Burnout, depersonalization, and anxiety contribute to post‐traumatic stress in frontline health workers at COVID‐19 patient care, a follow‐up study

Abstract

Introduction We designed a follow‐up study of frontline health workers at COVID‐19 patient care, within the same working conditions, to assess the influence of their general characteristics and pre‐existing anxiety/depression/dissociative symptoms and resilience on the development of symptoms of post‐traumatic stress disorder (PTSD), while monitoring their quality of sleep, depersonalization/derealization symptoms, acute stress, state anxiety, and burnout. Methods In a Hospital reconfigured to address the surge of patients with COVID‐19, 204 frontline health workers accepted to participate. They completed validated questionnaires to assess mental health: before, during, and after the peak of inpatient admissions. After each evaluation, a psychiatrist reviewed the questionnaires, using the accepted criteria for each instrument. Correlations were assessed using multivariable and multivariate analyses, with a significance level of .05. Results Compared to men, women reporting pre‐existing anxiety were more prone to acute stress; and younger age was related to both pre‐existent common psychological symptoms and less resilience. Overall the evaluations, sleep quality was bad on the majority of participants, with an increase during the epidemic crisis, while persistent burnout had influence on state anxiety, acute stress, and symptoms of depersonalization/derealization. PTSD symptoms were related to pre‐existent anxiety/depression and dissociative symptoms, as well as to acute stress and acute anxiety, and negatively related to resilience. Conclusions Pre‐existent anxiety/depression, dissociative symptoms, and coexisting acute anxiety and acute stress contribute to PTSD symptoms. During an infectious outbreak, psychological screening could provide valuable information to prevent or mitigate against adverse psychological reactions by frontline healthcare workers caring for patients.

SARS/MERS/SARS-CoV-2 Outbreaks and Burnout Syndrome among Healthcare Workers. An Umbrella Systematic Review

“…HCWs include frontline nurses in emergency departments [47] and ICUs [48], Libyan [49] or Indian [50] physicians, Spanish nurses [51], Japanese radiological technologists and pharmacists [52], and others. A state of persistent burnout, that influenced sleep quality, was observed in a longitudinal study on a small group of HCWs [53]. Higher levels of stress [54] and long shifts [55] have been consistently associated with increased levels of BOS in HCWs.…”

Burnout of Healthcare Workers amid the COVID-19 Pandemic: A Japanese Cross-Sectional Survey

“…While some mitigating interventions including mindfulness, counseling those at risk of burnout, and reducing workload have been proposed as measures to address the widespread burnout of HCWs [9,10,13,15], given the unprecedented surge in the number of COVID-19 cases, individual efforts might not be sufficient to overcome the issue. Recently, psychological resilience has been highlighted as a protective factor against burnout [30][31][32][33].…”

“…A study by Amanullah et al reported that exposure to COVID-19 did not correlate with increased burnout [7]. In contrast, other cross-sectional studies noted that frequent contact with COVID-19 was the most important factor associated with psychological burden and burnout [13][14][15].…”

“…Now, because of the pandemic, HCWs have been exposed to an unprecedented level of stress since March 2020, when the pandemic spread all over the world. Several studies have been conducted to look into the prevalence of and factors related to burnout [7][8][9][10][11][12][13][14][15]. However, there is noc uniform pattern about the factors related to burnout of HCWs.…”

Guidelines for Mountain Rescue During the COVID-19 Pandemic: Official Guidelines of the International Commission for Alpine Rescue

“…The global pandemic has caused considerable stress to many rescuers and nonrescuers alike. Acute stress injury may exacerbate preexisting anxiety, depression, and other psychological illnesses and result in more serious stress disorders (Miguel-Puga et al, 2021 ). Education and increased awareness of stress injuries could be valuable to build resilience and prevent adverse psychological consequences in mountain rescuers (Krystal, 2020 ).…”