COVID-19 Mental Health Consequences

The Impact of COVID-19 on the Mental Health of Chinese Healthcare Workers

COVID-19 Mental Health Consequences

Introduction
In December 2019, a novel pneumonia affliction caused by a coronavirus disease outbreak has subsequently spread across the globe causing an unprecedented degree of concern and panic among the world community. Over the course of the subsequent four months, almost every nation on Earth has been afflicted by this pandemic.

The Coronavirus outbreak and subsequent COVID-19 pandemic, originating in the city of Wuhan, China has placed healthcare workers on the frontline of this battle against this insidious disease. The effects on these critical workers are now being studied in detail in order to determine the psychological impacts and burdens being placed on them.

Fear of infection, stigmatization, enormous workloads, exhaustion, and a lack of support has caused significant levels of stress, anxiety, and depression among these important people, with the long-term implications yet to be determined.

This study aims to evaluate and determine the mental health outcomes among these participants and to quantify the magnitude of adverse symptoms as well as the associated potential risk. This ultimately will serve in the promotion of mental healthcare among health workers.

Discussion
The study evaluated a sample of over 1200 healthcare workers, predominantly married women, working in various hospitals, aged 26 to 40 years. The group was divided into 3 subsets – those working in Wuhan city, those within Hubei Province and those outside of Hubei Province. The study found that women, specifically nurses, holding intermediate titles and working within Wuhan City were most at risk of suffering from adverse symptoms, including stress, anxiety, and depression.

Most of these sources of distress arose from concern surrounding the potential of infections transmitted to friends and family, the rapid spread of the virus, and the worryingly high mortality rate. Compounding this was the parallel shortage of supplies and a lack of personal protective equipment.

The majority of participants in the study, female nurses, reported more severe feelings of depression and anxiety than physicians. This was due, in no small part, to their very close proximity to COVID-19 patients, consistent contact with the afflicted, coupled with extended working hours. Those with less work experience and junior titles were inevitably more susceptible to these adverse symptoms.

Of particular interest during the course of the study was that the severity of symptoms of depression, anxiety, stress, and insomnia was far more pronounced for those working within Wuhan than for those working outside of the city in surrounding Hubei Province and other regions. This invariably arose as a result of Wuhan being named the epicenter of the pandemic and those victims need to be identified for special attention.

The study is subject to several limitations including the fact that its scope was limited by most participants being from Hubei Province, it was only conducted over a 6-day period and also, that it does not distinguish between preexisting mental health conditions and new, COVID-19 associated symptoms. A final limitation on results arose from the fact that, with a 68.7% response rate, response bias may, of course, exist.

Conclusions
The study concluded, in detail, that the overwhelming majority of healthcare workers working to stem the spread of COVID-19 experienced a myriad of severe mental health associated symptoms including anxiety, stress, depression, insomnia, and distress. Healthcare workers are a critical cog in the effort to fight against the spread of the COVID-19 Pandemic. As such, their protection is of paramount importance, not only against potential infection but also of their mental health states. If women, nurses, and frontline workers, in particular, are left unprotected, these negative mental health effects may be felt for many years to come.

This pandemic has arrived at a time when the decision-making in our healthcare system has been increasingly transitioned to non-clinical leadership and the whims of the market. A balance has been lost and this crisis has served to highlight some of the many core deficiencies in our system, but we as physicians also know that what makes our system great is the people, the clinical perspective. 

This crisis will pass eventually but there will be others behind it.  We have to take care of ourselves and each other.  We have to remember why we chose this work.

Daria Hanson
About the author

Dr. Hanson attended Case Western Reserve University where she completed both medical school and a master’s degree program in Medical Anthropology. After a one-year internship in Internal Medicine at MetroHealth Medical Center through Case Western Reserve University, she completed a joint residency program in psychiatry at Massachusetts General Hospital and McLean Hospital through Harvard Medical School. She is presently in the process of completing an MBA through the Isenberg School of Business at the University of Massachusetts. Dr. Hanson has worked in medical leadership over the past 10 years striving to better serve both the patients and the providers of mental health care. She has been on the Board of Directors of the National Alliance for Mental Health and has worked to partner with the community through acute care programs and police training on mental illness. Outside of work you will find her with her family and friends enjoying the beautiful outdoors on Cape Cod, MA.

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