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Cited by 276COVID-19 and Mental HealthHealthcare professionals’ stress and burnoutOccupational Health and Burnout

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Symptoms of Anxiety, Depression, and Peritraumatic Dissociation in Critical Care Clinicians Managing Patients with COVID-19. A Cross-Sectional Study

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Azoulay, Elie, Cariou, Alain, Bruneel, Fabrice, Demoule, Alexandre, Kouatchet, Achille, Reuter, Danielle, Souppart, Virginie, Combes, Alain, Klouche, Kada, Argaud, Laurent, Barbier, François, Jourdain, Mercé, Reignier, Jean, Papazian, Laurent, Guidet, Bertrand, Géri, Guillaume, Resche-Rigon, Matthieu, Guisset, Olivier, Labbé, Vincent, Mégarbane, Bruno, Van Der Meersch, Guillaume, Guitton, Christophe, Friedman, Diane, Pochard, Frédéric, Darmon, Michael, Kentish-Barnes, Nancy·2020·American Journal of Respiratory and Critical Care Medicine
DOI 10.1164/rccm.202006-2568ocPMC PMC7667906
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Abstract

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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Figures

Figure 1. Violin plots depicting the probability density of anxiety, depression, and peritraumatic dissociation across different categories of healthcare providers.
Figure 1. Violin plots depicting the probability density of anxiety, depression, and peritraumatic dissociation across different categories of healthcare providers.CC BY-NC-ND · PubMed Central
Figure 2. Box plots depicting respondents’ fear of coronavirus disease (COVID-19) infection according to the presence of symptoms of (A) anxiety (light gray indicates no symptoms of anxiety, and dark gray indicates presence of symptoms of anxiety), (B) depression (light gray indicates no symptoms of depression, and dark gray indicates presence of symptoms of depression), or (C) peritraumatic dissociation (light gray indicates no symptoms of peritraumatic dissociation and dark gray indicates presence of symptoms of peritraumatic dissociation). ***P < 0.0001 between respondents with and without symptoms.
Figure 2. Box plots depicting respondents’ fear of coronavirus disease (COVID-19) infection according to the presence of symptoms of (A) anxiety (light gray indicates no symptoms of anxiety, and dark gray indicates presence of symptoms of anxiety), (B) depression (light gray indicates no symptoms of depression, and dark gray indicates presence of symptoms of depression), or (C) peritraumatic dissociation (light gray indicates no symptoms of peritraumatic dissociation and dark gray indicates presence of symptoms of peritraumatic dissociation). ***P < 0.0001 between respondents with and without symptoms.CC BY-NC-ND · PubMed Central
Figure 3. Box plots depicting respondents’ (A) anxiety (Hospital Anxiety and Depression Scale anxiety subscale), (B) depression (Hospital Anxiety and Depression Scale depression subscale), and (C) peritraumatic dissociation (Peritraumatic Dissociation Questionnaire scale) according to the ability of healthcare providers (HCPs) to rest during the pandemic (dark gray indicates no ability at all to rest, medium gray indicates that HCPs could rest from time to time, and light gray indicates that HCPs could often rest). ***P < 0.0001 between the group of respondents indicating no ability at all to rest versus the two other groups.
Figure 3. Box plots depicting respondents’ (A) anxiety (Hospital Anxiety and Depression Scale anxiety subscale), (B) depression (Hospital Anxiety and Depression Scale depression subscale), and (C) peritraumatic dissociation (Peritraumatic Dissociation Questionnaire scale) according to the ability of healthcare providers (HCPs) to rest during the pandemic (dark gray indicates no ability at all to rest, medium gray indicates that HCPs could rest from time to time, and light gray indicates that HCPs could often rest). ***P < 0.0001 between the group of respondents indicating no ability at all to rest versus the two other groups.CC BY-NC-ND · PubMed Central
Figure 4. Box plots depicting respondents’ (A) anxiety (Hospital Anxiety and Depression Scale anxiety subscale), (B) depression (Hospital Anxiety and Depression Scale depression subscale), and (C) peritraumatic dissociation (Peritraumatic Dissociation Questionnaire scale) according to the ability of healthcare providers (HCPs) to care for their own family during the pandemic (dark gray indicates no ability at all to care for their own family, medium gray indicates that HCPs could care for their own family from time to time, and light gray indicates that HCPs could often care for their own family). ***P < 0.0001 between the group of respondents indicating no ability at all to care for their own family versus the two other groups.
Figure 4. Box plots depicting respondents’ (A) anxiety (Hospital Anxiety and Depression Scale anxiety subscale), (B) depression (Hospital Anxiety and Depression Scale depression subscale), and (C) peritraumatic dissociation (Peritraumatic Dissociation Questionnaire scale) according to the ability of healthcare providers (HCPs) to care for their own family during the pandemic (dark gray indicates no ability at all to care for their own family, medium gray indicates that HCPs could care for their own family from time to time, and light gray indicates that HCPs could often care for their own family). ***P < 0.0001 between the group of respondents indicating no ability at all to care for their own family versus the two other groups.CC BY-NC-ND · PubMed Central

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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
DOI
10.1164/rccm.202006-2568oc
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
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 › Medicine › Public Health, Environmental and Occupational Health › 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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