Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study

Abstract

Background: COVID-19 has put extraordinary stress on healthcare workers. Few studies have evaluated stress by worker role, or focused on experiences of women and people of color. Methods: The "Coping with COVID" survey assessed US healthcare worker stress. A stress summary score (SSS) incorporated stress, fear of exposure, anxiety/depression and workload (Omega 0.78). Differences from mean were expressed as Cohen's d Effect Sizes (ESs). Regression analyses tested associations with stress and burnout. Findings: Between May 28 and October 1, 2020, 20,947 healthcare workers responded from 42 organizations (median response rate 20%, Interquartile range 7% to 35%). Sixty one percent reported fear of exposure or transmission, 38% reported anxiety/depression, 43% suffered work overload, and 49% had burnout. Stress scores were highest among nursing assistants, medical assistants, and social workers (small to moderate ESs, p < 0.001), inpatient vs outpatient workers (small ES, p < 0.001), women vs men (small ES, p < 0.001), and in Black and Latinx workers vs Whites (small ESs, p < 0.001). Fear of exposure was prevalent among nursing assistants and Black and Latinx workers, while housekeepers and Black and Latinx workers most often experienced enhanced meaning and purpose. In multilevel models, odds of burnout were 40% lower in those feeling valued by their organizations (odds ratio 0.60, 95% CIs [0.58, 0.63], p< 0.001). Interpretation: Stress is higher among nursing assistants, medical assistants, social workers, inpatient workers, women and persons of color, is related to workload and mental health, and is lower when feeling valued.

Facing COVID-19 Pandemic in a Tertiary Hospital in Milan: Prevalence of Burnout in Nursing Staff Working in Sub-Intensive Care Units

“…Staff working in SICUs and ICUs reported more traumatic events than staff working in COVID-19-free units [ 11 ]. Overall, larger than 50% prevalence of burnout risk among HCWs working in COVID-19 units was also reported by other international studies [ 12 , 13 , 14 , 15 ].…”

Racial and Gender Discrimination Predict Mental Health Outcomes among Healthcare Workers Beyond Pandemic-Related Stressors: Findings from a Cross-Sectional Survey

“…As discrimination was a significant predictor of these outcomes, this finding seemingly contradicts the logic that heightened experiences of racial discrimination among Black HCWs would translate to heightened adverse mental health outcomes. Other studies have also identified that Black HCWs had lower or similar prevalence of adverse mental health outcomes compared with White HCWs [2,[36][37][38], a phenomenon consistent with what has been termed the Black-White mental health paradox [39]. One potential explanation could be that stigma prevented Black HCWs from reporting the severity of mental health symptoms [40].…”

“…There might be other mechanisms of resiliency among Black HCWs that can explain this association, such as positive coping strategies [41]. For example, a recent national survey study on stress during the COVID-19 pandemic identified that, compared with White HCWs, Black and Latinx HCWs experienced less severe burnout and heightened meaning and purpose, suggesting that positive coping could have protected against symptoms of burnout, including those that were heightened by their experiences of racial discrimination [38]. Furthermore, John Henryism, a high-energy coping style to manage psychosocial stressors such as discrimination, could explain this finding.…”

Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam

“…In our study, the prevalence of stress in the group directly in charge of treating and taking care of patients, who were physicians and nurses, was 50.3% and 46.3%, respectively ( Table 1 ). Overload of work, contact with severely ill COVID-19 patients, along with the fear of infection and infecting relatives, are factors that cause stress in this group [ 19 , 20 ]. A high prevalence of stress (50%) was also observed among laboratory workers.…”

“…In Da Nang, laboratory workers also draw blood or obtain nose or throat swabs. Handling of bio-samples from suspected or infected patients increases the risk of exposure, leading to increased stress [ 20 , 21 , 22 ]. In addition, too much work and wearing PPE for long periods of time in hot weather exposed laboratory workers to heat stress, affecting both cognitive and physical performance, leading to increased stress [ 22 , 23 , 24 ].…”