Symptoms of anxiety, depression, and peritraumatic dissociation in critical care clinicians managing patients with COVID-19. A cross-sectional study
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Rationale: Frontline healthcare providers (HCPs) during the coronavirus disease (COVID-19) pandemic are at high risk of mental morbidity. Objectives: To assess the prevalence of symptoms of anxiety, depression, and peritraumatic dissociation in HCPs. Methods: This was a cross-sectional study in 21 ICUs in France between April 20, 2020, and May 21, 2020. The Hospital Anxiety and Depression Scale and the Peritraumatic Dissociative Experience Questionnaire were used. Factors independently associated with reported symptoms of mental health disorders were identified. Measurements and Main Results: The response rate was 67%, with 1,058 respondents (median age 33 yr; 71% women; 68% nursing staff). The prevalence of symptoms of anxiety, depression, and peritraumatic dissociation was 50.4%, 30.4%, and 32%, respectively, with the highest rates in nurses. By multivariable analysis, male sex was independently associated with lower prevalence of symptoms of anxiety, depression, and peritraumatic dissociation (odds ratio of 0.58 [95% confidence interval, 0.42–0.79], 0.57 [95% confidence interval, 0.39–0.82], and 0.49 [95% confidence interval, 0.34–0.72], respectively). HCPs working in non–university-affiliated hospitals and nursing assistants were at high risk of symptoms of anxiety and peritraumatic dissociation. Importantly, we identified the following six modifiable determinants of symptoms of mental health disorders: fear of being infected, inability to rest, inability to care for family, struggling with difficult emotions, regret about the restrictions in visitation policies, and witnessing hasty end-of-life decisions. Conclusions: HCPs experience high levels of psychological burden during the COVID-19 pandemic. Hospitals, ICU directors, and ICU staff must devise strategies to overcome the modifiable determinants of adverse mental illness symptoms.
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Research in Italy and France found high rates of depressive symptoms, post-traumatic stress disorder, and burnout among health-care workers; younger age, female sex, nursing role, and direct care of COVID-19 patients were risk factors for adverse psychological outcomes.
“Studies from Italy and France reported a high prevalence of depressive symptoms, post-traumatic stress disorder, and burnout; risk factors for adverse psychological outcomes included younger age, female sex, being a nurse, and working directly with patients with COVID-19.7, 8, 9”
From COVID-19: a heavy toll on health-care workers (2021) · cites this paper as [9]
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- Authors
- Azoulay, E., Cariou, A., Bruneel, F., Demoule, A., Kouatchet, A., Reuter, D., Souppart, V., Combes, A., Klouche, K., Argaud, L., Barbier, F., Jourdain, M., Reignier, J., Papazian, L., Guidet, B., Géri, G., Resche-Rigon, M., Guisset, O., Labbé, V., Mégarbane, B., Van Der Meersch, G., Guitton, C., Friedman, D., Pochard, F., Darmon, M., & Kentish-Barnes, N.
- Affiliations
- Medical ICU, St. Louis University Hospital, Public Assistance Hospitals of Paris, Paris, France
- Université Paris Cité (FR)
- Hôpital André Mignot (FR)
- Inserm (FR)
- Centre Hospitalier Universitaire d'Angers (FR)
- Centre Hospitalier Sud Francilien (FR)
- Hôpital Saint-Louis (FR)
- Hôpital Lapeyronie (FR)
- Hospices Civils de Lyon (FR)
- Centre hospitalier universitaire d'Orléans (FR)
- Hôpital Roger Salengro (FR)
- Centre Hospitalier Universitaire de Nantes (FR)
- Assistance Publique Hôpitaux de Marseille (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Clinical Research Unit, St. Louis Hospital, Paris, France
- Hôpital Saint-André (FR)
- Medical-Surgical ICU, Avicenne University Hospital, Public Assistance Hospitals of Paris, Bobigny, France
- Centre Hospitalier du Mans (FR)
- Hôpital Raymond-Poincaré (FR)
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-11-01
- Volume
- 202
- Issue
- 10
- Pages
- 1388-1398
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- PMC
- PMC7667906
- OpenAlex
- W3081772318
- Cited by
- 272
- References
- 36
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 28 · 2023: 38 · 2022: 87 · 2021: 88 · 2020: 6
- FWCI
- 21.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Keywords
- COVID-19 pandemic, critical care clinicians, anxiety, depression, peritraumatic dissociation, mental health, mental health of healthcare workers, intensive care unit, nurses, sex differences, fear of infection, visitor restrictions, end-of-life decisions, psychological burden
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, Anxiety, Critical Care, Cross-Sectional Studies, Depression, Female, France, Health Personnel, Humans, Male, Pneumonia, Viral, Surveys and Questionnaires, Stress, Psychological, Prevalence, Coronavirus Infections, Stress Disorders, Traumatic, Pandemics
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