Healthcare workers experienced a high mental health burden during COVID-19, but less is known about the effect on intensive care staff.
Healthcare workers are three times more likely to be infected with COVID-19 than individuals in the community. However, during viral epidemics, an additional burden on healthcare workers is the impact on their mental well-being that comes with the associated increased workload, resulting in stress and anxiety. With thousands of patients around the world developing more severe infection, the focus has been on management within intensive care units. Such units are a very demanding environment with staff continually exposed to traumatic and stressful events and a 2007 study found a higher incidence of post-traumatic stress disorder (PTSD) among critical care nurses. Given the high levels of 28-day mortality in patients with COVID-19, this undoubtedly increases the mental health burden of intensive care personnel even further. However, there is a lack of data specifically examining the mental well-being of intensive care staff.
Using an online survey, a team from the Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, Imperial College, London, UK, sought to better understand the mental health burden experienced by the intensive care staff. The overall objective was to establish the prevalence of indices of depression, insomnia and PTSD, which the authors suspected to be high among intensive care personnel. The survey was conducted among all healthcare professionals working in the intensive care environment and spread across UK, France, Italy, Belgium, Egypt, Taiwan and mainland China.
For the survey, three previously validated questionnaires were included: the two-item patient health questionnaire (PHQ-2) which aimed to assess the severity of depression, an 8-item Athens insomnia scale (AIS -8) and the 10-item trauma screening questionnaire. (TSQ). The corresponding cut-off values for these questionnaires are 3 (PHQ-2), 8 (AIS-8) and 6 (TSQ). In addition to these questionnaires, the authors have included a series of general well-being questions.
The final cohort consisted of 515 responses from seven different countries and the majority of respondents were female (73%), of white ethnicity (73%) and aged 31 to 40 (43.3%). Interestingly, 5.8% of respondents reported a pre-existing mental health problem. Just over half (52.4%) were nurses, the rest being senior doctors (13.8%), residents / fellows (8.9%) and junior doctors (6.4%), physiotherapists and others. In addition, almost two thirds (60.2%) had been redeployed from another specialty and only one third (33.8%) were normally based in an intensive care unit.
The median scores were 2, 10 and 3 for PHQ-2, AIS-8 and TSQ, respectively. Overall, 37.3%, 78.6%, and 27.7% of participants had scores for PHQ-2, AIS-8, and TSQ, respectively, above the cutoffs for each condition. Across countries, 16-44% of respondents exceeded the threshold for depression, 60-80% for insomnia and 17-35% for PTSD.
The authors concluded that the COVID-19 pandemic has created a significant mental health burden on critical care staff and recommended that all such staff have access to mental wellness resources, especially given the possibility further increases in infection rates in the future.
Ezzat A. The global mental health burden of COVID-19 on critical care staff. Br J Nurses 2021