The COVID-19 pandemic has placed a tremendous strain on the mental health of our frontline healthcare workers. Not only are they working long hours under extremely stressful circumstances, but many of their patients are dying despite heroic efforts to save them.
In addition, many live in fear that they might contract and transmit the disease to their family and friends. This has led some workers to isolate themselves from loved ones, adding grief and loneliness to their distress.
Study of healthcare workers in China sheds light on the impact of COVID-19 on mental health
A recent study published in JAMA Psychiatry illustrates how great the impact on frontline healthcare workers’ mental health can be. The authors surveyed 1,257 health workers at 34 hospitals in China using several different validated instruments, including the Chinese versions of the following:
- 9-item Patient Health Questionnaire
- 7-item Generalized Anxiety Disorder scale
- 7-item Insomnia Severity Index
- 22-item Impact of Event Scale-Revised
They found many reported mental health symptoms as follows:
- 50.4% reported depression
- 44.6% anxiety
- 34.0% insomnia
- 71.5% distress
Nurses, women, frontline health workers, and those working in the epicenter of the outbreak, Wuhan, had more severe symptoms than those with other characteristics. For example, frontline workers “engaged in direct diagnosis, treatment, and care of patients with COVID-19” had a higher risk of depression, anxiety, insomnia, and distress compared to workers who were not doing these activities. They concluded that mental health interventions need to be implemented immediately with a special focus of women, nurses, and frontline workers.[i].
Mental health symptoms in healthcare workers may persist beyond the crisis
For some people working in health care systems, the symptoms of stress will subside with the crisis. However, others will need additional help to restore their mental health.
The figure below illustrates how mental health issues for workers may persist long after the cases of viral infection have diminished. Many will be suffering some kind of mental health issues, including post-traumatic stress, symptoms of major depression, generalized anxiety, and substance use disorders.
Evidence-based self-care behaviors may help healthcare workers cope with mental health symptoms
So, what can healthcare workers do to ensure that they are prioritizing their mental health? Evidence-based self-care behaviors and activities that may help health workers cope with an often-chaotic environment should be readily available.
In fact, self-care tools should be considered an essential component of any healthcare system’s mental health plan for workers, including:
- Self-care techniques to manage stress and build resilience during acute stress/crises
- Tools to reduce stress via healthy actions, calming practices, building, or re-focusing on connectedness with others
- Ways to build self-efficacy and resiliency, support hopeful beliefs, and develop a resilient mindset
- Access to mental well-being resources, such as articles and community forums.
- Introduction of employee assistance programs (EAP), telephone and internet counseling, and intervention programs
Healthcare system leaders throughout the country can help their employees deal with the current crisis and the aftermath of the pandemic by ramping up employee mental health and well-being plans now. In addition, they should be prepared to sustain that level of support for at least a year post-crisis.
Some workers may need additional help
For some, self-care practices may not be enough. Stress may be overwhelming for employees who are burned-out in their jobs or who were experiencing depression or anxiety before this crisis. For them, it may be a struggle to get through another day.
For this reason, mental health response plans should include support by mental health care professionals who can prescribe medications and other appropriate mental health support services, as needed.
It is crucial that employees self-advocate during this difficult time. However, it is also critical that leaders in the healthcare systems step up to ensure they are taking care of their own.
We often see health care workers as very self-reliant people who do not readily ask for help when it comes to their own well-being. To ensure that employees are getting the support they need, health care system leaders must encourage and normalize asking for help. It’s also essential that employees be able to ask for help anonymously so that they feel comfortable seeking support.
Plans should include training to recognize signs indicating when someone needs more than self-care support. Such symptoms might consist of irritability, insomnia, and cognitive mistakes. These symptoms will require creating a framework that helps match the right support to the correct mental health status.
How Health Care System Leaders Can Get Involved
Visible leadership is an integral part of any preparedness plan. The current impact and aftermath of the pandemic demand accurate, timely, and frequent communication by health care system leaders.
It also requires innovative ways for leaders to stay connected with their teams so that they can communicate their gratitude to workers and their support for employees and their families.
At the very least, health workers will appreciate a simple acknowledgment of how stressful their jobs are and details about the efforts underway to support them. Having open and honest conversations with each other as well as leaders in the system can help reduce anxiety.
While leadership may not be able to address all of the issues health care workers face, being part of the conversation is an important step.
Topics to address
Topics of discussion can include ways that workers can protect their family and loved ones. Examples include creating separate living spaces or providing stringent protocols that guide them on how to safely enter their homes after their shift (e.g., removing clothing and showering immediately).
It is also crucial to implement measures that take into account the following issues:
- schedules that allow for adequate sleep and rest breaks
- the opportunity to attend to personal and family needs
- the availability of healthy meals during shifts
- And, of course, the provision of adequate supplies of high quality personal protective equipment
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The bottom line
Health care system leaders who put in place a comprehensive mental health and well-being plan for their workers now through a one-year post-crisis phase can help employees recover and grow in their careers.
When workers know that leadership is being supportive professionally and personally, it can enhance performance. It will also make our healthcare systems more reliable, and resilient in the years ahead.
[i] Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. J.A.M.A. Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229
Husseini Manji, MD, FRCPC and Jennifer Turgiss, DrPH, MS
Husseini Manji, M.D., F.R.C.P.C., is the Global Therapeutic Area Head for Neuroscience at Janssen Research & Development, L.L.C. Dr. Manji previously worked at the National Institute of Mental Health, serving as the Director of the largest Mood & Anxiety Disorders Program in the world.
Dr. Manji has led decades of research and development focused on anxiety and mood disorders. He is also a member of and drives important mental health initiatives with key organizations like the National Academy of Medicine and the World Economic Forum.
Follow Dr. Manji on Linkedin
Jennifer Turgiss, DrPH, M.S. is the Vice President, Behavior Science and Advanced Analytics at Johnson & Johnson. She is a Doctor of Public Health and has spent her career focused on health and wellness. Dr. Turgiss currently leads the development of health behavior change interventions at Johnson & Johnson Health and Wellness Solutions, Inc.
In her role, she specializes in applying evidence-based behavioral and social sciences into health interventions to deliver better health outcomes through digital/technology, training of healthcare providers, and health communications programs. Follow Dr. Turgiss on Twitter.