Mental health among outpatient reproductive health care providers during the US COVID-19 epidemic

Abstract

Introduction Both inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers. Methods We conducted a survey with open-ended responses among outpatient reproductive health providers across the U.S. engaged in contraceptive care to collect data on their experiences with stress, anxiety and depression during the COVID-19 epidemic. The study population included physicians, nurses, social workers, and other health professions [n = 288]. Data were collected from April 21st–June 24th 2020. We used content analysis of free text responses among providers reporting increased stress, anxiety or depression. Results Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression related to care provision during the COVID-19 epidemic. The major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers’ changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown. Conclusions US outpatient providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US. Plan English summary Both inpatient and outpatient providers may be at increased risk of stress, anxiety and depression from their roles as health providers during the COVID-19 epidemic. This study explores how the US COVID-19 epidemic has increased feelings of stress, anxiety and depression among outpatient reproductive health providers across the US. We conducted a survey from April 21st to June 24th, 2020 among outpatient reproductive health providers, including physicians, nurses, social workers and other health professions. We asked open-ended questions to understand why providers reported increased stress, anxiety and/or depression. Two-thirds (184) of providers reported increased stress and one-third (96) reported increased anxiety or depression from care provision during the COVID-19 epidemic. Major sources of stress, anxiety and depression were due to patient care, worry about becoming infected or infecting family members, work- and home-related concerns, experiencing provider burnout, and fear of the unknown. Concerns about quality of patient care, providers’ changing responsibilities, lack of personal protective equipment, and difficulty coping with co-worker illness and absence all contributed to provider stress and anxiety. Worries about unemployment and childcare responsibilities were also highlighted. Providers attributed their stress, anxiety or depression to feeling overwhelmed, being unable to focus, lacking sleep, and worrying about the unknown. This study highlights that US outpatient reproductive health providers are experiencing significant stress, anxiety, and depression during the US COVID-19 epidemic. Policy and programmatic responses are urgently needed to address the widespread adverse mental health consequences of this epidemic on outpatient providers, including reproductive health providers, across the US.

A cross‐sectional analysis of factors associated with stress, burnout and turnover intention among healthcare workers during the COVID‐19 pandemic in the United States

“…Stress can lead to feelings of anxiety, fear, guilt, anger, social withdrawal, rumination, depression, insomnia and negative self‐assessments (Karnatovskaia et al., 2020). Since the onset of the pandemic, healthcare workers have experienced worsening work conditions and increased workloads; understaffing; faulty or missing personal protection and other medical equipment; a lack of testing; unmet needs for training, such as respiratory training for patients with COVID‐19; and higher than usual rates of sickness and death due to complications related to COVID‐19 among patients and colleagues (Chirico et al., 2021; Comfort et al., 2021; Norful et al., 2021; Walker & Tolentino, 2020).…”

A Review Study on the Trends of Psychological Challenges, Coping Ways, and Public Support During the COVID-19 Pandemic in the Vulnerable Populations in the United States

“…The authors also reported that the most common coping behavior was physical therapy or exercise, while most responders were interested in an individual therapist with online self-guided counseling. Comfort et al ( 30 ) conducted a study on HCWs from an outpatient clinic in April–June 2020 and assessed their mental health challenges during the COVID-19 pandemic. The authors found that there was a two-third increase in stress levels, whereas there was a one-third increase in anxiety/depression levels.…”

“…The reasons were mostly due to patient care, worrying about contracting and spreading infection, work- and home-related concerns, burnout, and fear of the unknown. Other contributory factors were lack of personal protective equipment, difficulty coping with co-worker illness, and absence ( 30 ).…”

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“…The results of studies (Comfort et al, 2021;Havaei et al, 2021;Smith et al, 2020) and surveys (Registered Practical Nurses Association of Ontario, 2021; Statistics Canada, 2021) carried out in North America have indicated also that the health of HCWs, including nurses, was weakened. In a cross-sectional correlational study conducted in British Columbia, Canada, Havaei et al (2021) examined the impact of COVID-19 workplace conditions on mental health outcomes in a sample of 3,676 nurses and found the following prevalence rates: post-traumatic stress disorder 47%, anxiety 38%, depression 41% and high emotional exhaustion 60%.…”

“…The results of studies (Comfort et al., 2021; Havaei et al., 2021; Smith et al., 2020) and surveys (Registered Practical Nurses Association of Ontario, 2021; Statistics Canada, 2021) carried out in North America have indicated also that the health of HCWs, including nurses, was weakened. In a cross‐sectional correlational study conducted in British Columbia, Canada, Havaei et al.…”