COVID-19 Accelerated Psych Problems for Critical Care Clinicians

Approximately one third of critical care workers reported some degree of depression, anxiety, or somatic symptoms in the early phase of the COVID-19 pandemic, based on survey results from 939 healthcare professionals.

The emotional response of professionals in a critical care setting in the early phase of the COVID-19 pandemic has not been well-studied, write Robyn Branca, PhD, and Paul Branca, MD, of Carson Newman University and the University of Tennessee Medical Center, both in Knoxville, in an abstract presented at the 2022 Critical Care Congress.

The prevalence of depression, anxiety, and somatization is low in the general population overall, but the researchers predicted that these conditions increased among workers in critical care settings early in the pandemic.

To assess the prevalence of psychological problems during that time, they sent an email survey on April 7, 2020, to members of the Society of Critical Care Medicine. The survey collected data on demographics, perceived caseload, and potential course of the pandemic. The survey also collected responses to assessments for depression (using the Patient Health Questionnaire-9), anxiety (using the Generalized Anxiety Disorder Scale-7), and symptom somatization (using the Patient Health Questionnaire-15).

Of the 939 survey respondents, 37% were male, 61.4% were female, and 1.4% gave another or no response.

Overall, 32.3% reported encountering 0-50 COVID-19 cases, 31.1% had encountered 51-200 cases, 12.5% had encountered 201-500 cases, 9.4% had encountered 501-1000 cases, and 13.7% had encountered more than 1000 cases.

Based on the PHQ-9 depression scale, 44.9% of the respondents had minimal symptoms, 31.1% mild symptoms, 14.3% moderate symptoms, and 9.7% met criteria for severe depressive symptoms. Based on the GAD-7 anxiety scale, 35.5% had minimal symptoms, 32.9% mild, 16.8% moderate, and 14.8% had severe symptoms. Based on the PHQ-15 somatization scale, 39.6% of respondents showed minimal symptoms, whereas 38.2% showed mild symptoms 17.3% moderate symptoms, and 4.9% had a severe degree of somatic symptoms.

The study findings were limited by the reliance on self-reports; however, the results indicate that a high percentage of critical care workers experienced significant, diagnosable levels of depression, anxiety, and somatic symptoms, the researchers said.

The standard guidance is to pursue individual intervention for anyone with scores of moderate or severe on the scales used in the survey, the researchers said.

Therefore, the findings represent “an alarming degree of mental health impact,” they emphasize. “Immediate mitigation efforts are needed to preserve the health of our ICU workforce.”

The study is important at this time because clinician fatigue and occupational stress are at endemic levels, said Bernard Chang, MD, of Columbia University Irving Medical Center, New York City, in an interview. “It is vital that we take stock of how frontline workers in critical care settings are doing overall,” said Chang, who was not involved with the study but has conducted research on mental health in frontline healthcare workers during the pandemic.  

Chang said he was not surprised by the findings. “This work builds on the growing body of literature in the pandemic noting high levels of stress, fatigue, and depression/anxiety symptoms across many frontline workers, from emergency department staff, first responders and others,” he said. “These are all data points highlighting the urgent need for a broad safety net, not only for patients but the providers serving them.”

The take-away message: “Clinicians are often so focused on providing care for their patients that they may overlook the need to care for their own well-being and mental health,” said Chang.  

As for additional research, “We need to now take this important data and build on creating and identifying tangible solutions to improve the morale of the acute care/healthcare workforce to ensure career longevity, professional satisfaction, and overall well-being,” Chang emphasized. Mental health and morale affect not only healthcare workers, but also the patients they care for, he said. Well-cared for health care providers can be at their best to provide the optimal care for their patients, he added.

The study received no outside funding. The researchers and Chang have disclosed no relevant financial relationships.

Critical Care Med. January 2022. Full text

Society for Critical Care Medicine 2022 Critical Care Congress: Star Research Presentation. Presented April 19, 2022

Heidi Splete is a freelance medical journalist with 20 years of experience.

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