The COVID-19 pandemic potentially increases doctors’ work demands and limits their recovery opportunity; this consequently puts them at a high risk of adverse mental health impacts. This study aims to estimate the level of doctors’ fatigue, recovery, depression, anxiety, and stress, and exploring their association with work demands and recovery experiences. This was a cross-sectional study among all medical doctors working at all government health facilities in Selangor, Malaysia. Data were collected in May 2020 immediately following the COVID-19 contagion peak in Malaysia by using self-reported questionnaires through an online medium. The total participants were 1050 doctors. The majority of participants were non-resident non-specialist medical officers (55.7%) and work in the hospital setting (76.3%). The highest magnitude of work demands was mental demand (M = 7.54, SD = 1.998) while the lowest magnitude of recovery experiences was detachment (M = 9.22, SD = 5.043). Participants reported a higher acute fatigue level (M = 63.33, SD = 19.025) than chronic fatigue (M = 49.37, SD = 24.473) and intershift recovery (M = 49.97, SD = 19.480). The majority of them had no depression (69.0%), no anxiety (70.3%), and no stress (76.5%). Higher work demands and lower recovery experiences were generally associated with adverse mental health. For instance, emotional demands were positively associated with acute fatigue (adj. b = 2.73), chronic fatigue (adj. b = 3.64), depression (adj. b = 0.57), anxiety (adj. b = 0.47), and stress (adj. b = 0.64), while relaxation experiences were negatively associated with acute fatigue (adj. b = −0.53), chronic fatigue (adj. b = −0.53), depression (adj. b = −0.14), anxiety (adj. b = −0.11), and stress (adj. b = −0.15). However, higher detachment experience was associated with multiple mental health parameters in the opposite of the expected direction such as higher level of chronic fatigue (adj. b = 0.74), depression (adj. b = 0.15), anxiety (adj. b = 0.11), and stress (adj. b = 0.11), and lower level of intershift recovery (adj. b = −0.21). In conclusion, work demands generally worsen, while recovery experiences protect mental health during the COVID-19 pandemic with the caveat of the role of detachment experiences.

Unplanned absenteeism (UA), which includes medically certified leave (MC) or emergency leave (EL), among nurses may disturb the work performance of their team and disrupt the quality of patient care. Currently, there is limited study in Malaysia that examines the role of stressors in determining absenteeism among nurses. Therefore, apart from estimating the prevalence and the reasons of UA among nurses in Malaysia, this study aims to determine its stressor-related determinants. A cross-sectional study was conducted among 697 randomly sampled nurses working in Selangor, Malaysia. Most of them were female (97.3%), married (83.4%), and working in shifts (64.4%) in hospital settings (64.3%). In the past year, the prevalence of ever taking MC and EL were 49.1% and 48.4%, respectively. The mean frequency of MC and EL were 1.80 (SD = 1.593) and 1.92 (SD = 1.272) times, respectively. Meanwhile, the mean duration of MC and EL were 4.24 (SD = 10.355) and 2.39 (SD = 1.966) days, respectively. The most common reason for MC and EL was unspecified fever (39.2%) and child sickness (51.9%), respectively. The stressor-related determinants of durations of MC were inadequate preparation at the workplace (Adj.b = −1.065) and conflict with doctors (adjusted regression coefficient (Adj.b) = 0.491). On the other hand, the stressor-related determinants of durations of EL were conflict with spouse (Adj.b = 0.536), sexual conflict (Adj.b = −0.435), no babysitter (Adj.b = 0.440), inadequate preparation at workplace (Adj.b = 0.257), lack of staff support (Adj.b = −0.190) and conflict with doctors (Adj.b = −0.112). The stressor-related determinants of the frequency of MC were conflicts over household tasks (Adj.b = −0.261), no time with family (Adj.b = 0.257), dangerous surroundings (Adj.b = 0.734), conflict with close friends (Adj.b = −0.467), and death and dying (Adj.b = 0.051). In contrast, the stressor-related determinants of frequency of EL were not enough money (Adj.b = −0.334), conflicts with spouse (Adj.b = 0.383), pressure from relatives (Adj.b = 0.207), and inadequate preparation (Adj.b = 0.090). In conclusion, apart from the considerably high prevalence of unplanned absenteeism and its varying frequency, duration and reasons, there is no clear distinction in the role between workplace and non-workplace stressors in determining MC or EL among nurses in Malaysia; thus, preventive measures that target both type of stressors are warranted. Future studies should consider longitudinal design and mixed-method approaches using a comprehensive model of absenteeism.

Objectives: This paper aims to estimate the level of acute fatigue, chronic fatigue and intershift recovery among doctors working at public hospitals in Malaysia and determine their inter-relationship and their association with work-related activities during non-work time. Design: Cross-sectional. Setting: Seven core clinical disciplines from seven tertiary public hospitals in Malaysia. Participants: Study was conducted among 330 randomly-sampled doctors. Response rate was 80.61% (n=266). Results: The mean score of acute fatigue, chronic fatigue and intershift recovery were 68.51 (SD=16.549), 54.60 (SD=21.259) and 37.29 (SD=19.540), respectively. All these scores were out of 100 points each. Acute and chronic fatigue were correlated (r=0.663), and both were negatively correlated with intershift recovery (r=−0.704 and r=−0.670, respectively). Among the work-related activities done during non-work time, work-related ruminations dominated both the more frequent activities and the association with poorer fatigue and recovery outcomes. Rumination on being scolded/violated was found to be positively associated with both acute fatigue (adjusted regression coefficient (Adj. b )=2.190, 95% CI=1.139 to 3.240) and chronic fatigue (Adj. b =5.089, 95% CI=3.876 to 6.303), and negatively associated with recovery (Adj. b =−3.316, 95% CI=–4.516 to –2.117). Doing work task at workplace or attending extra work-related activities such as locum and attending training were found to have negative associations with fatigue and positive associations with recovery. Nevertheless, doing work-related activities at home was positively associated with acute fatigue. In terms of communication, it was found that face-to-face conversation with partner did associate with higher recovery but virtual conversation with partner associated with higher acute fatigue and lower recovery. Conclusions: Work-related ruminations during non-work time were common and associated with poor fatigue and recovery outcomes while overt work activities done at workplace during non-work time were associated with better fatigue and recovery levels. There is a need for future studies with design that allow causal inference to address these relationships.

Prenatal ultrasonographic detection of fetal structural anomaly may adversely affect maternal mental health throughout pregnancy, particularly in the current COVID-19 pandemic. This study aims to prospectively assess maternal stress, anxiety, and depression following ultrasonographic detection of fetal structural anomaly from diagnosis until delivery during the COVID-19 pandemic. A total of 141 pregnant women at a tertiary hospital who underwent detailed scans between 16 and 24 gestational weeks were included and categorized into the study (anomaly finding, n = 65) and comparison (normal finding, n = 76) groups. Self-administered questionnaires of 10-item Perceived Stress Scale (PSS-10) and Hospital Anxiety and Depression Scale (HADS) were used to assess maternal stress, anxiety, and depression at prior detection (T₁), two-to-four weeks post-detection (T₂), one-to-two weeks prior to delivery (T₃), and one-to-two weeks post-delivery (T₄). Repeated measures of analysis of variance (ANOVA) were conducted to assess time-, between-group, and time–group interaction effect. In general, maternal stress improved, but anxiety worsened, while depression persisted, over the time from T₁ to T₄. The average maternal stress and anxiety levels were significantly higher among groups with fetal anomaly. The maternal stress and anxiety level were significantly affected within one-to-two weeks post-detection of fetal structural anomaly. In conclusion, maternal mental health parameters were affected differently during the COVID-19 pandemic, with higher vulnerability of stress and anxiety among pregnant women with fetal structural anomaly particularly within one-to-two weeks post-detection.

Dual competing responsibilities between work and family are the challenges faced by most of the healthcare staff. Ineffective handling of these responsibilities may contribute to absenteeism which further disrupt the quality of work and reduce customer satisfaction. The aims of this study were to determine the prevalence of job absenteeism and to identify the association between family responsibilities and job absenteeism among nurses in teaching hospital. This was a cross sectional study targeted to nurses working in medical and surgical field based in a hospital. Questionnaires were distributed using stratified random sampling. Those with working services of less than one year were excluded. The mean age was 35.9 (SD=6.44) years old. Majority were female (94.0%) and Malay (96.0%). The one-year prevalence of absenteeism was 78.0% and majority were due to emergency leaves. Taking care of elderly and no help obtained for taking care of child showed significant associations with job absenteeism which both yielded four times higher odds for being absent. Employees with additional family responsibilities should receive support by the organisation to prevent further job absenteeism among nurses.

Healthcare workers typically work in shift to ensure smooth operation of healthcare industries around the clock. However, working in shift put them at risk of developing occupational fatigue and sleepiness during and after work, with multiple adverse effects to themselves and patients under their care. This review aims to identify available evidence-based intervention for fatigue and sleepiness among healthcare workers working in shift. We searched PubMed, Scopus and CENTRAL database from January 2013 to December 2017. Selection criteria included randomised controlled trials (RCTs) that investigated the effect of any interventions on fatigue and/or sleepiness among shift workers. Two authors independently screened titles and abstracts for relevant studies, extracted data, and assessed risk of bias. We included 8 relevant trials with 7 review-relevant participants. Given the methodological diversity of the included studies in terms of interventions and assessment tools, it is not possible to determine the effectiveness of these interventions to reduce occupational fatigue or sleepiness among healthcare workers working in shift. More good quality RCTs with comparable assessment tools is needed.