In a recent study posted to the medRxiv* pre-print server, a team of researchers surveyed the prevalence of mental health disorders in intensive care unit (ICU) workers from England from November 2020 to April 2021.
The winter of 2020-2021 witnessed an unprecedented surge of critically ill COVID-19 patients in all the 56 ICUs of National Health Services (NHS), England. During this time, all the surveyed ICU units exceeded 100% of their baseline capacity, thus showing healthcare workers, particularly junior nursing staff, were most impacted due to this public health emergency.
As the ongoing pandemic situation and the backlog of care are still exerting pressures on ICU resources, it is crucial to identify risk factors to help ensure that appropriate support is made available for them and to inform future pandemic planning.
About the study
In the present study, an anonymized web-based survey was designed and run in 56 NHS ICUs to probe the prevalence of the following mental health disorders in the ICU staff - probable depression, probable PTSD, probable general anxiety disorder (GAD), and problem drinking. All the staff working in ICUs, including doctors, nurses, and other healthcare professionals, were eligible to participate, and they received the survey through departmental email and messaging groups.
The 56 NHS hospitals provided data for the study, including demographic details, such as age, gender, job role, and seniority, to help researchers explore their demographic and professional predictors. The data collection occurred across three-time points - 19 November to 17 December 2020, 26 January to 17 February 2021, and from 14 April to 24 May 2021.
Any mental disorder (AMD) was the primary variable, which referred to those meeting the threshold criteria for at least one of the probable mental disorders: moderate or severe anxiety or depression, problem drinking, or PTSD.
Following questionnaires with binary outcomes were set to indicate a case: the 9-item patient health questionnaire (PHQ-9) with a score of >9 indicating probable moderate depression and >19 probable severe depression; the 6-item post-traumatic stress disorder checklist (PCL-6) with a score of >17 indicating the presence of probable PTSD; audit-C with a score of >7 indicated problem drinking; the 7-item GAD scale with a score >9 indicated a probable moderate anxiety disorder and >15 indicated probable severe anxiety disorder.
A work and social adjustment scale (WSAS) added to the survey identified how a problem in ICU staff's life affected their work. It consisted of five items evaluated on an 8-point Likert scale, and a score of >20 indicated severe psychopathology-related functional impairment, and a score of >10 indicated moderate functional impairment.
At the peak of the 2020-2021 COVID-19 patient surge, close to two thirds and over half of the sampled ICU staff met the threshold criteria for at least one of the surveyed probable mental health disorders and functional impairment, the impact of which further deteriorated their mental health due to the presence of probable PTSD, anxiety or depression. These results suggested a potential association between poorer mental health and patient outcomes.
Consistent with previous findings showing that younger adults of the general population are more likely to report poor mental wellbeing, the likelihood of reporting AMD was higher in junior nurses. This study, thus, showed a relationship between seniority and mental health among ICU staff.
At all three time points of the study, a substantial number of ICU workers met or exceeded the threshold for probable PTSD. In the absence of any pre-pandemic data to draw any inference from, authors found these rates comparable with that seen in British military veterans deployed during the war in Afghanistan.
The association between functional impairment and patient safety outcomes demonstrated by the current study is highly concerning. Future research should explore these relationships in further detail to ensure patient safety and collect identifiable information for linking cases over time for a more refined statistical analysis. Additionally, the WSAC results could help in a detailed analysis of functional impairment.
The authors recognized the exceptional nature of the COVID-19 pandemic and the extraordinary pressure it exerted on the NHS, England. Based on the study findings, the authors emphasized ensuring psychologically healthy workplaces for patient safety. They recommended providing adequate support, especially for the junior nursing staff, efficient resourcing, and staffing of intensive care units so that individuals reporting high levels of stress could be rested or temporarily rotated away from higher intensity clinical roles. More importantly, they recommended decreasing workload intensity to reverse the adverse effects on the mental health of ICU staff.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.