Coronavirus pandemic: Doctors and nurses are experiencing high rates of depression, anxiety and distress
A study based on 1,257 healthcare workers across 34 hospitals in China found that 50.4%, 44.6%, 34%, and 71.5% of all participants reported symptoms of depression, anxiety, insomnia, and distress
Doctors and nurses are experiencing depression, anxiety, insomnia, and distress -- especially nurses, those in Wuhan, and frontline medical workers directly engaged in diagnosing, treating, or providing care to COVID-19 patients.
The analysis shows that overall, 50.4%, 44.6%, 34%, and 71.5% of all participants reported symptoms of depression, anxiety, insomnia, and distress, respectively.
These are the findings of a study from China, which is among the first to look at how the coronavirus pandemic is impacting doctors, nurses, and other healthcare personnel, and assess the magnitude of mental health outcomes among them. The pandemic has killed over 11,400 so far, and over 275,450 cases have been reported globally.
“This study aimed to provide an assessment of the mental health burden of Chinese healthcare workers, which can serve as important evidence to direct the promotion of mental well-being among them,” says the research team in their findings published in JAMA Network Open. It includes experts from the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Renmin Hospital of Wuhan University, Wuhan, China; and Wuhan Youfu Hospital, Wuhan, China, among others.
“The findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and frontline healthcare workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions,” say researchers.
The experts collected demographic data and mental health measurements of 1,257 healthcare workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Healthcare workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible. Among these responding participants, a total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Further, 493 (39.2%) were physicians, and 764 (60.8%) were nurses (90.8% of whom were female). Participants were divided into three groups -- Wuhan, other regions in Hubei province, and regions outside Wuhan province -- to compare interregional differences.
“Of the participants, 760 (60.5%) worked in Wuhan, 261 (20.8%) worked in Hubei province outside Wuhan, and 236 (18.8%) worked outside Hubei province. A total of 522 participants (41.5%) were frontline healthcare workers directly engaged in diagnosing, treating, or caring for patients with or suspected to have COVID-19. Nearly all participants (1220 or 97.1%) lived in urban areas,” says the study.
Of the participants, a significant chunk -- 634 or 50.4% -- had symptoms of depression. Further, 899 or 71.5% were distressed, 560 or 44.6% had anxiety, 427 or 34% had insomnia.
The research team found that nurses, women, frontline workers, and those in Wuhan reported experiencing more severe symptom levels of depression, anxiety, insomnia, and distress. For example, 24 or 4.9% of physicians reported having severe depression as compared to 54 or 7.1% nurses. Severe anxiety was reported by 10 or 3.4% men as opposed to 56 or 5.8% women. The analysis also shows that severe insomnia among frontline workers versus second-line workers was 9 or 1.7% and 3 or 0.4% respectively.
Another finding in our study was that compared with those in Hubei province outside Wuhan and those outside Hubei province, healthcare workers in Wuhan reported more severe symptoms of depression, anxiety, insomnia, and distress. Severe distress was reported by more workers in Wuhan -- 96 or 12.6% -- as compared to 19 or 7.2% among workers from Hubei (outside Wuhan) and 17 or 7.2% among those outside Hubei.
Compared with those working in tertiary hospitals, participants working in secondary hospitals were more likely to report severe symptoms of depression (53 or 5.6% versus 25 or 7.7%; anxiety (48 or 5.1% versus 18 or 5.5%), and insomnia (10 or 1.0% versus 2 or 0.6%), but not distress.
“Being a woman and having an intermediate professional title were associated with severe symptoms of depression, anxiety, and distress (for example, severe depression among women: odds ratio of 1.94; severe anxiety among those with intermediate professional titles: odds ratio of 1.82). Compared with working in a tertiary hospital, working in secondary hospitals was associated with more severe symptoms of depression (odds ratio of 1.65), and anxiety (odds ratio of 1.43). Working outside Hubei province was associated with a lower risk of feeling distressed than working in Wuhan (odds ratio of 0.62),” say researchers in their findings.
They add, “Compared with working in second-line positions, working in the frontline directly treating patients with COVID-19 appeared to be an independent risk factor for all psychiatric symptoms. Together, our findings present concerns about the psychological well-being of physicians and nurses involved in the acute COVID-19 outbreak.”
The experts say that in a previous study during the acute SARS outbreak, 89% of healthcare workers who were in high-risk situations reported psychological symptoms.
The researchers explain that the psychological response of healthcare workers to an epidemic of infectious diseases is complicated. Sources of distress may include feelings of vulnerability or loss of control and concerns about the health of self, the spread of the virus, health of family and others, changes in work, and being isolated.
“The fact that COVID-19 is human-to-human transmissible, associated with high morbidity, and potentially fatal may intensify the perception of personal danger. Additionally, predictable shortages of supplies and an increasing influx of suspected and actual cases of COVID-19 contribute to the pressures and concerns of healthcare workers,” say experts.
Based on their findings, the researchers recommend that special interventions to promote mental well-being in healthcare workers exposed to COVID-19 must be immediately implemented, with women, nurses, and frontline workers requiring particular attention.