A One-Year Longitudinal Study: Changes in Depression and Anxiety in Frontline Emergency Department Healthcare Workers in the COVID-19 Pandemic

Abstract

Frontline healthcare workers (HCWs) fighting COVID-19 have been associated with depression and anxiety, but there is limited data to illustrate these changes over time. We aim to quantify the changes in depression and anxiety amongst Emergency Department (ED) HCWs over one year and examine the factors associated with these changes. In this longitudinal single-centre study in Singapore, all ED HCWs were prospectively recruited face-to-face. Paper-based surveys were administered in June 2020 and June 2021. Depression and anxiety were measured using DASS-21. The results of 241 HCWs who had completed both surveys were matched. There was significant improvement in anxiety amongst all HCWs (Mean: 2020: 2.85 (±3.19) vs. 2021: 2.54 (±3.11); Median: 2020: 2 (0–4) vs. 2021: 2 (0–4), p = 0.045). HCWs living with elderly and with concerns about infection risk had higher odds of anxiety; those living with young children had lower odds of anxiety. There was significant worsening depression amongst doctors (Mean: 2020: 2.71 (±4.18) vs. 2021: 3.60 (±4.50); Median: 2020: 1 (0–3) vs. 2021: 3 (0–5), p = 0.018). HCWs ≥ 41 years, living with elderly and with greater concerns about workload had higher odds of depression. HCWs who perceived better workplace support and better social connectedness had lower odds of depression. In summary, our study showed significant improvement in anxiety amongst ED HCWs and significant worsening depression amongst ED doctors over one year. Age, living with elderly, and concerns about workload and infection risk were associated with higher odds of depression and anxiety.

Sleep Disorders and Mental Stress of Healthcare Workers during the Two First Waves of COVID-19 Pandemic: Separate Analysis for Primary Care

“…However, until now, limited published studies were available evaluating the changes in the mental health of HCPs during the course of the pandemic and more specifically comparing the differences over the different waves. Similar to our findings, other studies [ 44 ] also reported higher odds of psychological distress, such as depression and anxiety, among those HCPs who were involved with the treatment of patients suffering from COVID19. Additionally, a longitudinal study that was carried out in Japan and evaluated four waves of the pandemic showed that even when the cases of COVID 19 were low, HCPs continuously experienced high psychological distress [ 45 ].…”

“…The existing literature reported that the prevalence of psychological symptoms in HCPs during the COVID-19 pandemic was higher than in the previous epidemics [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. We found that during the second wave, the participants felt angrier and lonelier compared to the first, with 22% presenting clinically significant anger and 54.3% indicating significant loneliness.…”

“…Stress is a well-known cause of sleep disturbances in HCPs [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] and possibly due to that, the prevalence of sleep disturbances in COVID-19 medical staff was higher than in other community groups [ 53 ]. In Wuhan, HCPs experienced high levels of depression anxiety, anger, fear and stress, due to the possibility of infection, the direct exposure to disease and excessive work pressure [ 51 ].…”

COVID-19–Related Trajectories of Psychological Health of Acute Care Healthcare Professionals: A 12-Month Longitudinal Observational Study

“…AcHCPs (working in intensive care, anaesthesia, and emergency medicine) were the vast majority of front-line HCPs during the COVID-19 pandemic. AcHCPs faced personal protective equipment, medications, and ventilator shortages and needed to care daily for severely ill or dying patients ( Greenberg et al, 2015 ; Magnavita et al, 2020b ; Th’ng et al, 2021 ; Tsan et al, 2021 ).…”

A year after COVID‐19: Its impact on nurses' psychological well‐being

“…Compared with 2020, there was an increase in burnout, poorer self‐rated health and reduced job dedication among the nurses 2021. Similar longitudinal analysis studies, albeit conducted among doctors in the United Kingdom and Ireland (Roberts et al, 2021 ) and Singapore (Th'ng et al, 2021 ), reported an increase in the prevalence of psychological distress (44.7%) and trauma (23.7%) (Roberts et al, 2021 ) during the COVID‐19 pandemic. Similarly, a study conducted in an emergency department in Singapore reported a significant worsening of the depression level reported among the doctors (Th'ng et al, 2021 ).…”