Short abstract
Healthcare workers are at significant risk of psychological morbidity during the COVID‐19 pandemic. Anxiety and depression is highest in young, female, and supportive workers.
Keywords: Covid‐19, Health service research, Women’s Health
While Severe‐Acute‐Respiratory‐Syndrome‐CoronaVirus‐2 (SARS‐CoV‐2/Covid‐19) causes physical morbidity for healthcare workers (HCWs), 1 Covid‐19 also carries psychological morbidity for HCWs. 2 , 3 This morbidity translates to anxiety and depressive symptomatology. To this end, we assessed anxiety and depression among HCWs during Covid‐19 pandemic.
A prospective study was performed on HCWs at a tertiary‐level maternity‐only hospital, Dublin, Ireland. An anonymous online survey was offered to all maternity HCWs, 600 staff at the time of the pandemic. Self‐reported Generalized‐Anxiety‐Disorder‐7 (GAD‐7) and Patient‐Health‐Questionnaire‐9 (PHQ‐9) scores were collected to assess severity of anxiety and depression (A&D).
Survey responses were analyzed using statistical software (IBM‐SPSS‐Version‐24.0). Median scores were compared using Mann‐Whitney‐U or Kruskal‐Wallis‐H tests. Approval from institutional review board was granted for this study prior to its commencement.
From 20th April to 5th May 2020, 240/600 (40%) hospital staff completed the questionnaire. Midwifery (36%) and administrative staff (22%) made up the largest proportion of the cohort (Table 1). 20.3% of HCWs had moderate to severe depression and 21.0% had moderate to severe anxiety. A&D scores were significantly higher in younger HCWs (GAD‐7 9.00 vs 1.00; P<0.001, PHQ‐9 9.00 vs 0.5; P<0.001) and amongst administrative staff (GAD‐7 7.00 vs 3.00, P=0.001; PHQ‐9 6.00 vs 2.00, P = 0.010). Anxiety scores were higher in female HCWs (GAD‐7 5.00 vs 2.00; P=0.027). Depression scores were similar between genders (PHQ‐9 4.00 vs 3.00; P=0.144).
Table 1.
Baseline demographics of participants who completed the survey, with responses and variation in GAD‐7 and PHQ‐9 scores with baseline characteristics.
| Baseline demographics | n | Median | Range | P Value | |
|---|---|---|---|---|---|
| GAD‐7 scores | |||||
| Gender | Female | 175 | 5.00 | 0–21 | 0.027 |
| Male | 22 | 2.00 | 0–20 | ||
| Age | 18‐25 y | 9 | 9.00 | 0–12 | 0.000 |
| 25‐40 y | 110 | 5.5 | 0–21 | ||
| 40‐50 y | 64 | 3.50 | 0–21 | ||
| 50‐60 y | 50 | 3.00 | 0–21 | ||
| Over 60 y | 7 | 1.00 | 0–10 | ||
| Underlying health conditions | Yes | 44 | 5.5 | 0–21 | 0.454 |
| No | 195 | 5.00 | 0–21 | ||
| Role | Midwife/Nurse | 87 | 4.00 | 0–21 | 0.001 |
| Doctor | 36 | 3.00 | 0–14 | ||
| Laboratory staff | 22 | 5.00 | 0–17 | ||
| Clerical/Administrative staff | 53 | 7.00 | 0–21 | ||
| Support staff | 42 | 4.0 | 0–21 | ||
| PHQ‐9 scores | |||||
| Gender | Female | 175 | 4.00 | 0–24 | 0.144 |
| Male | 22 | 3.00 | 0–20 | ||
| Age | 18‐25 y | 9 | 9.00 | 0–14 | 0.001 |
| 25‐40 y | 110 | 4.00 | 0–24 | ||
| 40‐50 y | 64 | 3.00 | 0–18 | ||
| 50‐60 y | 50 | 4.00 | 0–19 | ||
| Over 60 y | 7 | 0.50 | 0–4 | ||
| Underlying health conditions | Yes | 44 | 4.00 | 0–21 | 0.322 |
| No | 195 | 4.00 | 0–24 | ||
| Role | Midwife/Nurse | 87 | 3.00 | 0–24 | 0.010 |
| Doctor | 36 | 2.00 | 0–15 | ||
| Laboratory staff | 22 | 5.00 | 0–15 | ||
| Clerical/Administrative staff | 53 | 6.00 | 0–24 | ||
| Support staff | 42 | 4.50 | 0–21 | ||
Bold indicates statistically significant values (P<0.05).
On social isolation, 47% (112/240) HCWs experienced low mood triggered by loneliness. A total of 37% (88/240) felt limitation of activity contributed to psychological deterioration. Household tensions were reported by healthcare workers, 14% (34/240) with partners and 20% (48/240) with other household members including children.
Significant proportions of healthcare workers in obstetric settings are experiencing psychological distress during the Covid‐19 pandemic. A total of 20% reported moderate to severe anxiety and depression with rates highest in younger healthcare workers, female staff and workers in supportive roles.
Despite being more likely to have comorbidities and greater mortality rates if infected with Covid‐19, older colleagues had lower rates of A&D. Matured coping mechanisms to deal with stressors could explain this. Younger HCWs also worry about older family, as seen in a similar study on pregnant women. 4 Increased levels of A&D in administrative staff compared to front line HCWs may represent a rationalization of risk instilled in professional training of doctors and nurses/midwives.
While HCWs care for patients during this crisis, we must recognize that they are not immune to psychological distress. As the pandemic progresses, this psychological burden is likely to worsen. Recognizing this can aid healthcare leaders to support HCWs, prevent burnout and retain their confidence as we face this pandemic moving forward.
AUTHOR CONTRIBUTIONS
The study was conceived by MPOC and SWL. Study was designed by SWL MPH, SM, SR and GAC. Data collection was performed by GAC and SJM. Data was analysed by GAC. The manuscript was drafted by GAC and edited by SJM, SM, SR, TF, MPH, SWL and MPOC.
CONFLICT OF INTEREST
The authors have no conflicts of interest.
References
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