What drives persistent distress in COVID-19 frontliners?

Frontline nurses in Singapore and Japan are at risk of prolonged psychological distress after caring for COVID-19 patients, according to a recent study. Such distress also persists in healthcare workers who have underlying medical conditions or who have dealt with an outbreak in the hospital.

“This survey identified factors that contributed to the prolonged psychological distress of frontline nurses and physicians involved in the care of patients with COVID-19 in hospitals in Singapore and Japan,” the researchers said. “This identification of factors could help us seek out vulnerable healthcare providers who need urgent mental care during the COVID-19 pandemic.”

The study administered the Kessler Psychological Distress Scale (K10) to assess prolonged psychological distress in frontline healthcare workers, defined as a score of ≥30 during the period when distress was greatest and during the final 30 days of the survey. An online self-report questionnaire was also used to identify potential determinants of psychological distress.

A total of 1,644 responses were included in the final analysis, drawn from 62 nurses and 64 physicians in Singapore, and to 1,280 nurses and 238 physicians in Japan. On average, participants had an average K10 score of 24.45 point during the peak of psychological distress and 20.06 points during the most recent 30 days of the survey. [Front Psychiatry 2022;doi:10.3389/fpsyt.2022.781796]

At both time periods, feeling nervous and feeling tired for no good reason were the strongest contributors to the total K10 score.

Multivariate logistic regression analysis revealed that frontline nurses were more than twice as likely to experience prolonged psychological distress than physicians (adjusted odds ratio [OR], 2.40, 95 percent confidence interval [CI], 1.24–4.66). Similarly, having an underlying medical condition aggravates the odds of prolonged psychological distress in frontline medical workers (adjusted OR, 1.74, 95 percent CI, 1.22–2.46).

Experiencing prejudice because of their work in COVID-19 care also led to higher odds of prolonged psychological distress (adjusted OR, 3.05, 95 percent CI, 2.23–4.18), as did having to deal with panicked patients or those who refused to follow quarantine protocols (adjusted OR, 2.36, 95 percent CI, 1.71–3.25).

A COVID-19 outbreak in the hospital was also a significant correlate of prolonged psychological distress, increasing its likelihood by more than two times (adjusted OR, 2.05, 95 percent CI, 1.38–3.04).

On the other hand, the researchers also documented significant protective factors against prolonged distress, including having more hospital beds (adjusted OR, 0.73, 95 percent CI, 0.57–0.94), careful use of personal protective equipment (adjusted OR, 0.52, 95 percent CI, 0.37–0.73), and being knowledgeable about COVID-19 (adjusted OR, 0.82, 95 percent CI, 0.72–0.94).

“Multiple measures, including adequate medical resources, education on precautionary measures, and effective communication strategies tackling discrimination and social sanctions against frontline healthcare providers are critical to mitigate and prevent prolonged psychological distress,” the researchers said.