Working condition and health status of 6,317 front line public health workers during the COVID-19 epidemic across 5 provinces in China: a cross-sectional study

Abstract

Background: Public health workers at China CDCs and primary health care institutes (PHI) constitute one of the main workforces for implementing prevention and control measures to contain the COVID-19 epidemic, but their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of frontline public health workers in China during the epidemic. Methods: Between February 18 to March 1, 2020, we conducted a cross-sectional survey among 2,313 CDC workers and 4,004 PHI workers in ve provinces across China experiencing different scales of COVID-19 epidemic. We interviewed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health by self-constructed questionnaire and standardized measurements. To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results: The prevalence of depression, anxiety, and poor self-rated health was 21.3%, 19.0%, and 9.8%, respectively, among public health workers (27.1%, 20.6% and 15.0% among CDC workers; and 17.5%, 17.9% and 6.8% among PHI workers). The majority (71.6%) participated in both eld and non-eld work and gave immense efforts. Nearly 20.0% have worked all night for more than 3 days and 45.3% had worked during the whole period of Chinese New Year. Three risk factors and two protective factors were found independently associated with all three health outcomes in our nal multivariate models, including working all night for >3 days (ORm=1.67~1.75, p<0.001), concerns about being infected at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), starting COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and capability to persist for more than 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusion: Chinese public health workers gave immense efforts and personal sacri ces to curb the COVID-19 epidemic and were exposed to risk of mental health problems. Efforts should be taken to improve the working condition and health status of public health workers to maintain the morale and effectiveness of public health workers in the ght against the epidemic. health workers involved in the epidemic containment efforts, (2) the roles and job functions they played, (3) the challenges associated with their work, and (4) factors that were associated with their mental and physical health. Methods Study design This cross-sectional study was conducted from February 18 to March 1, 2020. Data was collected from ve provinces (Hubei, Guangdong, Sichuan, Jiangsu and Gansu) which were purposely selected to cover different levels of epidemic severity de ned by numbers of reported cases (by March 5, 2020, 67466, 1351, 539, 631, and 102 COVID-19 cases were reported in the selected ve provinces), and to cover different regions of the country (center, southern, western, eastern, and northern). In each province, 3-5 cities were...

Prevalence of mental health problems and associated factors among front-line public health workers during the COVID-19 pandemic in China: an effort–reward imbalance model-informed study

“…This could not have been achieved without the immense effort and commitment from medical workers and public health workers. Chinese public health workers, who work at the Chinese Centre for Disease Control and Prevention (China CDC) or primary health care institutes (PHIs), made various contributions to prevent and control the spread of COVID-19, such as epidemiological investigation, surveillance, professional technical guidance, specimen collection and examination, health education and report epidemic data [4,5]. These workers are therefore an indispensable section of the anti-pandemic effort.…”

“…During public health emergencies, such as those resulting from the SARS and MERS epidemics and the COVID-19 pandemic, public health workers and medical workers face numerous stressors such as risk of infection, heavy workload, inadequate equipment and social support [4,6], and are consequently at high risk of developing mental health problems. The mental health and associated risk factors of medical workers have typically been well studied and documented during epidemics such as SARS [7,8] and MERS [9,10], and the ongoing COVID-19 pandemic [11,12].…”

“…The mental health and associated risk factors of medical workers have typically been well studied and documented during epidemics such as SARS [7,8] and MERS [9,10], and the ongoing COVID-19 pandemic [11,12]. However, the mental health status and associated risk factors of public health workers have been overlooked: we identified only one study [4] that has examined the prevalence of mental health problems among public health workers during the COVID-19 pandemic. This study found that the prevalence of probable depression and anxiety among public health workers during the pandemic in China was 21.3% and 19.0%, respectively.…”

“…ERI theory posits that failed reciprocity, such as high extrinsic effort and over-commitment by workers leading to low reward, likely generates strain and negative health outcomes in workers [24,26]. Previous studies found that occupational groups, such as public health workers who had excessive workrelated motivations and attitudes without alternative, non-work-related foci, will frequently suffer from failed reciprocity [27], leading to a higher risk of developing mental health problems [4]. Thus, the ERI model is an appropriate tool to use for investigating the association between work stress factors (i.e., effort, reward and over-commitment) and mental health problems (i.e., depression and anxiety) in front-line public health workers in the COVID-19 pandemic, as these workers have been greatly overburdened and under extreme pressure.…”

COVID-19 adversely affects the psychological status of healthcare workers in the emergency room

“…Similarly, the Middle East respiratory syndromecoronavirus (MERS-CoV) epidemic has caused elevated stress among healthcare workers [20]. Previously, Li et al indicated that depression and anxiety were observed in 21.3% and 19.0% of the frontline healthcare workers at the beginning of the COVID-19 outbreak [21]. In another study among 1257 healthcare workers, the prevalence of depression, anxiety, insomnia and distress were 0.4%, 44.6%, 34.0% and 71.5%, respectively [22].…”