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

Abstract

Background Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic. Methods Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). 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%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusions Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.

Mental Health Help-Seeking and Associated Factors Among Public Health Workers During the COVID-19 Outbreak in China

“…The validated Chinese version of the Patient Health Questionnaire (PHQ-9) was used to assess the level of depression. Participants were asked to report how frequently they had experienced nine core depressive symptoms in the past 2 weeks ( 11 ). Items are assessed on 4-point Likert-type scales, ranged from not at all (0) to nearly every day (3).…”

“…During the COVID-19 outbreak period, a recent survey conducted in the epicenter Wuhan, China found that approximately 30% of front-line medical workers reported severe anxiety compared to general medical staff in another city (16%), where the epidemic was not serious ( 10 ). Another survey of PHW across five provinces in China also reported a high prevalence of depression (21.3%) and anxiety (19.0%) ( 11 ).…”

We must practice what we preach: a framework to promote well-being and sustainable performance in the public health workforce in the United States

“…The nature and extent of this impact across all sectors of public health, however, is not well understood. In a 2020 study of frontline workers focused and prevention and management of COVID-19 in China, one in five reported depression or anxiety, or both, and having worked through the night for at least 3 days in February–March 2020 [ 1 ]. A survey of workers in epidemiology and other areas of public health practice in the United States (U.S.) conducted in August–September 2020 found that two-thirds of respondents were experiencing burnout, with a greater prevalence among those who had been in their role for 1 to 4 years (as opposed to less than one), and those who worked in academia (as opposed to practice) [ 2 ].…”

Difficulties encountered by public health workers in COVID-19 outbreak: a cross-sectional study based on five provinces

“…This study found that the mental health problems of public health workers are also of concern, and further explored their specific sources of distress, such as: being treated differently at work, feeling aggrieved at work, family members not understanding and worrying about routine work outside the epidemic. Li et al found a higher reported rate of depression (21.3 %) and anxiety (19.0 %) among the public health workers in COVID-19 epidemic [ 9 ]. The mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers were also reported with a prevalence of 28.1 % in major depressive Dissorder [ 10 ].…”