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Ontario Medical Review
July 19, 2022
Stuart Foxman

Health-care professionals shoulder mental health burden of the pandemic

Disaster psychiatry conference draws international panel of trauma experts

Physicians know all about COVID-19 precautions, yet they’re far from immune against one of the pandemic’s biggest risks: the impact on their own mental health.

“A lot of studies have identified high rates of symptoms in health-care workers during the pandemic: anxiety, depression and post-traumatic stress disorder,” said Dr. Rima Styra, an associate professor of psychiatry at the University of Toronto, and a staff psychiatrist at Toronto’s University Health Network.

Dr. Styra was speaking at the Psychiatric Dimensions of Disasters virtual training course earlier this month, where she shared alarming data from one U.S. survey of more than 1,000 health-care professionals. Nearly one in five had quit their jobs since COVID hit. Among those who’ve stayed, another 19 per cent have considered leaving the sector entirely.

She said there’s a staffing crisis within health care across North America and elsewhere in the world. While the reasons may be complex, Dr. Styra points to one factor that’s mentioned frequently in reports on the topic.

The fifth annual Psychiatric Dimensions of Disasters training event was presented by Disaster Psychiatry Canada, Department of Psychiatry, University of Toronto, with support from the OMA. The program drew 600 attendees from 15 countries, who heard from leading trauma experts from Canada, the U.S., Australia, Japan, Singapore and Israel.

“The psychosocial disruption is massive.” — Dr. Jun Shigemura, a psychiatrist and a professor for the Faculty of Health Sciences at Mejiro University in Saitama, Japan

She said there’s a staffing crisis within health care across North America and elsewhere in the world. While the reasons may be complex, Dr. Styra points to one factor that’s mentioned frequently in reports on the topic.

“There’s a common theme: the burnout experienced by staff, with prolonged or repeated stress,” Dr. Styra said.

An issue pre-COVID, the pandemic has also identified compassion fatigue as another hazard due to persistent exposure to suffering, weariness of constantly giving and caring, and feeling helpless to provide what patients need. All of that can add to “the psychological burden and lead to moral injury,” she said.

Beyond personal harms, emotional, physical and spiritual distress can have significant professional implications. Dr. Styra noted the connection to reduced work satisfaction, decreased productivity, lower quality of care and more medical errors.

During disasters, panic, hopelessness, desperation and emotional exhaustion are all common, said Dr. John Wong Chee Meng, professor, mental health and neuroscience at the Yong Loo Lin School of Medicine, National University of Singapore. Moreover, health-care staff are “overwhelmed and overworked” by the pandemic, he said.

He explained that COVID-19 presents the classic traits of VUCA:

  • Volatility: the emergence of the virus and variants, and changes to pandemic measures in quick succession
  • Uncertainty: no one can predict when an end or cure will arrive
  • Complexity: the pandemic affects health care, businesses, the economy, social life, etc.
  • Ambiguity: few pre-existing best practices to follow

“The psychosocial disruption is massive,” added Dr. Jun Shigemura, a psychiatrist and a professor for the Faculty of Health Sciences at Mejiro University in Saitama, Japan. “It’s not only about psychological outcomes, it’s about cognitive, emotional and behavioural outcomes.”

Cases, illnesses, deaths, isolation and the upending of work and life routines can frighten and distress anyone. Health-care professionals are no exception and are also at the eye of the pandemic storm.

In a disaster like COVID-19, they’re like soldiers on the front lines of a battle, which takes a different toll, he said.

Dr. Shigemura recalled the first COVID-related death in Japan, which wasn’t from the virus itself. A 37-year-old government official tasked with overseeing returnees from Wuhan at a quarantine facility near Tokyo was found dead of an apparent suicide in February 2020. Authorities suspected he jumped off a dormitory at the National Institute of Public Health, where some of the quarantined were staying.

Dr. Shigemura noted too that compared to disasters like wildfires, earthquakes or tsunamis, pandemics have a distinctive feature. “Obviously you cannot see them, so some people call them stealth disasters, and these events usually result in unique and complex psychosocial responses.”

Among the public, fear and confusion can be high, said Dr. Shigemura. People might not sense their health risks. Rumours and conspiracy theories can spread, as we’ve seen with the rising “infodemic,” he said, adding that people can lose trust in the authorities and start to scapegoat, with the targets including health-care workers and scientists.

“Because our enemy is invisible, people tend to attack the visible easy targets,” he said, noting that many health-care workers in Japan were stigmatized, and some health-care facilities were vandalized.

Stressors are a toxin

A disaster’s effects unfold in phases, said Dr. Joshua Morganstein, associate professor and vice-chair, department of psychiatry, and deputy director, Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences, Bethesda, Md.

He explained that the start often brings a heroic phase (immediate response to help people survive and recover) and a honeymoon phase (community cohesion in the face of shared adversity).

Eventually, “the sense of unity diminishes, and gives way to division, anger and blaming,” he said. “In most disasters, disillusionment sets in. This can chip away at that sense of togetherness among community members and increase risk for adverse mental health effects.”

Throughout the phases, he suggests we “think of stressors like a toxin such as lead or radon, and understand the aspects of exposure such as who, when and how much.

“Asking for help can be difficult, particularly for health-care workers and others whose work is in a profession that's devoted to the care and safety of others, sometimes at the expense of their own well-being,” Dr. Morganstein said.

The best way front-line health workers can protect themselves is to maintain a sense of connectedness and hope, he said, and “in health care, team cohesion and leadership support are consistently protective.”

The mental health effects of the pandemic are “an occupational syndrome” that calls for a systems-oriented, organizational-level response, said Dr. Styra.

According to many studies, she said “a lack of perceived support predicted psychological distress,” she said. Some hospital systems have been proactive in offering support, she added, pointing to best practices such as easy access to psychiatric consultations, online mental health resources, facilitated peer discussions, peer support groups and buddy systems.

Dr. Styra said leaders in the workplace can play a major role in helping health-care workers cope and giving them the tools they need to succeed. That will only augment what individuals do to manage stress and their mental health on their own, and with the support of their circle of family and friends.

In his conclusion, Disaster Psychiatry Canada founder and program chair, Dr. Frank Sommers, reminded participants of the still valid old saying: Think Globally, Act Locally.

“It’s important for us to take care of ourselves first, so we can also take care of our patients,” Dr. Styra said.

Stuart Foxman is a Toronto-based writer.

In conversation with...

Dr. Frank Sommers, a founding chair of Disaster Psychiatry Canada who has organized five annual Psychiatric Dimensions of Disasters training events dating back to 2018, shares his thoughts on the toll disasters can take on the public and health-care workers and how one can regain their psychological footing.

Read the OMR online exclusive, From Trauma to Triumph: Recovering After Disaster Strikes.