Health care workers have been on the front lines of the COVID-19 pandemic since March, many of them facing very difficult and stressful situations, such as long hours, lack of equipment, unknowns about spread of the virus, and concerns for their own safety and that of their families. Some health care workers have lost colleagues or family members to COVID-19. The mental health concerns the workforce faces are devastating and may linger long after the pandemic ends.

A rapid review of literature related to the mental health of the frontline workers during pandemics, published in Psychiatric Services, an APA journal, in October, found that few interventions to address providers’ mental health needs have been implemented and concludes that “evidence-based interventions are urgently needed to better serve health workers both during and following epidemics/pandemics.”

But a new study, also in Psychiatric Services, offers suggestions for workers and administrators for supporting their resilience.

Workers Under Stress

Like other recent psychiatric symptoms and about 40% reported symptoms suggesting a diagnosable disorder. About one in seven health care workers screened positive for posttraumatic stress disorder 47% showed mild depressive symptoms and 17% showed significant depressive symptoms. Almost one-third reported mild symptoms of anxiety and about one-third reported significant anxiety symptoms 5% indicated suicidal thoughts.

Nearly half of the more than 1,600 workers surveyed were mental health professionals (psychiatrists, psychologists, or social workers), 15% were in emergency medicine, and 11% were pediatric health care workers.

Among the individual factors found to be contributing to increased risk of mental health symptoms were a history of mental illness, concerns about personal risk of infection, need to care for family, risk of spreading infection, and isolation from family. Organizational and workplace factors contributing to increased risk included not believing in the values and actions of their organization, feeling unable to say no to specific organizational demands, and limited access to personal protective equipment.

Supports Leaders Can Offer

Study lead Kevin P. Young, Ph.D., and colleagues suggest proactive interventions for health care workers can help prevent or minimize mental health problems and improve their quality of life, and in turn improve quality of care for patients. Among their suggestions that health care leaders can take are:

• encouraging team cohesion and a strong social support network
• providing access to peer support
• assessing needs at regular intervals, change course and develop new support resources when necessary
• keeping workers informed and listen to their feedback
• encouraging monitoring of their own stress reactions
• facilitating access to formal treatment when necessary
• providing adequate protection and training
• offering psychological support from both

The authors suggest that health care administrators and workers share responsibility for designing and implementing supportive mental health programs during crisis events and the interventions should be pragmatic, flexible and responsive to unique situations.

Factors Outside the Medical Setting

In a separate study, researchers at Yale also conducted a national survey of health care workers and found significant mental health concerns. Of the more than 1,100 participants who completed the survey, 14% had probable major depression, 16% probable generalized anxiety disorder, 23% probable post-traumatic stress disorder and 43% probable alcohol use disorder.

The study also asked open ended questions to identify contributing factors. Factors negatively impacting health care workers’ well-being during the pandemic included national government policies, misinformation disseminated by political leaders, discrimination against people of Asian descent, and community non-compliance with social distancing. These findings can help inform interventions and policies to support workers and foster their resiliency during the COVID-19 pandemic and future outbreaks, the authors note.