More than 125,000 Americans are currently hospitalized with COVID-19 – more than at any other point during the pandemic. Most of these patients are seriously ill, with low oxygen levels and potential organ failure. Most need constant monitoring and many need a ventilator because they are not able to breathe.
Since the beginning of the pandemic, researchers have been studying how COVID-19 affects those infected, as well as its impact on their caregivers. Studies conducted across the globe have demonstrated that caring for critically ill COVID-19 patients takes a serious toll on the mental health of care providers.
One such study surveyed more than 600 physicians, advanced practice providers, residents and nurses in April 2020, during the peak of COVID-19 hospitalizations in New York City. Fifty-seven percent of participants showed signs of acute stress; 48 percent showed signs of depression and 33 percent showed signs of anxiety. Nurses and advanced practice providers showed higher levels of psychological distress than doctors.
On a positive note, 61 percent of study participants reported they felt an increased sense of meaning and purpose in their work since the COVID-19 outbreak. The majority of participants used exercise as a coping mechanism.
A systematic review published in December 2020 found similar results. Health researchers from England and Greece combined data from 13 studies with more than 33,000 participants internationally. They found nearly 40 percent of health care workers caring for COVID-19 patients experienced depression and nearly 45 percent experienced anxiety.
A systematic review of 117 studies conducted by Spanish researchers attempted to identify risk factors among healthcare workers. It found that younger caregivers and female caregivers were more likely to experience psychological distress such as acute stress, anxiety, burnout and depression.
A study of 204 healthcare workers in Mexico published last month offered more insight into who among health care workers is at the greatest risk of psychological distress. Researchers found that caregivers with pre-existing symptoms of anxiety and depression were more likely to experience post-traumatic stress disorder after caring for COVID-19 patients, and that caregivers who experienced burnout before the pandemic were more likely to experience higher levels of debilitating anxiety and stress.
Female and younger caregivers were more likely to experience a decline in mental health. And caregivers who demonstrated resilience before the crisis were more likely to fare well while caring for COVID-19 patients. This study suggests that it may be helpful to provide mental health screenings for caregivers during infectious outbreaks to identify those at greater risk for mental health problems.
Unfortunately, we lack evidence on how best to support frontline healthcare workers. A systematic review conducted by the Cochrane Collaboration found only one study that measured the effects of interventions to support the mental health of caregivers during an outbreak. This study examined a program to support caregivers during an Ebola outbreak, but the evidence provided was of low quality.
The Cochrane review did find 16 studies that looked at the best ways to implement support programs during infectious disease epidemics. The researchers found that programs to support caregiver mental health were easier to implement when the caregivers were aware they needed support. Giving caregivers time to engage in the support program, adapting programs to local needs and creating a positive, safe and supportive learning environment were all important strategies in implementing support programs.
The take-home message: caregiving during an infectious disease epidemic affects the mental health of frontline health care workers. While there is not clear evidence about intervention programs that can help, researchers have identified some of the key components of implementing effective support programs. This is clearly an area where more research is needed.
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