No abstract

significant associations with psychological distress were found for the presence of multiple co-morbidities in staff, direct involvement in COVID-19 patient care, receiving a quarantine order, and redeployment outside normal professional boundaries (Table 1). Insomnia, based on the first item of the GHQ-12, was reported by 45 participants (16.7%). Redeployment to work outside areas of usual clinical practice was reported by 41.9% of participants. The majority (59.3%) perceived their workload to be similar to pre-pandemic levels. Just 12.2% of participants had family, friends, or colleagues diagnosed with COVID-19. Formal PPE training was received by 256 (94.8%) participants with 149 (55.2%) being confident in correct usage and their ability to protect from infection. Situations where recommended PPE was unavailable were encountered by 46 (17.0%). Risks of getting infected (83.6%) and infecting family members (78.0%) were the top two concerns (Supplementary Appendix 2). This study shows significant psychological distress amongst anaesthesiologists and nurses working in ICUs in the context of the COVID-19 pandemic. While lower than reported in the outbreak epicentre in China, which reported depression in 50.4% and anxiety in 44.6% of healthcare workers, we found a twofold higher prevalence of anxiety and up to threefold higher prevalence of depression than reported amongst general healthcare workers in Singapore and Italy during this pandemic. 3,4,7 Many would regard even pre-pandemic work in such high-acuity environments as stressful and emotionally exhausting, thus potentially accounting for the differences compared with general healthcare workers. Indeed, pre-pandemic studies of occupational stress identified similar levels of anxiety and stress (29.0e35.7%) in ICU physicians and nurses using the GHQ-12. 5,8 Thus, the contention that COVID-19 has provoked all the elements of psychological distress in respondents still requires testing. Our study has limitations. Socioeconomic status, which may influence outcomes and intervention planning, was not assessed. Neither a pre-crisis baseline nor follow-up to assess the temporal changes in psychological distress was available. Being a single-centre snapshot, further studies in other populations are necessary for generalisability. Lastly, clinical interviews by a psychiatrist would have been ideal. Nonetheless, we identified risk factors for psychological distress that may be useful for identifying at-risk individuals, and respondent concerns of the infection risk, adequacy of PPE, and redeployment outside normal professional boundaries are still issues that need to be addressed. The psychological distress prevalent amongst providing anaesthesia and intensive care providers during this pandemic necessitates policies for screening of at-risk individuals and adoption of early psychological support interventions for affected staff. 9,10