Fadiga, sofrimento psicológico, resiliência e uso de cigarro, álcool e outras substâncias psicoativas por fisioterapeutas brasileiros durante a pandemia de COVID-19

Abstract

Objective: To analyze fatigue, psychological distress, resilience, and the use of cigarettes, alcohol, and other psychoactive substances among Brazilian physiotherapists during the COVID-19 pandemic. Methods: This cross-sectional, descriptive, and exploratory study involved 670 physiotherapists active during the pandemic across Brazil’s five macroregions. An online questionnaire was administered between October and December 2020. The study adhered to the STROBE and CHERRIES guidelines, ensuring standardization in electronic research. Psychological distress was assessed using the General Health Questionnaire (QSG-12); substantial fatigue, by the Dutch Fatigue Scale; resilience, by the Brief Resilient Coping Scale (EBCR); and substance use, by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST – WHO). Exploratory and confirmatory factor analyses were conducted for the QSG-12, Fatigue Scale, and EBCR. A canonical correlation analysis was performed between the QSG-12 and the Fatigue Scale. ASSIST outcomes were modeled via machine learning for three abuse endpoints (tobacco products, alcohol, and psychoactive substances). Tobacco abuse was modeled with a multilayer perceptron artificial neural network, while alcohol and psychoactive substance abuse were modeled with eXtreme Gradient Boosting (XGBoost). Results: The presence of psychological distress, substantial fatigue, and low resilience was detected among participants. Canonical correlation analysis revealed a strong association between the depression factor and substantial fatigue. Tobacco product abuse was linked to younger age (mean = 22 years), gender, single marital status, and non-religiosity. Excessive alcohol consumption correlated with non-practice of religion, higher frequency of use, and concurrent psychoactive substance use. Psychoactive substance abuse was associated with low resilience, larger household size, longer professional tenure, higher fatigue, greater psychological distress, and more frequent alcohol intake. Conclusion: All instruments demonstrated high statistical reliability, and the machine learning models exhibited excellent performance and predictive power. Findings underscore the physical and emotional vulnerability of physiotherapists during the pandemic and support the implementation of targeted intervention and support strategies to improve working conditions, as well as the development of public policies aimed at enhancing professionals’ quality of life. Moreover, these results provide a robust foundation for learning and readiness in future health emergencies.