Anasthasia Shilov, Illustrations Editor

A study at the Yale School of Public Health found that the COVID-19 pandemic has resulted in adverse psychological consequences for healthcare workers, including higher rates of post-traumatic stress disorder and alcohol-use disorder.   

Doctorate of medicine and of philosophy student Rachel Hennein and Assistant Professor of Public Health Sarah Lowe conducted a study to examine the psychological burden of the COVID-19 pandemic on healthcare workers across the nation. Using a survey distributed to frontline workers at the onset of the pandemic, the study found that approximately 14 percent of respondents had probable major depression, 15 percent had generalized anxiety disorder, 23 percent had post-traumatic stress disorder — or PTSD — and over 40 percent likely suffered from alcohol-use disorder. The study was published in the journal PLOS One on Oct. 26.

“[A] noteworthy finding was the high levels of mental health problems in the study,” Lowe wrote in an email to the News. “The levels of PTSD and alcohol use disorder in particular were well above what is typically seen in the general population and speak to the mental health needs of healthcare workers.” 

In the study, 1,132 healthcare workers from 25 medical centers across the United States responded to an online survey. The survey contained questions from common screening documents used to assess symptoms of depression, anxiety, PTSD and alcohol-use disorders. 

The survey also asked participants two open-ended questions: what was your most hopeful experience during the COVID-19 pandemic, and what was the most upsetting experience you faced during this period? 

“We felt that it was important to capture the voices of healthcare workers during this unprecedented time, to have them detail their experiences in their own words, and to help identify unique stressors and sources of resilience that we had not considered,” Lowe wrote. 

The researchers found that participants’ responses mapped onto an existing theory of health development called the Social-Ecological Model. This model states that multiple factors influence emotional wellbeing, ranging from individual characteristics and experiences to factors like local or national policies, workplace environments and community support systems.  

Lowe said that within this model, many healthcare workers expressed frustration over a shortage of proper personal protective equipment, an inept federal response to the pandemic and a lack of community adherence to public health guidelines. 

One EMT who responded to the survey described one of her most “heartbreaking” calls in over 30 years of work — when she transported a COVID-19 patient into her ambulance as the patient’s children stood in the driveway, crying. They knew this would likely be their last chance to say goodbye to their father, given restrictions on hospital visits. 

A medical resident described in the survey how she made the difficult decision to live apart from her two-year-old son, who remains in the care of his grandmother, as she works on the front lines. She wrote that she constantly worries about being a good parent and that this stress is compounded by fears that the bonds she worked so hard to form with her child will be broken by this period of separation. 

“Having friends and family not take the pandemic seriously is upsetting,” wrote another physician who responded to the survey. “I am telling family members daily that their loved one has died alone in a hospital room. Seeing them go about their daily lives without masks or consideration for those who they might kill, or that they might get sick themselves, is infuriating. This and the general state of the country at large make it difficult to keep my morale up. It feels like drowning.”  

All comments captured by the survey were subject to The Health Insurance Portability and Accountability Act of 1996 — or HIPAA regulations — which hide, among other types of identifying information, the names of commenters.

Hennein, the lead author of the study, said that stories like these serve as critical reminders to the general public that complying with public health protocols remains imperative — not only to prevent disease transmission, but also to decrease the workload and protect the mental health of people working on the front lines.  

Department Chair of Epidemiology Albert Ko did not contribute to the study but commended on the researchers’ work, saying that this research highlights many important issues including the fatigue and emotional hardships experienced by health care workers in the midst of a massive stressor event like a pandemic. 

He noted in particular that nurses, janitorial staff and even hospital employees who deliver cafeteria food to patients, many of whom come from marginalized communities that have been hit the hardest by the pandemic, are risking their safety everyday to keep the rest of the population safe. He said that they deserve a public that complies with safety guidelines to limit viral spread. 

“I hope that readers are empowered by their ability to significantly contribute to the COVID-19 pandemic response through wearing masks and physically distancing from others,” Hennein wrote. “We all have a part in battling this pandemic. We must remember this during the holiday season approaching.” 

As of Nov. 19, the Centers for Disease Control and Prevention reported 11,465,722 total positive cases in the U.S. since Jan. 21.  

Sydney Gray | sydney.gray@yale.edu 

Correction, Nov. 20: The article has been updated to reflect that Sarah Lowe is an assistant professor, not an associate professor.