Mental Health in Frontline Medical Workers during the 2019 Novel Coronavirus Disease Epidemic in China: A Comparison with the General Population

Background: Recent studies report that hospital staff at the forefront of caring for COVID-19 patients experience increased psychological distress. To effectively manage the outbreak of COVID-19, China established COVID-19 designated and non-designated hospitals. To date, few studies have examined the impacts of COVID-19 on psychological health of staff working at non-designated hospitals. This study is to explore factors affecting psychological health of non-designated hospital staff in China during the COVID-19 pandemic.Methods: Data were collected through an online questionnaire between February and March 2020. The questionnaire consists of General Health Questionnaire (GHQ-20), Social Support Rating Scale (SSRS), Simplified Coping Style Questionnaire (SCSQ), sociodemographic characteristics, employment history, health status, and contact history of COVID-19. The questionnaire was distributed through hospital WeChat groups and work colleague referrals. A total of 470 non-designated hospital staff members completed the questionnaire. Multiple Linear Regression analysis was used to interpret the associations among social support, coping styles, sociodemographic factors, job roles, and psychological status. Data were analyzed using SPSS version 21.0.Results: The non-designated hospital staff differed significantly in anxiety and depression subscores of the GHQ-20 by their job roles, levels of social support, and history of mental disorders. Staff with medical job roles, good self-reported health status, no previous mental disorders, adequate social support, and positive coping styles scored lower in GHQ-20 total score, which indicated healthier psychological status.Conclusions: The results indicate that history of mental health disorders, non-medical job roles, and inadequate social support are associated with greater psychological distress. Personalized support should be provided to those who are vulnerable and in need of social and psychological support.

IntroductionThe Coronavirus Disease 2019 (COVID-19) pandemic has resulted in psychological distress in health care workers (HCWs). There is a need to characterize which HCWs are at increased risk of psychological sequela from the pandemic.MethodsHCWs across seven hospitals in New York City were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study App. Participants wore an Apple Watch for the duration of the study measuring HRV throughout the follow up period. Surveys were obtained daily.ResultsThree hundred and sixty-one HCWs were enrolled. Multivariable analysis found New York City COVID-19 case count to be significantly associated with increased longitudinal stress (p=0.008). A non-significant decrease in stress (p=0.23) was observed following COVID-19 diagnosis, though there was a borderline significant increase following the 4-week period after a COVID-19 diagnosis via nasal PCR (p=0.05). Baseline emotional support, baseline quality of life and baseline resilience were associated with decreased longitudinal stress (p<0.001). Baseline resilience and emotional support were found to buffer against stressors, with a significant reduction in stress during the 4-week period after COVID-19 diagnosis observed only in participants in the highest tertial of emotional support and resilience (effect estimate −0.97, p=0.03; estimate −1.78, p=0.006). A significant trend between New York City COVID-19 case count and longitudinal stress was observed only in the high tertial emotional support group (estimate 1.22, p=0.005), and was borderline significant in the high and medium resilience tertials (estimate 1.29, p=0.098; estimate 1.14, p=0.09). Participants in the highest tertial of baseline emotional support and resilience had significantly reduced amplitude and acrophase of the circadian pattern of longitudinally collected heart rate variability.ConclusionOur findings demonstrate that low resilience, emotional support, and quality of life identify HCWs at risk of high perceived longitudinal stress secondary to the COVID-19 pandemic and have a distinct physiological stress profile. Assessment of HCWs for these features can identify and permit allocation of psychological support to these at-risk individuals as the COVID-19 pandemic and its psychological effects continue in this vulnerable population.

The COVID-19 pandemic had a significant effect on healthcare globally. Additional pressure created by coronavirus adversely affected the mental health and psychological well-being of healthcare workers, leading many to question their desire and willingness to continue working in healthcare. This study aimed to identify predictors for career change ideation among healthcare professionals in two countries; Lithuania and the United Kingdom amid the coronavirus pandemic. In total, 610 healthcare professionals from Lithuania and the UK (285 and 325, respectively) participated in a survey from May to August 2020. Psychological distress and psychological well-being were measured using the self-report scales “DASS-21” and “WHO-5”. Almost half of the sample (49.2%), 59.6% and 40.0% in Lithuanian and the UK, respectively, exhibited career change ideation, the country effect was significant (AOR = 2.21, p < 0.001). Stronger ideation to leave healthcare was predicted by higher levels of depression (AOR = 1.10, p = 0.005), stress (AOR = 1.10, p = 0.007), anxiety surrounding inadequate personal protective equipment (AOR = 2.27, p = 0.009), and lower psychological well-being scores (AOR = 1.10, p = 0.007). We conclude that psychosocial support must be provided for healthcare professionals to prevent burnout and loss of staff amid the pandemic.