Psychological burden high among health care providers during COVID-19 pandemic
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A survey of health care providers in ICUs across France highlighted a significant burden of mental health symptoms, including anxiety, depression and peritraumatic dissociation during the COVID-19 pandemic.
The cross-sectional survey included responses from 1,058 health care providers (median age, 33 years; 71% women; 68% nursing staff) from 21 ICUs across France from April 20 to May 21. Researchers used the Hospital Anxiety and Depression Scale and the Peritraumatic Dissociative Experiences Questionnaire to assess factors independently associated with reported symptoms of mental health disorders.
The overall prevalence of anxiety was 50.4%, prevalence of depression was 30.4% and prevalence of peritraumatic dissociation was 32%. Nurses had higher rates of anxiety (62.1%), depression (40.6%) and peritraumatic dissociation (46%) than other health care providers.
Significantly lower prevalence of anxiety (OR = 0.58; 95% CI, 0.42-0.79), depression (OR = 0.57; 95% CI, 0.39-0.82) and peritraumatic dissociation (OR = 0.49; 95% CI, 0.34-0.72) were associated with male sex.
Researchers reported higher risk for symptoms of anxiety and peritraumatic association among health care providers working in nonuniversity-affiliated hospitals and in nursing assistants.
The researchers identified six potentially modifiable determinants of psychological burden:
- fear of being infected;
- inability to rest;
- inability to care for family;
- struggling with difficult emotions;
- regret about the restrictions in visitation policies; and
- witnessing hasty end-of-life decisions.
“Critical care health care providers have been facing tremendous psychological burden during the COVID-19 pandemic. Understanding the psychological insult created by a public health crisis, as well as its determinants, may help hospitals, health care providers and communities to better prepare for such disasters,” Elie Azoulay, PhD, professor of medicine, specialty pulmonary medicine and critical and intensive care at the University of Paris-Diderot, Sorbonne, and faculty of medicine at the St. Louis University Hospital, Paris, and colleagues wrote. “This point is particularly important because even in countries where the pandemic seems to be somewhat under control, further surges may well occur in the near future.”
Azoulay and colleagues noted that the six potentially modifiable determinants of psychological burden identified in this study may help guide preventive strategies in critical care providers.
“These preventive strategies should be aimed at all ICU health care providers, notably the nurses and nursing assistants, in whom the burden was particularly great,” the researchers wrote. “Health care providers working in settings where the number of deaths is high are also particularly vulnerable.”
Azoulay and colleagues concluded that research on the long-term psychological outcomes are warranted.
The researchers noted several limitations of the study, including surveying only health care providers in ICUs in France and its survey design.