'Every clinician is also a patient': Study shows psychological impact of COVID-19 pandemic on health care workers
Health care workers in Wuhan and other regions of China reported experiencing psychological burden related to the novel coronavirus pandemic, according to results of a survey study published in JAMA Network Open. Those in Wuhan, women, nurses and frontline health care workers directly engaged in the diagnosis, treatment and care of patients with COVID-19 were especially affected.
“The ever-increasing number of confirmed and suspected cases, overwhelming workload, depletion of personal protection equipment, widespread media coverage, lack of specific drugs and feelings of being inadequately supported may all contribute to the mental burden of these health care workers,” Jianbo Lai, MSc, of the department of psychiatry at Zhejiang University School of Medicine First Affiliated Hospital, and colleagues wrote. “Previous studies have reported adverse psychological reactions to the 2003 SARS outbreak among health care workers. Studies showed that those health care workers feared contagion and infection of their family, friends and colleagues, felt uncertainty and stigmatization, reported reluctance to work or contemplating resignation, and reported experiencing high levels of stress, anxiety and depression symptoms, which could have long-term psychological implications.”
The researchers noted that the treatment and care of patients with COVID-19 have led to similar concerns about the psychological adjustment, mental health and recovery of health care workers. Local and national mental health institutions have deployed telephone-, internet- and application-based counseling or interventions in response to the outbreak. Specifically, the State Council of China announced in February that it was setting up nationwide psychological assistance hotlines during the epidemic. Despite these responses, evidence-based evaluations and mental health interventions targeting frontline health care workers are relatively scarce, according to the investigators.
To address this gap, Lai and colleagues aimed to assess the magnitude of mental health outcomes and associated factors among health care workers treating individuals exposed to the virus in China. They conducted a cross-sectional, survey-based, region-stratified study using mental health measurements and demographic data of 1,257 health care workers in 34 hospitals in China from Jan. 29 to Feb. 3. The researchers included only those who worked in hospitals equipped with fever clinics or wards for patients with COVID-19. Main outcomes and measures included the degree of symptoms of anxiety, insomnia, distress and depression, which they assessed by the Chinese versions of the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, the 22-item Impact of Event Scale-Revised and the 9-item Patient Health Questionnaire, respectively. They performed multivariable logistic regression analysis to identify factors associated with mental health outcomes.
The researchers reported a participation rate of 68.7%. Further, 64.7% of respondents were aged 26 years to 40 years and 76.7% were women. A total of 764 (60.8%) were nurses, 493 (39.2%) were physicians, 760 (60.5%) worked in hospitals in Wuhan and 522 (41.5%) were frontline health care workers.
A significant proportion of respondents reported the following symptoms:
- depression, 50.4%;
- anxiety, 44.6%;
- insomnia, 34%; and
- distress, 71.5%.
Compared with other health care workers, frontline health care workers, those working in Wuhan, nurses and women reported more severe degrees of all measurements of mental health symptoms. Respondents from outside Hubei province had lower risk for symptoms of distress than those in Wuhan (OR = 0.62; 95% CI, 0.43-0.88). Frontline health care workers who engaged in direct diagnosis, treatment and care of patients with COVID-19 had a higher risk for symptoms of depression (OR = 1.52; 95% CI, 1.11-2.09), anxiety (OR = 1.57; 95% CI, 1.22-2.02), insomnia (OR = 2.97; 95% CI, 1.92-4.6) and distress (OR = 1.6; 95% CI, 1.25-2.04).
“Protecting health care workers is an important component of public health measures for addressing the COVID-19 [pandemic],” the researchers wrote. “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.”
In a related editorial, Roy H. Perlis, MD, MSc, of the Center for Quantitative Health and department of psychiatry at Massachusetts General Hospital, highlighted the inevitable but mitigable risks associated with health care professions.
“Across the world, physicians, nurses and other frontline health care workers do heroic and lifesaving work in stressful settings on a daily basis,” Perlis wrote. “However, the toll that providing such care takes must also be recognized: sooner or later, every clinician is also a patient. Even outside epidemics, wars and other public health crises, health care workers face mounting stresses, exacerbated by structural changes in medicine but ultimately reflecting the nature of the work itself. Such stresses far exceed the popular but imprecise concept of burnout.” – by Joe Gramigna
Disclosures: The study authors report no relevant financial disclosures. Perlis reports biotech investments in Burrage Capital, Outermost Therapeutics, Psy Therapeutics and RID Ventures, as well as personal fees from Genomind and Takeda Pharmaceutical Co.