Symptoms of Mental Health Disorders in Critical Care Physicians Facing the Second COVID-19 Wave

Abstract

BACKGROUND: Working in the ICU during the first COVID-19 wave was associated with high levels of mental health disorders.RESEARCH QUESTION: What are the mental health symptoms in health-care providers (HCPs) facing the second wave? STUDY DESIGN AND METHODS: A cross-sectional study (October 30-December 1, 2020) was conducted in 16 ICUs during the second wave in France. HCPs completed the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised (for post-traumatic stress disorder), and the Maslach Burnout Inventory.RESULTS: Of 1,203 HCPs, 845 responded (70%) (66% nursing staff, 32% medical staff, 2% other professionals); 487 (57.6%) had treated more than 10 new patients with COVID-19 in the previous week. Insomnia affected 320 (37.9%), and 7.7% were taking a psychotropic drug daily. Symptoms of anxiety, depression, post-traumatic stress disorder, and burnout were reported in 60.0% (95% CI, 56.6%-63.3%), 36.1% (95% CI, 32.9%-39.5%), 28.4% (95% CI, 25.4%-31.6%), and 45.1% (95% CI, 41.7%-48.5%) of respondents, respectively. Independent predictors of such symptoms included respondent characteristics (sex, profession, experience, personality traits), work organization (ability to rest and to care for family), and self-perceptions (fear of becoming infected or of infecting family and friends, feeling pressure related to the surge, intention to leave the ICU, lassitude, working conditions, feeling they had a high-risk profession, and "missing the clapping"). The number of patients with COVID-19 treated in the first wave or over the last week was not associated with symptoms of mental health disorders. INTERPRETATION:The prevalence of symptoms of mental health disorders is high in ICU HCPs managing the second COVID-19 surge. The highest tiers of hospital management urgently need to provide psychological support, peer-support groups, and a communication structure that ensure the well-being of HCPs.

Psychosocial Impact of the COVID-19 Pandemic on Healthcare Workers and Initial Areas of Action for Intervention and Prevention—The egePan/VOICE Study

“…Similar findings were reported by Belanti et al, 2020, who found that workload and lack of emotional support at the workplace were particularly predictive of mental distress in terms of burnout among nurses during the pandemic [ 38 ]. A study on French HCWs in intensive care identified the fear of infecting themselves or relatives with the virus as a predictor of various mental health problems [ 39 ]. Additionally, in their systematic review, Skolaridis et al postulate that the fear of infecting relatives is an important stress factor for healthcare workers in epidemics and pandemics.…”

A cross‐sectional study of COVID‐19 pandemic‐related organizational aspects in health care

“…For example, for staff having worked 20 years at an elective orthopaedic outpatient clinic, qualifications to care for acute seriously ill COVID‐19 patients may be sparse. Therefore, considering competencies as suggested may not only decrease nurses’ distress (Azoulay et al., 2021 ; Heesakkers et al., 2021 ) but may also improve patient safety (Aiken et al., 2014 ).…”

Ethical Lessons from an Intensivist’s Perspective

“…The sheer numbers of patients, as well as the time needed to put on and remove personal protective equipment, meant that the time available for each patient was inevitably less than normal, and many staff members felt they were unable to provide the quality of care that they would under non-pandemic conditions. Lack of effective treatments, difficulties communicating with patients and their relatives, the need to make rapid, complex ethical decisions regarding which patients to admit or when to withhold or withdraw treatment, responsibility for new, non-ICU-trained members of the team transferred from other units, and fears about catching the virus and passing it on to their own family members, all added to the psychological burden on ICU teams with high rates of insomnia, depression, anxiety, post-traumatic stress disorder, and burnout [ 38 , 39 , 40 , 41 , 42 , 43 ]. Various strategies have been proposed to try and limit some of the psychological impact, including adequate training and senior support for new or re-allocated staff, availability of clinical psychologists for individual assessments and consultation, and regular team debriefing and support sessions [ 44 , 45 ].…”