Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data

  1. Robert P Hirten
  2. Matteo Danieletto
  3. Lewis Tomalin
  4. Katie Hyewon Choi
  5. Micol Zweig
  6. Eddye Golden
  7. Sparshdeep Kaur
  8. Drew Helmus
  9. Anthony Biello
  10. Renata Pyzik
  11. Claudia Calcagno
  12. Robert Freeman
  13. Bruce E Sands
  14. Dennis Charney
  15. Erwin P Bottinger
  16. James W Murrough
  17. Laurie Keefer
  18. Mayte Suarez-Farinas
  19. Girish N Nadkarni
  20. Zahi A Fayad

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Abstract

The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact.

Objective

This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress.

Methods

HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally.

Results

A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial.

Conclusions

High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic.

Article activity feed

  1. Version published to 10.2196/31295
  2. Version published to 10.2196/preprints.31295
  3. ScreenIT

    SciScore for 10.1101/2020.12.21.20248593: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Study Procedures: Participants downloaded the custom Warrior Watch Study App to their iPhones and completed eligibility questions prior to signing electronic consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    However, there are several limitations to our study. The Apple Watch provides HRV data in one-time dimension (SDNN) limiting evaluation of other metrics with outcomes of interests. The Apple Watch also provides HRV sampling sporadically throughout the day. While our modelling accounts for this, a denser sampling would allow expanded analyses. Our findings demonstrate that low resilience, emotional support, and quality of life identify HCWs at risk of perceived and physiological longitudinal stress secondary to the COVID-19 pandemic. Assessment of HCWs for these features can permit allocation of psychological support to at-risk individuals as the COVID-19 pandemic and its psychological effects continue in this vulnerable population.

    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.
    • Thank you for including a protocol registration statement.

    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.

  4. Version published to 10.1101/2020.12.21.20248593v1 on medRxiv