Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

Abstract

ObjectivesThe psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.DesignA prospective online three-part longitudinal survey.SettingAcute hospitals in the UK and Ireland.ParticipantsFrontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.Primary outcome measuresPsychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.ResultsThe initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).ConclusionFindings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.Trial registration numberISRCTN10666798.

The COVID-19 Clinician Cohort (CoCCo) Study: Empirically Grounded Recommendations for Forward-Facing Psychological Care of Frontline Doctors

“…In relation to previous studies, findings from this study reflect similar themes drawn out elsewhere during the pandemic [15][16][17][18][19][20][21][22] suggesting 'commonality' in experiences of frontline workers [40]. This extends across specialties, gender and ethnicity within our sample-few discrepancies were identified between groups, despite recent quantitative studies reporting significant differences in psychological distress related to age, gender [2,3,[33][34][35], ethnicity, and specialty [1,27,28]. Accounts of working through two waves of the pandemic reflected a sense of immense and prolonged pressure, the second wave causing considerably higher stress.…”

“…Of the 346 CERA [1,27,28] participants who gave consent to be contacted for follow-on studies, 44 consented to interview (12.7%), and 36 were contacted to take part, as per our sampling frame requirements. Five people who consented were contacted for an interview but did not respond.…”

“…The COVID-19 Clinicians Cohort (CoCCo) study is a follow-on study from the 'COVID-19 Emergency Response Assessment', also known as CERA (IRAS: 281944) [1,[27][28][29]. CERA is a five-phase longitudinal study which sought to examine the prevalence and nature of distress in frontline doctors during the first wave (Spring 2020) and second wave (Winter 2020) of the COVID-19 pandemic [1,[27][28][29].…”

“…Participants in the CERA study completed quantitative measures of psychological distress, a demographic questionnaire and further questions pertaining to personal and professional characteristics (see CERA study for further details [1,27,28]). From the CERA study battery of measures, data relating to gender, specialty, ethnicity (individual demographic items), and traumatic stress (Impact of Events Scale-Revised, IES-R) were extracted to select a purposive sample for the CoCCo study (see Section 2.2).…”

“…Of those who consented to participate, a purposive sample of doctors was selected for maximum variation on four characteristics: gender, specialty, IES-R score, and ethnicity. These factors have been associated with higher levels of traumatic stress [1,2,27,28,[33][34][35]. Those with IES-R scores 24 or above (indicating clinical levels of distress) were eligible to take part, as these doctors were more likely to have experience of psychological distress and demonstrate care needs.…”