New Study Explores the Psychological Impact of COVID-19 Among Health Care Providers

^{By: Yvette C. Terrie, RPh, consultant pharmacist}

According to the results of a survey study published in JAMA Network Open, health care workers in Wuhan and other regions of China reported experiencing psychological burdens due to the current COVID-19 pandemic. The survey study revealed that in Wuhan, nurses, women, and frontline health care workers directly involved in the diagnosis, treatment, and care of patients with COVID-19 were particularly affected. The overall objective of the study was to evaluate the extent of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China.

This cross-sectional study involved 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China. The study was conducted via a region-stratified, 2-stage cluster sampling from January 29, 2020, to February 3, 2020. During this period, the total confirmed cases of COVID-19 exceeded 10,000 in China. 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 measured 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 conducted 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. The researchers disclosed that a substantial percentage of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly involved in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. The researchers noted that 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.

Results from the survey reported that among participants, overall, 50.4%, 44.6%, 34.0%, and 71.5% of all participants reported symptoms of depression, anxiety, insomnia, and distress, respectively.

The authors concluded that in this survey study of physicians and nurses in hospitals with fever clinics or wards for patients with COVID-19 in China, health care workers responding to the spread of COVID-19 described high rates of symptoms of depression, anxiety, insomnia, and distress. They concluded that protecting health care workers is an essential component of public health measures for addressing the COVID-19 epidemic. They also noted that extraordinary interventions to foster 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.

Lead author, Jianbo Lai, MSc, of the department of psychiatry at Zhejiang University School of Medicine First Affiliated Hospital, and colleagues stated, “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.”  

The researchers also noted that, “Protecting health care workers is an important component of public health measures for addressing the COVID-19 [pandemic]. 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.”

Yvette C. Terrie, Consultant Pharmacist and Medical Writer and creator of A Pharmacist’s Perspective. 

Sources:

• 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. doi:10.1001/jamanetworkopen.2020.3976.
• 'Every clinician is also a patient': Study shows psychological impact of COVID-19 pandemic on health care workers. Healio. https://www.healio.com/psychiatry/practice-management/news/online/{8758ec11-a51d-4fa6-95e9-38376725ceb0}/every-clinician-is-also-a-patient-study-shows-psychological-impact-of-covid-19-pandemic-on-health-care-workers . Published March 31, 2020. Accessed April 1, 2020.