The emotional toll of COVID-19 on health workers is vast and varied
Two studies today in JAMA network open describe the emotional toll of the COVID-19 pandemic on healthcare workers (HCWs), one showing that American HCWs experienced a range of negative emotions as the pandemic progressed, and the other concluding that mental distress eased 14 months after the start of the pandemic among Italian clinicians.
The pandemic “shook my faith in medicine”
In the USA to study, a team led by researchers at Duke University surveyed 1,344 healthcare workers in 2020 about their emotional state before the availability of COVID-19 vaccines. They recruited healthcare workers via email and social media from April 24 to May 30 (phase 1) and from October 24 to November 30 (phase 2).
Phase 1 involved 335 survey respondents of which 32.6% were aged 35 to 44, 86% were female, and 87.8% were white. Phase 2 included 1,009 participants, of whom 38.1% were aged 35 to 44, 90.5% were female, and 93.7% were Caucasian. Respondents included nurses, physicians, advanced practice practitioners and chaplains.
Healthcare workers have reported emotions related to changes in family, social life, and work function. They expressed fear of contracting COVID-19 and spreading the infection to family and friends, stigma, understaffing and insufficient personal protective equipment (PPE).
Healthcare workers also reported experiencing fear in phase 1, progressing to fatigue in phase 2, as well as isolation, alienation and betrayal from co-workers, management, the health system and the community. One respondent said, “My fear levels went down, just because they weren’t sustainable.”
In open-ended responses, participants said that seeing patients die alone as a result of the isolation measures was “heartbreaking” and also “has also” shaken my faith in medicine, it makes me feel vulnerable and scared … it doesn’t. there is not much that modern medicine can do to help. “
Healthcare workers also report growing mistrust and fear of patients and colleagues “who lied and hid in the dark. [sic] symptoms ultimately exposing myself, my patients, and clinic staff. One participant said criticism on social media was “the most painful moral wound … [emergency room] only changes to have to fight on social media. “
Researchers have called these types of emotional distress “moral injury … resulting from transgressive events or acts that create dissonance within the being itself due to a disturbance or violation of one’s existential orientation and his system of values âââ. They added that moral damage can arise from an internal conflict between, for example, the priority given to patients over productivity.
Moral injuries, the authors noted, are linked to medical errors, healthcare worker burnout and suicidal ideation, and will likely leave mental illness and burnout in their wake.
“The moral injuries were not only suffered after a single moral dilemma, but also while working in morally damaging environments,” the researchers wrote.
âThese experiences can serve as potential starting points for organizations to engender and enhance organizational and individual recovery, team building and trust. System-level solutions that address personnel and personal protective equipment shortages are needed to promote HP [health professional] well-being. “
Symptoms subside over time
Italian observation to study, led by researchers at the University of Rome Tor Vergata, involved an online mental health survey of 2,856 healthcare workers across Italy from March 1 to April 30, 2020 – when parts of the country were inundated with COVID-19 patients – and from the same period in 2021.
Of the 2,856 TS, 34.9% responded to the follow-up questionnaire. Participants were on average 43 years old and 82.0% were women.
Respondents’ symptoms of depression (b, -2.88), anxiety (, -2.01) and post-traumatic stress disorder (PTSD) (b, -0.77) decreased over time , but symptoms of insomnia increased (b, 3.05). Working on the front lines of care in 2020 was linked to fewer symptoms of depression (b, -1.04), while hospitalization for COVID-19 was linked to more symptoms of depression (b, 5.96) . Younger age (b, -0.36) and frontline work in 2020 (b, -1.04) were associated with less anxiety.
Male sex was linked to increased insomnia (b, 1.46). Working on the front line in 2020 (b, -0.42) and working as a doctor (b = -0.52) were associated with fewer symptoms of PTSD, while younger age (b, 0.35) and males (b, 0.12) were linked to more PTSD symptoms.
Female gender was linked to persistent depression (odds ratio [OR], 3.69), anxiety (OR, 6.50) and remitting PTSD (OR, 2.99) and incident (OR, 2.60). Younger age was associated with relapsing-remitting depression (OR, 1.22) and incident (OR, 1.46) and persistent (OR, 1.27) PTSD.
Of the 2,856 TS, 629 (65.5%) were resilient to depression, 181 (18.8%) had recurrent depression, 58 had incident cases (6.0%) and 92 (9.6%) reported persistent depression.
Anxiety cases included 701 (73.3%) resilient, 149 (15.6%) remitting, 45 (4.7%) incidents, and 61 (6.4%) persistent. Of the anxiety trajectories, 858 (88.9%) were resilient, 77 (8.0%) were remitting, 20 (2.1%) were incident, and 10 (1.0%) were persistent. PTSD cases have been characterized as resilient (363 [38.5%]), remitting (267 [28.3%]), incident (86 [9.1%]) or persistent (226 [24.0%]).
âThe results of this study highlight a downward trend in mental health symptoms among Italian healthcare workers,â the authors concluded. âAge, gender and frontline working position were relevant risk factors for the persistence of conditions over time. These findings could inform workplace policies that should avoid overexposure of healthcare workers to frontline jobs in the future. “