Key Takeaways:

• The first study to look at the mental health on health care workers treating COVID-19 patients in China finds high levels of distress, anxiety, depression and insomnia

• In a commentary on the study, Mass General’s Roy Perlis, MD, MSc, says that the levels of distress are particularly concerning and could lead to PTSD

• More research is needed to find way to help health care providers cope with the stress of COVID-19 at Mass General and beyond

The world is a very different place now than it was just a month ago. The global spread of the COVID-19 has health care workers trying to manage a disease that scientists are still working to understand. While many believe that times like these are what health care workers train for, the mental toll it takes to make these life and death decisions is undeniable.

The United States has yet to see its peak number of cases, so it is important to prepare ourselves as best as possible by looking to our international colleagues who have more experience. In an effort to better understand the psychological impact that treating COVID-19 patients has on health care providers, Roy Perlis, MD, MSc, the Director of the Center for Qualitative Health, looked to experts in China.

A team of researchers led by Jianbo Lai, MSc, and at the Zhejiang University School of Medicine recently published a JAMA Network Open study that examined the mental health of health care workers exposed to COVID-19 in China.

Perlis recognized the study was not only important for those in China, but could have implications for colleagues in the US as well. He recently examined their findings via a commentary and live Q&A webcast for JAMA Network Open.

Summary of study findings

Lai and colleagues conducted an online survey completed by 1,257 health care workers across 34 hospitals over the course of four days, from January 29, 2020, to February 3, 2020. The survey included items that evaluated levels of depression, anxiety, insomnia and distress.

More than 70% of respondents reported symptoms of distress. Roughly half were experiencing symptoms of depression and/or anxiety and one-third reported symptoms of insomnia.

Initial thoughts

In his webcast and commentary, Perlis says one of the most concerning metrics in his view was the level of psychological distress.

Of the 70% of respondents who reported symptoms of distress, about one-third reported levels of distress associated with the development of post-traumatic stress disorder (PTSD). While it doesn’t necessarily mean that all of them will develop PTSD, “It is a reminder to us that beyond the acute symptoms that people may experience, we need to be alert for the downstream consequences,” he writes.

Another point to consider is that health care workers are people too, and that some of the anxiety they are feeling may not necessarily have to do with the acts of providing care. “We can’t lose sight of the fact that everyone, to varying degrees, is experiencing this as an incredibly traumatic event or set of experiences,” says Perlis.

Health care workers are heroically fighting this on the frontlines and “we know what to do in an emergency,” Perlis explains, but “it’s when you get home and you start worrying about yourself and your family and your colleagues who are still at the hospital that you can start to notice what a source of stress this is.”

Researchers also found that frontline healthcare workers who had direct contact with patients were more at risk for developing mental health symptoms than those in supporting roles. Those in senior positions tended to fare better than their more junior colleagues, which Perlis says could be due to the notion that providers with more years under their belt may be more resilient.

How does the stress of COVID-19 compare to that from other epidemics and experiences?

Perlis notes that the findings from Lai’s COVID-19 study are consistent with findings gathered during the SARS epidemic of 2003, but that it is difficult to make direct comparisons given the current pandemic is different than a lot of traumatic events that have been studied.

The focus of many studies examining trauma tends to be a single acute stressor or event, but Perlis argues the COVID-19 pandemic is more like, “chronic stress punctuated by moments of more acute stress,” making it similar to the experience of a war. Like a war, experiencing a pandemic cannot be boiled down to a single day or event, which is why more research needs to be done to try and understand the implications.

How do we proceed?

One of the positive things we can take away from this paper and previous studies is that there is now a lot of discussion surrounding how best we can take care of ourselves and each other, says Perlis. Resources are being made available online and those resources should be utilized as much as possible, but we must also be aware that some people may require different levels of care, especially as time goes on.

Situations like a pandemic are very complex, and it is important we remember that the impact of times like these will not simply vanish after the peak has passed.

“I think we’re at the point in the conversation where we should acknowledge, absolutely take care of yourself,” Perlis explains, “do the things that you can, but also realize that for some people, there will be a need for additional help.”

If you or someone you know is looking for mental health resources, please feel free to visit the Mass General Department of Psychiatry’s Guide to Mental Health Resources for COVID-19.

COVID-19 Research at Mass General
Researchers and clinicians at Massachusetts General Hospital Research Institute are mobilizing to develop new strategies to diagnose, treat and prevent COVID-19. Learn more.

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