Work-Related and Personal Factors Associated With Mental Well-Being During the COVID-19 Response: Survey of Health Care and Other Workers

Abstract

Background The response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created an unprecedented disruption in work conditions. This study describes the mental health and well-being of workers both with and without clinical exposure to patients with coronavirus disease (COVID-19). Objective The aim of this study is to measure the prevalence of stress, anxiety, depression, work exhaustion, burnout, and decreased well-being among faculty and staff at a university and academic medical center during the SARS-CoV-2 pandemic and describe work-related and personal factors associated with their mental health and well-being. Methods All faculty, staff, and postdoctoral fellows of a university, including its medical school, were invited in April 2020 to complete an online questionnaire measuring stress, anxiety, depression, work exhaustion, burnout, and decreased well-being. We examined associations between these outcomes and factors including work in high-risk clinical settings and family/home stressors. Results There were 5550 respondents (overall response rate of 34.3%). Overall, 34% of faculty and 14% of staff (n=915) were providing clinical care, while 61% of faculty and 77% of staff were working from home. Among all workers, anxiety (prevalence ratio 1.37, 95% CI 1.09-1.73), depression (prevalence ratio 1.28, 95% CI 1.03-1.59), and high work exhaustion (prevalence ratio 1.24, 95% CI 1.13-1.36) were independently associated with community or clinical exposure to COVID-19. Poor family-supportive behaviors by supervisors were also associated with these outcomes (prevalence ratio 1.40, 95% CI 1.21-1.62; prevalence ratio 1.69, 95% CI 1.48-1.92; and prevalence ratio 1.54, 95% CI 1.44-1.64, respectively). Age <40 years and a greater number of family/home stressors were also associated with these poorer outcomes. Among the subset of clinicians, caring for patients with COVID-19 and working in high-risk clinical settings were additional risk factors. Conclusions Our findings suggest that the pandemic has had negative effects on the mental health and well-being of both clinical and nonclinical employees. Mitigating exposure to COVID-19 and increasing supervisor support are modifiable risk factors that may protect mental health and well-being for all workers.

Mental health of health care workers during the COVID-19 pandemic and evidence-based frameworks for mitigation: A rapid review

“…As shown in Table 1, the majority of studies were from China (n = 43, 49%), followed by the United States (n = 7), Italy (n = 5), Singapore (n = 3), Turkey (n = 4), Iran (n = 3), Pakistan (n = 3), India (n = 2), Poland (n = 2), Saudi Arabia (n = 2), Spain (n = 2), Colombia (n = 1), Ecuador Many studies found that women experience worse mental health outcomes on multiple instruments as compared to men. 6,8,14,17,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45…”

“…13,21,22,27,32,37,49,50,51 These adverse outcomes were also seen in HCWs with friends or family with COVID-19 infection 22,32,33,34,49 and in HCWs with colleagues who were hospitalized or died of COVID-19. 39 Further, working in COVID-19 designated hospitals compared to nondesignated hospitals 25,49,52 and working in COVID-19 specific isolation wards 13,22,40,45 were associated with poorer mental health outcomes. However, smaller single-institution studies in Romania 53 and in Guangzhou, China, 54 where there were fewer COVID-19 cases, did not find differences in mental health outcomes between HCWs working in dedicated versus nondedicated wards.…”

“…Direct contact with COVID-19 patients was associated with poor mental health outcomes, 8,13,31,35,36,43,45,46,47,48 as well as personal fear of infection and perceived threat of contagion. 13,21,22,27,32,37,49,50,51 These adverse outcomes were also seen in HCWs with friends or family with COVID-19 infection 22,32,33,34,49 and in HCWs with colleagues who were hospitalized or died of COVID-19.…”

“…A large multicenter study of 1422 HCWs in Spain found 41.1% prevalence of burnout, with burnout positively and significantly related to anxiety, depression and PTS symptoms. 42 Risk factors for burnout identified in this review included women HCWs, 44,82 nurses, 82 direct contact with COVID patients, 45 fear of infection, 27 increased work stress, 27 and presence of somatic symptoms. 82 In a single-institution study in China, burnout was significantly lower in frontline HCWs compared to non-frontline HCWs.…”

Should health care institutions provide job accommodations for health care workers with serious mental health concerns during the COVID-19 pandemic?

“…[22] Some data on U.S. HCWs have begun to emerge, with data from a survey of U.S. university employees in April 2020 demonstrating that those working in a clinical capacity had higher anxiety and lower emotional wellbeing compared to nonclinical workers. [23] A survey of residents and clinical fellows at the same university's training program, who were also surveyed in April 2020, found that trainees exposed to COVID-19 patients reported significantly higher stress, burnout, and anxiety than non-exposed trainees. [24] Both groups reported levels of depression consistent with prior studies of resident physicians, as well as similarly low professional fulfillment from their current clinical activities.…”