Addressing Clinician Mental Health After COVID-19

Rachel Schwartz, MD, PhD

Coronavirus disease 2019 (COVID-19) has resulted in the over-extension of healthcare providers. In fact, the pandemic has exacerbated pre-existing burnout and moral injury and is taking a mental and emotional toll on those caring for patients with COVID-19.

The pandemic has led to the rapid development and deployment of innovative solutions in medicine and well-being resources for clinicians. In an effort to guide clinician mental health and well-being resource allocation, Rachel Schwartz, MD, PhD, and colleagues conducted a literature review to provide a map for how and where these resources should be used.

Schwartz and the team conducted a database search using the keywords COVID or corona, mental health, trauma, resilience, coping, anxiety, burnout, wellness or wellbeing, occupational stress, frontline or medical or hospital of healthcare workers or medical students or physician or nurse, and pandemic or outbreak or surge. They included 96 articles in the review.

Further, the investigators peer-reviewed well-being resources gathered by the Collaborative for Healing and Renewal in Medicine network —a group of medical educators and academics working to promote well-being among trainees and practicing physicians. The team reviewed practice guidelines and resources from healthcare organizations and professional societies.

Intervention levels for well-being efforts fell into 3 categories: individuals (emotional awareness and self-care), organizational (mental health support programs and engaged leadership), and societal (supportive culture in medicine and national policies that enhance well-being).

The team noted the growing evidence of distress and mental health issues among those treating patients with COVID-19. In China, many healthcare workers reported depression, anxiety, insomnia, and distress. The findings of a systematic review demonstrated the same reported ailments. Such workers also experienced excessive work hours, had inadequate personal protective equipment, infection rate among their medical staff, a lack of support, and extensive media coverage, all of which contributed to adverse psychological outcomes.

There were 7 themes and associated interventions that emerged from the review:

1. The need for resilience and stress reduction training: Integrating such practices as part of clinician training could reduce distress.
2. Providing for clinicians’ basic needs: Ensuring a clinician’s basic needs like food, adequate rest, shelter, childcare, transportation, and personal protective equipment is essential for their psychological well-being.
3. The importance of specialized training for pandemic-induced changes in job roles: To prepare for future needs, hospitals could adopt specialized skills assessment and training programs.
4. Recognition and clear communication from leadership: Executives from the top down must be able to provide clinicians with up-to-date information and reassurance.
5. Acknowledgment of and strategies to address moral injury: It is important to proactively assess psychological well-being and to provide informal and professional support to clinicians.
6. The need for peer and social support interventions: Social connection can improve clinician well-being.
7. Normalization and provision of mental health support programs: Federal funding is needing to track clinician wellness and establish resources to care for those negatively affected by their COVID-19 service.

The findings of the analysis highlighted frontline workers were at the highest risk for developing acute stress, depression, anxiety, and insomnia. A majority of clinicians experienced increased irritability, change in food habits, difficulty falling asleep, and muscle tension. One study demonstrated twice the rates of anxiety and depression in frontline providers compared with nonclinical staff.

Clinicians require proactive psychological protection. It is necessary to implement institutional and societal infrastructure for clinician well-being, including training, programs, and delivering mental healthcare to clinicians.

The study, “Addressing Postpandemic Clinician Mental Health,” was published online in the journal Annals of Internal Medicine.