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A high proportion of staff working in intensive care units during the COVID-19 pandemic have experienced mental health conditions, a new study shows.

In a study of 515 healthcare staff working in intensive care units (ICUs) across seven countries, the researchers found that on average 48 percent of participants showed signs of mental health conditions - depression, insomnia and post-traumatic stress disorder (PTSD). Their mental health was assessed using a detailed questionnaire and a clinical scoring system. 

The team also found a 40 per cent increase in the conditions for those who spent more than six hours in personal protective equipment (PPE) over a course of a day, compared to those who didn’t.

The study, led by researchers at Imperial College London, is published in the British Journal of Nursing and is the first to evaluate ICU workers’ mental health during the COVID-19 pandemic. In line with the UK Government’s report on burnout in NHS staff published in June 2021, the researchers suggest that the high level of mental health conditions found among the ICU staff surveyed should inform local and national wellbeing policies.

Mental health resources

This is a timely study which acts as a stark reminder of the personal challenges healthcare staff are facing as a result of COVID-19.  Dr Ahmed Ezzat Honorary Clinical Fellow at Imperial College London

Dr Ahmed Ezzat, lead author of the study and Honorary Clinical Fellow at Imperial College London, said: “This is a timely study which acts as a stark reminder of the personal challenges healthcare staff are facing as a result of COVID-19.  As within wider society, mental illness of healthcare staff still remains a taboo subject for some. Recent  public campaigns have started the conversation, but we have a long way to go. COVID-19 has acutely exacerbated the issue, and our concern is how staff resilience has been exhausted and what national medium or long term resources are set in place by policy makers to safeguard this  workforce from severe mental illness. We have an opportunity to hold a national dialogue of healthcare leaders, stakeholders and governments around the world to address mental health within healthcare.”

Dr Matthieu Komorowski, senior author of the study and Clinical Senior Lecturer in the Department of Surgery and Cancer at Imperial College London, said:

“The COVID-19 pandemic has impacted the physical and mental health of healthcare workers around the world.  The large number of patients admitted to hospital at the height of the pandemic has put considerable demand and pressure on ICUs and staff.   Although there has been much reporting on the mental health of frontline workers there has been little done to assess the impact of the pandemic on those who were treating the sickest patients in ICU.

“This study shows the impact of working in ICU on staff’s mental health.  We saw high levels of depression, insomnia and PTSD.   Factors such as individual isolation, loss of social support during lockdown, combined with a change in work pattern may have exacerbated these conditions. 

“Work related stress is well documented in healthcare workers and this has been worsened by the COVID-19 crisis.  The results of this study suggest that all ICU staff should have access to early and effective mental health assistance as part of a wider staff health and wellbeing strategy.   This is especially pressing as hospitals and governments prepare their workforce for potential further surges of COVID-19 patients.”

During the height of the COVID-19 pandemic there were large intakes of patients admitted to ICUs, exceeding capacity. To manage demand, many hospitals have had to increase the ICU workforce via staff redeployment, with staff required to undertake duties that require different skills from their normal roles.

Although the mental health burden in healthcare workers caused by COVID-19 has gained increasing attention, there has been a lack of data, especially relating to healthcare workers in ICU.  The researchers wanted to examine whether critical care staff experienced adverse mental health in a similar way to frontline healthcare workers, during the height of the COVID-19 pandemic.

Global impact of working in ICU

The team recruited 515 healthcare workers working in ICUs in May 2020. They covered a range of roles such as nurses, junior and senior doctors, healthcare assistants and physiotherapists. Participants were from the UK (73), France (309), Italy (31), Taiwan (29), Belgium (2), Egypt (3) and China (68). They were recruited by word of mouth, emails and social media platforms. 

Using a detailed questionnaire, the team asked participants questions on their wellbeing and anxieties.  They then scored their responses using three different grading systems used in clinical settings to identify depression, PTSD and insomnia.  The team found that across the various countries explored, 37 percent of respondents exceeded the threshold for signs of depression, 78 for insomnia and 28 percent for PTSD. 

The team also identified an increase in the scores in those who spent more than six hours in PPE over a course of a day.  On average, there was a 40 percent increase in the depression score for those spending over six hours in PPE compared to those who didn’t and a 23 per cent increase in the insomnia and PTSD scores, suggesting that mental health conditions amplify with longer time spent in PPE.

The authors also found that 57 percent of respondents declared feeling very or extremely worried about getting infected, while 21 percent were very or extremely worried about dying after catching the virus. Overall, 78 percent of respondents reported feeling at least a little numb about the loss of human lives, and most (89 percent) thought about these difficult experiences outside of work.

Finally, 88 percent agreed that healthcare staff should be offered dedicated time off work once it was clinically safe to do so, and 85 percent were in favour of offering individual counselling sessions to healthcare workers.

The authors acknowledge there are some limitations to the study as respondents were self-selecting rather than randomly chosen, which could affect how representative this group was of ICU workers as a whole.  Of those who responded, 11 said they had pre-existing mental health conditions.  Despite this, the researchers suggest the data provides a useful indicator of mental wellbeing across ICU staff and the findings can be used to devise local and national policies to address this.