Impact of the COVID-19 pandemic on critical care health care workers depression, anxiety, and stress levels

Hammond, N.E.; Crowe, L.; Abbenbroek, B.; Elliott, R.; Tian, D.H.; Donaldson, L.H.; Fitzgerald, E.; Flower, O.; Grattan, S.; Harris, R.; Sayers, L.; Delaney, A.

AIM: Determine levels of depression, anxiety and stress symptoms and factors associated with psychological burden amongst critical care health care workers in the early stages of the coronavirus disease (2019) (COVID-19) pandemic. METHODS: Anonymous web-based survey distributed in April 2020. All health care workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of health care workers that reported moderate to extremely severe scores on the Depression Anxiety Stress Scale-21 (DASS-21) RESULTS: Of the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were female; median age was 41 years old. Nurses made up 2269 (60.2%) of respondents with most [2029 (53.8%)] working in Intensive Care Units.Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety and 1057 (28.0%) moderate to extremely severe stress scores. Mean ± standard deviation DASS-21 depression, anxiety and stress scores amongst woman vs men were: 8.0 ± 8.2 vs 7.1 ± 8.2 (p=0.003); 7.2 ± 7.5 vs 5.0 ± 6.7 (p<0.001); and 14.4 ± 9.6 vs 12.5 ± 9.4 (p<0.001) respectively.After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included; not being clinically prepared (β 4.2, p<0.001), an inadequate workforce (β 2.4, p=0.001), having to triage patients due to lack of beds and or equipment (β 2.6, p=0.001), virus transmission to friends and family (β 2.1, p=0.009), contracting COVID-19 (β 2.8, p=0.011), being responsible for other staff (β 3.1, p<0.001), and being asked to work in an area that was not in the respondents expertise (β 5.7, p<0.001). CONCLUSION: In this survey of critical care health care workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety and stress symptoms with females reporting higher scores compared to men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further.