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Updated: August 6, 2020

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

Summary

The following is a summary of evidence sources that provide high quality information on the impacts of COVID-19 on the mental health of front-line workers. For additional information about each of the sources, see the Table below.

The authors of one review and four expert commentaries state that front-line workers may experience considerable psychological distress such as depression, anxiety, helplessness and insomnia as a result of the COVID-19 pandemic [2,5,6,8,9]. An expert review and an expert commentary noted that sources of anxiety for front-line workers include: 1) insufficient access to personal protective equipment (PPE); 2) fear of infecting their families; 3) lack of rapid access to testing and accurate information; 4) feeling unsupported by their organization; 5) limited access to childcare; and 6) stigmatization of psychological vulnerability [7,10]. This commentary and another review noted that if specific stressors are identified, it is beneficial for an organization to create targeted approaches to address these specific needs [1,7]
 
To mitigate the mental health impacts of COVID-19 on front-line workers, a combination of strategies is recommended as follows. One review and one commentary suggested that ensuring quality and honest communications to all workers is essential to build trust among workers [2,5]. The World Health Organization provides guidance in its Mental health and psychosocial considerations during the COVID-19 outbreak, by recommending: 1) worker rotations from high-stress to lower-stress functions; 2) providing a buddy system to partner less experienced workers with more experienced colleagues; and 3) ensuring workers are adequately rested and staying connected with friends and family [3]. In  Maintaining your and your family’s well-being during a pandemic, the Canadian Medical Association recommended: 1) implementing a mental health first aid course for staff; 2) creating teams to separate clinical and resource allocation decisions; and 3) encouraging staff to support each other [4]. Further, several reviews and commentaries found that implementing shorter schedules with greater flexibility (i.e., that allow workers to care for family members) and providing online mental health support may further reduce stress among front-line workers [1,3,5].
 
In a commentary on t he mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus, it was suggested that protecting the mental health of workers is not only important to the health of the worker but in the overall control of the epidemic [6].

Evidence

What‘s Trending on Social Media and Media

In Toronto, Dr. Robert Maunder and Dr. Jonathan Hunter from Mount Sinai Hospital and the University of Toronto create a YouTube video: Three steps to coping with anything (including COVID-19) directed to help their hospital colleagues. 

A Twitter thread started by UofT Medicine encourages users to share what tips and advice they have about staying well during the pandemic. 

A COVID-19 Women Physicians’ Emotional Well-Being Facebook group hosts more than 3,000 members in the hopes of creating a safe space for female physicians to support each other through COVID-19.

The Centre for Addiction and Mental Health (CAMH) partners with Cisco Canada’s Webex to increase the number of virtual visits they can offer to patients and frontline workers during the COVID-19 pandemic.

Organizational Scan

The Centre for Addiction and Mental Health (CAMH) has developed a self-referral form to help healthcare providers access the services and support they need [11].

In partnership with the Canadian Mental Health Association (CMHA), St. Joseph’s Healthcare Hamilton has increased support to front-line workers by providing virtual counselling sessions, peer-to-peer support and phone call sessions whenever needed [12].

The Canadian Psychological Association has put out a call requesting that all psychologists donate their time to provide free counselling for health care providers. Their website connects healthcare providers with these counsellors [13].

The Centre for Effective Practice has compiled a list of resources developed specifically for health care providers [14].

The Ontario Hospital Association has compiled a list of resources (i.e., Ontario, national, and international categories) developed specifically for health care providers [15].

The Royal College of Physicians and Surgeons of Canada has also compiled a list of COVID-19 health professional wellness resources including general resources and articles, services/drop-ins for physicians, and other physician resources [16].

Review of Evidence

Resource Type/Source of Evidence Last Updated
Preventing occupational stress in healthcare workers
— Ruotsalainen et al.
Systematic Review

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. 

Last Updated: April 6, 2015
COVID-19 Critical Intelligence Unit: Mental health of healthcare workers
— New South Wales Government
Rapid Review

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. 

Last Updated: April 14, 2020
Mental health and psychosocial considerations during the COVID-19 outbreak
— WHO: World Health Organization
International Guidance

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. 

Last Updated: March 17, 2020
Maintaining you and your family’s well-being during a pandemic
— CMA: Canadian Medical Association
Professional Organization

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. 

Last Updated: May 13, 2020
Mitigating the psychological effects on COVID-19 on health care workers
— Wu et al.
Commentary

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.

Last Updated: April 26, 2020
The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus
— Kang et al.
Commentary

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. 

Last Updated: February 4, 2020
Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic
— Shanafelt et al.
Commentary

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.

Last Updated: April 6, 2020
Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019
— Lai et al.
Single Study

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. 

Last Updated: March 22, 2020
Brief Psychotic Disorder Triggered by Fear of Coronavirus? A Small Case Series
— Martin Jr.
Commentary

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. 

Last Updated: March 24, 2020
The mental health of doctors during the COVID-19 pandemic
— Galbraith et al.
Rapid Review

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.

Last Updated: April 23, 2020
CAMH enhances virtual capacity to respond to demand for mental health services
— CAMH: Centre for Addiction and Mental Health
Organizational Scan

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

Last Updated: May 3, 2020
COVID 19: Mental Healt Services for HCW
— St. Joseph’s Healthcare Hamilton
Organizational Scan

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

Last Updated: May 13, 2020
Psychology works for COVID-19, Psychologists giving back to front line service providers
— Canadian Psychological Association
Organizational Scan

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

Last Updated: May 13, 2020
Mental health and well-being support for providers
— CEP: Centre for Effective Practice
Organizational Scan

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

Last Updated: August 5, 2020
Strengthening Mental Health and Wellness During COVID-19
— OHA: Ontario Health Association
Organizational Scan

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

Last Updated: May 13, 2020
Wellness resources for health professionals
— Royal college of Physicians and Surgeons of Canada
Organizational Scan

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

Last Updated: August 6, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

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