Background: As the COVID-19 pandemic persists, many have grown concerned about the mental health of frontline healthcare workers. Given the rising death toll, potential for overcrowding hospitals, and resource shortages, a comprehensive assessment of healthcare workers’ well-being during COVID using validated measures of anxiety, depression, and burnout is needed to help improve the healthcare workforce’s mental wellbeing.
Methods: A restricted, self-selection survey, created through REDcap, was distributed on social media platforms (Facebook, Twitter, Instagram) for 14 days. Qualifying participants were at least 18 years of age and a healthcare worker clinically active during COVID-19. Respondents were asked to reflect on the month with their highest volume of covid patients. The Patient Health Questionnaire-4 (PHQ-4) was used to assess anxiety and depression. Descriptive statistics were used to quantify personal and professional demographics. A total PHQ4 score of > 3 for the “feeling nervous” and “inability to control worrying” questions defined anxiety, while PHQ4 score of > 3 for the “feeling down” and “loss of pleasure” questions defined depression. Multivariate logistic regression was used to test the association between demographics and anxiety or depression during the pandemic.
Results: Of the 983 eligible respondents, 906 completed all portions of the survey. Participants were mostly female (75.2%, n=699), white (70.3%, n=654), aged 30-49 (70.5%, n=692), and physicians (64.3%, n=598). Eighty percent (n=744) of respondents cared for COVID patients. Across all respondents, anxiety was identified in 39.1% (n=357) and depression in 32.7% (n=302). Relative to physicians, non-physicians had increased odds of anxiety (OR 1.9; CI: 1.4, 2.7). Black non-physicians had increased odds of anxiety (OR 4.7, CI: 1.3, 17.1). Relative to the youngest age group (18-24), older respondents were 4-8 times more likely to report depressive symptoms: 30-39 years [OR 3.7, CI: 1.2, 11.6], 40-49 years [OR 6.1, CI: 1.9, 19.3], 50-60 years [OR 3.5, CI: 1.0, 12.1], > 60 years [OR 7.7, CI: 1.1, 53.1]. Being Hispanic increased the odds of depression (OR 1.9, CI: 1.2, 2.9) compared to non-Hispanics. Relative to respondents with a significant other, those without reported increased odds of depression (OR 1.5, CI: 1.0, 2.2). Qualitative comments revealed specific stressors (“More and more patients put me under great pressure both mentally and physically”), feelings of burnout (“I am exhausted. Mentally, physically, psychologically”), and concerns about leadership response (“I’m extremely stressed about American politics”).
Conclusions: Nearly 7 months after the start of the COVID-19 pandemic, approximately 40% of surveyed healthcare workers reported anxiety and over 30% reported depression. With the increasing cases and deaths associated with the COVID-19 pandemic, it is imperative to increase recognition of and mitigation strategies for the impact of COVID-19 on the mental health of our healthcare workers.