Pandemic-related stress and suicide risk among healthcare professionals during the pandemic

Abstract

Background

Depression and suicide are common in the hospital workplace. Extreme stress is more likely in periods of major crisis.

Methods

To determine the stress levels and sources of stress for healthcare providers, a survey was administered to approximately 3000 clinicians in a single healthcare system in April 2022, gathering both quantitative and free-text responses.

Results

A total of 485 clinicians completed the questionnaire. Their responses revealed a high level of pandemic-related, personal, and professional stress, as well as burnout. Top stressors included staffing issues, increased workload, isolation and lack of professional connection, administrative and policy struggles, dealing with patient expectations, mental health and emotional toll, lack of resources and support, training and career disruptions, and public misinformation. In addition, 3.9% confided in someone about thoughts of taking their life, and 2% indicated they currently had thoughts of suicide. Overall, 1.8% of respondents experienced no stress; 19.7%, a little stress; 37.9%, a moderate amount of stress; 24.3%, a lot of stress; and 16.4%, a great deal of stress.

Conclusions

Healthcare institutions must address these issues by providing more support, resources, and mental health services to healthcare workers.

Clinician suicide is a topic of growing professional and public health concern during normal environmental circumstances and was magnified in the face of the stress of the pandemic.^1–3 Despite working to improve the health of others, clinicians often sacrifice their own well-being to do so. Furthermore, there are systemic barriers in place that discourage self-care and help-seeking behaviors among clinicians. The consequences of inaction are dire for both the clinician and patient. During a pandemic-type crisis, depression among clinicians increases by more than 620%, and medical errors are more likely as a result. For clinicians, avoidance of treatment may result in worsening illness—or even death by suicide. A recent meta-analysis found that suicide rates during periods of crisis were 3 times higher for clinicians than for the general population. To investigate stress and burnout in our healthcare system during the COVID-19 pandemic, we conducted a survey to identify stress, depression, and suicidal ideations.

METHODS

This study was approved by the Baylor Scott & White Health (BSWH) institutional review board (IRB 021-062). It aimed to identify and measure the increased risk of suicide among physicians and housestaff during a pandemic as a baseline against which to measure the results of suicide intervention. The authors developed the survey based on their experience working with physicians and residents to manage their environmental stressors before the pandemic.

The survey was deployed in April 2022 through SurveyMonkey using a list of approximately 3000 teaching faculty and housestaff provided by the BSWH administration. All responses were anonymous. Recipients were given 30 days to respond to the survey, and a reminder email was sent out every week. Collected data were managed within SurveyMonkey and exported for statistical analysis. Respondents’ data were summarized by frequency and percentage.

RESULTS

A total of 485 participants completed the survey, for a response rate of 16%. There were slightly more women than men, and most were between the ages of 35 and 54 (Table 1). Less than a third were residents or fellows. The respondents represented a wide array of specialties, including internal medicine, general surgery, cardiology, anesthesiology, pediatrics, radiology, and psychiatry. About a quarter of the respondents practiced at Baylor University Medical Center at Dallas or Baylor Scott & White Medical Center – Temple; the others specified various BSWH locations, including BSW All Saints, BSW Grapevine, BSW Waco, BSW Plano, and others (Table 1). Table 2 summarizes respondents’ experience of different types of stressors: situational, personal, professional, suicidal, and overall.

Table 1.

Demographic characteristics of survey respondents (n = 485)

Category	Variable	n	%
Age	<25	0	0
	25–34	132	27.2%
	35–44	154	31.8%
	45–54	119	24.5%
	55–64	55	11.3%
	65+	25	5.2%
Sex	Male	234	48.3%
	Female	249	51.3%
	Prefer not to say	2	0.4%
Training level for residents/fellows	PGY 1	12	2.5%
	PGY 2	15	3.1%
	PGY 3	26	5.4%
	PGY 4	18	3.7%
	PGY 5	17	3.5%
	PGY 6	8	1.7%
	PGY 7	5	1.0%
	Other (please specify)	42	8.7%
Degree for practicing physician	MD	427	88.0%
	DO	58	12.0%
Years in practice	1–5	161	33.2%
	6–10	81	16.7%
	11–15	84	17.3%
	16–20	40	8.3%
	21–25	53	10.9%
	26–30	39	8.0%
	Other (please specify)	27	5.6%
Hospital location	Baylor University Medical Center, Dallas	119	24.5%
	Baylor Scott & White, Temple	135	27.8%
	Other	231	47.6%

Table 2.

Clinicians’ reports of stressors during the pandemic (n = 485)

Type of stressor	Question	Skipped	None	A little	A moderate amount	A lot	A great deal
Pandemic situation	Sleep deprivation/fatigue issues	16	10.9%	28.6%	35.4%	17.1%	8.1%
	Electronic medical records and patients now allowed to review your notes	16	24.1%	36.3%	19.7%	10.1%	9.4%
	Interaction with medical staff and peers	16	27.1%	41.2%	21.5%	7%	3.2%
	Dealing with difficult patients	16	9.4%	29.4%	29.6%	18.1%	13.4%
	Inadequate time for patient care	16	13.7%	26.7%	27.3%	19.2%	13.2%
	Managing difficult conversations with family members	16	19.8%	40.3%	23.9%	9.8%	6.2%
Personal	Family needs and stressful interactions with stay-at-home schooling, etc.	19	27.9%	29%	21.2%	12.9%	9%
	Financial responsibilities or fear of losing your job	19	44.4%	26.2%	15.9%	7.1%	6.4%
	Social isolation	19	20.2%	32.8%	26.6%	10.1%	10.3%
	Fatigue	19	9.7%	24.9%	27.3%	22.1%	16.1%
	Personal health/not being able to go to your gym	19	21.7%	30.7%	21.7%	15.9%	10.1%
Professional	Responsibility for COVID-19 patient care	23	15.4%	31%	27.5%	16.7%	9.5%
	Supervision responsibilities of junior residents/ medical students	23	53%	31.2%	10.6%	3.9%	1.3%
	Changes in patient management and preparation	23	11%	34%	30.5%	15.4%	9.1%
	Undefined expectations on how to treat patients with COVID-19	23	16.5%	27.5%	25.8%	18%	12.3%
	Increased administrative work as a result of the pandemic	23	19.1%	28.1%	23.6%	13.9%	15.4%
	Changing views on a future career in medicine related to the pandemic	23	32.7%	23.2%	16.5%	10.4%	17.3%
Suicidal ideation and plan*	Felt burnout during this pandemic	28	20.8%				79.2%
	Wished to escape from life during this pandemic	28	60.8%				39.2%
	Started to act on self-harm or suicidal thoughts, but stopped before doing anything	28	96.5%				3.5%
	Told someone you were thinking about taking your life or were planning to do this	28	96.1%				3.9%
	Presently thinking about ending your life	28	98%				2%
	Other than the pandemic, had preceding events such as a sudden loss or feelings of depression	28	67.8%				32.2%
Overall	Overall stress level during this pandemic	28	1.8%	19.7%	37.9%	24.3%	16.4%

^*Response options were no (placed under “none”) and yes (placed under “a great deal”).

Situational stressors

The two variables respondents rated as causing the most stress were dealing with difficult patients and having inadequate time for patient care (Table 2). Based on the quantitative responses, as well as 190 responses to the open-ended question about pandemic-related stressors, the situational stressors experienced by healthcare professionals during the pandemic were ranked by intensity.

Seven stressors were considered high impact: (1) a lack of staffing (persistent shortages of staff affecting care quality, leading to burnout and stress); (2) inadequate personal protective equipment (PPE) and safety measures (limited access to protective gear early in the pandemic, increasing the risk of infection); (3) administrative burden (excessive administrative tasks, such as paperwork, emails, and tracking metrics, which took away from patient care, increasing stress); (4) patient deaths (the emotional toll of treating and witnessing high numbers of COVID-related deaths, particularly from patients refusing vaccines); (5) isolation and family concerns (social isolation, the inability to visit or care for family members, and the stress of potentially infecting loved ones); (6) supply chain issues (shortages of medical supplies, such as gloves and surgical instruments, making it difficult to provide necessary care); and (7) patient misinformation and refusal of care (difficulty dealing with patients who denied COVID severity, refused vaccines, or insisted on unproven treatments).

Five stressors had a moderate impact: (1) job security and financial stress (concerns about job stability, pay cuts, and lack of compensation for increased workloads); (2) mask-wearing (where wearing masks and face shields impeded communication and caused physical discomfort); (3) increased workload and stress (facing longer hours, additional shifts, and more demanding work, often with fewer breaks); (4) patient expectations and behavior (where patients became more demanding, confrontational, and reluctant to follow medical advice); and (5) family and childcare issues (managing work-life balance, especially with children at home due to school closures or illness).

Three variables had a lower impact (little or none): (1) telemedicine and video visits (adapting to virtual visits and the challenges of maintaining quality care remotely); (2) personal health issues (with some reporting struggles with their own health concerns but feeling they had relatively manageable stress); and (3) disruption of routine care (challenges in continuing elective procedures and providing regular care due to overwhelmed hospitals).

These findings highlight the varied and significant stressors faced by healthcare professionals during the pandemic, including fatigue, patient care time constraints, and interactions with patients and medical staff. The stressors varied across healthcare professionals’ roles and locations, but the common themes included staffing shortages, emotional strain from patient deaths, administrative challenges, and the ever-evolving COVID-related guidelines and restrictions.

Personal stressors

The survey aimed to assess the personal stressors individuals experienced during the pandemic, focusing on several key areas. A total of 466 participants provided responses, with 19 skipping this part of the survey. Social isolation and fatigue were the stresses reported most frequently (Table 2). Overall, the responses highlighted the broad impact of the pandemic on people’s personal lives, from family dynamics to health, work, and emotional well-being. The widespread anxiety, fear, and frustration associated with managing multiple stressors during such a challenging time were commonly reported.

Several recurring themes were found in the open-ended responses. The first theme was family and relationships. Many respondents reported strained family relationships due to differing views on the pandemic crisis, especially regarding vaccination and COVID-related health measures. There were also reports of difficulty in managing relationships due to isolation and political polarization within families. Several individuals experienced the illness or death of family members, either due to COVID-19 or other health issues, leading to emotional distress and anxiety. Finally, respondents mentioned increased stress related to caring for children, especially with the closure of schools and daycare centers, as well as concerns about children’s social development, mental health issues, and the challenges of balancing childcare with work.

The second theme was health-related concerns. Several respondents experienced personal health issues or struggled with the lingering effects of COVID-19, which added to their stress, and they had concerns about contracting or transmitting the virus to vulnerable family members. Mental health concerns, related to both family members and themselves, were significant stressors. These included anxiety, depression, and a lack of emotional support due to the isolating nature of the pandemic.

Work/financial strain was the third theme. Many individuals noted challenges with balancing their work and personal lives, particularly when working from home, dealing with the stress of the pandemic at work, or experiencing burnout from long hours and added responsibilities. Financial stress was also common, including fears of job loss, financial instability, and the financial impact of family members losing work or being unable to secure childcare. Some respondents reported significant stress due to an increased workload, fear of infecting others, and concerns over their colleagues’ well-being.

Under the theme of social isolation, many respondents expressed feelings of loneliness and isolation due to restrictions on social gatherings, canceled plans, and the inability to visit family members. This led to frustration, particularly for those with young children or family members who were particularly vulnerable.

Logistical and daily life challenges were also discussed. Restrictions on travel were a significant source of stress for many respondents, especially those who had family living in different states or countries. Inadequate childcare options, school closures, and the difficulty of virtual learning for children caused stress for many parents, especially those with special needs children. Fear of exposure to COVID-19 was widespread, with concerns about infecting vulnerable family members, as well as the stress of not being able to seek necessary medical care due to pandemic restrictions.

The last theme related to coping mechanisms and personal behavior. Some respondents mentioned using alcohol or other coping mechanisms more than usual, often to deal with stress and frustration. A lack of time for self-care, such as exercising, eating healthy, or engaging in hobbies, was also highlighted as a significant stressor.

Professional stressors

Most respondents felt some degree of stress related to all survey areas of professional stressors (Table 2). Two-thirds of respondents reported that the pandemic had affected their thoughts about their careers to some extent. A total of 108 respondents provided additional information about professional stressors.

Overall, the top stressors were as follows:

• Staffing issues. There was consistent mention of staffing shortages, high turnover, and the added pressure of covering roles due to the absence of staff. Healthcare workers faced challenges with inexperienced or inadequate staffing.

• Increased workload. Many professionals reported an increase in their patient panels, the volume of patient interactions, and administrative tasks, leading to burnout and stress. There were reports of having to handle additional duties without proportional increases in resources or compensation.

• Isolation and lack of professional connection. Many expressed the stress of being isolated from peers, with reduced opportunities for in-person meetings or social gatherings. This loss of connection and support was seen as a significant stressor.

• Administrative and policy struggles. Stress from administrative expectations, constant policy changes, increased focus on non–evidence-based metrics, and a perceived lack of support from leadership was common. Some also expressed frustration with healthcare administrators prioritizing profits over patient care.

• Dealing with patient expectations. The tension between patient beliefs (often influenced by misinformation) and medical recommendations led to difficult interactions. Some professionals felt conflicted about maintaining patient care under increasing stress and workload.

• Mental health and emotional toll. The emotional strain of dealing with the loss of colleagues, burnout among peers, and the personal toll of witnessing struggling coworkers was widely mentioned. There was also mention of the challenges of managing personal health risks and fears of transmitting COVID to loved ones.

• Lack of resources and support. Many respondents pointed to resource scarcity, including a lack of medical supplies, proper compensation, or support from leadership in addressing the burdens placed on healthcare providers.

• Training and career disruptions. There were reports of interruptions to training, particularly in specialties like surgery, which caused stress for individuals whose career development was delayed or disrupted.

• Public misinformation. Healthcare workers expressed stress in dealing with misinformation about COVID-19, as well as frustration in having to manage false statements from the public and even from within their organizations.

Common themes, then, were increased administrative burden, staff shortages and increased workload, lack of leadership support, and emotional strain.

Burnout and depression

The data gathered from this survey revealed significant mental health and stress impacts among healthcare professionals during the COVID-19 pandemic (Table 2). Overall, 79.2% reported experiencing burnout during the pandemic, while 20.8% did not. A notable portion of respondents (39.2%) expressed a desire to escape from life. In addition, 3.5% reported having self-harm or suicidal thoughts but stopped before acting. Only 3.9% confided in someone about thoughts of taking their life. Nine respondents, 2%, indicated they currently had thoughts of suicide. About a third of respondents indicated that events such as loss or depression before the pandemic contributed to their stress.

The overall stress levels varied: 1.8% (8 respondents) experienced no stress; 19.7% (90 respondents) experienced a little stress; 37.9% (173 respondents) experienced a moderate amount of stress; 24.3% (111 respondents) experienced a lot of stress; and 16.4% (75 respondents) experienced a great deal of stress.

Two themes were evident in the free-text responses:

• Impact on mental health. Comments highlighted personal struggles with burnout, anxiety, depression, and posttraumatic stress disorder (PTSD), which were exacerbated by pandemic-related stressors, such as high workload, patient deaths, and conflicts with patients over health protocols. Several respondents expressed concerns over administrative burdens, lack of adequate support, and a feeling of being undervalued by their institutions. Some healthcare professionals mentioned contemplating retirement or leaving medicine altogether due to the overwhelming stress and lack of personal fulfillment in their work.

• Coping mechanisms. Responses indicated coping strategies such as yoga, therapy, medications (SSRIs), and reliance on their faith, family, or hobbies (e.g., golf) to manage stress. Several respondents mentioned that the pandemic made them reevaluate their priorities, with some seeking new career paths or reconsidering their roles within healthcare.

This survey highlights the toll the pandemic has taken on the mental health and emotional well-being of healthcare workers, underscoring the need for systemic changes, increased support, and improved working conditions to address burnout and mental health concerns.

DISCUSSION

The current study aimed to explore the impact of the environmental crisis and the COVID-19 pandemic on stress, burnout, and suicide risk among clinicians, particularly focusing on physicians and housestaff. With a sample of 485 respondents, the study uncovered a variety of stressors and challenges faced by healthcare professionals during the pandemic. The results of this study underscore the profound impact the COVID-19 pandemic had on healthcare professionals, revealing substantial professional and personal stressors, mental health challenges, and the resultant burnout experienced by the workforce. The data highlight both common and unique stressors experienced by a diverse group of healthcare providers, shedding light on the urgent need for systemic changes to mitigate these challenges.

The most salient professional stressors identified were staffing shortages, increased workload, administrative burdens, and the emotional toll of patient care. A significant portion of respondents (27.5%) reported moderate to high stress due to the responsibility of managing COVID-19 patients, and many others described feeling overwhelmed by the increased patient load and inadequate staffing. These findings are consistent with the broader literature on healthcare worker burnout during the pandemic, where the rapid influx of patients combined with shortages of staff and resources placed immense strain on healthcare providers. The lack of adequate PPE, compounded by evolving COVID-19 guidelines, further heightened the stress for medical professionals.

Administrative burdens, including an increase in paperwork and tracking metrics, were also identified as major stressors. Over 40% of participants indicated that these duties were stressful, detracting from their ability to focus on direct patient care. This administrative overload is a persistent issue that was exacerbated during the pandemic and has been linked to physician burnout in previous studies. The frustration expressed by respondents about the perceived prioritization of non–evidence-based metrics over patient care reflects the broader concern about healthcare’s shift toward administrative tasks at the expense of clinical responsibilities.

Another prominent source of stress was the challenge of managing patient expectations, particularly those influenced by misinformation about COVID-19. Healthcare professionals found it increasingly difficult to engage with patients who refused to adhere to medical advice or who denied the severity of the pandemic. This added emotional strain on medical providers, who were already coping with their own concerns about personal safety and the risk of transmitting the virus to their families.

In addition to professional challenges, healthcare workers also faced significant personal stressors, especially related to family responsibilities, financial concerns, and social isolation. A large portion of participants (44.4%) reported experiencing minimal financial stress, but many others (30%) experienced varying degrees of anxiety regarding job security and financial stability. These concerns were likely exacerbated by the instability and unpredictability of the healthcare system during the pandemic, with many workers facing reduced hours or compensation cuts. Similarly, many participants described heightened stress due to family needs, particularly related to childcare and schooling challenges. The closure of schools and daycare centers led to difficulties in balancing work and personal responsibilities, which further contributed to overall stress levels.

Social isolation was another personal stressor reported by healthcare workers. Although many did not feel isolated, a significant portion (32.8%) of respondents reported experiencing varying degrees of isolation during the pandemic, highlighting the toll of social distancing measures on emotional well-being. The inability to visit family members, combined with the added burden of fearing for loved ones’ health, exacerbated feelings of loneliness. The need for social support and connection is critical for healthcare workers, and the pandemic has underscored the importance of fostering these connections, both within healthcare settings and outside of work.

The survey results indicate that burnout was widespread among healthcare professionals during the pandemic, with 79.2% of respondents reporting experiencing burnout. This high prevalence of burnout is not surprising, given the extreme and sustained stressors that healthcare workers face. A substantial portion (39.2%) of respondents expressed a desire to escape from life, and a small but concerning percentage (3.5%) reported having suicidal thoughts, emphasizing the severe mental health toll of the pandemic on healthcare providers. These findings are in line with previous studies that have highlighted the mental health crisis among healthcare workers during the pandemic, particularly among those on the frontlines of COVID-19 care.

The emotional strain of witnessing patient deaths, managing the uncertainty surrounding COVID-19, and grappling with administrative burdens led to a significant psychological impact, including increased anxiety, depression, and PTSD. Many respondents reported using coping mechanisms such as therapy, yoga, and medications to manage their stress, though some also resorted to alcohol or other substances. The need for effective mental health support and coping strategies is clear, as healthcare workers are at a higher risk for developing mental health issues, including depression and PTSD, due to the intense and sustained nature of the pandemic-related stressors they face.

Despite the overwhelming challenges, healthcare workers displayed significant resilience in coping with the stress of the pandemic. Many respondents mentioned reevaluating their priorities and exploring alternative career paths, while others indicated a desire to continue in healthcare but with changes to the system to reduce burnout and improve working conditions. Some individuals also reported leaning on family, faith, or hobbies to manage stress, highlighting the importance of personal support networks in mitigating the effects of professional stress.

However, the data also reveal a critical need for institutional support. Most respondents expressed feelings of being unsupported by their leadership, particularly in terms of empathy, compensation, and recognition. This lack of support from healthcare institutions was a significant source of frustration, contributing to the emotional toll on healthcare workers. Ensuring that healthcare providers receive the necessary support, both financially and emotionally, is essential for reducing burnout and promoting long-term retention in the field.

While this study provides valuable insights into the stressors faced by healthcare professionals during the COVID-19 pandemic, there are several limitations. The survey sample is primarily from one healthcare network in Texas, which may limit the generalizability of the findings to other regions or healthcare systems. Additionally, the data relied on self-reported responses, which may be subject to biases, such as social desirability or recall bias. Future studies should seek to expand the sample size and geographical diversity to better capture the experiences of healthcare workers across the United States and globally.

Future research should also explore the long-term effects of the pandemic on healthcare professionals, particularly in terms of mental health outcomes and career trajectories. Understanding how healthcare workers have coped with the ongoing stress of the pandemic and identifying effective interventions will be essential for mitigating future waves of stress and burnout.

In conclusion, the results of this study highlight the significant professional and personal stressors faced by healthcare clinicians during the COVID-19 pandemic, leading to widespread burnout and mental health challenges. Suicidal ideation (albeit smaller than the researchers anticipated) is still a real issue that needs to be addressed and given attention by institutional leadership. Healthcare institutions must address these issues by providing more support, resources, and mental health services to healthcare workers. The pandemic revealed systemic issues in healthcare that must be addressed to ensure the well-being of the workforce and, by extension, the patients they serve.

Funding Statement

The authors acknowledge funding through the Caruth Foundation for $100,000.

Disclosure statement/Funding

The authors acknowledge funding through the Caruth Foundation for $100,000. The authors report no conflict of interest.