This document provides a summary of the impacts of the COVID-19 pandemic on the mental health of healthcare workers. It begins with background on the origins and spread of COVID-19. It then discusses several known cases of healthcare workers who died by suicide due to mental health impacts of working during the pandemic. The document proposes a typology of suicide among healthcare workers, identifying predictive risk factors. It offers recommendations for managing mental health difficulties, including strategies for different risk levels. Finally, it provides resources for mental health support services and concludes by emphasizing the importance of addressing healthcare workers' mental wellbeing during the crisis.

1. Submitted by: Venus S. Dulay, RN
Reviewed to: Dr. David De Jesus, RN, PgDip,FISQua
Covid19pandemic
The ultimate
causality of

2. OVID
2
…to kill the fears
of death
by death’s own
hands

3. DISCLAIMER:
I have no actual or
potential conflict of
interst in relation to
this presentation
To be able to classify
the Typology of suicide
among healthcare
professional in the
light of CoVid-19
pandemic.
Objective 01
To be able to identify
potential risk factors
associated with suicide
among healthcare
professional.
Objective 02
To be able to
enumerate managing
strategies for positive
mental wellbeing
during such pandemic.
Objective 03

4. Impact of
Co-Vid 19
Pandemic
4
December 31, 2019 when the first case of Pneumonia with
unknown origin in Wuhan, China was reported to WHO. In
71 days, the once unknown has been declared as a global
pandemic and carries, to date ,an alias of Covid 19. It’s been
136 days (as of 15May, 2020) and our digits continuous to
rise.The mortality and morbidity is unfathomable. The global
effect to healthcare system and economy is devastating. The
consequence to social and moral integrity of each individual
worldwide is downgrading to the core.
With our current stage, no doubt mental health issues are
also rising in the same rapid pace as the spread of the
virus.
OUTBREAK Situation:
4 307 287 – Confirmed cases
295 101 – Confirmed deaths
216 – Countries, areas or territories
with cases
Last update 15 May 2020 by WHO

5. Ultimate casuality…
sui·cide |ˈsü-ə-ˌsīd
5
When everyone is so focused on managing and treating signs and symptoms of
the infected. And while the WHO’s current major objective focuses on the prevention
of human-to-human transmission, limiting the spread of infection to close contacts and
medical professionals, prevention of developing of complication of the infected and
trying to create a treatment or vaccine; there is one important issue currently brewing
as well. This concerns the mental well being of frontliners- nurses and doctor alike and
the general population at large. If left brewing, a tragic ending may result to

6.  Daniela Trezzi, 34
ICU Nurse, Lombardy Italy
According to a report by
the Daily Mail, she was
terrified and feeling guilty
that she may have
infected others, and took
her own life.
6People who have paid
the ultimate price…
She took her own life out of fear she was spreading
the novel Coronavirus to others. Tragic, heroic, and
heartbreaking story. Remember her name
#DanielaTrezzi pic.twitter.com/mFifsi5RSf

7. “she tried to do
her job and it
killed her”
 Lorna Breen, 49
ER Doctor, New York
Presbyterian Allen
Hospital City
Contacted the virus, recovered, was
hospitalized again and treated due
to exhaustion, then later took her
own life with self-inflicted
injuries
Words from her father, a physician
himself and director of the very
hospital where her daughter works,
Dr. Philip Breen
He added: “Make sure she’s praised as a hero,
because she was. She’s a casualty just as much
as anyone else who has died.”

8. John Mondello, Emergency medical
technician (EMT), aged 23, killed
himself after working at COVID-19's hotspots
for less than 3 months,
as reported in New York Post.
“ He told me he was experiencing a lot of anxiety
witnessing a lot of death, he’d feel it was heavy
experience when he’d fail to save a life”
A collegue said to SinChew Daily
8

9. Other frontliners
across UK and Italy,
who may have paid the
ultimate price
She was found
unresponsive in
her ward.
King’s College
Hospital,
London Threw herself in
the Piare River of
Cortellazzo
Jesolo Hospital
(CoVid-19
Ward),Venice
Took own life while at
home awaiting result
of CoVid-19 test
Volunteered to
work with CoVid-19
patientd, Jesolo
Hospital
Nurse
in her
20’s
Female
nurse,
49y/o
Female
nurse with
initials SL
9

10. Suicide among
nurses is
IGNORED and
UNACKNOWLEDGE
It is so lagged
10
Even in the national data of United States, it’s
statistics is non-existent, while datas for Physician,
Teachers, Public Officers, Firefighters and Military
personnel are readily available.
A study though in Queensland found that nurses
regardless of gender has suicide rate higher than any
other educated professional

11. Suicide
among
Doctors
Contrary to nurses, National data
for the suicide rate of doctors is not
only readily available but up-to-date.
Comprehensive studies and literatures
are remarkably filed for several
decades; and all these proved and
illustrated that the suicide rate of
doctors deemed to be higher
than the general population.
SUICIDE among doctors is said to be
5 and 7 times of the general population
In a narrative review by
Ventriglio, Watson and Bhugra
11

12. A nurse or a doctor, does
it really matter?
Both are VULNERABLE
12

13. An Observer’s
typology of
suicide
Saxby Pridmore and Milford McArthur
Suicide is possible only in the presence of a
PREDICAMENT.
Predicament 1- MDP ( Mental Disorder is Present)
Predicament 2- MDA (Mental Disorder is Absent)
…each predicament may take 2 forms:
PVCD- Very Clearly the Driver of suicide
PLCD- Less Clearly the Driver of suicide
TYPE 1 Suicide- MDP-PVCD:
Mental disorder is clearly present and from observer’s
point of view is the definite primary driver of suicide.
TYPE 2 Suicide-MDP-PLCD:
It is a retrospective and speculative type. In this
case mental disorder is present and considered
the main driver but was unrecognized and
untreated.
Type 4 Suicide- MDA-PLCD:
No underlying mental disorder and relatively no
identified distressing external factors either; at least from
the observer’s point of view nothing sufficient that may
have motivated the self-kill.
TYPE 3 Suicide- MDA-PVCD:
Apparently NO mental disorder, instead suicide
is driven by external factors, distressing enough
to resort to self-killing.
13

14. 14
To support the
morale and mental
health of the frontline healthcare
professionals, healthcare
organizations should introduce
shorter working periods, regular
breaks and rotating shifts.
Ho et al. 2020
May be classified under TYPE 3
Suicide: MDA-PVCD. In this time of
Co-Vid 19 Pandemic, healthcare
professional are faced with multitude
of distressing external factors leaving
them vulnerable and potentially
subjecting them to the risk of taking
their own lives just so to put an end to
this uncontrollable demise.
Suicide
among healthcare
professionals
itstypology

15. 15
Low Risk
General
population
Mild to
moderate
symptoms
-Universal
strategy
Intermediate risk
Family
members, close
contacts,
comorbid
disorder. elderly
Moderate to
sever
symptoms-
selected
strategy
High risk
Patients.
Healthcare
provider
Severe
symptoms-
Indicated
Strategy
Recommended
RISK SEVERITY
of COVID19

16. 16
Distress
related
to covid
Mild and
intermittent
Moderate to
severe &
persistent
Psycho
logical
pharmacol
ogical
Both
psychologica
l and
pharmacolog
ical
Diagnosis
specific
treatment
recommendati
on
Relaxation
exercises,
supportive
counselling&
problem solving
strategies
Consulting
mental health
professionals
Realaxation &
life style
modification
measures
Strengthening
and social
support
Reassurance
Recommended
management approach
tomental health
difficulties
inthemidstof
COVID19

17. - Excessive workload
The pacing of the spread
of the Co-Vid 19 is so fast
that the volume of
patients is overwhelming
in number.
Physial and
Environmental
distress
-Longer hours of work
While volume of patient never
ceases to increase and front liners
themselves are being infected, hours
of work needs to be increased to
accommodate the increased
healthcare services demand.
All these add injury to the already bruised & vulnerable healthcare professionals
RISK
/Aggrevating
FACTORS
Amonghealthcareworkers
17
- Insufficient PPE’s and
healthcare infrastructure
Plain and simple, demand for
healthcare services rapidly shot
up and that resources of many
countries is not enough.

18. -Moral injury and Burnout
Anxiety and compassion fatigue in witnessing human suffering
and death; ethical conflicts- the dilemma of sticking to ones
pledge or saving oneself and family from the risk of contacting
and spreading the disease. Isolation(call it social distancing to
sound lighter and more acceptable, still it’s a form of isolation)
and the inevitable imbalance work-life cycle.
Amplifying the situation is the inadequate supply of PPE’s as well.
To some institution and corporations, deployment anywhere at
anytime otherwise will be subjected to
disciplinary action, not stating the obvious but it is definitely
termination. It is the feeling of being devalued by the system
you serve ( just ask nicely for goodness sake, voluntary exists in
our vocabulary you know)And it’s of no difference from ordinary
people in the community, who tends to discriminate because of
the stigma that if you’re a member of the healthcare you are
definitely a carrier.
Emotional
distress
All these add injury to the already bruised & vulnerable healthcare professionals
RISK
/Aggrevating
FACTORS
Amonghealthcareworkers
18

19. 19Common
early
warning
signs
As published by MOPH of
Qatar Feeling irritable, stressed and teary
 Wanting to spend a lot of time alone
 Tiredness and exhaustion
 Difficulty relaxing and concentrating
 Feeling sad or bad about self
 Eating unhealthy and skipping meals
 Poor sleeping pattern
 Feeling hopeless and helpless
 Having thoughts of harming self
 Feeling worried, fearful, nervous or tense
 Physical symptoms ( sweating, trembling, dizziness or rapid
heartbeat)

20. Strategies in
maintaining
mental well being
In the midst of Co-Vid 19 Pandemic
Do’s
 Take breaks from watching, reading, or
listening to news stories and social media.
 Take care of your body- eat balanced diet,
exercise and meditate, sleep plenty.
 Stay active- it helps release ENDORPHINS
 Plan your fun/Unwind- find activities suitable
to self and time
 Stay connected- maintain, improve and
increase healthy relationships with
supportive significant others and friends ,it is
a powerful tool to improve resilence.
 Find your “push button”
20
PUSH BUTTON: is saying
“NO” to give time and
space for self to:
contemplate and reflect

21. Strategies in
maintaining
mental well being
In the midst of Co-Vid 19 Pandemic
Don’ts
 Substance use.
 Eating too much fast food
 Excessive online activity.
 Excessive watching of television(mostly
News)
 Focusing on the negative aspects of co-
Vid 19 pandemic.
 Posting about Co-Vid19 on social
media and spreading fake news
 Believing fake news.
21

22. Be sad.
Get angry.
Be confused.
Be scared.
It’s OK! It’s normal !
Confront it. Continue to live.
Talk to someone and seek help.
22

23. 23
National Mental
Health Helpline
Qatar
Call the toll
free
number,1600
This is launched by Ministry of Public
Health in collaboration of Primary
Health Care Corporation and Hamad
Medical Corporation ( Mental Health
Service). Staffed by a team of mental
professionals to give support, advice
and care for those experiencing mental
and emotional problems as brought
about by this pandemic.

24. The Triumph of Death ( Palermo)
c. 1446
This is
Everyone’s
Fight.
Pandemic will end. Regardless of
its origin, its kind and nature, the
course has always been the
same. It will end just like the
Athenian Plague of 430 B.C or
the Black Plague of 1334 or the
Spanish Flu Pandemic of 1918-
1920 or the SARS, the first
outbreak of 21st century and
which happens to be the same
family as COVID 19.
Let’s not allow this virus to limb
our lives, our healthcare system
much further. If there is this one
power left of us during this
pandemic, it is the power not to
let our mental well being “go
over the edge”. Let us break the
stigma of mental health and
psychological concerns.
Acknowledge our being as
humans, subject to anxiety,
frustration, sadness, isolation,
feels hurt, gets tired and so on.
24

25. The Triumph of Death ( Palermo)
c. 1446
We should not be ashamed to seek
professional help instead of resorting
to substance abuse or self-medicating.
Break the notion that asking help is a
sign of weakness, and let us change
the culture of “ walling off”. Personal
should be separated from
professional, but in the midst of
pandemic like this, we need to loosen
up a bit the professional mode and
start to look at the person as a whole.
Ask your colleagues “ are you ok
today?; “ how is your family coping
nowadays?” After all,
we are a family, a community
inside a unit. Let’s safeguard each
other by being vigilant of any hint
of behavioural or emotional
changes of our colleagues.
People see us as HEROES
who do not wear CAPES.
Heroes are needed today
much more tomorrow. So
hang in there!
Continuation…
This is
Everyone’s
Fight.
25

26. References:
26
COVID-19 situation reports. (n.d.). Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-
2019/situation-reports/
Davidson, J., J. Mendis, A. R. Stuck, G. DeMIchele, and S. Zisook. 2018. Nurse suicide: Breaking the silence. NAM
Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://nam.edu/nurse-suicide-
breaking-the-silence.
Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by
healthcare workers during covid-19 pandemic. Bmj, m1211. doi: 10.1136/bmj.m1211
How to Relieve Stress: A 6-Step Plan to Feeling Good. (n.d.). Retrieved from
https://www.hopkinsmedicine.org/health/wellness-and-prevention/how-to-relieve-stress-a-6-step-plan-to-feeling-
good
Kar, S. K., Arafat, S. M. Y., Kabir, R., Sharma, P., & Saxena, S. K. (2020). Coping with Mental Health Challenges During
COVID-19. Medical Virology: From Pathogenesis to Disease Control Coronavirus Disease 2019 (COVID-19), 199–213.
doi: 10.1007/978-981-15-4814-7_16
Pridmore, S., & McArthur, M. (n.d.). An Observers Typology of Suicide | Request PDF. Retrieved from
https://www.researchgate.net/publication/41411157_An_Observers_Typology_of_Suicide
Smith, E. M., & Kingsborough Community College of the City University of New York. (n.d.). Suicide risk assessment
and prevention : Nursing Management. Retrieved from
https://journals.lww.com/nursingmanagement/Fulltext/2018/11000/Suicide_risk_assessment_and_prevention.6.asp
x
Sofer, D. (2018). Suicide Among Nurses. AJN, American Journal of Nursing, 118(8), 14. doi:
10.1097/01.naj.0000544147.83703.35
Ventriglio A, Watson C, Bhugra D. Suicide among doctors: A narrative review. Indian J Psychiatry 2020; 62:114-20.

27. ThankYou
27
These slides are uploaded for the
information and as a partial
requirement of Philippine women’s
University in Master of Nursing
(MAN); subject: Nursing Practicum