COVID-19 is having a destructive impact on health-care workers’ mental well-being

Abstract

Background The coronavirus disease 2019 (COVID-19) may aggravate workplace conditions that impact health-care workers’ mental health. However, it can also place other stresses on workers outside of their work. This study determines the effect of COVID-19 on symptoms of negative and positive mental health and the workforce’s experience with various sources of support. Effect modification by demographic variables was also studied. Methods A cross-sectional survey study, conducted between 2 April and 4 May 2020 (two waves), led to a convenience sample of 4509 health-care workers in Flanders (Belgium), including paramedics (40.6%), nurses (33.4%), doctors (13.4%) and management staff (12.2%). About three in four were employed in university and acute hospitals (29.6%), primary care practices (25.7%), residential care centers (21.3%) or care sites for disabled and mental health care. In each of the two waves, participants were asked how frequently (on a scale of 0–10) they experienced positive and negative mental health symptoms during normal circumstances and during last week, referred to as before and during COVID-19, respectively. These symptoms were stress, hypervigilance, fatigue, difficulty sleeping, unable to relax, fear, irregular lifestyle, flashback, difficulty concentrating, feeling unhappy and dejected, failing to recognize their own emotional response, doubting knowledge and skills and feeling uncomfortable within the team. Associations between COVID-19 and mental health symptoms were estimated by cumulative logit models and reported as odds ratios. The needed support was our secondary outcome and was reported as the degree to which health-care workers relied on sources of support and how they experienced them. Results All symptoms were significantly more pronounced during versus before COVID-19. For hypervigilance, there was a 12-fold odds (odds ratio 12.24, 95% confidence interval 11.11–13.49) during versus before COVID-19. Positive professional symptoms such as the feeling that one can make a difference were less frequently experienced. The association between COVID-19 and mental health was generally strongest for the age group 30–49 years, females, nurses and residential care centers. Health-care workers reported to rely on support from relatives and peers. A considerable proportion, respectively, 18 and 27%, reported the need for professional guidance from psychologists and more support from their leadership. Conclusions The toll of the crisis has been heavy on health-care workers. Those who carry leadership positions at an organizational or system level should take this opportunity to develop targeted strategies to mitigate key stressors of health-care workers’ mental well-being.

An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study

“…This approach has been developed in several countries in addition to Spain [18,19]. This is particularly relevant because some current data in Spain using the EASE scale are suggesting that during the third wave, the level of distress reported by health care professionals is increasing up to 3 times, with 8.8% of respondents being classified into the fourth category of scores, probably as a result of accumulated fatigue and a feeling of starting over [5]. Therefore, caring for those who care has become a priority for public health strategies [20,21].…”

“…Stress, hypervigilance, fatigue, difficulty sleeping, inability to relax, and fear were common symptoms among health care professionals at the start of the pandemic [5]. The content validity analysis conducted in this study identified behaviors and responses related to these symptoms; the EASE scale items seek to assess the scale's effect on those who provide care to COVID-19 patients.…”

“…In the forthcoming months, we can expect professionals to be affected during the outbreak as a consequence of stress overload [5], having seen their professional codes violated [3] due to insufficient resources to care for COVID-19 patients, contradictory instructions, or the interruption in the continuity of care of non-COVID-19 patients. Also, we can expect an increase of affective and anxiety reactions and symptoms, including, in some cases, posttraumatic stress among the professionals who saw their health and that of their loved ones threatened [32,33].…”

“…The recovery of professionals' health, teamwork, and workers' morale in health care organizations, particularly where the deceased include professionals from the team itself, will probably require specific and wide-ranging actions. Actions that promote a positive dynamic within the health care teams are more likely to be successful [5], for example, by reflecting on how they have acted, what has worked, and what could have been done differently [34][35][36].…”

“…At that time, there was a perception that the uncertainty about COVID-19 patients' evolution, care pressure, and lack of means affected the emotional balance of health professionals. The most observed responses were related to acute stress, moral injury, and compassion fatigue [3][4][5][6]. The Spanish health system, in particular, has been overwhelmed by the number of patients with COVID-19; during the first wave of the outbreak, as of May 26, 2020, there had been 236,259 cases and 27,117 deaths.…”