Majority of frontline workers treating COVID-19 patients in Wuhan, China, are experiencing symptoms of psychological distress, according to a paper published recently in the medical journal JAMA Network Open. Led by the department of psychiatry, part of the Zhejiang University School of Medicine at the First Affiliated Hospital, the study examined the mental health of 1,257 medical personnel.
Some of the worries bothering physicians and nurses with an overwhelming workload include unpredictable transmissions, well-being of patients and their own families, shortage of supplies, influx of new patients and the looming possibility of death. There is also the stigmatization and distancing of the medical fraternity as potential carriers of COVID-19, adding to the mental health crises.
Participants of the study were not only employed in hospitals at the epicenter of the global pandemic in Wuhan, but also in other regions of the Hubei province and hospitals from seven other provinces. Epidemics and pandemics cause physician-burnout at a fast pace unlike any other occupational hazard they might experience, therefore this study is much needed to shed light on the subject that is often brushed under the carpet. In fact, similarly, psychological symptoms were reported by 89 percent of healthcare workers during the SARS outbreak in 2003.
What The Study Found
A cross-sectional survey of 1,830 medical practitioners was initiated across 34 hospitals with patients housing COVID-19 patients or designated fever clinics. January 29 to February 3 was the duration of the assessment completed by 1,257 healthcare workers, which corresponded with the time period of confirmed cases peaking and rising above 10,000 in China.
The survey included people at various levels of the hierarchy. As many as 76.7 percent of the participants were women, 60.8 percent were nurses and 39.2 percent were physicians. Of all the participants, 64.7 percent were between the ages of 26 to 40 years old.
Participants were assessed using Chinese equivalents of the 22-item Impact of Event Scale–Revised, the 7-item Insomnia Severity Index, the 7-item Generalized Anxiety Disorder Scale and 9-item Patient Health Questionnaire to check all the measures of mental health in order to quantify their problems. Multivariable logistic regression analysis was used to breakdown some factors.
With the help of these scales, the researchers were able to identify symptoms of mental health problems in both the doctors and nurses. The results were as follows:
- 634 participants had symptoms of depression (50.4 percent)
- 560 participants experienced symptoms of anxiety (44.6 percent)
- 427 participants showed symptoms of insomnia (34.0 percent)
- 899 participants underwent psychological distress (71.5 percent).
Nurses are most likely to be infected with COVID-19 due to the close contact with patients for long hours, the study found. Also, this possibility makes them more vulnerable to psychological problems, as per the study’s findings. Since 90 percent of the nurses were women and 71.5 percent of them held junior titles, they had less work experience to handle the trauma.
Furthermore, working at the epicenter of the outbreak in Wuhan caused healthcare professionals to report more severe symptoms than those working outside Wuhan in the Hubei province. Proximity made a difference because these symptoms were even more stronger than compared with others outside the Hubei province. “Of the participants, 760 (60.5 percent) worked in Wuhan, 261 (20.8 percent) worked in Hubei province outside Wuhan, and 236 (18.8 percent) worked outside Hubei province,” the researchers stated in the paper.
Moreover, as per the study, 41 percent were frontline healthcare professionals who had diagnosed and cared for the patients firsthand, therefore putting themselves at risk and simultaneously causing stress about the outcome. “Compared with working in second-line positions, working in the frontline directly treating patients with COVID-19 appeared to be an independent risk factor for all psychiatric symptoms,” the researchers explained.
On February 2, the State Council of China announced that hotlines offering people psychological help were set up. “However, evidence-based evaluations and mental health interventions targeting front-line health care workers are relatively scarce,” the researchers emphasized.