The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders

  1. Rebecca C. Hendrickson
  2. Roisín A. Slevin
  3. Katherine D. Hoerster
  4. Bernard P. Chang
  5. Ellen Sano
  6. Catherine A. McCall
  7. Gillian R. Monty
  8. Ronald G. Thomas
  9. Murray A. Raskind

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Abstract

Background

The COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood.

Objectives

Examine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes.

Design

Observational, self-report, single time-point online assessment.

Participants

A total of 510 US HCW ( N  = 301) and FR ( N  = 200) with occupational duties affected by the COVID-19 pandemic.

Main Outcomes and Measures

CROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents’ likelihood of leaving current field and occupational functioning were assessed with 2-item PROMIS subscales. Relationships were modeled using multivariable regression. Open-ended responses were coded using rapid template analysis.

Results

CROS total scores correlated significantly with all four psychiatric symptom domains ( R ’s = .42–.53), likelihood of leaving one’s current occupation ( R  = .18), and trouble doing usual work ( R  = .28), all p’ s < .001. Half of HCW indicated a decreased likelihood of staying in their current occupation as a result of the pandemic. CROS were fit to a 3-factor model consisting of risk, demoralization, and volume factors. All CROS factors were associated with psychiatric symptom burden, but demoralization was most prominently associated with psychiatric symptoms and negative occupational outcomes. Among psychiatric symptoms, PTSD symptoms were most strongly associated with negative occupational outcomes. Open-ended statements emphasized lack of protection and support, increased occupational demands, and emotional impact of work duties.

Conclusions and Relevance

These results demonstrate potentially treatable psychiatric symptoms in HCW and FR experiencing CROS, impacting both wellbeing and the health care system. Mitigating CROS, particularly by addressing factors driving demoralization, may improve HCW and FR mental health, occupational functioning, and retention.

Article activity feed

  1. Version published to 10.1007/s11606-021-07252-z
  2. ScreenIT

    SciScore for 10.1101/2020.12.16.20248325: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was approved by the VA Puget Sound Health Care System Human Subjects Committee.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data analysis: Data analyzed using R and RStudio.
    RStudio
    suggested: (RStudio, RRID:SCR_000432)
    Figures used ggplot2.
    ggplot2
    suggested: (ggplot2, RRID:SCR_014601)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The current work has significant limitations. The number of first responders included is low, and replication in a larger sampling will be required. Additionally, the use of targeted outreach and paid advertising targeting regions with high rates of Covid-19 cases for recruitment, rather than systematic sampling of a defined population, means that the absolute rates of exposure to pandemic-related occupational stressors and of psychiatric symptoms reported in the population sampled should not be presumed to reflect rates in all health care workers, nationally or internationally. In addition, the assessment of covid-19 related occupational stress used in this study has not been validated. It is expected that future work, using a larger total number of respondents, will be able to provide psychometric validation of the exposure questionnaire. Particularly important will be the completion of a factor analysis, and an assessment of which aspects of pandemic-related occupational stressors are most closely related to both psychiatric symptoms and self-reported functional impairment and likelihood of leaving one’s current field. Such additional information could guide more targeted interventions to change health care workers’ and first responders’ experiences during such period of increased stress. Finally, although insomnia and particularly PTSD symptoms were found to mediate the relationship between occupational exposure and self-reported functional impairment, suggesting that pre...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.12.16.20248325 on medRxiv