Preventing mental health disorders in healthcare workers during the COVID-19 pandemic

L. A. Strizhakov; S. A. Babanov; D. V. Vinnikov; N. A. Ostryakova; A. S. Agarkova

doi:10.21886/2219-8075-2023-14-1-112-118

Preventing mental health disorders in healthcare workers during the COVID-19 pandemic

L. A. Strizhakov, S. A. Babanov, D. V. Vinnikov, N. A. Ostryakova, A. S. Agarkova

https://doi.org/10.21886/2219-8075-2023-14-1-112-118

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Abstract

Objective: based on a comprehensive assessment of the levels of anxiety and burnout syndrome among medical workers of COVID hospitals, develop measures to prevent mental health disorders.
Materials and methods: examined: group 1 — medical workers of COVID hospitals (n=201); group 2 — medical workers of multidisciplinary hospitals (n=195); group 3 — medical workers of the outpatient clinic link (n=186). Control group (n=190) — employees of engineering, technical and economic specialties (healthy). Methods: psychological (“integrative anxiety test”, authors: A.P. Bizyuk, L.I. Wasserman, B.V. Iovlev (2005); method for diagnosing professional burnout according to V.V. Boyko). During statistical processing, the significance of differences was determined using one-way analysis of variance (ANOVA) followed by intergroup comparisons according to Dunnet’s test. The obtained data were processed using the statistical package “Statistica” from StatSoft (USA).
Results: in the study of the phases of emotional burnout, it was revealed that medical workers in COVID hospitals had significantly higher scores of the phase of stress, phases of resistance compared to medical workers in multidisciplinary hospitals and outpatient services. At the same time, the total score of the exhaustion phase was significantly increased in medical workers in COVID hospitals compared to medical workers in multidisciplinary hospitals, but there were no significant differences in this indicator when compared with medical workers in outpatient services. It has been established that among medical workers of COVID hospitals, the indicator “alarming assessment of prospects” prevails; in medical workers of multidisciplinary hospitals — “asthenic component”; among medical workers of the outpatient clinic link — a «phobic component».
Conclusions: among medical workers of COVID hospitals, there is a high level of formation of phases of emotional burnout and anxiety. Measures to prevent mental health disorders of medical workers in COVID hospitals include: socio-psychological, professional and organizational.

Keywords

emotional burnout, anxiety, medical workers

For citations:

Strizhakov L.A., Babanov S.A., Vinnikov D.V., Ostryakova N.A., Agarkova A.S. Preventing mental health disorders in healthcare workers during the COVID-19 pandemic. Medical Herald of the South of Russia. 2023;14(1):112-118. (In Russ.) https://doi.org/10.21886/2219-8075-2023-14-1-112-118

Introduction

The coronavirus disease 2019 (COVID-19) was first identified in Wuhan in China in December 2019 [1]. The important impact of the COVID-19 pandemic on all aspects of society was noted in the study by Holmes et al. At the same time, the direct and indirect psychological and social consequences of the pandemic affecting the mental health of people can be noticed not only now but also in the future [2]. Referring to Gunnell et al., Holmes also considered the possible impact of COVID-19 on an increase in the risk of suicide. The 2003 epidemic of severe respiratory syndrome (SARS) in which there was a 30% increase in the number of suicides among people aged 65 years, and 29% of medical workers experienced various emotional disorders, was cited as an example [2]. A number of studies [3–5] have highlighted the strong impact of the COVID-19 pandemic on medical workers, including those directly involved in the treatment of patients with the new coronavirus infection. The main psychological consequences of the pandemic are expressed in increased levels of stress and anxiety. Anxiety, as a rule, means a state in which a person perceives situations as threatening, this perception can be subjective, since it is an indefinite feeling of impending danger [6]. The feeling of fear is the main component of anxiety. Today, the issue of studying the features of anxiety and emotional burnout manifestation in medical workers in the context of a pandemic caused by the new coronavirus infection becomes important.

The study is aimed at developing measures to prevent mental health disorders based on a comprehensive assessment of the levels of anxiety and professional burnout syndrome among medical workers in COVID-19 hospitals.

Materials and methods

The study was performed at the Department of Occupational Diseases and Clinical Pharmacology named after professor Vladislav Vasilievich Kosarev, an Honored Scientist of the Russian Federation, of FSBEI HE “Samara State Medical University” of the Ministry of Health of the Russian Federation and the Department of Occupational Pathology of the Regional Center for Occupational Pathology of the SBHI SR “Samara Medical and Sanitary Unit No. 5 of the Kirov District”. In order to achieve the goal of the study, a survey and analysis were conducted among the following groups of medical workers: group 1 — medical workers of COVID-19 hospitals providing medical care to patients with COVID-19 (n=201); group 2 — medical workers of multidisciplinary hospitals providing medical care in their main profile, working in the “normal mode”, and periodically identifying patients with the new coronavirus infection COVID-19 (n=195); group 3 — medical workers of outpatient clinics providing medical care in conditions of an increased epidemic threshold for acute respiratory viral infections (ARVI), influenza, and new coronavirus infection COVID-19 (n=186). The control group included employees of engineering, technical, and economic specialties, not related by their profile of activity to work in medical organizations (healthy). The “Integrative test for anxiety (ITA)” [7] was applied to study the components of situational anxiety in medical workers. The diagnostic method by V.V. Boyko was used to study the syndrome of emotional burnout [8].

The study was performed in accordance with international GCP standards.

During statistical processing, the significance of differences was determined using one-way analysis of variance (ANOVA) followed by intergroup comparison done using Dunnet's test. The obtained data were processed using the Statistica package from StatSoft (USA).

Results

The severity of the emotional burnout phases was assessed and analyzed after processing the results of the survey of medical workers of COVID-19 hospitals (working in the “red zone”), medical workers of outpatient clinics providing medical care in conditions of an increased epidemic threshold for ARVI, influenza, and COVID-19, as well as medical workers of multidisciplinary hospitals providing medical care in their main profile and periodically identifying patients with COVID-19.

Table 1

Formation of phases of emotional burnout in the studied groups of medical workers

	*Group 1*	*Group 2*	*Group 3*	*Control group*	panova	p1–2	p1–3	p2–3
Total stress phase score	50.24±0.96 p1–4≤0.001	43.49±1.11 p2–4≤0.001	39.47±0.98 p3–4≤0.001	31.58±0.88	≤0.001	≤0.001	≤0.001	0.041
Total resistance phase score	52.89±0.81 p1–4≤0.001	47.65±0.90 p2–4≤0.001	44.05±1.03 p3–4≤0.001	37.71±0.76	≤0.001	≤0.001	≤0.001	0.051
Total exhaustion phase score	47.92±0.95 p1–4≤0.001	44.24±1.21 p2–4≤0.001	38.31±1.01 p3–4=0.005	34.44±1.04	≤0.001	0.098	<0.001	<0.001

Note: group 1 — medical workers of COVID-19 hospitals (working in the “red zone”); group 2 — medical workers of the outpatient clinics providing medical care in conditions of an increased epidemic threshold for ARVI, influenza and COVID-19; group 3 — medical workers of multidisciplinary hospitals providing medical care in their main profile and periodically identifying patients with COVID-19; group 4 — control group.

Table 1 demonstrates that when analyzing the total stress phase score, its significant increase was determined in the group of medical workers of COVID-19 hospitals (working in the “red zone”) (p1–4≤0.001), medical workers of multidisciplinary hospitals (p3–4≤0.001) as well as medical workers of outpatient clinics (p2–4≤0.001) compared to the control group. It was found that the total stress phase score was significantly higher in medical workers of COVID-19 hospitals (working in the “red zone”) compared to medical workers of multidisciplinary hospitals (p1–3≤0.001) and medical workers of outpatient clinics (p1–2≤0.001). At the same time, the total stress phase score in medical workers of multidisciplinary hospitals was significantly lower compared to medical workers of outpatient clinics (p2–3=0.041).

When analyzing the total resistance phase score, its significant increase was determined in the group of medical workers of COVID-19 hospitals (working in the “red zone”) (p1–4≤0.001), medical workers of multidisciplinary hospitals (p3–4≤0.001), and medical workers of outpatient clinics (p2–4≤0.001) compared to the control group. At the same time, it was found that the total resistance phase score was significantly higher in medical workers of COVID-19 hospitals (working in the “red zone”) compared to medical workers of multidisciplinary hospitals (p1–3≤0.001) and medical workers of outpatient clinics (p1–2≤0.001). However, no significant differences were revealed when comparing the group of medical workers in multidisciplinary hospitals and the group of medical workers in outpatient clinics (p2–3=0.051).

When assessing the total exhaustion phase score, its significant increase was determined in the group of medical workers of COVID-19 hospitals (working in the “red zone”) (p1–4≤0.001), medical workers of multidisciplinary hospitals (p3–4=0.005), and medical workers of outpatient clinics (p2–4≤0.001) compared to the control group. At the same time, the total exhaustion phase score was significantly higher in the medical workers of COVID-19 hospitals (working in the “red zone”) compared to the medical workers of multidisciplinary hospitals (p1–3<0.001), but there were no significant differences compared to the medical workers of the outpatient clinics (p1–2=0.098). However, the total exhaustion phase score in medical workers of multidisciplinary hospitals was significantly lower compared to medical workers in outpatient clinics (p2–3≤0.001).

The indicators of situational anxiety were assessed and analyzed after processing the results of the survey of medical workers with the “Integrative test for anxiety (ITA)” [7].

Table 2

Indicators of the components of situational anxiety in the studied groups of medical workers

	Group 1	Group 2	Group 3	Group 4	panova	p1–2	p1–3	pb2–3
Emotional discomfort	5.97±0.12 p11–10≤0.001	4.7±0.10 p2–10≤0.001	3.96±0.12 p3–10=0.399	3.67±0.11	≤0.001	≤0.001	≤0.001	≤0.001
Asthenic component	6.25±0.10 p1–10≤0.001	5.32±0.07 p2–10≤0.001	4.91±0.14 p3–10=0.05	3.81±0.12	≤0.001	≤0.001	≤0.001	≤0.001
Phobic component	5.60±0.10 p1–10≤0.001	6.26±0.07 p2–10≤0.001	4.28±0.12 p3–10≤0.001	3.51±0.12	≤0.001	≤0.001	≤0.001	≤0.001
An alarming assessment of the prospects	6.87±0.10 p1–10≤0.001	5.63±0.08 p2–10≤0.001	4.49±0.12 p3–10=0.003	3.88±0.13	≤0.001	≤0.001	≤0.001	≤0.001
Social protection	6.38±0.11 p1–10≤0.001	5.69±0.14 p2–10≤0.001	4.28±0.11 p3–10=0.003	4.06±0.10	≤0.001	≤0.001	≤0.001	≤0.001
General level of anxiety	6.22±0.11 p1–10≤0.001	5.34±0.07 p2–10≤0.001	4.18±0.11 p3–10=0.056	3.72±0.12	≤0.001	≤0.001	≤0.001	≤0.001

Note: group 1 — medical workers of COVID-19 hospitals (working in the “red zone”); group 2 — medical workers of the outpatient clinics providing medical care in conditions of an increased epidemic threshold for ARVI, influenza, and COVID-19; group 3 — medical workers of multidisciplinary hospitals providing medical care in their main profile and periodically identifying patients with COVID-19; group 4 — control group.

Table 2 demonstrates that for all components, the indicators were significantly higher in the group of medical workers of infectious hospitals providing medical care to patients with COVID-19 (working in the “red zone”) compared to medical workers of other study groups.

In medical workers of infectious hospitals providing medical care to patients with the new coronavirus infection COVID-19 (working in the “red zone”), the “alarming assessment of prospects” indicator prevailed. The “social protection” indicator prevailed in medical workers of hospitals that provided medical care in their main profile, operating in the “normal mode” and periodically identifying patients with the new coronavirus infection COVID-19. In medical workers of outpatient clinics providing medical care in conditions of an increased epidemic threshold for ARVI, influenza, and the new coronavirus infection COVID-19, the “phobic component” indicator prevailed, reflecting the most specific factor in the structure of alarm-anxiety.

The surveyed group of medical workers of COVID-19 hospitals providing medical care to patients with COVID-19 showed a significantly increased total stress phase score compared to medical workers of multidisciplinary hospitals and medical workers of outpatient clinics. This might be due to the fact that high workload levels and the threat of COVID-19 infection significantly increased the stress phase score in medical workers of COVID-19 hospitals. The results of this study are consistent with those of other studies [9–10]. At the same time, in a group of medical workers of outpatient clinics providing medical care in conditions of an increased epidemic threshold for ARVI, influenza, and the new coronavirus infection COVID-19, total stress phase score was significantly higher than in medical workers of multidisciplinary hospitals. This could be explained by the fact that in the context of the COVID-19 pandemic, the number of patients, and hence the workload, had increased by many times in medical workers of outpatient clinics. Overtime work became widely practiced. Medical workers in outpatient clinics also faced a shortage of personal protective equipment (PPE). There were problems due to the lack of the possibility of rapid testing when symptoms of COVID-19 appeared and others.

The total resistance phase score was significantly higher in medical workers of COVID-19 hospitals (working in the “red zone”) compared to medical workers in multidisciplinary hospitals and medical workers in outpatient clinics. A person, consciously or not, strives for psychological comfort, for reducing the pressure of external situations with the help of the means available to him. In conditions of extreme stress, physical fatigue, and emotional exhaustion, such methods of protection as formalized contact with patients and the lack of emotional involvement in work can be used.

The total exhaustion phase score was significantly higher in the medical workers of COVID-19 hospitals (working in the “red zone”) compared to the medical workers of multidisciplinary hospitals. This could be explained by the fact that medical workers in COVID-19 hospitals experienced tremendous physical exertion, prolonged fatigue, and a high risk of infection. They constantly faced anxiety and other negative emotions from patients and, in some cases, their families.

For all components, anxiety indicators were significantly higher in the group of medical workers of infectious hospitals providing medical care to patients with the new coronavirus infection COVID-19 (working in the “red zone”).

In infectious hospitals providing medical care to patients with the new coronavirus infection COVID-19 (working in the “red zone”), the “alarming assessment of prospects” indicator prevailed – the projection of fears not on the current state of affairs, but on the future, general concern for the future against the background of increased emotional sensitivity. Anne Rimoin, a professor at the University of California at Los Angeles, wrote: “This is a new virus, new to humanity, and no one knows where it will lead” [11].

In medical workers of hospitals that provided medical care in their main profile, operating in the “normal mode” and periodically identifying patients with the new coronavirus infection COVID-19, the “social protection” indicator prevailed. Factor loads and the experience of communicating with people who had high anxiety indicators, indicated the predominance of weariness, sleep disorders, lethargy and passivity, and rapid fatigue.

In medical workers of outpatient clinics providing medical care in conditions of an increased epidemic threshold for ARVI, influenza, and the new coronavirus infection COVID-19, the “phobic component” indicator prevailed, reflecting the most specific factor in the structure of alarm-anxiety. In the picture of the emotional background, feelings of an incomprehensible threat, self-doubt, and own uselessness predominated and had peak values. This was most likely due to the fact that medical workers in outpatient clinics daily encountered a large number of unexamined patients who might be infected with the new coronavirus infection. This, along with a high level of professional workload, might increase fear and anxiety in this group of medical workers. Medical workers of outpatient clinics might fear for their own health and the health of their family members. The control measures taken could also increase the “phobic component” in medical workers of outpatient clinics providing medical care in conditions of an increased epidemic threshold for ARVI, influenza, and the new coronavirus infection COVID-19.

The results obtained allow proposing certain measures, including socio-psychological and professional-organizational measures, for the prevention of mental health disorders among medical workers in the context of the COVID-19 pandemic. The first group of preventive measures includes the provision of information by the media about the difficulties of working in COVID-19 hospitals. Support from the administration of the medical institution, colleagues, and family is also an effective preventive measure. The second group includes compliance with the rules for organizing work and leisure, the possibility of obtaining psychological training and additional education, free access to PPE, the possibility of separate residence at the risk of family infection, the availability of time and place for recreation, catering and, communication with loved ones during the duty schedule, and the ability to refuse to work with infected patients.

Conclusion

While studying the phases of emotional burnout, it was revealed that medical workers in COVID-19 hospitals (working in the “red zone”) had significantly higher stress and resistance phase scores compared to medical workers in multidisciplinary hospitals and the ones in outpatient clinics.
While studying the anxiety for all components, it was identified that the indicators were significantly higher in the group of medical workers in COVID-19 hospitals (working in the “red zone”) compared to medical workers in multidisciplinary hospitals and the ones in outpatient clinics.
The prevention of mental health disorders among medical workers in the context of a COVID-19 pandemic can include socio-psychological and professional-organizational measures.

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About the Authors

L. A. Strizhakov

First Moscow State Medical University named after I.M. Sechenov (Sechenov University)
Russian Federation

Leonid A. Strizhakov, Dr. Sci. (Med.), Head of the Center for Occupational Pathology of the Ministry of Health of Russia, Professor of the Department of Internal, Occupational Diseases and Rheumatology

Moscow

Competing Interests: