SCIENTIFIC
Psychological Impact of Coronavirus Disease-2019 on Healthcare Workers
AUTHORS :
Lisa Calderwood , MPH Charleston Area Medical Center Institute for Academic Medicine
James Mears , MD WVU School of Medicine - Charleston Division Department of Family Medicine
Scott A . Fields , PhD WVU School of Medicine - Charleston Division Department of Family Medicine
INTRODUCTION
The sudden emergence of the coronavirus disease-2019 ( COVID-19 ) caused international concern due to the highly contagious transmission of the novel coronavirus and its propensity to cause severe illness and death in some patients . 1 , 2 Healthcare workers were vulnerable to infection due to their proximity to severely ill patients . 3 Due to the trauma they have witnessed and the fear that they may contract the illness themselves or transmit it to their loved ones , healthcare workers could be at higher risk of experiencing anxiety , depression , and stress-related mental illness , such as post-traumatic stress disorder ( PTSD ).
By March 11 , 2020 , the novel coronavirus had spread to over 100 countries with more than 120,000 cases and over 4,000 deaths , leading the World Health Organization to declare it a pandemic . 3 The highly contagious nature of the disease led to donning of personal protective equipment ( PPE ) among medical personnel . 2 Inadequate supplies of PPE led to further distress . Unlike natural disasters that occur in a very short time then lead to an aftermath of dealing with illness or injury , the COVID-19 pandemic caused a continuing threat for contact with seriously ill patients requiring intense care . Similar to exposure to stress during war or other significant traumatic events , healthcare workers exposed to traumatic events , especially in the emergency room setting , have been reported to be at risk to experience psychological stress , anxiety , and PTSD . 4
ABSTRACT
PURPOSE We studied the psychological impact of the coronavirus disease-2019 ( COVID-19 ) on employees at an urban tertiary care center in the United States ’ mid-Atlantic region .
METHODS A Research Electronic Data Capture , or RED- Cap , survey was completed by 1,116 employees who worked during the COVID-19 pandemic at the tertiary care center . Data included findings from a demographic survey , the Impact of Events Scale-Revised ( IES-R ), the Patient Health Questionnaire – 9 ( PHQ-9 ), and the Generalized Anxiety Disorder – 7 ( GAD-7 ). A series of Chi- square and , as appropriate , Fisher ’ s Exact tests were performed to compare outcomes among healthcare workers .
RESULTS Healthcare employees who had direct contact with patients during the pandemic had
Prior studies concerning the psychological effects of pandemics on healthcare workers have revealed that influenza , severe acute respiratory syndrome , and Middle East respiratory syndrome , have all contributed to adverse psychological symptoms . 5-10 A study concerning COVID-19 in Wuhan , China , indicated that mild mental health disturbances occurred in 34.4 %, moderate disturbances occurred in 22.4 %, and severe disturbances occurred in 6.2 % of healthcare workers measured by the Patient Health Questionnaire - 9 ( PHQ-9 ), Generalized Anxiety Disorder - 7 ( GAD-7 ), Impact of Events Scale-Revised ( IES-R ), and Insomnia Severity Index scores . Compounding the problem , those individuals who were more severely affected psychologically sought help less often via printed materials or digital media . 11 In our research , we studied the psychological impact of the COVID-19 pandemic on employees at an urban tertiary care center in the United States ’ mid-Atlantic region .
METHODS significantly higher scores ( increased impairment ) on the GAD-7 ( P <. 05 ), PHQ-9 ( P <. 001 ), and IES-R scales ( P <. 01 ). Employees with prior psychiatric diagnoses had significantly higher scores on those same corresponding psychological measures ( P <. 001 ). Employees who identified with a set of spiritual beliefs had significantly lower scores on the GAD-7 ( P <. 001 ) and PHQ-9 ( P <. 01 ). Employees reporting five or more years of work experience had lower markers of distress across measures ( P <. 05 ).
CONCLUSIONS The COVID-19 pandemic has had a profound psychological effect on healthcare workers . Our findings point to patient contact and prior psychologic distress as risk factors for impairment , while employee spirituality and prior work experience appear to mitigate risk . Healthcare leaders may use our findings to help employees cope with health crises .
STUDY POPULATION
Our Institutional Review Board-approved survey was completed by employees at an urban tertiary care center in the mid-Atlantic region of the United States . The survey was performed using Research Electronic Data Capture , or REDCap , a secure web application for building and managing online surveys . An invitation to participate was sent via individual institutional e-mail accounts to all employees who worked at the medical center during the period of January 1 , 2020 , through April 30 , 2020 .
MAIN MEASURES
The primary outcome was the measurement of distress of healthcare workers who worked directly with patients diagnosed with the novel coronavirus compared to those who did not work directly with those patients . Data collection included a survey instrument developed specifically for this study as well as three validated psychological measures listed below . The survey instrument included information about job
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