Impact of the COVID-19 pandemic on the mental health of frontline healthcare workers in a highly affected region in Brazil

Abstract

Background The COVID-19 pandemic had a major impact on the mental health of healthcare workers (HCWs), especially in low and middle-income countries, which had to face additional political, social, and economic challenges. We thus aimed to assess the prevalence of mental health outcomes and the associated factors in HCWs treating COVID-19 patients in one of the most affected regions in Brazil. Methods We used the Respondent-Driven Sampling method to assess the risks of COVID-19 infection and symptoms of mental disorders in nurses, nursing technicians, and physicians who worked on the frontline in the metropolitan region of Recife. 865 healthcare workers completed a survey regarding sociodemographic data, work-related risks, and symptoms of mental disorders - SRQ-20 for common mental disorders (CMD); AUDIT-C for problematic alcohol use; GAD-7 for anxiety; PHQ-9 for depression; PCL-5 for post-traumatic stress disorder (PTSD). Gile’s successive sampling estimator was used to produce the weighted estimates by professional category. A Poisson regression model with robust variance was used to analyze factors associated with a positive screening for CMD. We will present the results of a cross-sectional analysis of the mental health outcomes after the first peak of COVID-19 – from August 2020 to February 2021. Results The prevalence ratios for a positive screening for CMD were 34.9% (95% CI: 27.8–41.9) in nurses, 28.6% (95% CI: 21.3–36.0) in physicians, and 26.6% (95% CI: 16.8–36.5) in nursing technicians. Nurses presented a higher prevalence of depressive symptoms (23%). Positive screening for problematic alcohol use (10.5 to14.0%), anxiety (10.4 to 13.3%), and PTSD (3.3 to 4.4%) were similar between the professional categories. The main factors associated with CMD in nurses and physicians were related to an intrinsic susceptibility to mental illness, such as previous or family history of psychiatric disorder, and female sex. Among nurse technicians, work-related factors, such as accidents with biological material, presented the strongest association with CMD. Conclusion The mental health of HCWs fighting COVID-19 in Recife was severely affected. It is crucial that healthcare services provide adequate working conditions and psychological support, investing in programs to promote and protect HCWs mental health.

Mental health symptoms and associated factors among primary healthcare workers in China during the post-pandemic era

“…In addition, we performed multiple logistic regression analyses to examine the associations between depression/anxiety and other factors ( Tables 2 , 3 ), and our results showed that working as a nurse is one of the risk factors for an increase in the levels of depression and anxiety. Moreover, the unpredictable pressure exerted by the COVID-19 pandemic on healthcare systems brings big challenges to nurses, which may affect their mental health well-being ( 32 , 44 ). Furthermore, several other studies conducted during the initial and ongoing phase of the COVID-19 pandemic also reported similar findings ( 23 , 45 ).…”

“…Anxiety symptoms were measured using clinically validated scales for GAD-7, which evaluate the frequency of anxiety symptoms over the past 2 weeks ( 32 , 33 ). The total score ranges from 0 to 21, with a high score indicating a greater severity of anxiety.…”

Management Support for Healthcare Workers’ Mental Health and Burnout during the COVID-19 Pandemic: A Cohort Study

“…In recent years, increasing workloads and work-life imbalances have led to mental distress and a high level of burnout among healthcare workers [30], which reached an extremely high level during the pandemic [31]. Frontline healthcare workers working with COVID-19-positive patients have had a moderate association with occupational burnout symptoms, increased likelihood of mental distress, increased risk of sleep problems [32][33][34], and emotional exhaustion [11]. And those working in isolation wards have felt fear of infecting family [35], experienced problematic alcohol use [36], and had higher levels of anxiety and depression than the general population [37,38].…”

Primary healthcare in the aftermath of the COVID-19 pandemic: a qualitative interview study in Sweden

“…The adaptations in PHC during the pandemic have been discussed regarding opinion-based lessons learnt 4 11 12 and in empirical studies based on data from frontline providers or managers in countries such as Brazil, 13 Benin, 14 UK 15 and Sweden. 7 9 Furthermore, multinational studies 16 17 have identified common challenges in PHC, such as managing information flows, and highlighted the differences in the approaches taken by PHC workers when dealing with patients with COVID-19 symptoms.…”