Health care workers’ mental health improved over time during pandemic

Mental health outcomes among health care workers have improved compared with the beginning of the COVID-19 pandemic, according to a longitudinal cohort study conducted in Italy.

“In the early stages of the COVID-19 pandemic, frontline health care workers experienced high levels of psychological distress and adverse mental health outcomes, including depression, anxiety, insomnia and posttraumatic stress symptoms,” Rodolfo Rossi, MD, PhD, of the department of systems medicine at the University of Rome Tor Vergata in Italy, and colleagues wrote in JAMA Psychiatry. “Furthermore, frontline [health care workers] had higher levels of mental health symptoms compared with the general population. Common risk factors included being female and younger, being a nurse, having a lower socioeconomic status or a lower educational level, having high risks of contracting COVID-19, and being socially isolated.”

According to the researchers, long-term longitudinal data are sparse in this area, with varying results related to overall trends in mental health outcomes among health care workers. In the current study, Rossi and colleagues sought to examine the mental health situation of health care professionals throughout Italy 14 months after the pandemic began. They analyzed data from 2,856 health care workers aged 18 years or older between March 1, 2020, and April 30, 2020, using an online questionnaire. Follow-up occurred between March 1 and April 30.

As exposures, the researchers used frontline vs. second-line position, job type, COVID-19 hospitalization and colleagues or family members having experienced effects of COVID-19. Depression symptoms, anxiety symptoms, insomnia symptoms and posttraumatic stress symptoms served as main outcomes and measures. Rossi and colleagues outlined four distinct trajectories to describe the mental state of participants: resilient, remittent, incident and persistent.

Of the initial 2,856 participants, 997 responded to follow-up. Most (82%) were female, and the mean age of participants was 42.92 years. Results showed depression symptoms, anxiety symptoms and posttraumatic stress symptoms all reduced over time. Conversely, symptoms of insomnia increased during that same period.

At the beginning of the study, frontline workers experienced decreased symptoms of depression. Hospitalization for COVID-19 showed an association with increased depression symptoms. Younger participants and those employed as frontline health care workers during the first iteration of the study displayed an association with reduced symptoms of anxiety.

The results further showed that men were prone to insomnia when employed on the frontlines during the initial study interval. Physicians in that period exhibited a reduction in posttraumatic stress symptoms. Younger participants and men were found to have an increase in posttraumatic stress symptoms.

Most (65.5%) participants had a resilient depression trajectory. A total of 18.8% were considered remittent, 6% percent incident and 9.6% persistent. Regarding anxiety symptoms, 73.3% of participants were considered resilient, 15.6% remittent, 4.7% incident and 6.4% persistent. Symptoms of insomnia were also shown to improve, with 88.9% considered resilient, 8% remittent, 2.1 incident and 1% persistent. The posttraumatic stress symptom trajectories were 38.5% resilient, 28.3% remittent, 9.1% incident (9.1%) and 24% persistent.

The study further revealed that extended periods of working alongside patients with COVID-19 displayed a significant correlation with negative mental health outcomes, while disengaging from employment as a frontline health care worker showed a high degree of correlation with abatement of mental health issues.

“These results could inform working policies that should avoid overexposure of [health care workers] to frontline working positions in the future,” Rossi and colleagues wrote.