It’s been just over a year since the COVID-19 pandemic started in the United States. Despite the hope we are starting to feel, I’m left wondering about the toll that this pandemic will have on health care workers for years to come. What will be the mental health repercussions among these people we have so critically depended on?
Over the past year, I’ve observed my husband hold steadfastly to his meditation routine. He keeps a daily journal. He runs an hour each day. He’s had these routines for years, but there was an added intensity this year as he works as a doctor caring for patients with COVID-19.
I saw him grapple with the stress and anxiety created by this pandemic. He worried about potential surges in patients. He dreaded having to choose between two lives if hospital resources became scarce. Yes, doctors, nurses, health staff and other essential workers are our heroes. But they are also human, and their jobs became significantly harder this last year.
Together with my research team, we wanted to explore how this crisis affected the mental health of health care workers. There has rightly been a lot of attention on the impact of the pandemic on health workers on the front lines in emergency rooms. But we suspected that the pandemic’s impacts were much broader than most people realized. So we sought to understand how this crisis affected health workers outside of hospitals in outpatient settings.
We conducted the first national study of outpatient providers, surveying physicians, nurses and health staff from across 25 states to capture, in their own voices, their experiences providing care during the COVID-19 pandemic. These health workers revealed that the mental health repercussions are devastatingly widespread.
They didn’t mince words. Two-thirds reported increased stress and one-third reported increased anxiety or depression. One nurse from Tennessee simply said: “I can’t explain it — it’s horrible.”
Many health workers mentioned burnout and reported feeling isolated, lacking sleep, and being unable to focus. A nurse practitioner in Oregon reported “feeling overwhelmed, stressed … Don’t want to come to work. Feeling down and don’t feel like I have support.”
By far, the most common source of stress came from feelings of inadequacy around patient care. Health workers worried that patients would not know how to access care during the pandemic and would even avoid seeking care.
Health workers cited the stress from adapting to rapidly changing day-to-day work and shifting to COVID-related care. They highlighted the challenges of being short-staffed due to self-quarantine and illness and even death of co-workers.
To top it off, providers shared their fear due to their heightened risk of becoming infected with COVID-19 or bringing it home to their families. Lack of personal protective equipment exacerbated their fears. A health educator in Pennsylvania said they were “always wondering if this is the day that I get the virus.”
Health workers mentioned having to manage not only their own stress and anxiety, but also that of their staff and patients. A clinic manager said: “The responsibility to present a calm and supportive environment to patients and staff causes a repression of your own stress. This is exhausting.”
Health workers worried about finances and keeping their jobs. They, too, have families affected by closed schools and noted concerns about child care.
We are used to seeing our health workers hold it together. I saw that in my husband, both as a doctor and a father. That’s what they are trained to do and what they dedicate their lives to do. Yet we need to recognize the mental health repercussions of this crisis. We saw the heart-wrenching example of Dr. Lorna Breen, medical director at New York-Presbyterian Allen Hospital, who died by suicide.
Not only have front-line COVID-19 health workers been facing significant stress, anxiety and depression. These effects have been felt among workers throughout the health care system. We need to prepare for the ramifications of having put health workers through so much stress over the past year.
We need to confront the stigma experienced by health workers seeking help for mental illness. We need better systems to identify early signs of anxiety, depression and post-traumatic stress disorder. We need to provide health workers with access to counseling, treatment and psycho-social support.
Let us not forget that health workers have been one of our most crucial resources during this global pandemic. Whether they’re in an emergency room or keeping a community clinic up and running, they are facing unprecedented mental health consequences that cannot be ignored.
Alison B. Comfort is a health economist at the Bixby Center for Global Reproductive Health, in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco.
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