Half of the state's healthcare workers are at high risk of mental disorder after the first wave of covid-19

BarcelonaAlmost half of the health professionals in Spain have a high risk of suffering from a mental disorder after the first wave of coronavirus and 14.5% suffer from it in a disabling way, that is, with clear repercussions in their professional and personal lives. This is indicated by a study led by researchers from the Hospital del Mar Institute for Medical Research (IMIM), with data from more than 9,000 workers from 18 health centres in Spain, within the framework of the Mindcovid project. The main symptoms are depression, anxiety, panic attacks, post-traumatic stress disorder and substance abuse. According to a second study, by the same authors, 3.5% of health care workers had active suicidal ideation in the past month.

The studies have been published in the Revista de Psiquiatría y Salud Mental and in Depression & Anxiety and are based on a series of anonymous online surveys. A total of 9,138 professionals answered questions about work during the first wave, family relationships, personal impact of covid-19 on their family, social and work environment and a series of questions to detect possible mental disorders.

According to the study, 45.7% of participants are at high risk of some type of mental disorder, that is, they would need a professional evaluation to confirm the presence of a mental disorder. By pathology, 28% present depression; 22.5%, anxiety disorder; about 25%, panic; 22%, post-traumatic stress, and 6%, substance abuse.

"The data from the first wave of the pandemic indicate a much higher prevalence of disabling mental health problems in Spanish health professionals than expected," notes Dr Jordi Alonso, lead author of the study, director of the Epidemiology Programme at IMIM-Hospital del Mar and scientific co-director of CIBERESP. Alonso states that it is necessary to monitor the risk of the problems persisting and becoming chronic and to take into account the factors identified in the study in order to minimise them: "Some of these disorders can be reactive to acute stress and, with good management, we have to see if we can prevent them from becoming chronic". "We are concerned because this is a group that has to deal with an emergency, we need it, and we cannot afford to have people suffering and having to work," he added in statements to ACN.

Worse for young women

The prevalence of mental disorders is higher among young women who were not born in Spain and are not married. The group of nursing assistants is the one that shows the greatest impact. Two out of three assistants are at high risk for mental disorders. In the case of nurses, half are at high risk.

According to the study, having had a mental disorder before the pandemic doubles the risk of suffering again as a result of the pandemic. Higher prevalence is also seen among professionals who cared for covid-19 patients and those who have had the disease or have family members who were infected.

Eighty percent of the respondents were directly involved in the care of patients with covid-19, while 43% were in contact with them for most of the time, 17.4% contracted the disease and 112 required hospital admission. In 13.4% of the cases a member of the direct family was infected, and in one in four cases the professional had to be isolated or quarantined. Four in ten reported having suffered some kind of mental disorder before the pandemic.

Precedents increase risk

"The results of the study do not surprise us, but they worry us. They are very consistent with our clinical experience," says Dr Victor Perez, the last author of the paper, director of the Institute of Neuropsychiatry and Addictions at the Hospital del Mar (INAD), coordinator of the Mental Health Research Group at IMIM and a researcher at CIBERSAM.

Pérez explains that they see "many health care professionals with acute stress, exhaustion and anxiety, especially those who had previously experienced mental health problems". The Hospital del Mar, as well as other centres, set up an emotional support programme for the professionals.

In view of these results, the authors recommend following up on health professionals with previous mental disorders, as well as those who have had a high exposure to covid-19, who have suffered the infection or have been confined, and on health groups where the risk of suffering a mental disorder has been found to be higher. "We need to identify modifiable factors associated with risk or improvement in order to detect the level of unmet need from an emotional point of view," emphasises Alonso.

Active suicidal ideation

The Mindcovid study also documents a high prevalence of active suicidal ideation, 3.5%, and suicide attempts, 0.1%, during the first wave of the pandemic, as shown in the work published by Depression & Anxiety. This figure contrasts with the 0.7-0.9% estimated among the general population before the pandemic.

"It is worrying, especially considering the already increased risk of suicide among health professionals before the onset of the pandemic. The Mindcovid study shows that this increased risk of suicidal ideation is explained, in part, by the pressure suffered by health centres in terms of coordination and personnel during the first wave", says Dr Philippe Mortier, postdoctoral researcher at IMIM-Hospital del Mar, CIBERESP and another author of both papers.

According to the authors, the data highlights the need for social efforts to prevent contagion and to keep health systems from being overwhelmed. Another important stress factor for suicidal ideation that the study identifies is financial stress, such as fear of loss of income or loss of occupation due to the pandemic. A series of simulations showed that interventions that increase hospital preparedness and decrease financial insecurity among health care workers can lead to substantial reductions in suicidal ideation of up to 75%.

In addition to the Hospital del Mar and IMIM, the Barcelona Public Health Agency, the IDIAPJGol, the Emergency Medical System (SEM), the Vall d'Hebron University Hospital, the Research Institute of the Hospital de la Santa Creu and Sant Pau, the Hospital Clínic of Barcelona and other centres and institutions in Spain participated in the Mindcovid study. They have received funding from the Instituto de Salud Carlos III and the Generalitat.