New research findings suggest that during the first wave of the pandemic in 2020 nearly half (45%) of doctors working in emergency medicine, intensive care and anaesthetics reported psychological distress – substantially higher than figures for the general population.
A survey undertaken at the lead up, the peak and after the peak of the first pandemic wave involving 5,440 emergency, anaesthetics and intensive care frontline doctors gauged the prevalence and extent of psychological distress and trauma for individuals working on the frontline in hospitals in the UK and Ireland. The research is the first to take this approach by looking at changes over these time points.
Results from study, released early as a pre-print*, which was led by a team from the Royal College of Emergency Medicine and psychologists from the University of Bath, suggest that a significant proportion of the frontline doctors are now experiencing post-traumatic stress and battling distressing symptoms as a consequence, while continuing to work in highly pressurised hospital settings. This is all exacerbated by the worsening, current situation with COVID-19.
Significantly, results found frontline healthcare workers’ fears of infecting family members were the most important factor in determining their own psychological distress and trauma, over and above how confident individuals felt in their training or preparedness for the pandemic. The research also found that doctors’ concerns about their own wellbeing were key in understanding the mental health impact for individuals over the course of the pandemic. This related specifically to fears about contracting the virus and pre-existing mental health difficulties.
Emergency Medicine Doctor, Tom Roberts from the Royal College of Emergency Medicine who led the work explains: “Our findings highlight the stark realities for many doctors across the UK and Ireland in responding to the public health crisis and the toll this has placed on their mental health. The extent of the challenge has at times been overwhelming and we see from our results the real-life impact this has on individuals’ wellbeing. For policymaking, this is both an immediate challenge and a long-term term one which requires not just increased awareness and recognition of psychological distress among the workforce, but clear, tangible pathways to effective psychological care accessible to all.”
Dr Jo Daniels, clinical psychologist and senior lecturer from the University of Bath’s Department of Psychology, added: “We now know that doctors are working on the frontline while carrying the heavy burden of fear of infecting themselves, or critically, family members, while some continue to battle high levels of psychological distress. This distress was evident in the lead up to the first peak, but our study shows it sustained well beyond this time point. It is now a pressing and urgent concern; doctors are at breaking point and cannot continue to work effectively in these very high pressured, high risk environments without psychological support to address their mental health needs.
“What is at stake not only affects the long-term mental health of this vital workforce, but their ability to function and deliver the services we depend on. It is crucial that we call to action policymakers and professional bodies to provide a tangible pathway and package of psychological care tailored to this group, acknowledging mental health is a problem is simply not enough.”
The authors highlight that psychological support for doctors varies across the UK, dependent on resources and provision locally, but say an ‘overarching best practice pathway’ needs to be put in place to help managers best support staff over the longer-term. This might include formalised peer and team support structures and be enhanced by access to evidence-based interventions such as Cognitive Behavioural Therapy (CBT) for those most significantly affected. Crucially this support needs to fit around the practicalities of shift work and be tailored to the different clinical issues frontline workers face.
Professor Edd Carlton from the Royal College of Emergency Medicine added: “We know that access to wellbeing and mental health support varies for individuals and across the country. In the face the biggest challenge the NHS has ever faced we need to ensure formalised routes are in place to help colleagues get the support they need in whichever part of a hospital they are working, wherever they are in the country. Workers across the NHS have responded to COVID-19 with incredible bravery, commitment and dedication. Over and above warm words, what we need most is proper support to help deal with impacts this has had on us all.”
Results from the research found that:
- Prevalence of psychological distress was 44.7% (n=1334) in the acceleration survey, 36.9% (n=1098) at peak and 31.5% (n=918) during the deceleration phase.
- Prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration.
- Prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration.
- Worry of family infection due to clinical work was most strongly associated with both distress and trauma.
As part of its Royal College of Emergency Medicine CARES campaign to tackle the issues facing Emergency Medicine, the College is calling for a focus on retention from policy makers. This includes the need to recruit and train an additional 2,500 consultants across the UK to help alleviate pressure on existing staff, and the need to create a workplace environment that values staff wellbeing and respects staff member’s work life balance.
*This paper is being released early as a pre-print for healthcare and policy professionals while currently under review. As the pandemic continues the team will continue to monitor the mental health impacts for frontline healthcare workers.