Dissociation in Long-Term Care Home Staff During COVID-19: Challenges and Promising Practices.

Abstract

Objectives: Long-term care (LTC) staff may develop dissociation due to high-stress work environments and trauma exposures. This study aimed to (1) assess the prevalence of pathological dissociation in LTC home staff during the COVID-19 pandemic; (2) examine the associations of pathological dissociation with demographic characteristics, mental health, insomnia, and professional quality of life; and (3) examine whether pathological dissociation was sensitive to change following a coherent breathing intervention.

Design: We analyzed data from a pre-post breathing intervention study conducted between January and September 2022.

Settings and participants: Participants were 254 staff (care aides, nurses, and managers) from 31 LTC homes in Alberta, Canada.

Methods: We measured pathological dissociation using the Dissociative Experiences Scale-Taxon (DES-T). We conducted χ² test and t tests to examine the association of pathological dissociation with other variables pre-intervention. We used a 2-level random intercept logistic regression analysis to examine the change in pathological dissociation from pre- to post-intervention.

Results: About 12% and 8% of the sample experienced pathological dissociation pre- and post-intervention, respectively. Pathological dissociation was significantly associated with stress, psychological distress, anxiety, depression, posttraumatic stress disorder, and insomnia (P < .05); it was also significantly associated with language, race, and professional role (P < .05). Participants had lower odds of experiencing pathological dissociation post-intervention compared with pre-intervention (odds ratio, 0.41; P = .045).

Conclusions and implications: LTC home staff exhibited a high prevalence of pathological dissociation during COVID-19, significantly linked to other mental health measures. A coherent breathing intervention showed potential in reducing reports of dissociation. Further research is needed to understand dissociation in LTC staff and its interplay with mental health outcomes, sleep quality, and personal/work-related factors. Understanding the work environment's role and assessing interventions targeting working conditions could mitigate dissociation and promote a trauma-informed workplace. Rigorous study designs are needed to generate stronger evidence for nonpharmacological interventions like coherent breathing.