Healthcare workers experience mental health problems during and after pandemics

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Re: Healthcare workers experience mental health problems during and after pandemics

Post by trader32176 »

‘Nine months into it, the adrenaline is gone and it’s just exhausting’

12/21/20 ... 28099.aspx

In March, during the first week of the San Francisco Bay Area's first-in-the-nation stay-at-home order, KHN spoke with emergency department physicians working on the front lines of the burgeoning COVID-19 pandemic. At the time, these doctors reported dire shortages of personal protective equipment and testing supplies. Health officials had no idea how widespread the virus was, and some experts warned hospitals would be overwhelmed by critically ill patients.

In the end, due to both the early sweeping shutdown order and a state-sponsored effort to bolster the supply chain, Bay Area hospitals were able to avert that catastrophe. The region so far has fared much better than most other U.S. metro regions when it comes to rates of COVID infection and death. Even so, with intensive care unit capacity dwindling to critical levels statewide, San Francisco on Thursday issued another drastic order, announcing a mandatory 10-day quarantine for anyone returning to the city who has spent time outside the region.

Amid this fierce second surge, we circled back last week to check in with Dr. Jeanne Noble, director of the COVID response at the University of California-San Francisco medical center emergency department, to get her reflections on the Bay Area's experience. She explained how even as her hospital has made so many improvements, including recently launching universal testing so that everyone who comes to the emergency room is tested for COVID-19, the lockdown and burnout are wearing on her and her colleagues. The conversation has been edited for length.

Q: How are you doing at UCSF right now?

We did have a period of time before this last surge where we often had a few days with no COVID patients. That was great. That ended in late September. This morning we have 11 patients on ventilators in the ICU.

I think we're the first hospital in the state for universal testing. Everyone who comes to the ER gets tested. I've been working on this for months, but it's new this week. Now we have testing, so we don't have to do so much guesswork.

Q: When we spoke during the week of the first stay-at-home order, back in March, you were very worried. How do things compare now?

The supply [of masks] is just much better than it was back in March. In March, we had furloughed engineers from our local museum, the Exploratorium, making us face shields, and we started a makers lab in the library across the street to make supplies. It doesn't feel like that this time around. We have a longer horizon.

I think in terms of our COVID care and our hospital capacity, we are fine. But my own sort of perspective on all of this is: When are we going to be done with this? Because even though things are smoother — we have PPE, we have testing — it's a tremendous amount of work and stress. Frankly, the fact that my children have not been in school since March is one of my major sources of stress.

We're all working way more than we ever have before. And nine months into it, the adrenaline is gone and it's just purely exhausting.

Q: Can you tell me more about that, the physical and emotional toll on the hospital staff?

We don't allow eating in the ED anymore, so we don't have break rooms. Especially if you're the supervising doctor, you need to do this elaborate handoff to another doctor if you need to eat. You know, it's 10 hours into your shift and you want a cup of coffee.

The hassles and the discomforts. Wearing an N95 day after day is really uncomfortable. A lot of us have ulcers on our noses. They become painful.

And the lack of being able to socialize with colleagues is hard. The ED has always been a pretty intense environment. That's offset by this closeness and being a team. All of this emotional intensity, treating people day after day at these incredible junctures in their lives — a lot of the camaraderie and morale comes from being able to debrief together. When you're not supposed to be closer than a few feet from one another and you don't take off your masks, it's a lot of strain.

People are much less worried about coming home to their families. It hasn't been the fomite disease we were all worried about initially, worried we'd give our kids COVID from our shoes. But there's still the concern. Every time you get a runny nose or a sore throat you need to get tested, and you worry about what if you infected your family.

Q: So will you and your colleagues be able to take a break over the holidays?

We'll see what happens. We're just now starting to feel like we're seeing the post-Thanksgiving numbers. But I think that even without having to do extra shifts in the ED, certainly for someone like me doing COVID response, there's always a huge number of issues to work through. We just got the monoclonal antibodies, which is great, but that's a whole new workflow.

I think what is going to bother people the most is that we are in lockdown. Kind of longing for that relaxation and time with family that we're all kind of craving.

Q: It sounds like things are hard, but the hospital is in a relatively good place.

I was deployed to the Navajo Nation and helped with their surge in May in Gallup, New Mexico, and that is much, much harder than what we've faced in the Bay Area. In Gallup, at Indian Health Service, they were incredible in just the can-do attitude with way fewer resources than we have here. As of this summer, they had had the worst per capita surge in the country. They redesigned their ED essentially by cutting every room in half, hanging plastic on hooks you would use to hang your bicycle wheel. They hung thick plastic and right there doubled their capacity of patients they could see.

Our tents at UCSF are these blue medical tents with HVAC systems, heaters, negative pressure. They are really nice. There they had what looked like beach cabanas — open walls with just a tent overhead. In March and April they were taking care of patients in the snow. In the summer, it was hot and windy. When I was there, almost every single one of my patients had COVID.

That level of intensity was not something we had to go through in the Bay Area. Not to say that it's easy [here]; I just told you all the ways it's hard. But everything is relative. In terms of the COVID landscape, we have been very lucky.

Q: The Bay Area was early to close and has had stricter regulations than many parts of the country. As someone directly affected, what do you think of the response?

I think that we have benefited from early closures, unquestionably, when we did our shelter-in-place in March and probably saved 80,000 lives. It was really a tremendous and a bold move.

We've done some things well and other things not so well. We were very late to implement closures in a targeted fashion. Restaurants and dining reopened this summer, and a lot of us couldn't figure out why indoor dining was open. Why is indoor dining something we need to even be considering when we've just barely flattened our curve? It was very predictable that cases would go up when dining happened. And they did.

We need to evaluate what is more important for our society and well-being, and to say what is the risk associated with that activity. Schools are of high social value. And [the closures are] really hard for kids. We're seeing a lot of adolescents with suicidal ideation brought to the emergency department, which is related to school closure. I would put dining and restaurants as being of minimal social importance and very high risk.

We could have done this better. Closing [down society] when numbers go up is reasonable and that saves lives. But I think we know enough that it should not be an across-the-board closing. I mean, with this latest order, they temporarily closed parks. And we've been telling people to go outside. It's like, what? Are you kidding?
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Re: Healthcare workers experience mental health problems during and after pandemics

Post by trader32176 »

COVID-19 taking a disproportionate toll on female healthcare workers

1/11/21 ... rkers.aspx

Women in the healthcare workforce seem to be suffering stress and burnout in the current pandemic situation, disproportionately when compared to men, suggests a new preprint research paper published on the medRxiv* server.

Increased burden on health care workers

The coronavirus disease 2019 (COVID-19) pandemic has placed an immense burden on healthcare systems in many regions around the world. Healthcare workers (HCWs) are among the essential workers who come into close and prolonged contact with COVID-19 patients, exposing themselves to the potential risk of infection. In addition, they are faced with harassment, stigma, and both emotional and physical trauma as a result of their occupation, as other people fear that HCWs could ‘bring’ the infection to them.

All this has led to higher rates of stress, burnout, depression, anxiety, and coping mechanisms such as drinking and substance abuse. Suicide rates have also risen. In fact, Amnesty International has reported that over 7,000 HCWs have died since the pandemic began, while in the USA alone, almost 1,000 deaths have been reported among HCWs.

Women in healthcare under greater stress

Women are faced with more significant burdens in such a situation. Not only are they still forced to endure or challenge pre-existing workplace issues such as gender bias, discrimination, sexual harassment, and other inequalities, but they make up 75% of the health workforce. Female doctors are already depression-prone, and suffer more burnout and report more suicidal thoughts relative to their male counterparts. In addition, they carry out much more work unrelated to their professional duties, such as parenting and caregiving, compared to men – on average, this is 2.5 times greater.

Review of studies on HCW burnout reveals risk factors

The scientists looked at 47 studies from all over the world. They found that stress and burnout in female HCWs were primarily because of poorly structured organizations, roles at work, and policies. In over 40% of cases, the lack of adequate resources was cited, including not having access to personal protective equipment (PPE) and having too few staff. Also, those directly caring for COVID-19 patients had increased stress and burnout in 43% of the studies. In about 38% of studies, HCWs were found to have a higher burden at work, with more COVID-19 patients to care for, but without enough compensation.

Two-thirds of HCWs said they were concerned about passing on the infection to their family, and they were worried about their own safety as well. Over a third of women were at high risk for stress and burnout. Women who were young, had no family, or had young children to care for were more likely to be emotionally stressed and experienced burnout. Inexperienced HCWs, and those who felt they were not capable of the work demanded of them in caring for COVID-19 patients, were at higher risk.

Over a quarter traced their burnout to their organization's culture, patient care protocols, and their interactions with society at large. Patient care protocols failed to clearly define the steps, especially when related to poor infection care guidelines, which were repeatedly identified as stress triggers. When peers, managers, and organizational leaders were supportive of their work, women HCWs were less likely to suffer burnout.

Idolization coupled with persecution

One phenomenon is the universal idolization of HCWs in the mass as heroes who are combating the epidemic on the frontline, with a paradoxical stigmatization and avoidance of them at personal level due to their presumed contagion risk. The first attitude imposed a higher burden of expectations on HCWs, increasing their feeling of moral responsibility and stress as they tried to meet such expectations. On the other hand, their social isolation led to immense emotional turmoil. Such burdens were only increased by social distancing, in keeping with government guidelines.
Public and governmental responsibility

The government and public authorities also contributed to burnout in other ways. Public health failures such as non-preparedness for a pandemic, as well as failures to prepare official guidelines and set up facilities for the screening and treatment of the disease, led to increased stress and burnout in young women.

Supportive measures

Less than 40% of the studies dealt with measures that could make women workginh in healthcare feel more supported. In about a third of the studies, individual well-being and resilience were addressed. These included regular exercise, mental health support, and faith-based activities, as well as hobbies.

In a fifth of studies, the researchers promoted interventions at the organizational level, such as changing the work type or schedule, improving communication about work policies, providing physical resources such as PPE, offering training relating to the proper management of the disease, and financial support. More down-to-earth interventions included providing rest areas, food, and resiliency training. No evidence was offered that any or all of these measures were useful, however, but some studies did show that undesirable coping mechanisms were at work, such as avoidant coping and substance use.

Severe dearth of data

There is a severe shortage of information on how race, culture, profession, and leadership affect the risk of stress during the pandemic. For instance, it is astonishing and tragic that fully a third of female nurses who have died during this period in the USA are Filipino. There is also little data on how burnout affects HCWs at different levels of the organizational hierarchy.

Policies such as the US Families First Coronavirus Response Act allowed employers to exclude HCWs from the 80 hours of paid sick leave that could be availed of citing COVID-19-related benefits. This discriminatory act caused much anxiety and stress among people in these professions. Not much is known about how such stress and burnout affect the quality of care or patient safety, absenteeism, and even long-term decisions about whether to work, especially among female HCWs.


The researchers concluded that much remains to be known about how COVID-19 affected female HCWs. Such data is important in quantifying, describing and eventually preventing female burnout in the health and allied professions. National health organizations should gather more data in this area to enable sound conclusions to be drawn and improve health for women in the healthcare workforce.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

Sriharan, A. et al. (2021). Women in Health Care Experiencing Occupational Stress and Burnout during COVID-19: A Review. medRxiv preprint doi:, ... 21249468v1
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Re: Healthcare workers experience mental health problems during and after pandemics

Post by trader32176 »

Study reveals rising risk of mental health problems among COVID-19 health care professionals

1/12/21 ... onals.aspx

The daily toll of COVID-19, as measured by new cases and the growing number of deaths, overlooks a shadowy set of casualties: the rising risk of mental health problems among health care professionals working on the frontlines of the pandemic.

A new study, led by University of Utah Health scientists, suggests more than half of doctors, nurses, and emergency responders involved in COVID-19 care could be at risk for one or more mental health problems, including acute traumatic stress, depression, anxiety, problematic alcohol use, and insomnia. The researchers found that the risk of these mental health conditions was comparable to rates observed during natural disasters, such as 9/11 and Hurricane Katrina.

"What health care workers are experiencing is akin to domestic combat," says Andrew J. Smith, Ph.D., director of the U of U Health Occupational Trauma Program at the Huntsman Mental Health Institute and the study's corresponding author. "Although the majority of health care professionals and emergency responders aren't necessarily going to develop PTSD, they are working under severe duress, day after day, with a lot of unknowns. Some will be susceptible to a host of stress-related mental health consequences. By studying both resilient and pathological trajectories, we can build a scaffold for constructing evidence-based interventions for both individuals and public health systems."

The study appears in the Journal of Psychiatric Research. In addition to U of U Health scientists, contributors include researchers from the University of Arkansas for Medical Sciences; University of Colorado, Colorado Springs; Central Arkansas VA Health Care System; Salt Lake City VA Healthcare System; and the National Institute for Human Resilience.

The researchers surveyed 571 health care workers, including 473 emergency responders (firefighters, police, EMTs) and 98 hospital staff (doctors, nurses), in the Mountain West between April 1 and May 7, 2020. Overall, 56% of the respondents screened positive for at least one mental health disorder. The prevalence for each specific disorder ranged from 15% to 30% of the respondents, with problematic alcohol use, insomnia, and depression topping the list.

"Frontline providers are exhausted, not only from the impact of the pandemic itself, but also in terms of coping day to day," says Charles C. Benight, Ph.D., co-author of the study and a professor of psychology at the University of Colorado, Colorado Springs. "They're trying to make sure that their families are safe [and] they're frustrated over not having the pandemic under control. Those things create the sort of burnout, trauma, and stress that lead to the mental health challenges we're seeing among these caregivers."

In particular, the scientists found that health care workers who were exposed to the virus or who were at greater risk of infection because they were immunocompromised had a significantly increased risk of acute traumatic stress, anxiety, and depression. The researchers suggest that identifying these individuals and offering them alternative roles could reduce anxiety, fear, and the sense of helplessness associated with becoming infected.

Alcohol abuse was another area of concern. About 36% of health care workers reported risky alcohol usage. In comparison, estimates suggest that less than 21% of physicians and 23% of emergency responders abuse alcohol in typical circumstances. Caregivers who provided direct patient care or who were in supervisory positions were at greatest risk, according to the researchers. They say offering these workers preventative education and alcohol abuse treatment is vital.

Surprisingly, health care workers in this study felt less anxious as they treated more COVID-19 cases.

"As these health care professionals heard about cases elsewhere before COVID-19 was detected in their communities, their anxiety levels likely rose in anticipation of having to confront the disease," Smith says. "But when the disease started trickling in where they were, perhaps it grounded them back to their mission and purpose. They saw the need and they were in there fighting and working hard to make a difference with their knowledge and skills, even at risk to themselves."

Among the study's limitations are its small sample size. It was also conducted early in the pandemic in a region that wasn't as affected by the disease as other areas with higher infection and death rates.

Moving forward, the researchers are in the final stages of a similar but larger study conducted in late 2020 that they hope will build on these findings.

"This pandemic, as horrific as it is, offers us the opportunity to better understand the extraordinary mental stress and strains that health care providers are dealing with right now," Smith says. "With that understanding, perhaps we can develop ways to mitigate these problems and help health care workers and emergency responders better cope with these sorts of challenges in the future."


University of Utah Health
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Re: Healthcare workers experience mental health problems during and after pandemics

Post by trader32176 »

Clinicians at leading cardiac center report burnout and high levels of distress

1/12/21 ... tress.aspx

More than half the clinicians surveyed at the Peter Munk Cardiac Centre reported burnout and high levels of distress according to a series of studies published today in the Canadian Medical Association Journal Open (CMAJ-OPEN). In these studies carried out before the COVID-19 pandemic, 78% of nurses, 73% of allied health staff and 65% of physicians described experiencing burnout.

" In my 35 years as a physician I have never seen a more serious issue for clinicians than burnout."

- Dr. Barry Rubin, Lead Author, Chair and Medical Director, the Peter Munk Cardiac Centre, UHN

Completed in 2019, the study used the Well-Being Index, a survey tool developed by the Mayo Clinic, a globally recognized academic medical center. 414 physicians, nurses and allied health staff answered a series of questions about the level of stress they experienced in the previous month.

The index measured fatigue, depression, burnout, anxiety or stress, mental and physical quality of life, work-life integration, meaning in work and distress.

The study also evaluated the respondent's perception of the adequacy of staffing levels, and of fair treatment in the workplace. The results were then compared to outcomes for corresponding healthcare professionals at academic health science centers in the United States.
Main findings and impact:

78% of nurses, 73% of allied health staff and 65% of physicians described burnout in the month prior to when the survey was administered.
79% of nurses, 56% of allied health staff and 55% of physicians had high levels of distress.
Lower levels of distress among all clinicians were associated with a perception of fair treatment at work and a perception of adequate staffing levels.

The impact of burnout on clinicians can include extreme fatigue, professional dissatisfaction, job turnover, decreased quality of life, and thoughts of suicide.

"Burnout also has a negative impact on the care we provide," says Dr. Rubin. "It is associated with an increased incidence of medical errors, serious safety events, readmission to hospital, worse patient outcomes and in some situations even increased patient mortality. Clinician burnout is a public health crisis that we must address now."

The findings of these studies are the first step in acknowledging the existence, depth, and degree of distress and burnout among clinicians at the Peter Munk Cardiac Centre.

"Our next steps will be to meet with nurses, doctors and allied health staff, so that we can understand the key drivers of burnout in the PMCC and develop targeted intervention strategies," says Dr. Rubin. "It is critical we address these issues and work together to bring about much-needed change. Healthcare workers give their all to care for others, it is time they are cared for too."

These studies were funded by the Peter Munk Cardiac Centre Innovation Fund.


University Health Network
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Re: Healthcare workers experience mental health problems during and after pandemics

Post by trader32176 »

Covid-19: Many ICU staff in England report symptoms of PTSD, severe depression, or anxiety, study reports


Nearly half of intensive care unit (ICU) and anaesthetic staff surveyed for a study reported symptoms consistent with a probable diagnosis of post-traumatic stress disorder (PTSD), severe depression, anxiety, or problem drinking.1

The preprint, produced by researchers at King’s College London, aimed to get a picture of the rates of probable mental health disorders in ICU and anaesthetic staff in six English hospitals during June and July 2020. It found that while over half reported good wellbeing, many showed signs of mental health problems.

The authors said that during the covid-19 pandemic, ICU staff have “faced a particularly challenging time” because of the high mortality among ICU patients with covid-19. “Difficulty in communication and providing adequate end-of-life support to patients and their next of kin, because of visiting restrictions, has been a specific stressor for all staff working in ICU,” they said.

The researchers asked volunteers to complete an anonymised survey of questions regarding depression, anxiety symptoms, symptoms of PTSD, wellbeing, and alcohol use. Just over 700 staff members completed the surveys, including 291 doctors (41%), 344 nurses (48.5%), and 74 other healthcare staff (10.4%).

The preprint said that over half (58.8%) of participants reported good wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (n=418, 58.8%). However, 45.4% (n=322) met the threshold for probable clinical significance on at least one of the following measures: severe depression (6.3%), PTSD (39.5%), severe anxiety (11.3%), or problem drinking (7.2%).

The study also reported that 13.4% of respondents reported having thoughts that they would be better off dead, or of hurting themselves several days or more frequently in the two weeks before completing the survey. Nurses were more likely to report these thoughts than other healthcare staff (19.2% v 7.6% for doctors and 9.5% for clinical staff.)

The preprint said, “While further validation studies are required to better understand what proportion would meet diagnostic criteria for PTSD on clinical assessment, these data suggest that ICU clinicians are at a significantly elevated risk of suffering with PTSD.

“Our findings of high levels of PTSD, and other mental health difficulties such as depressive anxiety disorders, are highly relevant given that there is strong evidence poor mental health is associated with functional impairment which would increase the risk of patient safety incidents.”

A major limitation of the research was that there was no baseline to compare these figures with as no survey was taken before the pandemic. The authors did note that a 2015 study of 335 ICU staff reported probable PTSD at 8% among staff working with adults and 17% among staff working with children.

Speaking to The BMJ, Clare Gerada—who runs the NHS Practitioner Health Programme (PHP)—noted a number of limitations to the study, including that people who filled out the survey were more likely to have problems to report. She said, however, that the PHP, which provides help for doctors and dentists across England with mental illness and addiction problems, has seen high rates of mental health problems among doctors during the pandemic, especially for severe depression.

Meanwhile, BMA mental health lead Andrew Molodynski said the findings were “extremely troubling, but sadly not surprising.”

“The BMA’s most recent tracker survey revealed that almost 60% of doctors in England, Wales, and Northern Ireland are now suffering from some form of anxiety or depression, with 46% saying their condition had worsened since the start of the pandemic,” he said.

“This research further highlights the vital importance of fostering a supportive workplace culture, and the need to provide universal access to high quality wellbeing support and occupational health services across the board. Equally, health and care workers must be protected at work and so it is crucial that they are urgently vaccinated so that they are able to be fit and well to continue providing care and keeping services running at time when the NHS is under unparalleled pressure.”

The research was funded by the National Institute for Health Research and Public Health England. One of the researchers works for NHS England.


Greenberg N, Weston D, Hall C, Caulfield T, Williamson V, Fong K. The mental health of staff working in intensive care during covid-19.MedRxiv2020.11.03.20208322 [Preprint]. 2020.
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