Anxiety and depression among public health workers during the COVID-19 pandemic

Abstract

Introduction: The public health workforce plays an essential role in the response to disasters and emergencies. Little is known about the prevalence of anxiety and depression among the public health emergency preparedness workforce responding to COVID-19 or the potential for social support to protect public health workers from adverse outcomes.Methods: A cross-sectional online survey was conducted among a sample of the public health workforce participating in the response to COVID-19. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using Poisson regression with robust standard errors.Results: Overall, 39.6 percent (140 of 345) of respondents reported anxiety and 29.4 percent (104 of 345) reported depression. The prevalence of anxiety and depression was higher among those who worked more hours (PR = 1.5; 95% CI: 1.2, 2.0) and days (PR = 1.3; 95% CI: 0.9, 1.8) per week. Anxiety was 40 percent more prevalent (PR = 1.4; 95% CI: 0.8, 2.4) among those with between 1 and 4 years of work experience, while depression was 60 percent more prevalent (PR = 1.6; 95% CI: 0.8, 3.1) among those with 5 to 9 years of experience. Compared to those with a bachelor’s degree, those with a master’s degree reported 30 percent more anxiety (PR = 1.3; 95% CI: 0.9, 1.9). Having at least three sources of social support related to comfort and caring reduced the prevalence of depression among those working the most hours per week (PR = 1.5; 1.1, 2.3 compared to PR = 2.0; 95% CI: 0.9, 4.5). Economic and practical support was more consistently protective, with a reduced prevalence of anxiety and depression among those working the most hours per week, days per week, and those with more education when at least three sources of support were reported.Discussion: Anxiety and depression symptoms and diagnoses have been associated with burnout and suicide among frontline disaster responders. The public health workforce on the frontlines of the COVID-19 emergency response has high rates of depression and anxiety, which must be addressed through robust individual- and organizational-level supports.

Changes in anxiety and depression among public health workers during the COVID-19 pandemic response

“…Household size and children being present in the home were not found to be associated with either GAD or depression. These findings were consistent with prior risk factors reported by the authors in the original survey populations and elsewhere in the literature (Pfender et al 2022 ; Guilaran et al 2018 ; Prati and Pietrantoni 2010 ).…”

“…We assessed social support with two questions from the Social Support Rating Scale (SSRC) that asked about available sources for support for comfort and caring and for economic support and practical problem solving. Sources of support included none, spouse/partner, other family members, friends, relatives, colleagues, companies, official or semi-official organizations such as parties, leagues, and unions, unofficial organizations such as religious organizations or social groups, and other (Xiao 1994 ; Pfender et al 2022 ).…”

“…The pandemic response also placed a considerable mental health burden on the public health workforce, specifically with elevated rates of anxiety and depression reported (Bryant-Genevier 2021 ; Pfender et al 2022 ; Stone et al 2021 ). Most studies on the mental health of the public health and healthcare workforces have focused on those with patient-facing occupations (e.g., doctors and nurses).…”

Public health nurses’ perceptions and experiences of emergency preparedness, responsiveness, and burnout during the COVID‐19 pandemic

“…Continued role-related challenges produced feelings of being overwhelmed and extremely tired, and feeling underappreciated, contributing to participants' emotional exhaustion, a tenet of burnout. This also aligns with a recent study that reported an association between higher emotional labor intensity and burnout among PHNs in South Korea on the frontlines of the COVID-19 pandemic (Kim et al, 2022) as well as other research examining effects of COVID-19 on clinical nurses in hospital settings (Arnetz et al, 2020;Guttormson et al, 2022;Kelley et al, 2021) and public health workers (Pfender et al, 2022;Stone et al, 2021). Burnout, like role strain, is associated with greater intention to leave the profession and turnover (Leiter & Maslach, 2009).…”

The experiences of public health nurses during the COVID‐19 in Taiwan: A qualitative study

“…Otherwise, an individual who is infected can easily create a breach in a community's pandemic prevention efforts, thereby endangering their family, their own safety and that of their colleagues and the public. Studies have indicated that nursing staff experienced considerable physical, mental and social stress during the COVID‐19 pandemic (Arnetz et al., 2020; Kelley et al., 2021; Motahedi et al., 2021; Pfender et al., 2022; Stone et al., 2021). Thus, an understanding of the complex and interrelated needs of frontline nurses can help health care organisations develop effective solutions for reducing stress in PHNs.…”