Frontline workers caring for COVID-19 patients face depression, distress

Physicians and nurses in hospitals equipped with fever clinics or wards for patients with coronavirus disease 2019 (COVID-19) in China report experiencing symptoms of depression, anxiety, insomnia and distress, according to a recent survey.

Psychological burden appears to be more common among nurses, women, those in Wuhan and frontline healthcare workers directly engaged in the diagnosis, treatment and care for COVID-19 patients.

“Protecting healthcare workers is an important component of public health measures for addressing the COVID-19 [pandemic],” the researchers said. “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.”

Of the 1,830 contacted individuals, 1,257 (68.7 percent) completed the survey. Among the participants, 764 (60.8 percent) were nurses and 493 (39.2 percent) were physicians, 760 (60.5 percent) worked in hospitals in Wuhan, and 522 (41.5 percent) were frontline healthcare workers. A significant number of these individuals experienced symptoms of depression (n=634; 50.4 percent), anxiety (n=560; 44.6 percent), insomnia (n=427; 34.0 percent) and distress (n=899; 71.5 percent). [JAMA Netw Open 2020;3:e203976]

In all measurements of mental health symptoms, more severe degrees were reported by nurses, women, frontline healthcare workers and those working in Wuhan than other healthcare workers (median Patient Health Questionnaire scores among physicians and nurses: 4.0 vs 5.0; p=0.007; median Generalized Anxiety Disorder scale scores among men vs women: 2.0 vs 4.0; p<0.001; median Insomnia Severity Index scores among frontline vs second-line workers: 6.0 vs 4.0; p<0.001; median Impact of Event Scale–Revised scores among those in Wuhan vs those in other China regions: 21.0 vs 18.0 in Hubei outside Wuhan and 15.0 outside Hubei; p<0.001).

In multivariable logistic regression analysis, participants from outside Hubei province appeared to have a lower risk of experiencing symptoms of distress than those in Wuhan (odds ratio [OR], 0.62, 95 percent confidence interval [CI], 0.43–0.88; p=0.008). In addition, frontline healthcare workers engaged in direct diagnosis, treatment and care of COVID-19 patients had a higher risk of symptoms of depression (OR, 1.52, 95 percent CI, 1.11–2.09; p=0.01), anxiety (OR, 1.57, 95 percent CI, 1.22–2.02; p<0.001), insomnia (OR, 2.97, 95 percent CI, 1.92–4.60; p<0.001) and distress (OR, 1.60, 95 percent CI, 1.25–2.04; p<0.001).

“Frontline nurses treating patients with COVID-19 are likely exposed to the highest risk of infection because of their close, frequent contact with patients and working longer hours than usual,” the researchers said. “Moreover, 71.5 percent of all nurses had junior titles, indicating that most had fewer years of work experience.” [JAMA 2003;290:2662-2663; Appl Nurs Res 2007;20:171-180]

In this cross-sectional, survey-based, region-stratified study, the researchers collected demographic data and mental health measurements from healthcare workers in 34 hospitals in China from 29 January 2020 to 3 February 2020. Healthcare workers in hospitals equipped with fever clinics or wards for COVID-19 patients were eligible.

The first case of COVID-19 was detected in Wuhan, China, in December 2019. More than 400,000 confirmed cases have been reported across the world, with nearly 18,000 deaths, as of 25 March 2020.