Treating coronavirus takes a toll on doctors’ and nurses’ mental health

If you’re finding it hard to stay home right now, imagine how it would feel to be a doctor or nurse. Health care workers don’t have the luxury of holing up in their homes to shield themselves from the coronavirus. They have to expose themselves to the risk, and some are separating themselves from their families for weeks to avoid transmitting the virus to them.

They’re not only suffering the anxiety of caring for sick patients — while facing a dire lack of personal protective equipment and rapidly changing hospital protocols — but also forgoing the calming companionship of their partners and children. It’s a whole different level of lonely from what most of us are dealing with.

So it should come as no surprise that the mental well-being of health care workers is in serious jeopardy. A new study, published this week in the Journal of the American Medical Association, quantifies that risk.

The survey-based study examines the mental health outcomes of 1,257 health care workers attending to Covid-19 patients in 34 hospitals in China. The results are not comforting. A large proportion of them report experiencing symptoms of depression (50 percent), anxiety (45 percent), insomnia (34 percent), and psychological distress (71.5 percent).

Women and nurses report especially severe symptoms — perhaps not surprising, given that they’re often called on to do extra emotional labor, like keeping up a steady stream of reassurances while suppressing their own feelings, which is known to take a toll. Front-line workers and those in Wuhan, the epicenter of the original outbreak, exhibit a greater psychological burden than Chinese health care workers farther from the epicenter.

The study notes that during the 2003 SARS outbreak, health care workers feared they would infect their family or friends and felt stigmatized because they were known to be in close contact with sick patients. They experienced significant long-term stress. Similar fears are probably contributing to health care workers’ distress now, in addition to the obvious concern that they are at higher-than-average risk of contracting Covid-19, the authors say.

“Protecting health care workers is an important component of public health measures for addressing the Covid-19 epidemic,” the study concludes. “Special interventions to promote mental wellbeing in health care workers exposed to Covid-19 need to be immediately implemented, with women, nurses, and frontline workers requiring particular attention.”

An Australian doctor pleaded with the public to socially distance in a March 16 Twitter thread. “Many of us are in tears, not at the thought of risking our own health (that comes with our job), but of distancing ourselves from our loved ones,” she added.

The study doesn’t specify which mental health interventions should be used to help health care workers, but the American Psychological Association (APA) notes that recommended methods for improving resilience during the SARS outbreak included a particular “stress appraisal and coping framework” as well as principles of “psychological first aid.”

The limitations of the study are worth noting. It can’t distinguish preexisting mental health symptoms from new symptoms, and it lacks longitudinal follow-up, since the survey was carried out during six days (January 29 to February 3). Plus, it focuses exclusively on health care workers in China.

Nevertheless, the mental health toll on health care workers in other countries is likely to be similarly dire.

Take Italy, for example. Doctors there have had to choose among patients for who gets put on a ventilator, a heartbreaking decision that may cause lasting psychological distress.

What’s more, because there aren’t enough infectious disease specialists to tend to all the Covid-19 patients, other doctors like ophthalmologists and dermatologists are being trained to care for them, for example by providing supplemental oxygen. (One Bergamo hospital trained 1,500 people in seven days.) Most have no experience watching a patient be intubated or die in front of them, and since that can be traumatic, some of them may end up with post-traumatic stress disorder or other mental health problems down the line.

In the US, the situation is rapidly worsening, too.

An epidemiologist in Atlanta who is separated from her spouse, a physician. “As I attempt to home school my kids (alone) with a new baby who screams if she isn’t held, I am worried about the health of my spouse and my family,” she tweeted.
Twitter

“We’re trying to keep up, but our leadership seems as confused as we are on the ground. I’m one step behind on crucial information, lack essential equipment, and drowning in community panic,” wrote Laura Danso, a family medicine physician assistant in Denver, Colorado, on March 21. “People look to me daily to provide some measure of reassurance. I have little to offer.”

Danso called the crisis “infuriating, and frustrating, and frightening,” yet reached the same conclusion so many other health care workers are voicing: “While everyone is home tomorrow, I will get up, cover up the dark circles, kiss my boys goodbye, and go to work.”

An ER doctor who worked during an Ebola outbreak in West Africa years ago said on Twitter that he is now afraid of Covid-19.
Twitter

The rest of us also need to protect our mental health. Here are some tips.

A pandemic can exert a serious mental health toll on anyone, regardless of whether they work in health care. So if you’re feeling more anxious than usual, know that you’re not alone. And know that there are some things you can do to mitigate the negative effects on your well-being.

The Centers for Disease Control and Prevention (CDC) recommends eating well-balanced meals, exercising regularly, and getting plenty of sleep. Your best defenses against becoming rundown prior to the pandemic are still your best defenses during it.

The CDC and the APA both warn that consuming too much coronavirus-related media — especially social media — can undermine mental health. If you can, it’s a good idea to limit your news intake to once or twice a day, and block out some time each day (say, between dinner and bedtime) when you don’t permit yourself to check the news. It’s important to stay informed, but past a certain point, checking for updates is not informing so much as agitating you.

The APA also notes that managing stress early on can prevent long-term mental health troubles. If you start to feel an acute increase in anxiety, depression, or other condition, consider seeking professional help sooner rather than later, if possible. Many therapists are now offering telemedicine options. The Substance Abuse and Mental Health Service Administration has a 24/7 distress helpline, reachable at 1-800-985-5990, as well as an app. Some companies are offering their employees free therapy during the pandemic.

There are also a variety of mindfulness meditation practices you can try, and they don’t cost a thing. Many neuroscience studies have shown that meditating can help us not only calm our own anxiety, but also act more altruistically toward other people.

Which brings us to another tip: Find ways to help other people — it’ll probably improve your mental health. Whether it’s volunteering to get groceries for an older person who’s staying home, or helping AI predict the spread of Covid-19, or donating to a good charity that’s doing coronavirus relief, research shows that helping others can make us happier and healthier, too.

Finally, consider helping any health care workers you know by sending them extra words of support during this pandemic. Avoid using stigmatizing language. Instead, honor them for doing lifesaving work at great personal risk.


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