ies on the topic , only about 16 % of the total employee population in the hospital system completed the survey . However , this response rate may be reasonable given a recent mode experiment using CMS CAHPS survey data showed a 20 % response rate to electronic survey made available by email . 19 Furthermore , the survey was conducted during an initial surge in COVID-19 cases in the United States , but the same level of surge had not yet occurred in the geographic area served by the medical center . Thus , the level of employee distress may be underreported if compared to the distress felt later during a more heightened time of the pandemic . A 2009 study on the psychological impact of the H1N1 influenza pandemic on hospital workers in Kobe , Japan , found that workers in highrisk work environments felt more anxiety about infection , exhaustion , and workload than workers in low-risk environments . 5 , 6 The present study found similar results , noting that healthcare employees working directly with patients scored higher on the IES-R , GAD-7 , and PHQ-9 , indicating distress even more broadly than anxiety alone . Initial observations during the recent COVID-19 outbreak in Wuhan , China , indicate 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 PHQ-9 , GAD- 7 , IES-R , and Insomnia Severity Index scores . 11 Our study showed similar results when looking at the PHQ-9 and IES-R scales , but fewer of our patients showed severe disturbance on the GAD-7 .
A recent study included data that indicated female healthcare professionals experienced higher levels of distress during the COVID-19 pandemic . 20 The same study also indicated that working with patients infected with the novel coronavirus , having less social support , and avoidance of social situations were associated with higher levels of distress . Having a positive attitude in the workplace and having children were associated with lower levels of distress . 20 In our study , females had higher PHQ-9 scores ( P <. 01 ) but comparison of GAD-7 and IES-R scores between males and females did not differ ( P =. 158 and P =. 189 , respectively .) The effect of religiosity on mental health during the COVID-19 pandemic was studied in a sample of participants who identified as American Orthodox Jews . Positive religious coping , intrinsic religiosity , and “ trust in God ” were strongly correlated with less stress in that study . 21 Similarly , the present study found lower PHQ-9 scores and GAD-7 scores in employees who reported that they practiced a specific religion , faith , or system of spiritual beliefs .
Considerations for future studies will include repeated measures , increased sample size , and the inclusion of functional outcomes such as lost wages or time off work , role and job transitions , and financial challenges .
IMPLICATIONS FOR HEALTHCARE LEADERS
The findings of this study point to patient contact and prior psychologic distress as risk factors for impairment , while employee spirituality and prior work experience appear to mitigate risk . Employees at higher risk for distress may need additional support during current or future health crises . The finding that any patient contact was associated with increased GAD-7 , IES-R , and PHQ-9 scores would indicate that leaders should attempt to support the psychological needs of healthcare workers at all times , not just during a crisis . A high number of workers reported feeling ill-prepared for a health crisis . The Stanford approach developed during the pandemic involved leaders who listen to employees and act on their requests . 22 Five requests of employees have been identified to assist in addressing anxiety during the COVID-19 pandemic , which include the following : “ hear me , protect me , prepare me , support me , and care for me .” 22
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