Healthcare workers’ mental health during the COVID-19 pandemic

The extraordinary demands placed on our healthcare systems and workforce during the COVID-19 pandemic have been met by heroic efforts and achievements of health professionals from all disciplines and specialties. Healthcare workers, and the staff that support them, have rightly been lauded (and literally applauded) for their efforts in keeping us safe during one of the most challenging and frightening events in our lives.

While the COVID-19 pandemic has seemingly waxed and waned in its risk to the health and wellbeing of most of us, the risk of infection has been a constant threat to the health and wellbeing of healthcare workers. This, coupled with work practices and personal demands, amid an environment of fear and distress, has taken a considerable toll on their mental health.

Like much of the information available about the effects of COVID-19, research data related to the effects of the pandemic on healthcare workers’ mental health are only preliminary and the quality of available data is limited^[1]. Undoubtedly though, healthcare workers’ mental health has suffered during the pandemic. Understanding the factors that increase healthcare workers’ risk of mental illness and the protective actions both individuals and organisations can take, will help improve outcomes for staff and their patients. 

Measuring the toll

Data from more than 50,000 doctors, nurses and allied health practitioners across 38 studies from around the world show mental illness in up to half of health professionals¹:

• The prevalence of anxiety is 39%
• The prevalence of depression is 36%
• The prevalence of post-traumatic stress disorder is 50%

An earlier analysis found the incidence of insomnia to be 39%^[2].

Understanding the risk factors

There are risk factors for various psychological conditions healthcare workers experienced during the COVID-19 pandemic^[3].

• Depression and anxiety

  • Interpersonal factors – Female gender, young age, poor coping mechanisms, low level of knowledge and education, previous pandemic experience, attention to negative pandemic information

  • Institutional factors – Frontline work, death from COVID-19 of a patient or close personal contact, high workload, less professional experience, being a nurse, lack of appropriate personal protective equipment (PPE)
• Post-traumatic stress disorder
  • Interpersonal factors – Female gender, young age, poor coping mechanisms, anxiety about infection
  • Institutional factors – Frontline work, death from COVID-19 of a patient or close personal contact, high workload, less professional experience, being a nurse, poor team cohesion
• Burnout
  • Interpersonal factors – Female gender, high alcohol intake, reluctance to work in a frontline role, attention to negative pandemic information
  • Institutional factors – Frontline work, high workload, less professional experience, lack of appropriate PPE, workplace conflict
• Insomnia
  • Interpersonal factors – Female gender, no tertiary education, attention to negative pandemic information
  • Institutional factors – Frontline work, high workload, professional role, concern for disease control

Adding to what we know

These effects of COVID-19 on the psychological wellbeing of healthcare workers, and their associations with interpersonal and institutional factors, were predictable from previous viral outbreaks^[4]. The risk factors for adverse psychological outcomes for healthcare professionals during previous outbreaks are the same as those listed above. Additional risk factors from previous outbreaks include:

• Interpersonal factors – Being a parent of young children, having a lifestyle impacted by the outbreak, lower income, chronic physical disease, pre-existing mental illness, history of substance misuse
• Institutional factors – A lack of compensation for staff

Protective factors that decrease the risk of psychological problems were also identified4:

• Interpersonal factors – Taking frequent short breaks from clinical duties and having adequate time away from work, having the support of peers and family
• Institutional factors – Positive feedback to staff, effective institutional support (e.g., adequate PPE, sufficient training, proven protocols to ensure staff safety), clear communication with staff, and staff support procedures

Many of the things that individual healthcare workers and their employers can do to prevent the damaging effects of COVID-19 on mental health are straightforward and inexpensive to implement. Fundamentally, healthcare workers need to, and have a right to, feel safe.

What comes next

As the pandemic has progressed, we have learned a great deal about the virus, the disease it causes, and effective ways to prevent and treat COVID-19. These advances have served to protect healthcare workers to some extent, as they have the rest of us.

We will likely live with the SARS-CoV-2 virus for the rest of our lives, long after these initial waves of the COVID-19 pandemic have passed. For health professionals, COVID-19 will likely influence their clinical practice forever. These people, who have performed their duties while fearing for the safety of themselves and their families, and kept the majority of us safe from COVID-19, will likely bear an emotional and psychological cost for some time.

We must ensure the provision of effective and enduring support for healthcare workers and implement what we have learnt so that they can not only enjoy the success of their efforts and our profound gratitude but be safe and well while they do the same for us.