Public Health Workers’ Mental Health Battered During Pandemic

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Among public health workers who responded to a recent survey, 53% reported having symptoms of at least one mental health condition in the preceding 2-week period.

Respondents’ most common symptoms were those associated with post-traumatic stress disorder (PTSD; 36.8%), followed by depression (32%) and anxiety (30.3%); about 8% said they had thoughts of suicide, reported Jonathan Bryant-Genevier, PhD, of the CDC, and colleagues.

After analyzing the results of this nonprobability-based online survey — which garnered responses from 26,174 public health workers across the U.S. from March 29 to April 16 — the researchers found that the highest prevalences of mental health-related symptoms were among those under age 29 (range 13.6% to 47.4%), transgender or nonbinary individuals of all ages (range 30.4% to 65.5%), and those who identified as multiple races (range 12.1% to 43.4%), the team reported in the Morbidity and Mortality Weekly Report.

The survey also showed that public health workers who weren’t able to take time off from work were nearly twice as likely to have symptoms of a mental health condition (prevalence ratio range 1.84-1.93) compared with those who were able to take time off.

“Several strategies could reduce adverse mental health symptoms among public health workers during public health emergencies,” Bryant-Genevier and colleagues wrote. “For example, expanding staffing size (e.g., recruiting surge personnel to backfill positions) and implementing flexible schedules might reduce the need for long work hours; encouraging workers to take regular breaks and time off could help avoid overwork and reduce the risk for adverse mental health outcomes.”

The rise in mental health conditions among both the general population and healthcare workers during the COVID-19 pandemic has been well documented, the authors pointed out. Yet, the extent of these symptoms has not been equally measured among public health workers, who have also been key players during the pandemic. And with a widespread deficit in public health workers in the U.S., the pressure on this particular group has continued to mount.

For their survey, Bryant-Genevier and colleagues used questions from the 9-item Patient Health Questionnaire (PHQ-9) for depression and suicidal ideation, the 2-item General Anxiety Disorder (GAD-2), and the 6-item Impact of Event Scale (IES-6) for PTSD.

Of the survey respondents, the majority identified as white (17,218) and female (19,873). Notably, one in five respondents expressed having a need for mental health counseling in the last 4 weeks, but not receiving these services. Employee assistance programs were available for 66.1% of the public health workers that were surveyed, yet only 11.7% of respondents had actually accessed them. However, of all respondents, 27.3% did not know whether or not their employer offered an employee assistance program.

The prevalence of mental health conditions among public health workers was higher than the previously reported rate — 40.9% — among the general population. While the prevalence of depression and anxiety symptoms among public health workers was similar to previous reports, PTSD symptoms in these workers were found to be 10% to 20% higher than previously reported rates among healthcare workers, frontline personnel, and the general public.

Survey respondents reported experiencing traumatic events and stressors since March 2020, including the feeling of being overwhelmed by their workload (72%) and feeling bullied, threatened, or harassed because of work (23.4%). Those who reported experiencing trauma and stress were also more likely to report symptoms of PTSD than those who did not experience the same type of trauma.

While the screening instruments used for the survey are all clinically validated, Bryant-Genevier and colleagues acknowledged that one of their study’s significant limitations was its use of self-reported mental health symptoms, which does not constitute a diagnosis of a mental health disorder. Other limitations, they noted, included the 2-week time frame that the survey questions covered, which might not reflect the breadth of symptoms experienced during the pandemic.

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    Kara Grant joined the Enterprise & Investigative Reporting team at MedPage Today in February 2021. She covers psychiatry, mental health, and medical education. Follow

Disclosures

One co-author disclosed an unpaid membership of the de Beaumont Foundation’s National Consortium for Public Health Workforce Steering Committee to represent the Association of State and Territorial Health Officials. No other conflicts of interest were disclosed.

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