Mental impact of Covid-19 among Spanish healthcare workers. A large longitudinal survey

Abstract

Aims Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors. Methods 8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview. Results 4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar. Conclusions Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565

Mental health problems and needs of frontline healthcare workers during the COVID-19 pandemic in Spain: A qualitative analysis

“…We found that mental health problems were reported as frequently as life-threatening problems such as lack of training to avoid infection or PPE shortages, indicating that mental health problems are still considered relevant for HCWs almost 1 year after the first pandemic outbreak. This result is in line with evidence from longitudinal survey studies conducted in Spain ( 7 , 9 ) and abroad ( 10 , 47 , 48 ), showing that poor mental health outcomes among HCWs tend to persist over time. In a country where one in two nurses had thought of quitting their job since the beginning of the pandemic ( 49 ), the increased levels of tiredness and exhaustion reported by some of our interviewees serve as a plausible explanation for this sustained poor mental health (“[we] had not been allowed to disconnect or deactivate [since the beginning of the pandemic]”; “[HCWs] have got used to sleeping 3 h a day and being tired”).…”

“…Since the beginning of the COVID-19 pandemic, healthcare workers (HCWs) from pandemic hotspots around the world have reported mental health symptoms such as anxiety, depression, acute and posttraumatic stress, and insomnia ( 1 – 5 ). Pre-pandemic cohort studies are lacking, and we cannot know whether these problems were more prevalent after the COVID-19 outbreak ( 6 ); however, follow-up studies suggest that they might persist for at least 1 year ( 7 – 10 ), leading to exhaustion and resignation ( 11 ). With new variants and surges of the virus pressuring health systems worldwide ( 12 ) and concerning evidence of job quit and turnover ( 13 – 15 ), reducing the mental health toll of the pandemic on essential workers remains necessary.…”

A Cross-Sectional Time Course of COVID-19 Related Worry, Perceived Stress, and General Anxiety in the Context of Post-Traumatic Stress Disorder-like Symptomatology

“…Training and the application of psychological first aid and referral to mental health resources should be provided as in-depth programs rather than trivial exercises in regulatory satisfaction [ 70 ]. This may be especially necessary in educators, as younger participants seem to experience a greater burden of symptoms that are associated with the development of PTSD [ 30 , 62 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ].…”

Panic Disorder and Burnout in the Workplace: Review of the Evidence and Recommendations for Future Research

“…Olga Lainidi 1 *, Eva Tzioti 2 , Maria Spiliou 3 , Panagiota Koutsimani 4 and Anthony Montgomery 5 1 University of Leeds, Leeds, UK 2 Mediterranean College, Thessaloniki, Greece 3 Aristotle University of Thessaloniki, Greece 4 University of Macedonia, Thessaloniki, Greece 5 Northumbria University, Newcastle, UK *Address all correspondence to: lndolga@gmail.com…”

“…More is known about the prevalence of panic attacks among healthcare professional after the COVID-19 pandemic compared with either pre-pandemic times or other occupations. Alonso et al, [5] in their longitudinal study on the impact of COVID-19 on Spanish healthcare workers, measured probable current mental disorders including major depressive disorder (MDD), Generalized Anxiety Disorder (GAD), Post-Traumatic Stress Disorder (PTSD), and Substance Used Disorders (SUDs) and work-related factors (e.g., care center preparedness, weekly working hours) among other variables. Panic attacks were measured as the number of panic attacks experienced in the 30 days prior to the interview.…”