Intervention to prevent adverse psychological outcomes amongst HCWs during epidemics is imperative
The Novel Coronavirus outbreak that appeared in China at the end of December 2019 was declared a Public Health Emergency of International Concern (PHEIC) on January 30, 2020 . Previous research during public health outbreaks has shown that health care workers (HCWs) were subject to high risks and stressors, both physical and psychological, that have potentially led to PTSD .
HCWs felt vulnerable, due to the risk of getting infected within a context of scarce resources, whilst their fundamental “duty to treat” was antagonistic to their need to protect their families and loved ones from further transmission .
Jianbo Lai and colleagues  aimed to evaluate mental health outcomes of HCWs who treated patients with COVID-19. Authors conducted a cross-sectional, hospital-based survey from January 29, 2020, to February 3, 2020. The endpoints were the prevalence of the symptoms of depression, anxiety, insomnia and distress, and their potential risk factors, by utilising three measurement tools validated in the Chinese population.
The study included 1,830 HCWs from 20 hospitals of Wuhan (the most affected area), seven hospitals in other regions of Hubei province and seven hospitals from other seven provinces with a high COVID-19 incidence. 1,257 completed questionnaires were returned (70.2% from physicians and 67,7% from nurses), yielding a response rate of 68.7%.
The findings revealed an overall high prevalence of depression (50.4%), anxiety (44.6%), insomnia (34.0%) and distress (71.5%) amongst HCWs. Women with an intermediate technical title experienced more severe symptoms while working in the front line was an independent risk factor for worse outcomes in all the above dimensions of interest.
STUDY STRENGTHS & LIMITATIONS
This is the first study that has assessed mental burden amongst HCWs in the epicentre of the pandemic from COVID-19 by adopting a robust methodology. Although a lack of a longitudinal follow-up did not allow authors to conclude the mental health status at a later stage of the pandemic, the study highlighted that timely and targeted intervention to prevent adverse psychological outcomes amongst HCWs during epidemics is imperative.
TAKE HOME MESSAGE
A considerable proportion of Chinese HCWs reported experiencing symptoms of depression, anxiety, insomnia, and distress, whilst frontline HCWs had a high risk of experiencing mental health burden during the pandemic from COVID-19. Further research is needed to develop evidence-based psychological interventions to support front-line HCWs during pandemics.
This article review was prepared and submitted by Silvia Calvino Gunther & Katerina Iliopoulou, on behalf of the ESICM N&AHP Committee;
1.Eurosurveillance Editorial Team (2020). Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 25(5), 200131e.
2. Paladino L et all. For the American College of Academic International Medicine (ACAIM). Reflections on the Ebola Public Health Emergency of International Concern, Part 2: The Unseen Epidemic of Post-traumatic Stress among Health-care Personnel and Survivors of the 2014-2016 Ebola Outbreak. J Glob Infect Dis. 2017 Apr-Jun; 9(2):45-50.
3. Lai TS, Yu WC. The lessons of SARS in Hong Kong. Clin Med (Lond). 2010;10(1):50–53.
4. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw. Open 3, e203976.