COVID-19-Related Stress Symptoms Among Emergency Department Personnel

Rodriguez, Robert M.; Montoy, Juan Carlos C.; Hoth, Karin F.; Talan, David A.; Harland, Karisa K.; Eyck, Patrick Ten; Mower, William; Krishnadasan, Anusha; Santibanez, Scott; Mohr, Nicholas; Monica Bahamon, M.P.H.; Carlson, Jestin N.; Chisolm-Straker, Makini; Driver, Brian; Faine, Brett; D, Pharm; Galbraith, James; Giordano, Philip A.; Haran, John P.; Higgins, Amanda; Hinson, Jeremiah; House, Stacey; Idris, Ahamed H.; Kean, Efrat; Krebs, Elizabeth; Kurz, Michael C.; Lee, Lilly; Liang, Stephen Y.; Lim, Stephen C.; Moran, Gregory; Nandi, Utsav; Pathmarajah, Kavitha; Paxton, James H.; Perez, Yesenia; Rothman, Richard; Schrading, Walter A.; Shuck, Jessica; Slev, Patricia; Smithline, Howard A.; Souffront, Kimberly; Steele, Mark; St. Romain, Michelle; Stubbs, Amy; Swanson, Morgan; Tiao, Josh; Torres, Jesus R.; Trent, Stacy; Uribe, Lisandra; Venkat, Arvind; Volturo, Gregory; Wallace, Kelli; Weber, Kurt D.

Importance During the coronavirus disease 2019 (COVID-19) pandemic, frontline emergency department (ED) healthcare personnel (HCP) may be particularly susceptible to anxiety, burnout, and post-traumatic stress disorder (PTSD). Objectives Among a comprehensive range of ED HCP, to assess symptoms of anxiety and burnout; specific COVID-19 work-related stressors; PTSD risk; and to determine perceptions of whether COVID-19 serologic testing of HCP would decrease self-reported anxiety. Design Prospective cohort study (enrollment from 5/13/20-7/8/20) using electronic surveys to capture participant self-reported symptoms before and after serologic testing for anti-SARS-CoV-2 IgG antibodies. Setting and Participants: Physicians, nurses, advanced practice providers (APPs), and non-clinical ED personnel at 20 geographically diverse United States EDs. Measurements We evaluated these domains: 1) effects of the COVID-19 pandemic on overall stress and anxiety; 2) COVID-19-related work stressors; 3) burnout; and 4) PTSD risk (measured using the Primary Care-PTSD Screen for DSM-5 [PC-PTSD-5], a five-item screening instrument in which a score of ≥3 signifies high risk for PTSD). We also assessed perceptions of whether results of COVID-19 antibody testing decreased participants’ self-reported anxiety. Results Of 1606 participants, 100% and 88% responded to the baseline and follow-up surveys, respectively. At baseline, approximately half (46.1%) reported symptoms of anxiety and burnout from their work, and 308 (19.2%, 95% CI 17.3-21.1%) respondents screened positive for elevated PTSD risk. Female respondents were more likely than males to screen positive (odds ratio [OR] 2.0, 95% CI 1.5-2.8). Common concerns included exposing their family and the health of co-workers diagnosed with COVID-19. After receiving antibody test results, 54% (95% CI 51.8-56.7) somewhat agreed, agreed, or strongly agreed that knowledge of their immune status had decreased their anxiety. A positive serology result indicating prior SARS-CoV-2 infection was associated with a higher likelihood of reporting decreased anxiety (2.83, 95% CI 1.28-6.25).