Why are COVID- 19 front line health workers are at risk of mental problems?

Jianbo Lai, from the department of psychiatry at the First Affiliated Hospital of Zhejiang University School of Medicine in Hangzhou, China, is the first author of the study, which appears in the journal JAMA Network Open.
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Lai and colleagues set out to examine the mental health outcomes of healthcare professionals who treated patients with COVID-19 in China.
Namely, they looked at healthcare professionals who worked in 34 hospitals that had fever clinics or wards for COVID-19 patients.

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Frontline healthcare professionals “who are directly involved in the diagnosis, treatment, and care” of people with COVID-19 were at the heart of the researchers’ interest.
These workers may be at a heightened risk of psychological distress and other mental health problems, write the authors, due to the ever increasing number of COVID-19 cases, the overwhelming workload, an information overload, and insufficient personal protective equipment and drugs.
Furthermore, the authors note, existing studies show that in similar situations, healthcare workers experience stigmatization, as well as fear of infection for themselves and their families.

Lai and team “collected demographic data and mental health measurements from 1,257 healthcare workers in 34 hospitals from January 29, 2020, to February 3, 2020.” Only hospitals with COVID-19 wards and fever clinics were eligible.
To assess the severity of symptoms of depression, anxiety, insomnia, and distress, the researchers used the Chinese versions of the “nine-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder scale, the seven-item Insomnia Severity Index, and the 22-item Impact of Event Scale-Revised.”
The researchers applied multivariable logistic regression analysis to find the factors that are associated with mental health problems.
The participation rate for the survey was 68.7%. More than 64% of the respondents were between the ages of 26 and 40 years, and over 76% of them were women.
More than 60% of the respondents were nurses, while physicians accounted for just over 39%. Frontline healthcare workers made up 41.5% of the respondents.

Frontline workers 52% more likely to have depression

Overall, the study found that:
  • 50.4% of respondents had symptoms of depression, 44.6% had symptoms of anxiety, 34.0% reported symptoms of insomnia, and 71.5% reported feelings of distress.
  • “Nurses, women, frontline healthcare workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other healthcare workers.”
  • Frontline healthcare workers who directly engaged in the diagnosis, treatment, and care of COVID-19 patients had a higher risk of depression symptoms.
Specifically, frontline healthcare workers were 52.0% more likely to have symptoms of depression, 57.0% more likely to have symptoms of anxiety, 60.0% more likely to experience distress, and almost three times as likely to have insomnia than those who were not on the frontline.
Furthermore, 18.0% of frontline healthcare workers who experienced depression had a severe form of the condition, compared with 12.9% of second-line workers
Also, 34.7% of frontline workers who experienced anxiety had severe symptoms compared with 25.0% of second-line workers. Similarly, 12.3% had severe insomnia compared with 4.5% of second-line workers, and 42.1% of frontline specialists who had psychological distress experienced severe symptoms, compared with 29.9% of second-line workers.
Lai and colleagues conclude, “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 after adjustment [for confounders].”
“Protecting healthcare workers is an important component of public health measures for addressing the COVID-19 epidemic,” they continue.
“Special interventions to promote mental well-being in healthcare workers exposed to COVID-19 need to be immediately implemented, with women, nurses, and frontline workers requiring particular attention.”
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