Presented by Dr Antoinette Miric
How is this pandemic traumatic for healthcare workers?
Trauma is often associated with something overtly violent, such as a car accident or a shooting. A situation is traumatic when “violates” familiar expectations about someone’s life and world, sending them into a “state of extreme confusion and uncertainty.” - Ciano Aydin
“In the case of this pandemic, prolonged uncertainty is compounded by the moral anguish health care professionals face when they do not have adequate resources to treat critically ill patients” Wendy Dean (psychiatrist and co-founder of the nonprofit Moral Injury of Healthcare)
Why now? What about this pandemic causes mental health issues in health care workers
Image 1 below explains a hypothesis by Prof Roger McIntyre from Toronto.
Our HCWs face a triple threat in a period of prolonged uncertainty.
Threat to health – Healthcare workers are threatened in their professional and their personal life. This is a new infectious agent which is a direct threat to one’s health and life, and in some healthcare workers their livelihood. Also, the fear of a 2nd surge.
Financial Stressors – Due to the extended period of the lockdown period, many families are facing major economic challenges, job losses. Facing loss of income within their families and also, fear of potential loss of own loss of income.
Social Isolation – both personally and professionally – Healthcare workers have been separated from their colleagues, families and their patients.
Based on her review of the below listed studies, Dr Miric shared the common factors across all studies:
- Females are more likely to experience mental health difficulties
- Nurses are affected more than doctors
- Younger less experienced healthcare workers are more affected
- Healthcare workers on the frontline struggle more
- Healthcare workers experience more signs of significant distress when
o A colleague is unwell or hospitalised
o A colleague passes away
o A colleague is in quarantine
- Healthcare workers are more prone to depression if they are:
o Directly exposed to the virus
o Are infected with the virus
Prevalence studies of healthcare workers in previous viral outbreaks – SARS 2002/2003 (Beijing)
Prevalence studies of healthcare workers in previous viral outbreaks – SARS 2002/2003 (Toronto)
Canadian Healthcare Workers in Toronto 2-3 months after SARS
Prevalence of Mental Health Symptoms: HCW (Wuhan) (end Jan 2020)
COVID-19 Healthcare Provider Study – New York
Why should we worry about the mental health of South Africa health care workers?
Even prior to the pandemic, mental health of HCWs in SA was already worrying. South African studies consistently show high levels of burnout (it is the most commonly researched topic) compared to more developed systems.
This is exacerbated by the current challenges facing HCW, some of which are:
1) Traumatic Exposure - Insufficient PPE, risk of infection and infecting loved ones
2) Moral Injury - Psychological distress that results from actions or the lack of them, which violates someone’s moral or ethical code
3) Workplace Stress - Challenges of acquiring PPE, of wearing PPE for long periods, of making life or death decisions, long work hours
4) Home Stress- Family and children at home – their anxieties, their needs, financial stresses
Factors that increase the risk of adverse psychological outcomes for HCW:
The factors that have been shown to increase the risk of adverse psychological outcomes for HCW can be put into 3 broad categories. Further detail relating to Individual Workplace and Personal factors are set out in the diagrams below.
