The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders

Abstract

Background The COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood. Objectives Examine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes. Design Observational, self-report, single time-point online assessment. Participants A total of 510 US HCW (N = 301) and FR (N = 200) with occupational duties affected by the COVID-19 pandemic. Main Outcomes and Measures CROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents’ likelihood of leaving current field and occupational functioning were assessed with 2-item PROMIS subscales. Relationships were modeled using multivariable regression. Open-ended responses were coded using rapid template analysis. Results CROS total scores correlated significantly with all four psychiatric symptom domains (R’s = .42–.53), likelihood of leaving one’s current occupation (R = .18), and trouble doing usual work (R = .28), all p’s < .001. Half of HCW indicated a decreased likelihood of staying in their current occupation as a result of the pandemic. CROS were fit to a 3-factor model consisting of risk, demoralization, and volume factors. All CROS factors were associated with psychiatric symptom burden, but demoralization was most prominently associated with psychiatric symptoms and negative occupational outcomes. Among psychiatric symptoms, PTSD symptoms were most strongly associated with negative occupational outcomes. Open-ended statements emphasized lack of protection and support, increased occupational demands, and emotional impact of work duties. Conclusions and Relevance These results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.

Emergency Stress, Hardiness, Coping Strategies and Burnout in Health Care and Emergency Response Workers During the COVID-19 Pandemic

“…In a 2020 online survey of U.S. health care workers, 76% reported exhaustion and burnout, 86% anxiety, 75% feeling overwhelmed, and 75% with sleep disturbances (Mental Health America, 2022 ). Recent studies have also found that COVID related stress is linked to a range of psychiatric symptoms as well as intentions to quit the occupation for health care workers and also first responders including firefighters and police (Hendrickson et al, 2022 ).…”

Relationship between Income and Mental Health during the COVID-19 Pandemic in China

“…McAlearney et al [ 11 ] studied the mental health status of first responders (including police, firefighters, and emergency medical services) and their influencing factors during the pandemic. Many similar studies have been conducted and can be found in the literature [ 12 , 13 , 14 ].…”

Mental Health of Emergency Department Healthcare Workers During COVID-19 in Brooklyn, New York

“…1,2,31,32,33,34 Unfavorable mental health symptoms among 'frontline' HCW including those working in the ED, 39,40 intensive care units, 41 and other HCW who have been in direct contact with patients with COVID-19 are reported to be common. 11,31,[42][43][44][45][46][47][48][49][50][51] The prevalence of clinically-relevant depressive, perceived stress, PTSD, and anxiety symptoms were higher among Brooklyn HCW compared to other published reports, [52][53][54][55][56] and similar to those reported among ED HCW, specifically. 11,39 We are one of the few published studies to compare clinical and non-clinical ED HCW since most published studies focus on clinical and/or frontline HCW only.…”