Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers’ infection and psychological distress during the COVID-19 pandemic in the USA

Oct 22, 2020BMJ open

Workplace factors linked to COVID-19 infection and mental stress in US healthcare workers

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Abstract

Twenty-nine percent of healthcare workers reported probable COVID-19 infection during the pandemic.

Emergency department workers had a higher likelihood of contracting COVID-19 (31.64%) compared to those in the ICU (23.17%) and inpatient settings (25.53%).
Healthcare workers who contracted COVID-19 reported increased levels of depressive symptoms, anxiety symptoms, and burn-out compared to those who did not.
The study included 3083 respondents from 48 states and US territories, with 2040 participants completing at least 80% of a 42-item survey.
Participants included physicians (31.12%), nurses (26.80%), and emergency medical technicians (13.04%), mainly from the Northeast and Southern USA.
Findings indicate significant physical and psychological risks faced by healthcare workers during the COVID-19 pandemic.

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OBJECTIVE: The COVID-19 pandemic has been associated with significant occupational stressors and challenges for front-line healthcare workers (HCWs), including COVID-19 exposure risk. Our study sought to assess factors contributing to HCW infection and psychological distress during the COVID-19 pandemic in the USA.

DESIGN: We conducted a cross sectional survey of HCWs (physicians, nurses, emergency medical technicians (EMTs), non-clinical staff) during May 2020. Participants completed a 42-item survey assessing disease transmission risk (clinical role, work environment, availability of personal protective equipment) and mental health (anxiety, depression and burn-out).

SETTING: The questionnaire was disseminated over various social media platforms. 3083 respondents from 48 states, the District of Columbia and US territories accessed the survey.

PARTICIPANTS: Using a convenience sample of HCWs who worked during the pandemic, 3083 respondents accessed the survey and 2040 participants completed at least 80% of the survey.

PRIMARY OUTCOME: Prevalence of self-reported COVID-19 infection, in addition to burn-out, depression and anxiety symptoms.

RESULTS: Participants were largely from the Northeast and Southern USA, with attending physicians (31.12%), nurses (26.80%), EMTs (13.04%) with emergency medicine department (38.30%) being the most common department and specialty represented. Twenty-nine per cent of respondents met the criteria for being a probable case due to reported COVID-19 symptoms or a positive test. HCWs in the emergency department (31.64%) were more likely to contract COVID-19 compared with HCWs in the ICU (23.17%) and inpatient settings (25.53%). HCWs that contracted COVID-19 also reported higher levels of depressive symptoms (mean diff.=0.31; 95% CI 0.16 to 0.47), anxiety symptoms (mean diff.=0.34; 95% CI 0.17 to 0.52) and burn-out (mean diff.=0.54; 95% CI 0.36 to 0.71).

CONCLUSION: HCWs have experienced significant physical and psychological risk while working during the COVID-19 pandemic. These findings highlight the urgent need for increased support for provider physical and mental health well-being.

Key numbers

29%

Prevalence of Probable COVID-19 Cases

Percentage of respondents meeting criteria for probable COVID-19 infection.

31.64%

Infection Rate in Emergency Department Workers

Proportion of emergency department HCWs who contracted COVID-19.

0.31

Increase in Depressive Symptoms Among Infected HCWs

Mean difference in depressive symptoms reported by infected HCWs.

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Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers’ infection and psychological distress during the COVID-19 pandemic in the USA

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