We live in unprecedented modern times experiencing how an outbreak of a particular viral disease, COVID-19, caused by SARS-CoV-2, also commonly referred to as the Coronavirus, is disrupting societies and personal lives. The virus is likely to spread to most, if not all, countries, illustrating the interconnectedness of the world. At the time of writing, Italy and Spain have become the epicenters in terms of fatalities in Europe, whereas the United States has recorded the most diagnosed cases worldwide. While many national measures to contain, suppress, mitigate, or delay the spread of the virus are being taken, there is great uncertainty as to which measures are appropriate or not, varying from instructions of stringent hand hygiene; travel restrictions; social distancing; and closure of schools, restaurants, bars and shops to a complete lock down of large parts of society. Science-based evidence informing the policy about the efficaciousness and possible adverse effects of these measures are urgently needed. As there is a lack of both data and insight into the mechanisms of the pandemic, generating this science-based evidence will take some time. Key epidemiological numbers, such as the attack rate of the disease and the infection–hospitalization and infection–fatality ratios, are not yet available, and estimates based on the existing limited data come with huge uncertainties (1, 2). Thus, scientists blindfolded by the lack of data have to inform a policy that needs to decide about far-reaching measures fundamentally changing societies and individuals’ lives. It’s an uncomfortable situation. COVID-19 is a tremendous challenge for occupational health. Workers in many occupations are facing high risks of becoming infected. There is a long list of jobs that involve direct contact with the public and close physical proximity to others. Workers in shops, bars, restaurants, fast food, and delivery services are at increased risk for exposure to infected persons due to the large number of daily contacts. Barbers, manicurists, and physical therapists work in close proximity to their customers. However, there are also many jobs where workers have the freedom of being able to work from home, thus considerably reducing the risk to contract the virus. For example, the authors of this editorial are working from home, but communication is easy through email and Skype. Without any doubt, healthcare personnel deservedly receive nationwide attention these days. They are at the forefront of combatting this outbreak. Not only is their work stress at record high, their healthcare organizations are under severe pressure and many are struggling to cope with care needs of so many critically ill patients simultaneously. Healthcare professionals are at increased risk of exposure to high viral load because of their close contact with COVID-19 patients, which puts them at risk of becoming infected. At the same time, they themselves are an important source of transmitting the disease to colleagues, patients, friends, and family. Healthcare workers cannot stay at home in times of capacity problems in health emergencies. In a recent letter, a physician asked himself the question: “Am I part of the cure, or am I part of the disease?” (3) Early evidence from Wuhan, the origin of the worldwide outbreak, indicated that - of all Coronavirus infected cases - almost 4% had comprised healthcare personnel, and five deaths among healthcare workers had been confirmed (4). In Italy, the most affected country in Europe, on March 26, 2020, it was reported that more than 5,000 healthcare workers had tested positive for the Coronavirus and more than 40 had died as a result of COVID-19 (5). The daily reality in Italian hospitals is grim: insufficient testing capacity, lack of suitable protective equipment, lack of mechanical ventilators, wards not isolated from each other, and patients in beds in corridors. The capacity of the national health system is stretched to its limits and, in the most affected region of Lombardy, clearly insufficient (6). In such a crisis, it is imperative to ensure that healthcare workers are protected, for their own safety and to safeguard the healthcare system but also to prevent transmission of the virus. It is obvious that we have to revert to the proven strategies to protect workers by creating awareness of risks and providing personal protective equipment as well as appropriate hygiene procedures. Almost 15 years ago, prompted by the SARS epidemic, Descatha and colleagues (7) already pleaded for such contingency plans in healthcare in the event of an influenza pandemic. Companies will have to deal with the psychosocial and psychological consequences of the current Coronavirus outbreak. Specifically, healthcare organizations will need to deal with insomnia, burnout, depressive symptoms, and post-traumatic stress disorders among healthcare workers. In Wuhan hospitals support teams have been set up to provide individual psychological guidance and group-based interventions (8). An important source of psychological distress are the impossible decisions (who to treat first?) under extreme work pressure. A recent analysis of previous major incidents called not only for peer-support programs during the crisis but also for active monitoring and adequate availability of mental treatment to prevent long-term damage to healthcare staff (9). The long-lasting societal effects of this pandemic are impossible to estimate yet. National, regional or global economic recessions seem to be inevitable. We know from previous economic crises, such as the recession in Finland in the 1990s (10) and the global financial crisis of 2007–2009 (11, 12) that there were marked effects on people’s health, both on those who lost their jobs and those remaining at work. Thus, efforts on containment, suppression and mitigation are not only needed with regard to the virus but also with...

Burnout has a long tradition of studies in the workplace and recently researchers suggested burnout is also rising among university students. The Maslach Burnout Inventory (MBI) is considered a valid measure of burnout. However, the student version of the MBI (MBI-SS) has received limited empirical support. The aim of this paper is to analyze the factorial validity, invariance, and latent profiles of the Italian version of the MBI-SS in a sample university students. A total of 7757 Italian university students participated in an online cross-sectional survey. Results from explorative and confirmatory factor analyses showed acceptable fits for the Italian version of the MBI-SS. In addition, multigroup analyses supported full-metric invariance of MBI-SS within gender and academic level (bachelor vs. master). Finally, results from latent profile analysis showed that a three latent profile model was the better solution for the data: (a) burned-out (high levels of exhaustion, cynicism (CY), and low professional efficacy (PE); n = 2665, 34.2%); (b) overextended (high levels of exhaustion, moderate other, n = 3953, 51.0%); and (c) engaged (moderate exhaustion, low CY, and high PE, n = 1149, 14.8%). The resulting three-profile solution in the present study partially agrees with a prior study as it replicated three of the five-profile solution identified. In sum, we suggest that the MBI-SS is valid and reliable and represents a robust instrument for the measurement of burnout among Italian speaking university students.

Mental health problems are highly prevalent among university students, but little is known about their underlying determinants. This study explores mental health among university students, the association between "effort-reward imbalance" (ERI), overcommitment and mental health, and to what extent ERI and overcommitment explain gender differences in mental health. Cross-sectional data were analyzed from 4760 Italian university students. The Kessler Psychological Distress Scale-10 was used to measure self-reported psychological distress, as an indicator of mental health, and the ERI - Student Questionnaire to measure effort, reward and overcommitment. The associations between ERI and overcommitment with psychological distress were estimated with multinomial logistic regression analyses. 78.5% of the respondents experienced psychological distress, with 21.3%, 21.1%, and 36.1% reporting respectively mild, moderate and severe psychological distress. Female students were more likely to report moderate and severe psychological distress. ERI and overcommitment were strongly associated with severe psychological distress with ORs respectively up to 19.9 (95% CI: 12.2-32.5) and 22.2 (95% CI: 16.1-30.7). ERI and overcommitment explained part of the higher odds of severe psychological distress among female students comparing to males, attenuating the ORs from 2.3 (95% CI: 1.9-2.7) to 1.4 (95% CI: 1.2-1.7). This cross-sectional study was performed on a large, but convenient sample. More than one out of three students reported severe psychological distress. Decreasing ERI and overcommitment may be beneficial in the prevention of psychological distress among university students and may reduce gender differences in psychological distress. Longitudinal studies are needed to further investigate these associations.

Mental health problems are highly prevalent among university students. Stress due to student life challenges may be a risk factor for poorer health. This study investigates to what extent student life challenges and changes therein are associated with mental health and self-rated health. In a longitudinal study with 568 Italian university students mental health was assessed using the Mental Health Inventory-5 (MHI-5) and self-rated health with a single item from the Short Form 36 Health Survey (SF36) (score ranges: 0-100) at baseline and at six months follow-up. Student life challenges were investigated using six subscales (score ranges: 1-4) of the Higher Education Stress Inventory (HESI). A between-within linear regression model was used to investigate whether a higher exposure to life challenges was associated with poorer health (between individuals) and whether changes in student life challenges were associated with changes in health (within individuals). Higher exposure to student life challenges was associated with poorer mental health (b ranging from -5.3 to -10.3) and self-rated health (b ranging from -3.1 to -9.6). An increase in student life challenges within individuals was associated with poorer mental health and self-rated health, in particular for high workload (b up to -5.9), faculty shortcomings (b up to -5.7), and unsupportive climate (b up to -5.6). Exposure to student life challenges and changes therein are associated with university students' health. Our findings suggest that student life challenges may be a target for interventions to improve mental health and self-rated health among university students.

Background: In the last decade academic stress and its mental health implications amongst university students has become a global topic. The use of valid and theoretically-grounded measures of academic stress in university settings is crucial. The aim of this study was to examine the factorial structure, reliability and measurement invariance of the short student version of the effort-reward imbalance questionnaire (ERI-SQ). Methods: A total of 6448 Italian university students participated in an online cross-sectional survey. The factorial structure was investigated using exploratory factor analysis and confirmatory factor analysis. Finally, the measurement invariance of the ERI-SQ was investigated. Results: Results from explorative and confirmatory factor analyses showed acceptable fits for the Italian version of the ERI-SQ. A modified version of 12 items showed the best fit to the data confirming the 3-factor model. Moreover, multigroup analyses showed metric invariance across gender and university course (health vs other courses). Conclusions: In sum, our results suggest that the ERI-SQ is a valid, reliable and robust instrument for the measurement of stress among Italian university students.

Mental health problems are a risk factor for loss of paid employment. This study investigates (i) the relation between depressive symptoms and different involuntary pathways of labour force exit and (ii) explores gender and geographical differences in this relation. The study population consisted of 5263 individuals in paid employment aged between 50 years and the country-specific retirement age from 11 European countries participating in the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE). Self-reported depressive symptoms at baseline were assessed using the EURO-D. Employment status was derived from interviews after 2 and 4 years. Cox proportional hazards regression analyses were used to investigate the association between depressive symptoms and labour force exit via disability benefit and unemployment. Population attributable fractions (PAFs) were calculated to estimate the contribution of depressive symptoms to these pathways of labour force exit. Both men and women with a EURO-D score ≥4 had a >2-fold increased risk of a disability benefit (HR: 2.46, 95%CI 1.68–3.60) after adjustment for demographics and work-related characteristics. Among men depressive symptoms elevated the risk of becoming unemployed at follow-up (HR 1.55; 95%CI: 0.94–2.57). The PAF was 0.18 for disability benefit and 0.04 for unemployment, and varied across European regions. Individuals with depressive symptoms are at increased risk of losing paid employment, which in turn may aggravate their symptoms. Targeting depressive symptoms with public health and occupational policies should be considered to reduce the burden of mental diseases in Europe.