The impact of working during the Covid-19 pandemic on health care workers and first responders: mental health, function, and professional retention

Background

The COVID-19 pandemic has greatly affected front line health care workers (HCW) and first responders (FR). The infection risk from SARS CoV-2, the high mortality of hospitalized COVID-19 patients and the duration of the pandemic have created sustained and often traumatic stressors affecting HCW and FR.

Objectives

To assess the relationship of COVID-19 stressor frequency scores to psychiatric rating scale scores amongst HCW and FR. To determine if psychiatric rating scale scores mediate stressor effects on perceived work function and likelihood of remaining in current occupation.

Design

Observational, self-report in a convenience sample.

Participants

118 HCW and FR caring for COVID-19 patients in the United States.

Main Measure

COVID-19 related stressor frequencies were assessed using a 17-item questionnaire. Psychiatric symptoms were assessed with the PTSD Checklist 5 (PCL5), the Patient Health Questionnaire 9 (for depression) (PHQ9), the Insomnia Severity Index (ISI), and the General Anxiety Disorder 7 (GAD7).

Key Results

Stressor frequency scores correlated significantly with PCL5 scores (R=.57, p<1e-8), PHQ scores (R=.35, P<.001), ISI scores (R=.38, p<1e-4), and GAD7 scores (R=.39, p<.001), likelihood of staying in current occupation (R=-.39,p<1e-4), and trouble doing usual work (R=.33,p<.001). 51% of HCW and 44% of FR indicated decreased likelihood of staying in their current occupation. PCL5 scores substantially mediated the association between stress frequency scores and work function impairment.

Conclusions

These results direct attention to recognizing potentially treatable psychiatric symptoms, particularly those of PTSD, in HCW and FR experiencing COVID-19 related stressors. They also suggest that mitigating COVID-19 related stressors when possible, such as by providing adequate personal protective equipment, can improve HCW and FR mental health, work function and retention in the health care work force.

Strengths and Limitations of this Study

• Detailed assessments of participants’ exposure to covid-19 related occupational stressors, current psychiatric symptoms, and self-reported occupational functioning and likelihood of remaining in their current field (functional outcomes).

• Assessment of the dose-response relationship between exposure to covid-19 related occupational stressors and current psychiatric symptoms and functional outcomes.

• Mediation analysis quantifying the potential for current psychiatric symptoms to mediate the relationship between exposure to covid-19 related occupational stressors and functional outcomes.

• Limitations: convenience sample, limited numbers of first responder participants