Depression, anxiety, and insomnia appear to be common consequences of the high stress environment faced by healthcare workers amid the coronavirus pandemic. The findings, published in JAMA Network Open as part of a study of Chinese healthcare workers, may foreshadow the mental health burden placed upon physicians, nurses, and other professionals as coronavirus disease 2019 (COVID-19) strains the medical system in the United States.
Between January 29 and February 3, 2020, Jianbo Lai, MSc, of the department of psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine,
Hangzhou, China, and colleagues conducted a multiregional cross-sectional study of 1257 healthcare workers from 34 hospitals. They assessed depression, anxiety, insomnia, and distress using the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder scale (GAD-7), 7-item Insomnia Severity Index (ISI), and 22-item Impact of Event Scale-Revised (IES-R), respectively. Researchers also considered geographic location, demographic data, and occupation, among other factors. Statistical analyses were performed using SPSS software.
Of the 1257 survey respondents (76.7% women; 64.7% aged 26 to 40 years), 522 (41.5%) reported being directly involved in diagnosing, treating, or caring for patients with or suspected to have COVID-19. The majority of the cohort (60.8%) were nurses, and 39.2% of respondents were doctors. Furthermore, most of the respondents worked in Wuhan (60.5%) or Hubei province (20.8%) in China.
Distress was widely reported (71.5%), followed by depression (50.4%), anxiety (44.6%), and insomnia (34.0%). Compared with men and secondary healthcare workers, women, and frontline healthcare workers reported more severe mental health symptoms across all measurements (all P <.001). Furthermore, compared with physicians, nurses experienced worse mental health outcomes (PHQ-9, P =.007; GAD-7, P =.008; ISI, P <.001; IES-R, P =.009). Of note, workers in Wuhan, the center of the epidemic, scored higher on all measures compared with workers in Hubei outside of Wuhan and those outside of Hubei altogether (all P <.001).
In a multivariable logistic regression, participants outside Hubei province demonstrated a lower risk of distress compared with participants in Wuhan (odds ratio [OR], 0.62; 95% CI, 0.43-0.88; P =.008). After adjustments, working on the frontline was an independent risk factor for all psychiatric symptoms (PHQ-9: OR, 1.52; 95% CI, 1.11-2.09; P =.01; GAD-7: OR, 1.57; 95% CI, 1.22-2.02; P <.001; ISI: OR, 2.97; 95% CI, 1.92-4.60; P <.001; IES-R: OR, 1.60; 95% CI, 1.25-2.04; P <.001). Being a woman was also a significant risk factor for depression and anxiety (PHQ-9: OR, 1.94; 95% CI, 1.26-2.98; P =.003; GAD-7: OR, 1.69; 95% CI, 1.23-2.33; P =.001).
Researchers noted that the study was limited in its scope by the relatively small number of respondents from outside of Hubei province, as well as the lack of follow-up.
“Protecting healthcare workers is an important component of public health measures for addressing the COVID-19 epidemic,” the researchers warned, “Special interventions to promote mental well-being in health care workers exposed to COVID-19 need to be immediately implemented, with women, nurses, and frontline workers requiring particular attention.”
Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976.