Moderating effect of work fatigue on the association between resilience and posttraumatic stress symptoms: a cross-sectional multi-country study among pharmacists during the COVID-19 pandemic

Samar Younes; Souheil Hallit; Irfan Mohammed; Sarah El Khatib; Anna Brytek-Matera; Shadrach Chinecherem Eze; Kenneth Egwu; Rawshan Jabeen; Nebojša Pavlović; Pascale Salameh; Michelle Cherfane; Marwan Akel; Chadia Haddad; Randa Choueiry; Feten Fekih-Romdhane; Katia Iskandar

doi:10.1186/s13030-024-00300-0

Moderating effect of work fatigue on the association between resilience and posttraumatic stress symptoms: a cross-sectional multi-country study among pharmacists during the COVID-19 pandemic

Biopsychosoc Med. 2024 Feb 19;18(1):4. doi: 10.1186/s13030-024-00300-0.

Authors

Samar Younes^{1

2}, Souheil Hallit^{3

4}, Irfan Mohammed⁵, Sarah El Khatib^{2

6}, Anna Brytek-Matera⁷, Shadrach Chinecherem Eze⁸, Kenneth Egwu⁹, Rawshan Jabeen¹⁰, Nebojša Pavlović¹¹, Pascale Salameh^{2

12

13

14}, Michelle Cherfane^{2

12}, Marwan Akel^{1

2}, Chadia Haddad^{2

12

15

16}, Randa Choueiry¹⁷, Feten Fekih-Romdhane^#^{18

19}, Katia Iskandar^#^{20

21

22

23}

Affiliations

¹ Department of Pharmaceutical Sciences, Faculty of Pharmacy, Lebanese International University, Beirut, Lebanon.
² Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT- LB), Beirut, Lebanon.
³ School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
⁴ Applied Science Research Center, Applied Science Private University, Amman, Jordan.
⁵ Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.
⁶ Department of Health Sciences, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
⁷ Eating Behavior Laboratory (EAT Younes et al. BioPsychoSocial Medicine, Institute of Psychology, University of Wroclaw, Wroclaw, Poland.
⁸ Federal Medical Centre, Makurdi Benue State, Makurdi, Nigeria.
⁹ Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Nigeria.
¹⁰ Department of Research & Development, Children's Hospital Karachi, Karachi, Pakistan.
¹¹ Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, 21000, Serbia.
¹² Gilbert and Rose Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
¹³ Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
¹⁴ Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.
¹⁵ Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
¹⁶ School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon.
¹⁷ Department of Medicinal Sciences, Faculty of Medicine, Lebanese University, Beirut, Lebanon.
¹⁸ Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, 2010, Tunisia.
¹⁹ Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
²⁰ Department of Pharmaceutical Sciences, Faculty of Pharmacy, Lebanese International University, Beirut, Lebanon. katia_iskandar@hotmail.com.
²¹ Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban (INSPECT- LB), Beirut, Lebanon. katia_iskandar@hotmail.com.
²² Institut supérieur de santé publique de l'université Saint-Joseph de Beyrouth, campus des sciences médicales, rue de Damas, BP 11-5076, Riad El Solh, Beyrouth, 1107 2180, Lebanon. katia_iskandar@hotmail.com.
²³ Faculty of Public Health-Section 2 (CERIPH), Lebanese University, Fanar, 90656, Lebanon. katia_iskandar@hotmail.com.

^# Contributed equally.

Abstract

Introduction: In the context of the COVID-19 pandemic, pharmacists, despite their vital contributions, have faced significant challenges that have impacted their mental well-being, potentially leading to the development of Post-Traumatic Stress symptoms (PTSS). The aim of this study was to investigate the role of work-related fatigue as a potential moderator in the relationship between pharmacists' resilience and their likelihood of experiencing PTSS during the COVID-19 pandemic.

Methods: A cross-sectional survey was conducted online in eight countries from January to December 2021, including Brazil, Lebanon, Nigeria, Pakistan, Poland, Serbia, and Tunisia. The mediation analysis was conducted using PROCESS MACRO (an SPSS add-on) v3.4 model 1, taking work fatigue as a moderator in the association between resilience and PTSS.

Results: A total of 442 pharmacists were enrolled in this study (mean age = 33.91 ± 10.36 years) with 59.5% of them being females. The results were adjusted over country, gender, working in contact with COVID-19, working patients, working mandatory hours, working voluntary hours, age, household crowding index and number of months engaged in COVID-19. The interactions resilience by physical (Beta = 0.02; p = .029), mental (Beta = 0.02; p = .040) and emotional (Beta = 0.03; p = .008) work fatigue were significantly associated with PTSS; for pharmacists with low to moderate levels of physical (Beta = - 0.33; p < .001 and Beta = - 0.21; p = .001), mental (Beta = - 0.29; p < .001 and Beta = - 0.18; p = .006) and emotional (Beta = - 0.31; p < .001 and Beta = - 0.17; p = .008) work fatigue, higher resilience was significantly related to lower PTSS levels. However, for pharmacists with high levels of physical/mental/emotional work fatigue, the association between resilience and PTSS became non-significant.

Conclusion: This study highlights the complex relationship between work-related fatigue, resilience, and PTSS in pharmacists. It emphasizes the need to address work-related fatigue for pharmacists' psychological well-being during crises, offering insights for tailored support and interventions.

Keywords: COVID-19; Multi-country study; Pharmacists; Posttraumatic stress disorder; Resilience; Work fatigue.