E-Health Psychological Intervention for COVID-19 Healthcare Workers: Protocol for its Implementation and Evaluation

Alejandro Dominguez-Rodriguez, Reyna Jazmín Martínez-Arriaga, Paulina Erika Herdoiza-Arroyo, Eduardo Bautista-Valerio, Anabel de la Rosa-Gómez, Rosa Olimpia Castellanos Vargas, Laura Lacomba-Trejo, Joaquín Mateu-Mollá, Miriam de Jesús Lupercio Ramírez, Jairo Alejandro Figueroa González, Flor Rocío Ramírez Martínez, Alejandro Dominguez-Rodriguez, Reyna Jazmín Martínez-Arriaga, Paulina Erika Herdoiza-Arroyo, Eduardo Bautista-Valerio, Anabel de la Rosa-Gómez, Rosa Olimpia Castellanos Vargas, Laura Lacomba-Trejo, Joaquín Mateu-Mollá, Miriam de Jesús Lupercio Ramírez, Jairo Alejandro Figueroa González, Flor Rocío Ramírez Martínez

Abstract

(1) Background: Healthcare workers have been affected by the COVID-19 pandemic. Digital interventions have been carried out that have been effective with this population; however, few have been reported in Latin America. Our aim is to describe the components and methods to evaluate the feasibility and utility of an online multi-component psychological intervention for healthcare workers in Mexico during COVID-19. (2) Methods: This study is a randomized clinical trial with two arms: (1) self-applied intervention and (2) intervention delivered online by therapists. The participants are randomly assigned to one arm, receiving the same treatment contents in both groups. The "Personal COVID" intervention consists of an internet platform containing 9 nuclear and 3 complementary modules. The objectives of the intervention are: (1) to reduce anxiety, depressive symptoms, burnout, and compassion fatigue, and (2) to increase the quality of life, sleep quality, self-care, and their skills to give bad news. The protocol has been registered on ClinicalTrials.gov (identifier: NCT04890665). (3) Discussion: This protocol is designed according to the highest scientific standards following the SPIRIT guidelines. The "Personal COVID" intervention is expected to be of high efficacy in treating the emotional distress of healthcare workers and promoting their health during the COVID-19 pandemic.

Keywords: COVID-19; anxiety; depression; healthcare workers; internet-based intervention; mental health.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Randomization process.
Figure 3
Figure 3
Animated videos of anxiety and depression sessions. (a) anxiety module; (b) depression module.
Figure 4
Figure 4
Main page of the Personal COVID Intervention where the participants need to log in (“iniciar sesion”) or create an account (“crear cuenta”).
Figure 5
Figure 5
Main menu of the Personal COVID Intervention with the onboarding process indicating to the participant how to use the platform.
Figure 6
Figure 6
Screen with all the available sessions or modules.

References

    1. Kisely S. Addressing the Psychological Needs of Workers in Health Care During the COVID-19 Pandemic Must Not Be an Afterthought. Jt. Comm. J. Qual. Patient. Saf. 2021;47:141–142. doi: 10.1016/j.jcjq.2021.01.001.
    1. Vizheh M., Qorbani M., Arzaghi S.M., Muhidin S., Javanmard Z., Esmaeili M. The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. J. Diabetes Metab. Disord. 2020;19:1967–1978. doi: 10.1007/s40200-020-00643-9.
    1. Ching S.M., Ng K.Y., Lee K.W., Yee A., Lim P.Y., Ranita H., Devaraj N.K., Ooi P.B., Cheong A.T. Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis. PLoS ONE. 2021;16:e0257983. doi: 10.1371/journal.pone.0257983.
    1. Saragih I.D., Tonapa S.I., Saragih I.S., Advani S., Batubara S.O., Suarilah I., Lin C.-J. Global prevalence of mental health problems among healthcare workers during the Covid-19 pandemic: A systematic review and meta-analysis. Int. J. Nurs. Stud. 2021;121:104002. doi: 10.1016/j.ijnurstu.2021.104002.
    1. Lluch C., Galiana L., Doménech P., Sansó N. The Impact of the COVID-19 Pandemic on Burnout, Compassion Fatigue, and Compassion Satisfaction in Healthcare Personnel: A Systematic Review of the Literature Published during the First Year of the Pandemic. Healthcare. 2022;10:364. doi: 10.3390/healthcare10020364.
    1. Ruiz-Fernández M.D., Ramos-Pichardo J.D., Ibáñez-Masero O., Cabrera-Troya J., Carmona-Rega M.I., Ortega-Galán M. Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain. J. Clin. Nurs. 2020;29:4321–4330. doi: 10.1111/jocn.15469.
    1. Robles R., Rodríguez E., Vega-Ramírez H., Álvarez-Icaza D., Madrigal E., Durand S., Morales-Chainé S., Astudillo C., Real-Ramírez J., Medina-Mora M.-E., et al. Mental health problems among healthcare workers involved with the COVID-19 outbreak. Rev. Bras. Psiquiatr. 2021;43:494–503. doi: 10.1590/1516-4446-2020-1346.
    1. Marvaldi M., Mallet J., Dubertret C., Moro M.R., Guessoum S.B. Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Neurosci. Biobehav. Rev. 2021;126:252–264. doi: 10.1016/j.neubiorev.2021.03.024.
    1. Johns G., Samuel V., Freemantle L., Lewis J., Waddington L. The global prevalence of depression and anxiety among doctors during the covid-19 pandemic: Systematic review and meta-analysis. J. Affect. Disord. 2021;298:431–441. doi: 10.1016/j.jad.2021.11.026.
    1. Hernández-Díaz Y., Genis-Mendoza A.D., Ramos-Méndez M., Juárez-Rojop I.E., Tovilla-Zárate C.A., González-Castro T.B., López-Narváez M.L., Nicolini H. Mental Health Impact of the COVID-19 Pandemic on Mexican Population: A Systematic Review. Int. J. Environ. Res. Public Health. 2022;19:6953. doi: 10.3390/ijerph19116953.
    1. Serrano-Ripoll M.J., Zamanillo-Campos R., Castro A., Roque M.A.F.-D., Ricci-Cabello I. Insomnia and sleep quality in healthcare workers fighting against COVID-19: A systematic review of the literature and meta-analysis. Actas Espanolas De Psiquiatr. 2021;49:155–179.
    1. Robles R., Morales-Chainé S., Bosch A., Astudillo-García C., Feria M., Infante S., Alcocer-Castillejos N., Ascencio L., Real-Ramírez J., Díaz D., et al. Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other Country-Level Epidemics: The Case of Mexico. Int. J. Environ. Res. Public Health. 2021;19:421. doi: 10.3390/ijerph19010421.
    1. Hernández-Díaz Y., Genis-Mendoza A., Fresán A., González-Castro T., Tovilla-Zárate C., Juárez-Rojop I., López-Narváez M., Martínez-Magaña J., Nicolini H. Knowledge, Emotions and Stressors in Front-Line Healthcare Workers during the COVID-19 Outbreak in Mexico. Int. J. Environ. Res. Public Health. 2021;18:5622. doi: 10.3390/ijerph18115622.
    1. Cortés-Álvarez N.Y., Vuelvas-Olmos C.R. COVID 19: Psychological Effects and Associated Factors in Mexican Nurses. Disaster Med. Public Health Prep. 2020;16:1377–1383. doi: 10.1017/dmp.2020.495.
    1. Ślusarska B., Nowicki G.J., Niedorys-Karczmarczyk B., Chrzan-Rodak A. Prevalence of Depression and Anxiety in Nurses during the First Eleven Months of the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health. 2022;19:1154. doi: 10.3390/ijerph19031154.
    1. Robles-Pérez E., González-Díaz B., Miranda-García M., Borja-Aburto V.H. Infection and death by COVID-19 in a cohort of healthcare workers in Mexico. Scand. J. Work. Environ. Health. 2021;47:349–355. doi: 10.5271/sjweh.3970.
    1. Zaçe D., Hoxhaj I., Orfino A., Viteritti A., Janiri L., Di Pietro M. Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: A systematic review. J. Psychiatr. Res. 2021;136:319–333. doi: 10.1016/j.jpsychires.2021.02.019.
    1. De Kock J.H., Latham H.A., Cowden R.G., Cullen B., Narzisi K., Jerdan S., Munoz S.-A., Leslie S.J., Stamatis A., Eze J. Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial. JMIR Ment. Health. 2022;9:e34002. doi: 10.2196/34002.
    1. Bertuzzi V., Semonella M., Bruno D., Manna C., Edbrook-Childs J., Giusti E., Castelnuovo G., Pietrabissa G. Psychological Support Interventions for Healthcare Providers and Informal Caregivers during the COVID-19 Pandemic: A Systematic Review of the Literature. Int. J. Environ. Res. Public Health. 2021;18:6939. doi: 10.3390/ijerph18136939.
    1. Hooper J.J., Saulsman L., Hall T., Waters F. Addressing the psychological impact of COVID-19 on healthcare workers: Learning from a systematic review of early interventions for frontline responders. BMJ Open. 2021;11:e044134. doi: 10.1136/bmjopen-2020-044134.
    1. Serrano-Ripoll M.J., Ricci-Cabello I., Jiménez R., Zamanillo-Campos R., Yañez-Juan A.M., Bennasar-Veny M., Sitges C., Gervilla E., Leiva A., García-Campayo J., et al. Effect of a mobile-based intervention on mental health in frontline healthcare workers against COVID-19: Protocol for a randomized controlled trial. J. Adv. Nurs. 2021;77:2898–2907. doi: 10.1111/jan.14813.
    1. Blake H., Bermingham F., Johnson G., Tabner A. Mitigating the Psychological Impact of COVID-19 on Healthcare Workers: A Digital Learning Package. Int. J. Environ. Res. Public Health. 2020;17:2997. doi: 10.3390/ijerph17092997.
    1. Pollock A., Campbell P., Cheyne J., Cowie J., Davis B., McCallum J., McGill K., Elders A., Hagen S., McClurg D., et al. Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: A mixed methods systematic review. Cochrane Database Syst. Rev. 2020;2020:CD013779. doi: 10.1002/14651858.cd013779.
    1. Lai F.H.-Y., Yan E.W.-H., Yu K.K.-Y., Tsui W.-S., Chan D.T.-H., Yee B.K. The Protective Impact of Telemedicine on Persons With Dementia and Their Caregivers During the COVID-19 Pandemic. Am. J. Geriatr. Psychiatry. 2020;28:1175–1184. doi: 10.1016/j.jagp.2020.07.019.
    1. Cheng W., Zhang F., Liu Z., Zhang H., Lyu Y., Xu H., Hua Y., Gu J., Yang Z., Liu J. A psychological health support scheme for medical teams in COVID-19 outbreak and its effectiveness. Gen. Psychiatry. 2020;33:e100288. doi: 10.1136/gpsych-2020-100288.
    1. Priede A., López-Álvarez I., Carracedo-Sanchidrián D., González-Blanch C. Mental health interventions for healthcare workers during the first wave of COVID-19 pandemic in Spain. Rev. Psiquiatr. Salud Ment. 2021;14:83–89. doi: 10.1016/j.rpsm.2021.01.005.
    1. Weiner L., Berna F., Nourry N., Severac F., Vidailhet P., Mengin A.C. Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: The Reduction of Stress (REST) study protocol for a randomized controlled trial. Trials. 2020;21:870. doi: 10.1186/s13063-020-04772-7.
    1. Han J., Zhang L., Liu Y., Zhang C., Zhang Y., Tang R., Bi L. Effect of a group-based acceptance and commitment therapy programme on the mental health of clinical nurses during the COVID-19 sporadic outbreak period. J. Nurs. Manag. 2022 doi: 10.1111/jonm.13696.
    1. Mukhtar S. Mental health and emotional impact of COVID-19: Applying Health Belief Model for medical staff to general public of Pakistan. Brain Behav. Immun. 2020;87:28–29. doi: 10.1016/j.bbi.2020.04.012.
    1. Scott A.J., Webb T.L., Rowse G. Self-help interventions for psychosis: A meta-analysis. Clin. Psychol. Rev. 2015;39:96–112. doi: 10.1016/j.cpr.2015.05.002.
    1. Fernández-Álvarez J., Díaz-García A., González-Robles A., Baños R., García-Palacios A., Botella C. Dropping out of a transdiagnostic online intervention: A qualitative analysis of client’s experiences. Internet Interv. 2017;10:29–38. doi: 10.1016/j.invent.2017.09.001.
    1. Melville K.M., Casey L.M., Kavanagh D. Dropout from Internet-based treatment for psychological disorders. Br. J. Clin. Psychol. 2010;49:455–471. doi: 10.1348/014466509X472138.
    1. Hassenzahl M. User experience (UX): Towards an experiential perspective on product quality; Proceedings of the 20th international conference on Association Francophone d’Interaction Homme-Machine; Metz, France. 2 September 2008; New York, NY, USA: Association for Computing Machinery; 2008.
    1. Tullis T., Albert B. Measuring the User Experience: Collecting, Analyzing, and Presenting Usability Metrics. Morgan Kaufmann; Waltham, MA, USA: 2013.
    1. Philippe T.J., Sikder N., Jackson A., E Koblanski M., Liow E., Pilarinos A., Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment. Health. 2022;9:e35159. doi: 10.2196/35159.
    1. Dominguez-Rodriguez A., Martínez-Luna S.C., Jiménez M.J.H., De La Rosa-Gómez A., Arenas-Landgrave P., Santoveña E.E.E., Arzola-Sánchez C., Silva J.A., Nicolas A.M.S., Guadián A.M.C., et al. A Self-Applied Multi-Component Psychological Online Intervention Based on UX, for the Prevention of Complicated Grief Disorder in the Mexican Population During the COVID-19 Outbreak: Protocol of a Randomized Clinical Trial. Front. Psychol. 2021;12:1–19. doi: 10.3389/fpsyg.2021.644782.
    1. Pan American Health Organization Mental Health. [(accessed on 2 March 2022)]. Available online: .
    1. Arnberg F.K., Linton S.J., Hultcrantz M., Heintz E., Jonsson U. Internet-Delivered Psychological Treatments for Mood and Anxiety Disorders: A Systematic Review of Their Efficacy, Safety, and Cost-Effectiveness. PLoS ONE. 2014;9:e98118. doi: 10.1371/journal.pone.0098118.
    1. Hollinghurst S., Peters T.J., Kaur S., Wiles N., Lewisand G., Kessler D. Cost-effectiveness of therapist-delivered online cognitive–behavioural therapy for depression: Andomized controlled trial. Br. J. Psychiatry. 2010;197:297–304. doi: 10.1192/bjp.bp.109.073080.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Lawrence Erlbaum Associates, Publishers; Hillsdale, NJ, USA: 1988.
    1. Study Randomizer. 2020. [(accessed on 22 May 2022)]. Available online:
    1. ITLAS Group E-mental health. [(accessed on 20 July 2022)]. Available online: .
    1. Adlin T., Pruitt J., Goodwin K., Hynes C., McGrane K., Rosenstein A., Muller M.J. Putting personas to work; Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; Montreal, QC, Canada. 22–27 April 2006; pp. 13–16.
    1. Optimal Workshop. 2022. [(accessed on 2 January 2022)]. Available online:
    1. Figma. 2022. [(accessed on 2 January 2022)]. Available online:
    1. Domínguez-Rodríguez A., Figueroa González J.A., Miriam L.R., de Jesús F.L. 2021. [(accessed on 4 August 2021)]. Available online: .
    1. Garcia-Campayo J., Zamorano E., Ruiz M., Pardo A., Perez-Paramo M., Lopez-Gomez V., Freire O., Rejas J. Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health Qual. Life Outcomes. 2010;8:8. doi: 10.1186/1477-7525-8-8.
    1. Spitzer R.L., Kroenke K., Williams J.B.W., Löwe B. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7: The GAD-7. Arch. Intern. Med. 2006;166:1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. González-Forteza C., Jiménez-Tapia J.A., Ramos-Lira L., Wagner F.A. Aplicación de la Escala de Depresión del Center of Epidemiological Studies en adolescentes de la Ciudad de México. Salud Pública Mex. 2008;50:292–299. doi: 10.1590/S0036-36342008000400007.
    1. Stamm B.H. The concise ProQOL manual. 2010. [(accessed on 18 May 2022)]. Available online: .
    1. Heritage B., Rees C.S., Hegney D. The ProQOL-21: A revised version of the Professional Quality of Life (ProQOL) scale based on Rasch analysis. PLoS ONE. 2018;13:e0193478. doi: 10.1371/journal.pone.0193478.
    1. Buysse D.J., Reynolds C.F., III, Monk T.H., Berman S.R., Kupfer D.J. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Jiménez-Genchi A., Monteverde-Maldonado E., Nenclares-Portocarrero A., Esquivel-Adame G., de la Vega-Pacheco A. Reliability and factor analysis of the Spanish version index of pittsburgh sleep quality in patients psychiatric [Confiabilidad y análisis factorial de la versión en español del índice de calidad de sueño de Pittsburgh en pacientes psiquiátricos] Gac. Med. Mex. 2008;144:491–496.
    1. Palomar J., Gómez N.E. Desarrollo de una Escala de Medición de Resiliencia con Mexicanos (RESI-M) Interdisciplinaria. 2010;27:7–22.
    1. Evers G., Isenberg M., Philipsen H., Senten M., Brouns G. Validity testing of the Dutch translation of the appraisal of the self-care agency A.S.A.-scale. Int. J. Nurs. Stud. 1993;30:331–342. doi: 10.1016/0020-7489(93)90105-4.
    1. Gallegos E. Validez y confiabilidad de la versión en español de la escala ASA. Desarro. Científico De Enfermería. 1998;6:260–264.
    1. Gallegos E. Validación De La Escala: Capacidades De Autocuidado Con Población Mexicana. [Investigación Inédita] Universidad Autónoma de Nuevo León; Monterrey, México: 1995.
    1. Foa E.B., Cashman L., Jaycox L., Perry K. The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychol. Assess. 1997;9:445–451. doi: 10.1037/1040-3590.9.4.445.
    1. Novy D.M., Stanley M.A., Averill P., Daza P. Psychometric comparability of English- and Spanish-language measures of anxiety and related affective symptoms. Psychol. Assess. 2001;13:347–355. doi: 10.1037/1040-3590.13.3.347.
    1. Plutchik R., Van Praag H.M. SUCIDE RISK. J. Offender Rehabil. 1994;21:173–186. doi: 10.1300/J076v21n03_11.
    1. Alderete-Aguilar C., Infecciosas I.N.D.E.R.I.C.V.D.D.I.D.E., Cruz-Maycott R., Candela-Iglesias M., Rodríguez-Estrada E., Reyes-Terán G. Assessment of depression, anxiety, hopelessness and suicidal risk in HIV+ inpatients. Salud Ment. 2017;40:23–28. doi: 10.17711/SM.0185-3325.2017.004.
    1. Ahorsu D.K., Lin C.-Y., Imani V., Saffari M., Griffiths M.D., Pakpour A.H. The Fear of COVID-19 Scale: Development and Initial Validation. Int. J. Ment. Health Addict. 2020;27:1–9. doi: 10.1007/s11469-020-00270-8.
    1. Huarcaya-Victoria J., Villarreal-Zegarra D., Podestà A., Luna-Cuadros M.A. Psychometric Properties of a Spanish Version of the Fear of COVID-19 Scale in General Population of Lima, Peru. Int. J. Ment. Health Addict. 2020;20:249–262. doi: 10.1007/s11469-020-00354-5.
    1. Botella C., Quero S., Serrano B., Baños R.M., García-Palacios A. Avances en los tratamientos psicológicos: La utilización de las nuevas tecnologías de la información y la comunicación. Anu. Psicol. 2009;40:155–170.
    1. Brooke J. SUS: A ’Quick and Dirty’ Usability Scale. Usability Eval. Ind. 1996;189:4–7.
    1. Hariton E., Locascio J.J. Randomised controlled trials—The gold standard for effectiveness research: Study design: Randomised controlled trials. BJOG. 2018;125:1716. doi: 10.1111/1471-0528.15199.
    1. Chan A.-W., Tetzlaff J.M., Altman D.G., Laupacis A., Gøtzsche P.C., Krleža-Jerić K., Hróbjartsson A., Mann H., Dickersin K., Berlin J.A., et al. SPIRIT 2013 Statement: Defining Standard Protocol Items for Clinical Trials. Ann. Intern. Med. 2013;158:200–207. doi: 10.7326/0003-4819-158-3-201302050-00583.
    1. Zolnikov T.R., Furio F. Stigma on first responders during COVID-19. Stigma Health. 2020;5:375–379. doi: 10.1037/sah0000270.
    1. Labrague L.J. Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: A systematic review of quantitative studies. J. Nurs. Manag. 2021;29:1893–1905. doi: 10.1111/jonm.13336.
    1. Martínez Arriaga R.J., González Ramírez L.P., Navarro Ruiz N.E., De la Roca Chiapas J.M., Reynoso González O.U. Resiliencia asociada a factores de salud mental y sociodemográficos en enfermeros mexicanos durante COVID-19. Enfermería Glob. 2021;20:1–32. doi: 10.6018/eglobal.452781.
    1. Feicht T., Wittmann M., Jose G., Mock A., Von Hirschhausen E., Esch T. Evaluation of a Seven-Week Web-Based Happiness Training to Improve Psychological Well-Being, Reduce Stress, and Enhance Mindfulness and Flourishing: A Randomized Controlled Occupational Health Study. Evid. Based Complement. Altern. Med. 2013;2013:1–14. doi: 10.1155/2013/676953.
    1. Jones C.J., Smith H., Llewellyn C. Evaluating the effectiveness of health belief model interventions in improving adherence: A systematic review. Health Psychol. Rev. 2013;8:253–269. doi: 10.1080/17437199.2013.802623.
    1. Kelson J., Rollin A., Ridout B., Campbell A. Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review. J. Med. Internet Res. 2019;21:e12530. doi: 10.2196/12530.
    1. Jiménez-Molina A., Franco P., Martínez V., Martínez P., Rojas G., Araya R. Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review. Front. Psychiatry. 2019;10:664. doi: 10.3389/fpsyt.2019.00664.
    1. Hedman E., Ljótsson B., Lindefors N. Cognitive behavior therapy via the Internet: A systematic review of applications, clinical efficacy and cost–effectiveness. Expert Rev. Pharm. Outcomes Res. 2012;12:745–764. doi: 10.1586/erp.12.67.
    1. Seyffert M., Lagisetty P., Landgraf J., Chopra V., Pfeiffer P.N., Conte M., Rogers M. Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0149139. doi: 10.1371/journal.pone.0149139.
    1. Mestre T.A. Nocebo and lessebo effects. Int. Rev. Neurobiol. 2020;153:121–146. doi: 10.1016/bs.irn.2020.04.005.
    1. Barello S., Graffigna G. Caring for Health Professionals in the COVID-19 Pandemic Emergency: Toward an “Epidemic of Empathy” in Healthcare. Front. Psychol. 2020;11:1431. doi: 10.3389/fpsyg.2020.01431.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren