The coronavirus (COVID-19) pandemic has had an enormous global impact 1. There is growing concern about the impact of the pandemic on the mental health of healthcare workers. Evidence indicates that healthcare workers have been disproportionately affected by the pandemic in comparison to the general population 2. In this blog post, we specifically look at how healthcare workers’ mental health has been affected by the COVID-19 pandemic.
Research has considered the impact of the pandemic on the mental health of a broad range of healthcare workers, including emergency service workers 3, intensive care workers 4, and maternity ward staff 5. Before COVID-19, healthcare staff were already subject to increased rates of mental health issues 6. In addition, redeployment in the workplace, isolation from loved ones, inadequate personal protective equipment (PPE), and increased risk of COVID-19 infection have been identified as potential factors contributing to psychological distress in healthcare workers during the pandemic 7. Subsequently, extensive research has explored the reasons why healthcare workers may be facing a mental health crisis, and what could be done to support this group.
Impact of COVID-19 on Mental Health
Experiencing distress and mental health problems during a pandemic is not a novel occurrence for healthcare workers 8. Previous health crises including SARS, Ebola, and MERS have been associated with increased risk of stress-related disorders, depression, and anxiety 8. Cross-cultural studies during the COVID-19 pandemic have similarly identified an increased risk of mental health issues in healthcare workers. For example, in an Italian survey study, as many as 44.9% of healthcare workers reported symptoms of psychological distress, which were mostly attributed to a significant increase in workload alongside worries about contracting the new coronavirus 9. In a survey study in China, symptoms of depression were identified in 25.2% of emergency staff, as well as post-traumatic stress disorder (PTSD) in 9.1% of this group 3. Having fewer years of professional experience, longer working hours, and lower levels of social support were associated with increased levels of mental health problems 3. Furthermore, symptoms of anxiety were identified in 23.2% of healthcare workers in a systematic literature review and meta-analysis 10. Elevated levels of psychological distress have also been observed in countries with low rates of death caused by coronavirus. For example, increased levels of psychological distress in medical professionals have been observed in Togo, where there have been very few COVID-19-related deaths 11. Despite the low death rate, healthcare workers may be at an increased risk of psychological distress due to pressure on the healthcare system and lack of equipment required to deal with the pandemic 11.
Clearly, COVID-19 has negatively impacted the mental health of healthcare workers. Factors such as imposed lockdown measures, knowing colleagues who have been infected, being quarantined, and experiencing stigma because of working in a clinical role, have been associated with increased psychological distress 6. One profession reportedly at high risk of experiencing mental health issues during the coronavirus pandemic is nursing. Nurses have consistently reported higher levels of depression and anxiety during the COVID-19 pandemic in comparison to other professionals, such as physicians 12. Arguably, nurses may witness more suffering and death than their colleagues 10 which is very distressing. Another group of healthcare professionals at increased risk of mental health problems during COVID-19 are staff who were already experiencing such problems before the start of the pandemic 13. Healthcare workers with pre-existing mental health problems were at increased risk of experiencing clinically significant symptoms of PTSD, depression, and anxiety in comparison to healthcare workers without pre-existing mental health problems 13. Many healthcare workers within this group might not have access to usual support systems as a result of the lockdown measures. Usual support systems, including having contact with family and friends, were not as accessible as they were prior to the pandemic 14.
Despite the unequivocal negative impact of the COVID-19 pandemic on healthcare professionals’ mental health, there has been a lack of clear guidance on how to reduce the risk of mental health issues in this population. Most studies about the impact of the pandemic on the mental health of healthcare workers have not suggested potential interventions 15. Where interventions have been recommended, very few studies have reported the outcome of these interventions 15. In a UK survey study, 42% of NHS and social care workers felt that the government has not done enough to support their mental health during the pandemic 16. When staff have been asked for suggestions, unsurprisingly, basic needs such as physical and safety requirements have been established as prerequisites to mental health interventions 17. As contracting coronavirus can increase the likelihood of experiencing mental health problems up to three times, ensuring appropriate PPE and limiting duration of contact with COVID-19 are pertinent preventative measures 12.
Mental health psychological support services, such as telephone support, walk-in clinics, and free access to online self-help (e.g., stress reduction self-help videos) have been made available to frontline health and social care workers experiencing distress 18 19. These services can offer low or high intensity psychological interventions to professionals who require support. Thus far, telephone support services and walk-in clinics have been reported as a helpful source of support for healthcare workers in neuroscience services 20. In a qualitative interview study in Singapore, nurses stressed the importance of receiving help from different sources, including the public, the workplace, and their own family and friends in order to reduce distress caused by the pandemic 21. Although research has often focused on the situation during the pandemic, support systems must be in place for healthcare workers who need psychological support in the long term. Various measures have been considered, including giving thanks, robust return to work interviews, active monitoring of high-risk individuals, and group discussions involving clinical and non-clinical staff 22.
It is important to recognise that some healthcare workers find that interventions do not reflect their lived experience as they fail to consider the challenges of their job roles 23. These challenges include exhaustion and understaffing issues in services which mean that some healthcare workers are unable to participate in interventions 23. Currently, there are very few qualitative studies exploring the lived experience of healthcare workers during the COVID-19 pandemic 21. Qualitative interview studies could help understand the needs of healthcare workers 21. Whilst survey studies aim to examine the needs of healthcare professionals in relation to their mental health, they could be suffering from survey fatigue due to the increased number of COVID-19 research studies 17. Survey fatigue can impact the quality of responses and reduce the response rates 17.
Another notable issue with surveys during the pandemic is sampling biases which may occur as a result of the type of healthcare workers who are willing to respond to those surveys 7. Individuals who are psychologically distressed at the time of the survey may be more willing to respond to surveys than other members of staff, leading to overrepresentation 7. It is also possible that individuals may not participate in mental health research as time spent taking part in research may impose additional practical demands on staff who are already experiencing higher workloads due to COVID-19 24, 25.
Although the evidence base suggests that healthcare workers have experienced increased levels of mental health problems due to the COVID-19 pandemic 10, studies rarely compare these to the experiences of non-healthcare workers. In a systematic review and meta-analysis of 62 studies, the highest levels of anxiety and depression were not found in healthcare workers or the general public but in healthcare patients who had pre-existing health conditions or who had been infected with coronavirus 26. Furthermore, a systematic review by De Kock et al. (2021) has highlighted the lack of comparison between healthcare workers and frontline workers who are vulnerable to similar levels of risk of contracting COVID-19 in the workplace 27. Comparison to these groups could provide additional knowledge about specific risk factors for psychological distress in different healthcare professions. Therefore, researchers must be cautious when making general conclusions about the prevalence of psychological distress and mental health problems in healthcare workers.
In this blog, we have considered and discussed the increased risk of experiencing mental health problems and psychological distress in healthcare workers during the COVID-19 pandemic. Overall, healthcare workers appear to experience high levels of distress and mental health issues during the pandemic, including anxiety and depression 10. Various factors have been attributed to the increase in psychological distress, including redeployment in the workplace, isolation from loved ones, inadequate PPE, and increased risk of coronavirus infection 7. Further research that considers the lived experiences of healthcare workers during the COVID-19 pandemic may shed light onto the type and severity of mental health issues experienced by healthcare workers and how these can be alleviated. This, in turn, could inform ways to provide effective psychological support for healthcare staff whose mental health has been impacted during and after the pandemic.
A bit about Olivia Sale:
“I am currently a final year undergraduate Psychology student working as a volunteer Research Assistant on the CARMS project. Last year I completed a professional placement as part of my degree as an Honorary Art Psychotherapy Service Assistant, where I co-facilitated an Art Psychotherapy group in the Early Interventions into psychosis service. I continued to work as an Art Psychotherapy Service Assistant through the coronavirus pandemic. I hope to start a Master’s degree in Clinical Psychology when I complete my undergraduate degree.”
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