COVID-19: High Psychological Cost for Healthcare Workers

Summary

As communities around the world continue to struggle to contain the spread of the novel coronavirus (COVID-19) and deal with the rapid proliferation of cases, a study from China reports worrying information about the psychological ramifications of COVID-19 on care medical workers: A survey of more than 1,200 nurses and doctors working in hospitals in the Wuhan region (where the outbreak originated) and across mainland China revealed that more than 50% reported symptoms of depression and more than 70% reported symptoms of psychological distress . The findings were published in JAMA Network Open .

“Protecting healthcare workers is an important component of public health measures to address the COVID-19 epidemic. "Special interventions to promote mental well-being in healthcare workers exposed to COVID-19 should be implemented immediately, and women, nurses and frontline workers require special attention," wrote Jianbo Lai, M.Sc., from Wuhan Renmin Hospital University in China and colleagues.

Researchers surveyed healthcare workers at 34 hospitals in China with fever clinics or COVID-19 wards between January 29, 2020 and February 3, 2020. (During this period, total confirmed COVID cases -19 exceeded 10,000 in China, according to the authors.)

The researchers assessed respondents’ depression, anxiety, insomnia, and distress using the Chinese versions of the Patient Health Questionnaire, the Generalized Anxiety Disorder scale, the Insomnia Severity Index, and the Revised Event Impact Scale.

Healthcare workers involved in the direct diagnosis, treatment and care of patients with COVID-19 were more likely to report symptoms of depression (odds ratio, 1.52), anxiety (odds ratio, 1.57), insomnia (odds ratio, 2.97), and distress (odds ratio, 1.60) compared to those not involved in the diagnosis, treatment, and care of patients with COVID-19.

"These findings, consistent with those observed in the 2003 severe acute respiratory system (SARS) epidemic, may help guide strategies to respond to the mental health sequelae of this and future epidemics," wrote Roy Perlis, MD, professor of psychiatry at Harvard Medical School, in an accompanying commentary.

"While the peak of the COVID-19 epidemic remains to be seen, it will eventually subside . The work of Lai et al. provides a reminder of the cost that will likely endure: the consequences of chronic stress, including major depression and anxiety disorders "Only as the world has joined efforts to control the COVID-19 infection will it be essential not to neglect the mental health consequences of fighting the epidemic."

Discussion

This cross-sectional survey included 1,257 respondents and revealed a high prevalence of mental health symptoms among healthcare workers treating COVID-19 patients in China, overall 50.4%, 44.6%, 34.0%, and 71.5% of all participants reported symptoms of depression, anxiety, insomnia, and distress, respectively.

Participants were divided into 3 groups (Wuhan, other regions in Hubei Province, and regions outside Wuhan Province) to compare interregional differences. Most of the participants were women, were nurses, were between 26 and 40 years old, were married and worked in tertiary hospitals with a junior technical degree.

Nurses, women, those working in Wuhan, and frontline workers reported more severe symptoms across all measurements.

Our study further indicated that being female and having an associate’s degree was associated with experiencing severe depression, anxiety, and distress. Working on the front line was an independent risk factor for worse mental health outcomes across all dimensions of interest. Together, our findings raise concerns about the psychological well-being of doctors and nurses involved in the acute COVID-19 outbreak.

In this study, a significant proportion of participants experienced symptoms of anxiety, depression, and insomnia , and more than 70% reported psychological distress .

In a previous study during the acute SARS outbreak, 89% of healthcare workers in high-risk situations reported psychological symptoms. The psychological response of healthcare workers to an infectious disease epidemic is complicated. Sources of distress may include feelings of vulnerability or loss of control and concerns about one’s health, the spread of the virus, the health of family and others, changes in work, and isolation.

The fact that COVID-19 is transmissible from human to human associated with high morbidity and potentially fatal evolution may intensify the perception of personal danger. Furthermore, foreseeable supply shortages and the increasing influx of suspected and actual COVID-19 cases contribute to the pressures and concerns of healthcare workers.

Of note, 76.7% of all participants were women, and 60.8% were nurses (90.8% of whom were women). Our findings further indicate that women reported more severe symptoms of depression, anxiety, and distress. Frontline nurses treating patients with COVID-19 are likely to be at the highest risk of infection due to their close and frequent contact with patients and working longer hours than usual. Additionally, 71.5% of all nurses had junior degrees, indicating that the majority had fewer years of work experience.

During the SARS outbreak, a study among healthcare workers in emergency departments also showed that nurses were more likely to develop distress and use behavioral disengagement than doctors.

Frontline nurses treating patients with SARS had a physical and psychological challenge in committing to providing high-quality nursing care for patients. Additionally, in the early stage of the SARS epidemic, nurses may have been less likely to be warned about exposure or given appropriate protections. of women and nurses who treat patients with COVID-19.

Another finding in our study was that, compared with those in Hubei Province outside Wuhan and those outside Hubei Province, healthcare workers in Wuhan reported more severe symptoms of depression, anxiety, insomnia, and distress.

Multivariable logistic regression analysis showed that working outside Hubei province was associated with a lower risk of distress. These findings indicated more stress among healthcare workers in Wuhan, the origin and epicenter of the epidemic in China.

Additionally, working in frontline healthcare with direct involvement with COVID-19 patients was an independent risk factor for all symptoms. As frontline healthcare workers in Wuhan were at especially high risk for symptoms of depression, anxiety, insomnia, and distress, their mental health may require special attention.