Since COVID-19 infections and deaths began to soar worldwide at the beginning of last year, one group has been at the forefront of the battle against the virus: health care workers, who frequently witness the devastation of the disease and are therefore at greater risk of suffering from related adverse psychological consequences.
A team of three researchers at the Yale School of Public Health released a paper investigating the pandemic’s mental health effects on health care workers to determine the most effective support strategies. Lead author Rachel Hennein GRD ’24, a medical and doctoral dual degree candidate at the Yale School of Medicine, was guided by senior author and principal investigator Sarah Lowe, a clinical psychologist and assistant professor at the School of Public Health. Emma Mew GRD ’25, a doctoral student at the School of Public Health, contributed by determining an analysis plan for the data.
“I really wanted to be able to contribute to the pandemic in some way,” Hennein said, who was asked to leave the hospital while on her clinical rotation because of the lack of personal protective equipment supplies. “I proposed doing a survey of health care workers to better understand their experiences during the pandemic and how we can best support them so that they can keep saving people’s lives.”
The paper, which was published in the journal PLOS One last month, is a follow-up on the group’s previous study that qualitatively examined the pandemic’s adverse psychological effects on health care workers. Hennein and Lowe created and rolled out a survey to 1,132 health care workers from 25 medical centers across the U.S. in May 2020, and the results were published in November of last year. The first study examined only the qualitative data from the survey, focusing on open-ended questions that asked participants about their upsetting and hopeful experiences as a result of the pandemic.
Using this previously collected data, the group’s most recent study focused on the health care workers’ answers to the survey’s quantitative questions, which the researchers converted into scores used to assess symptoms of depression, anxiety and alcohol-use disorders. The survey also contained questions on other subjects, such as their personal satisfaction with the government’s response to COVID-19.
“We tried to identify what were some predictors of mental health outcomes among the health care workers so that we can provide services that best support them,” Hennein said.
This study utilized a socio-ecological model, analyzing four socio-ecological factors that predict the mental health outcomes of health care workers. Some of these factors were individual ones such as gender, ethnicity and race, while others were interpersonal factors such as social support. The model also included institutional factors like hospital support in addition to community factors, such as perceived appreciation and stigmatization surrounding health care workers.
The researchers then analyzed the survey’s data to investigate the extent to which the four types of factors — individual, interpersonal, institutional and community — were associated with the adverse psychological consequences of depression, anxiety and alcohol-use disorders. By looking at all four factors, the scientists hoped to better understand how health care workers are feeling.
In the paper, the researchers emphasized the need to create interventions and strengthen social networks inside and outside the hospital, suggesting approaches such as peer-support systems and wellness checks. The researchers found that poor social support was a strong predictor for the presence of PTSD, anxiety and depression symptoms. Lowe proposed that hospitals incentivize teams to work together by hosting sponsored team lunches or having rest breaks that strengthen team cohesion and build morale, for example.
“[We should] make sure that health care workers have access to good mental health services, whether that be individual counseling, group therapy, resilience building activities,” Lowe said. “So that they’re able to continue their care despite the hectic schedules.”
Another notable study result was that for health care workers with a pre-pandemic mental health diagnosis, the odds of having probable major depression after the start of the pandemic were 2.49 times greater than the probability for those without such diagnosis. Moreover, nurses and health technicians had over twice the odds of probable major depression relative to physicians.
The study also found that, at the community level, every one hour increase in media consumption by health care workers was associated with an increased risk of probable generalized anxiety disorder by a factor of 1.37. The researchers found that constantly being exposed to the COVID-19 pandemic’s devastation on the news and general dissatisfaction with the government’s response to COVID-19 led to higher risks of adverse mental health effects among health care workers.
One significant limitation of the study is that it is cross-sectional, meaning the data came from a group of participants at only one specific point in time. Thus, it is difficult to assess causality between the factors and associated mental health outcomes.
“We can’t say if any of the factors that we found led to adverse mental health outcomes,” Hennein said. “For example, we looked at hospital team cohesion. … We found that lower team cohesion was associated with increased risk of depression. That doesn’t mean that bad teams lead to depression, that just means there’s a relationship there but we don’t know what direction it is.”
Sophia Pappa, a senior lecturer and researcher at Imperial College London, shared that Hennein’s work is a valuable study that adds to the extensive body of research surrounding the impact of the pandemic on health care workers’ wellbeing. She also commented that the researchers’ choice to include stigma against health care workers as a community factor in the survey is intriguing and might be something worth exploring further in the future.
Hennein added that the lack of time for connecting with their families and loved ones has also played a role, and people need to be mindful of the stress that is being placed on front-line workers. She emphasized that health care workers have been working overtime for more than a year at this point, which has likely contributed to the mental health problems the researchers observed.
“A lot of health care workers [said] that their most upsetting experiences were going out into the community and seeing people who were not wearing masks or hearing people say that this is all a hoax,” Lowe said. “A lot of them felt like it was a real slap in the face, given the sacrifices they were making.”
Since the News’ article on the original study, published on Nov. 20, an additional 16,991,138 new positive COVID-19 cases have been reported by the Centers for Disease Control and Prevention in the U.S.
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