Open Access Open Access  Restricted Access Subscription or Fee Access

Anxiety and depression among public health workers during the COVID-19 pandemic

Emily J. Pfender, MA, Kahler W. Stone, DrPH, MPH, Kristina W. Kintziger, PhD, MPH, Meredith A. Jagger, MPH, Jennifer A. Horney, PhD, MPH

Abstract


Introduction: The public health workforce plays an essential role in the response to disasters and emergencies. Little is known about the prevalence of anxiety and depression among the public health emergency preparedness workforce responding to COVID-19 or the potential for social support to protect public health workers from adverse outcomes.

Methods: A cross-sectional online survey was conducted among a sample of the public health workforce participating in the response to COVID-19. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using Poisson regression with robust standard errors.

Results: Overall, 39.6 percent (140 of 345) of respondents reported anxiety and 29.4 percent (104 of 345) reported depression. The prevalence of anxiety and depression was higher among those who worked more hours (PR = 1.5; 95% CI: 1.2, 2.0) and days (PR = 1.3; 95% CI: 0.9, 1.8) per week. Anxiety was 40 percent more prevalent (PR = 1.4; 95% CI: 0.8, 2.4) among those with between 1 and 4 years of work experience, while depression was 60 percent more prevalent (PR = 1.6; 95% CI: 0.8, 3.1) among those with 5 to 9 years of experience. Compared to those with a bachelor’s degree, those with a master’s degree reported 30 percent more anxiety (PR = 1.3; 95% CI: 0.9, 1.9). Having at least three sources of social support related to comfort and caring reduced the prevalence of depression among those working the most hours per week (PR = 1.5; 1.1, 2.3 compared to PR = 2.0; 95% CI: 0.9, 4.5). Economic and practical support was more consistently protective, with a reduced prevalence of anxiety and depression among those working the most hours per week, days per week, and those with more education when at least three sources of support were reported.

Discussion: Anxiety and depression symptoms and diagnoses have been associated with burnout and suicide among frontline disaster responders. The public health workforce on the frontlines of the COVID-19 emergency response has high rates of depression and anxiety, which must be addressed through robust individual- and organizational-level supports.


Keywords


COVID-19; mental health; anxiety; depression; emergency response

Full Text:

PDF

References


Rivera-Rodriguez E: Role of the Nurse during Disaster Preparedness: A Systematic Literature Review and Application to Public Health Nurses [doctoral dissertation], Walden University, Minneapolis, MN, USA. 2017. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=5353&context=dissertations.

McDavid K, Miguel Cruz MP: Environmental health shelter assessments: Using tools to protect occupants after disasters. J Environ Health. 2019 Dec 1; 82(5): 32-33.

Malilay J, Heumann M, Perrotta D, et al.: The role of applied epidemiology methods in the disaster management cycle. Am J Public Health. 2014 Nov; 104(11): 2092-3102.

McDade JE, Franz D: Bioterrorism as a public health threat. Emerg Infect Dis. 1998 Jul; 4(3): 493.

Henderson DA: Bioterrorism as a public health threat. Emerg Infect Dis. 1998 Jul; 4(3): 488.

Henderson DA: The looming threat of bioterrorism. Science. 1999 Feb 26; 283(5406): 1279-1282.

Watson CR, Watson M, Sell TK: Public health preparedness funding: Key programs and trends from 2001 to 2017. Am J Public Health. 2017; 107(S2): S165-S167.

Association of State and Territorial Health Officials: New data on state health agencies show shrinking workforce and decreased funding leading up to COVID-19 pandemic, 2020.

National Association of County and City Health Officials: Changes in local health department workforce and finance capacity since 2008, 2019.

Murthy BP, Molinari NAM, LeBlanc TT, et al.: Progress in public health emergency preparedness—United States, 2001-2016. Am J Public Health. 2017; 107(S2): S180-S185.

Naushad VA, Bierens JJ, Nishan KP, et al.: A systematic review of the impact of disaster on the mental health of medical responders. Prehospital Disaster Med. 2019; 34(6): 632-643.

Cai H, Tu B, Ma J, et al.: Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of coronavirus disease 2019 (COVID‑19) in Hubei, China. Med Sci Monit. 2020; 26: e924171.

Felice C, Di Tanna GL, Zanus G, et al.: Impact of COVID-19 outbreak on healthcare workers in Italy: Results from a National E-Survey. J Community Health. 2020; 45(4): 675-683.

García-Fernández L, Romero-Ferreiro V, López-Roldán PD, et al. Mental health impact of COVID-19 pandemic on Spanish healthcare workers. Psychol Med. 2020: 1-3.

Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3(3): e203976.

Preti E, Di Mattei V, Perego G, et al.: The psychological impact of epidemic and pandemic outbreaks on healthcare workers: Rapid review of the evidence. Curr Psychiatry Rep. 2020; 22(8): 43.

Stuijfzand S, Deforges C, Sandoz V, et al.: Psychological impact of an epidemic/pandemic on the mental health of healthcare professionals: A rapid review. BMC Public Health. 2020; 20(1): 1230.

Barello S, Palamenghi L, Graffigna G: Burnout and somatic symptoms among frontline healthcare professionals at the peak of the Italian COVID-19 pandemic. Psychiatry Res. 2020; 290: 113129.

Vo, T: A practical guide for frontline workers during COVID-19: Kolcaba’s comfort theory. J Patient Exper. 2020; 7(5): 635-639. DOI:10.1177/2374373520968392.

Kolves K, Kolves KE, De Leo D: Natural disasters and suicidal behaviors: A systematic literature review. J Affective Disord. 2013; 146: 1-14.

Guilaran J, de Terte I, Kaniasty K, et al.: Psychological outcomes in disaster responders: A systematic review and meta-analysis on the effect of social support. Int J Disaster Risk Sci. 2018; 9(3): 344-358.

Brooks SK, Dunn R, Amlôt R, et al.: Social and occupational factors associated with psychological distress and disorder among disaster responders: A systematic review. BMC Psychol. 2016; 4: 18. DOI:10.1186/s40359-016-0120-9.

Spitzer RL, Kroenke K, Williams JB, et al.: A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med. 2006; 166(10): 1092-1097.

Arroll B, Goodyear-Smith F, Crengle S, et al.: Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med. 2010; 8(4): 348-353.

Davies HT, Crombie IK, Tavakoli M: When can odds ratios mislead? BMJ. 1998; 316(7136): 989-991. DOI:10.1136/bmj.316.7136.989. 26. Center for State and Local Government Excellence: How does the public health workforce compare with the broader public sector? 2020.

Centers for Disease Control and Prevention: CDC’s public health emergency preparedness program: Every response is local, 2020. Available at https://www.cdc.gov/cpr/whatwedo/phep.htm. Accessed February 26, 2021.

Vinck L, Isken L, Hooiveld M, et al.: Impact of the 2009 influenza A (H1N1) pandemic on public health workers in the Netherlands. Eurosurveillance. 2011; 16(7): 19793.

Kintziger KW, Stone KW, Jagger MA, et al.: What’s left undone: The impact of the COVID-19 response on the provision of other public health services in the U.S. Under review at BMC Public Health. DOI: 10.21203/rs.3.rs-215247/v1.

Goldmann E, Galea S: Mental health consequences of disasters. Annu Rev Public Health. 2014; 35: 169-183.

Prati G, Pietrantoni L: The relation of perceived and received social support to mental health among first responders: A meta-analytic review. J Commun Psychol. 2010; 38(3): 403-417.

Halbesleben JRB: Sources of social support and burnout: A meta-analytic test of the conservation of resources model. J Appl Psychol. 2006; 91(5): 1134-1145.

Kaniasty K, Norris FH: Mobilization and deterioration of social support following natural disasters. Curr Directions Psychol Sci. 1995; 4(3): 94-98.

Chin ET, Huynh BQ, Lo NC, et al.: Projected geographic disparities in healthcare worker absenteeism from COVID-19 school closures and the economic feasibility of child care subsidies: A simulation study. BMC Med. 2020; 18(1): 1-8.

Adams G, Todd M: Meeting the school-age child care needs of working parents facing COVID-19 distance learning: Policy options to consider. Urban Institute. 2020.

Alon TM, Doepke M, Olmstead-Rumsey J, et al.: The Impact of COVID-19 on Gender Equality (No. w26947). National Bureau of Economic Research, 2020.

Bogaert K, Castrucci BC, Gould E, et al.: Changes in the state governmental public health workforce: Demographics and perceptions, 2014-2017. J Publ Health Manage Pract: JPHMP. 2019; 25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017(2 Suppl): S58-S66.

McCoy SI, MacDonald PDM: Need to amplify health security? Fuse academia and practice. Public Health Rep. 2020: 33354920935075.

Wilson RT, Troisi CL, Gary-Webb TL: A deficit of more than 250,000 public health workers is no way to fight Covid-19. Available at https://www.statnews.com/2020/04/05/deficit-public-healthworkers-no-way-to-fight-covid-19/. Published 2020. Accessed June 25, 2020.

Leider JP, Coronado F, Beck AJ, et al.: Reconciling supply and demand for state and local public health staff in an era of retiring baby boomers. Am J Prev Med. 2018; 54(3): 334-340.




DOI: https://doi.org/10.5055/jem.0606

Refbacks

  • There are currently no refbacks.


Copyright (c) 2022 Journal of Emergency Management