The Psychiatric Impact of COVID-19 on Health Care Workers

Study data published in Psychiatry Services outline the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on health care workers (HCWs) in the United States. According to a survey conducted in April 2020, nearly half of participating HCWs experienced serious psychiatric symptoms as a result of the COVID-19 pandemic.

Two-thirds of participants reported some level of clinical anxiety and nearly a fifth reported moderate to severe depressive symptoms, while 17% met the criteria for posttraumatic stress disorder (PTSD). A prior history of mental health disorders increased the likelihood of COVID-19-related psychiatric distress, though many HCWs without a prior history of mental health disorders also reported experiencing anxiety and depression.

Investigators constructed a 125-item survey to assess mental health symptoms among HCWs. HCWs were identified via the electronic mailing lists of health care institutions around the US.

Survey invitations were sent via e-mail. The survey captured demographic characteristics, perceived COVID-19 risk factors, exposure to patients with COVID-19, medical history, and workplace environment. The survey also included questions from validated psychiatric screening tools, including the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Primary Care PTSD Screen, and the Alcohol Use Disorders Identification Test. Logistic regression models were used to identify correlates of psychiatric symptoms among survey respondents.

A total of 1685 HCWs completed the survey, among whom 76% were women, 88% were white, and 69% were married. Nearly half (46%) described themselves as mental health professionals, while 15% were emergency medicine providers and 11% were pediatric providers. Over a third of participants were 60 years of age or older.

Of participants who completed the GAD-7, 63% experienced some degree of anxiety symptoms. Among those who completed the PHQ-9, 47% had mild depressive symptoms and 17% had clinically significant depressive symptoms. Approximately 14% of participants answered “yes” to at least 3 questions on the Primary Care PTSD Screen. Overall, 39% of surveys indicated the presence of clinically significant mental health symptoms.

Suicide ideation was reported by 5% of participants. Those with a history of psychiatric symptoms were significantly more likely to endorse current suicide ideation (8% vs 2%; P <.001). Suicide ideation was also more common among mental health practitioners compared to HCWs in other disciplines (7% vs 3%; P <.001). HCWs in pediatric disciplines reported higher levels of anxiety compared to other practitioners (P =.001).

In regression models, a history of psychiatric symptoms was associated with increased risk for anxiety (odds ratio [OR], 2.78; 95% confidence interval [CI], 2.09-3.70). Participants who reported any barriers to working during the pandemic were also more likely to report clinically significant anxiety (OR, 2.50; 95% CI, 1.80-3.48) and depression (OR, 2.15; 95% CI, 1.45-3.21) symptoms. Reported barriers to working included personal risk for infection, fears about infecting others, and having caregiving responsibility for vulnerable individuals, such as children or older adults. 

These data are consistent with results from other studies conducted among HCWs. However, the study population was limited to HCWs willing and able to fill out a survey about their experiences. As such, the results may not reflect the experiences of all HCWs in the US.

“Our study offers a tool and justification for surveying HCWs within an organization,” the investigators wrote. “By assessing attitudes and psychosocial experiences at multiple time points, leaders can assess the needs of their staff in real time, differentiate between the specific needs during and after the crisis, and utilize this information to better prepare for future crises.”

Reference

Young KP, Kolcz DL, O’Sullivan DM, Ferrand J, Fried J, Robinson K. Health care workers’ mental health and quality of life during COVID-19: Results from a mid-pandemic, national survey. Psychiatr Serv. Published online December 3, 2020. doi:10.1176/appi.ps.202000424