'Workforce at risk': Child care stress driving burnout, anxiety, depression

Child care stress during the COVID-19 pandemic has had a significant impact on health care workers, and more must be done to mitigate this burden on the workforce, according to researchers.

A previous survey revealed that one in five health care workers quit their job since the pandemic’s onset — a trend that followed a significant increase in stress, Elizabeth M. Harry, MD, SFHM, a primary care physician and associate professor of medicine at the University of Colorado, and colleagues wrote in JAMA Network Open.

“Before the pandemic, full-time care for one infant cost a mean of $21,700 annually in the US. This cost is greater than one-quarter of the average hospital nurse’s salary, more than one-third of an average medical resident’s salary, and more than two-thirds of a nursing assistant’s salary,” they wrote. “Health care workers have the added difficulty of trying to find care outside typical hours such as nights and weekends, with only 8% of the center-based care providing nonstandard coverage.”

During the pandemic, school closures and quarantine orders have exacerbated these issues, according to the researchers.

“The COVID-19 pandemic has had a myriad of effects on [health care workers] that put our workforce at risk,” they wrote.

Given the unique stress of child care accessibility among health care workers during the pandemic, Harry and colleagues surveyed 58,408 health care workers across 208 organizations between April 2020 and December 2020 to assess child care stress, workload, depression, anxiety and work intentions. Among the participants, 26.9% were physicians and 19.5% were nurses.

The researchers found that 21% of health care workers experienced high child care stress. These workers also had 115% greater odds of anxiety or depression and 80% greater odds of burnout.

Along with increased rates of depression, anxiety and burnout, the researchers found that high child care stress was associated with 28% greater odds of an intent to leave a job (OR = 1.28; 95% CI, 1.17-1.4) and 91% greater odds of an intent to reduce hours (OR = 1.91; 95% CI, 1.76-2.08).

The researchers reported that child care stress varied by demographic. Those in underrepresented ethnic and racial groups had 40% to 50% greater odds of reporting child care stress compared with white respondents.

“Recovery based on racial equity needs to include collecting data, involving racial and ethnic minority communities in the process, and increasing access to child care going forward,” the researchers wrote. “Without these efforts, individuals from minoritized groups will probably experience reduced participation in the workforce. Thus, reasons for [child care stress] in racial and ethnic minority groups should be addressed by health care organizations and explored in future scholarly studies.”

When evaluating gender differences, Harry and colleagues found that women had 22% greater odds of reporting child care stress compared with men. Women were also significantly more likely to report burnout (adjusted OR = 1.49; 95% CI, 1.41-1.57), experience anxiety and depression (aOR = 1.56; 95% CI, 1.47-1.6) and intent to reduce hours (aOR = 1.11; 95% CI, 1.02-1.2).

In response to the findings, the researchers proposed “a more intentional approach in the health care workplace to assessing and addressing child care concerns when worker assignments are made.”

“Workplaces that can accommodate change on short notice, provide on-site care for ill children or on-site schools, and are aware of worker concerns about their children will be better positioned to show workers they are a caring environment, one that, we hope, workers would be more likely to remain with rather than leaving for shift work in other settings, a scenario that is currently occurring in large numbers,” the researchers wrote. “Work-affiliated child care reduces [child care stress] and would be a reasonable strategy to mitigate the impact of child care stress on [intent to leave] or [intent to reduce].”