportion of people who were diagnosed with COVID-19 between European countries (10%) and Iran (62%). Similarly, 70% of Iranian ECPs were quarantined, as compared with 33% of quarantined ECPs in Europe.
ECPs from various countries agreed during the pandemic that telepsychiatry should be used more widely, particularly in rural and remote areas.Reference de Filippis, Soler-Vidal and Pereira-Sanchez22 A similar total percentage of participants used telepsychiatry in Iran and in European countries; however, more Iranian ECPs declared they did not have access to any recommendations on how to proceed with telepsychiatry consultations. Despite that, participants from Iran were more satisfied with telepsychiatry than their European colleagues and reported to be much more likely to use telemedicine after the pandemic.Reference Eissazade, Shalbafan and Saeed13
Limitations of the study
The data collection period was long, and the sample size was large (n >500 people). The course of the COVID-19 pandemic was variable, with periods of waves of increasing incidence, the severity of which also varied between countries, which may have influenced the responses given. The individual situation of respondents may have changed with the course of the pandemic, while answers to the survey were given once. The questionnaire was administered online and it was not possible to calculate the response rate. There could have been a possible bias related to the participation of those individuals who had a greater interest in the survey topic, including potentially those for whom the COVID-19 pandemic represented a greater burden. On the other hand, difficulties related to working conditions during the pandemic may have meant that fewer participants with a greater workload during this period found time to participate in the study.
Due to the large differences in the number of responses between countries, it was not possible to carry out a comparative analysis between them. Finally, the questionnaire used was developed in English for the purpose of this study. This might have limited non-English speakers to participate in the study, and the reliability of the answers provided may have depended on the degree of English proficiency.
Due to these limitations, the generalizability of the results obtained is to a certain extent limited.
Recommendations for changes in ECPs training and working conditions
We have identified independent factors that may be associated with better outcomes in terms of ECPs’ confidence in their knowledge and competencies and their adherence to pandemic-prevention guidelines, as well as with better well-being outcomes and satisfaction with telepsychiatry use. The majority of these factors are modifiable conditions linked to education and working arrangements, which can be improved. These conditions include (1) introduction of specific recommendations for ECPs during the pandemic, (2) additional educational activities for ECPs focused on the outbreak, (3) adequate provision of personal protective equipment in the workplace, (4) access to free psychological counselling, (5) no obligation by the authorities to change the place of work because of the pandemic, (6) access to free psychological counseling, (7) provision of guidelines for the use of telepsychiatry, and (8) provision of a dedicated closed platform for audiovisual communication in telemedicine.
Conclusions
The COVID-19 pandemic has affected early-career psychiatrists in Europe to varying degrees. The results of the study point to areas where decision-makers can improve the learning and working conditions for ECPs to increase their resilience, which can help to better prepare for future outbreaks.
A shorter training, better adherence to COVID-19-related recommendations, and access to a dedicated platform for telemedicine predicted a higher confidence in knowledge on COVID-19 symptoms and management among ECPs. Providing specific recommendations during the COVID-19 pandemic, access to additional educational activities for ECPs, following COVID-19-related recommendations, and access to protective equipment were the significant predictors of a higher confidence in managing patients with comorbidity of COVID-19 and mental disorders.
Following COVID-19-related recommendations at the workplace and access to the dedicated platform for telemedicine predicted assessing the COVID-19 pandemic as less negative for well-being. On the other hand, additional educational activities for ECPs, lack of possibility to take the exam on time during the COVID-19 pandemic, better adherence to COVID-related recommendations, diagnosis of COVID-19, and access to free psychological counselling were predictors of a more positive assessment of the impact of supervisors and co-workers on ECPs’ well-being.
Several factors were associated with the use of telepsychiatry. The obligation to change the place of work predicted a decreased satisfaction with telepsychiatry as well as a decreased willingness to use telepsychiatry after the COVID-19 pandemic. In contrast, a diagnosis of COVID-19, having recommendations for telepsychiatry, and access to a dedicated platform for telemedicine were predictors of an increased satisfaction with telepsychiatry. Similarly, additional educational activities for ECPs, having recommendations for telepsychiatry, and access to the dedicated platform for telemedicine were predictors of a greater willingness to use telemedicine after the pandemic.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/S1092852925100734.
Data availability
Data supporting the findings of this study are available from the corresponding author TMG on request.
Acknowledgments
The study was designed by members of the Early Career Psychiatrists Committee of the European Psychiatric Association (EPA), with guidance from members of the EPA Board, and the questionnaire was distributed with the help of the EPA and the European Federation of Psychiatric Trainees (EFPT).
Author contribution
Conceptualization: M.P.; T.M.G. Statistical analysis: E.C. All authors contributed to investigation, writing, reviewing, and editing the manuscript.
Financial support
The study did not receive any funding. The article processing charges were covered by the European Psychiatric Association.
Disclosures
OKa received consulting fees from the University of Exeter, grants from Swedish Institute and Lund University and declared contracts with Psychiatric Clinic of Minsk City and Psychiatric Clinic Malmö Sweden. GS received consulting fees from HLS Therapeutics and Thermo Fisher Scientific. TMG received honoraria for lectures and/or support for attending meetings from Valeant Polska, Lundbeck Poland, Apotex Poland/Aurovitas Pharma Polska, Celon Pharma, Neuraxpharm Polska, Exeltis Poland, Medice, Takeda Pharma, EGIS, and GL Pharma. Other authors declare no competing interests and potential conflicts.
Ethical approval
This study was approved by the Ethical Committee of the University of Lower Silesia (opinion no. 7/2022). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Participants agreed to participate in the survey and gave their informed consent electronically, before answering the survey questions.
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