What are the mental health impacts on front-line workers during the pandemic?

This review states that cognitive-behavioural therapy (i.e., stress management training) and mental and physical relaxation among healthcare workers effectively reduces stress. Changing work schedules may further reduce stress. Organizational interventions should focus on the reduction of specific stressors. 

This review describes how healthcare workers have experienced higher rates of depression, anxiety, insomnia and distress associated with the COVID-19 pandemic than the general public. 

This review offered recommendations for organizations including ensuring quality communication provided to all workers, rotating workers from high-stress to lower-stress functions, monitoring and providing staff with evidence-based treatments when necessary, and applying the principles of Mental Health First Aid to all staff. 

This guidance document outlines coping strategies for health care workers to include: adequate rest, sufficient and healthy food intake, staying physically active and staying connected with friends and family can be extremely beneficial.   Rotate workers from higher-stress to lower-stress functions, implement flexible schedules for workers caring for family members and provide a buddy system to partner inexperienced workers with more experienced colleagues. Focus should be placed on longer-term occupational capacity rather than repeated short-term crisis responses. 

This article describes ways in which distress can be mitigated in health organizations. These include holding staff debrief meetings on a regular basis, encouraging team members to support each other, implementing a buddy system to stay connected, creating triage teams to separate clinical and resource allocation decisions, and creating guides to advertise wellness supports for staff. If possible, implement a mental health first aid course to increase awareness, decrease stigma and identify appropriate language. 

This commentary notes that health care workers may experience considerable psychological distress as a result of providing direct patient care, trauma, quarantine or self-isolation. 

Strong leadership with honest communication is needed to offset fear. Adequate resources (i.e. medical supplies) and mental health support (especially online technology to encourage physical distancing) will reinforce confidence. Emphasizing the selflessness of health care will encourage a sense of purpose.

This commentary indicates that adverse mental health impacts are the result of inadequate protection from COVID-19 contamination, overwork, discrimination, isolation and exhaustion.

Mental health impacts may hinder attention and decision-making ability. Protecting mental health is therefore important to control the epidemic and the long-term health of workers. 

This article describes the main sources of anxiety among healthcare workers as identified through focus groups. These include access to appropriate PPE, fear of infecting their families, not having rapid access to testing if they develop symptoms, access to childcare, lack of access to accurate information, and feeling unsupported by their organization. 

Understanding the sources of anxiety among workers can allow organizations to create targeted approaches to address these sources.

This article reports the result of a survey that evaluated mental health outcomes affecting health care workers. Frontline workers experiencing a greater psychological burden were more likely to be women, have intermediate professional titles such as nurses, and be frontline health workers directly engaged in diagnosis, treatment and care for COVID-19 patients.

This study also reported that during the acute SARS outbreak, 89% of health care workers in high-risk situations report psychological symptoms. 

This article presents a case study of three frontline workers presenting to an emergency department with “corona psychosis”. The workers developed irrational behaviour, insomnia, suicidal thoughts, and helplessness corresponding to media coverage and immense stress related to COVID-19. 

This article describes the main sources of anxiety among healthcare workers as identified through focus groups. These include access to appropriate PPE, fear of infecting their families, not having rapid access to testing if they develop symptoms, lack of communication from leaders and feeling unsupported by their organization.

The article suggests providing education, training, and support at both the individual and organizational level would be beneficial to their mental health. This includes mindfulness skill and other self management and distressing skills being taught at the individual level and additional safeguards such as financial support for families of healthcare workers, recognition of their efforts, and reduction of stigmatism around seeking mental health would all be beneficial in improving the mental health of front-line workers.

Summary points from the news release by CAMH is available in the organizational scan.

Summary points from the institutional resource by St. Joseph’s Healthcare Hamilton is available in the organizational scan.

Summary points from the professional resource by the Canadian Psychological Association is available in the organizational scan.

Summary points from the clinical guidance by CEP is available in the organizational scan.

Summary points from the news article by OHA is available in the organizational scan.

Summary points from the document by the Royal college of Physicians and Surgeons of Canada is available in the organizational scan.