Mental Health

Health and academic professionals with dependents at greatest risk of quitting after COVID-19

April 7, 2021

Up to one in five employees at an academic medical institution are considering leaving their professions due to the strains of coping with the pandemic in their own lives, according to a new University of Utah Health study. Individuals who had caregiving responsibilities were among those most likely to contemplate leaving or reducing hours.

The findings suggest that retaining highly trained doctors, nurses, and scientists in the aftermath of the COVID-19 pandemic could be the next great health care challenge.

Headshot of Angela Fagerlin.

Angela Fagerlin, professor and chair of the Department of Population Health Sciences at the University of Utah School of Medicine. Photo credit: Charlie Ehlert.

“It’s sobering to learn that, during a time of economic recession, at least one-fifth of our workforce were considering leaving their jobs because of the severe levels of stress they were experiencing,” says Angela Fagerlin, the study’s senior author and professor and chair of the Department of Population Health Sciences at the University of Utah School of Medicine. “Many of these are people who have spent five to ten years of their adult lives training to do this kind of work. Yet, it’s so overwhelming and burdensome that they were potentially thinking about giving it all up.”

Although conducted at a single health care system, the researchers say these findings could have broader implications.

“We suspect these disturbing trends likely exist within other health care systems nationwide,” says Rebecca Delaney, the study’s lead author and a postdoctoral research fellow at the U of U School of Medicine. “These findings are alarming and a warning sign about the morale and well-being of doctors and nurses, as well as non-clinical health care scientists and staff.”

The study appears in JAMA Network Open.

Several studies have examined the effects of burnout, stress, depression, and anxiety on frontline medical staff during the global pandemic. However, most have only included frontline workers or physician trainees. Few of these studies have addressed important family-work balance issues, such as childcare needs during the pandemic, which contribute significantly to the stress and burnout of staff.

To remedy this oversight, Delaney and her colleagues distributed a web-based survey of all 27,700 clinical and non-clinical U of U Health faculty, staff, and trainees in August 2020. Survey items measured childcare needs, work-life balance needs, career development impact, and stress related to the pandemic.

Overall, 18 percent (n=5,030) completed the entire survey. The data was consistent across clinical and non-clinical respondents, confirming that everyone—men, women, those with and without children—were struggling with the impact of COVID-19, Delaney says.

Nearly half (48 percent) reported having at least one child 18 years old or younger. In addition, the researchers found:

  • 49 percent of those who had children reported that parenting and managing virtual education for children was causing them stress
  • Faculty (55 percent) and trainees (60 percent) reported decreased productivity
  • 47 percent of participants expressed concern about COVID-19 affecting their career development, with 64 percent of trainees being highly concerned
  • 30 percent reported considering reducing hours
  • 21 percent reported considering leaving the workforce

In addition to being a single health care system survey, other study limitations included the possibility of selection bias among those who chose to complete the survey. It’s also possible that more employees with children aged 18 or younger responded than those without children.

Although the researchers found that burnout, depression, and anxiety were important, they concluded that greater emphasis on work-life balance, accessibility to dependent care, and ongoing psychological and social support could prevent thousands of medical caregivers from joining this potentially devastating exodus.

“Health care systems must develop effective ways to ensure that well-trained clinicians, support staff, and non-clinical scientists are supported during this unprecedented time as well as after it,” Fagerlin says. “If they do that, then health systems will be more likely to retain a diverse and effective workforce.”

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In addition to Drs. Delaney and Fagerlin, U of U Health scientists Amy Locke, Mandy L. Pershing, Claudia Geist, Erin Clouse, Michelle Precourt Debbink, Benjamin Haaland, Amy J. Tanner, and Yoshimi Anzai contributed to this study.

The study, “Experiences of a Health System’s Faculty, Staff and Trainees Career Development, Work Culture, and Child Care Needs During the COVID-19 Pandemic” appears in JAMA Network Open. It was supported by a Jon M. Huntsman Presidential Endowed Chair awarded to Fagerlin, who is also a research scientist at the VA Salt Lake City Health Care System.

The overlooked casualties of COVID-19

March 3, 2021

The daily toll of COVID-19, as measured by new cases and the growing number of deaths, overlooks a shadowy set of casualties: The rising risk of mental health problems among health care professionals working on the frontlines of the pandemic.

A new study, led by University of Utah Health scientists, suggests more than half of doctors, nurses and emergency responders involved in COVID-19 care could be at risk for one or more mental health problems, including acute traumatic stress, depression, anxiety, problematic alcohol use and insomnia. The researchers found that the risk of these mental health conditions was comparable to rates observed during natural disasters, such as 9/11 and Hurricane Katrina.

Headshot of a male with brown hair, black suit jacket, blue tie, striped collared shirt, against a white background.

Andrew J. Smith, director of the U of U Health Occupational Trauma Program at the Huntsman Mental Health Institute.

“What health care workers are experiencing is akin to domestic combat,” says Andrew J. Smith, director of the U of U Health Occupational Trauma Program at the Huntsman Mental Health Institute and the study’s corresponding author. “Although the majority of health care professionals and emergency responders aren’t necessarily going to develop PTSD, they are working under severe duress, day after day, with a lot of unknowns. Some will be susceptible to a host of stress-related mental health consequences. By studying both resilient and pathological trajectories, we can build a scaffold for constructing evidence-based interventions for both individuals and public health systems.”

The study appears in the Journal of Psychiatric Research. In addition to U of U Health scientists, contributors include researchers from the University of Arkansas for Medical Sciences; University of Colorado, Colorado Springs; Central Arkansas VA Health Care System; Salt Lake City VA Healthcare System; and the National Institute for Human Resilience.

The researchers surveyed 571 health care workers, including 473 emergency responders (firefighters, police, EMTs) and 98 hospital staff (doctors, nurses), in the Mountain West between April 1 and May 7, 2020. Overall, 56% of the respondents screened positive for at least one mental health disorder. The prevalence for each specific disorder ranged from 15% to 30% of the respondents, with problematic alcohol use, insomnia and depression topping the list.

“Frontline providers are exhausted, not only from the impact of the pandemic itself, but also in terms of coping day to day,” says Charles C. Benight, co-author of the study and a professor of psychology at the University of Colorado, Colorado Springs. “They’re trying to make sure that their families are safe [and] they’re frustrated over not having the pandemic under control. Those things create the sort of burnout, trauma and stress that lead to the mental health challenges we’re seeing among these caregivers.”

In particular, the scientists found that health care workers who were exposed to the virus or who were at greater risk of infection because they were immunocompromised had a significantly increased risk of acute traumatic stress, anxiety and depression. The researchers suggest that identifying these individuals and offering them alternative roles could reduce anxiety, fear and the sense of helplessness associated with becoming infected.

Alcohol abuse was another area of concern. About 36% of health care workers reported risky alcohol usage. In comparison, estimates suggest that less than 21% of physicians and 23% of emergency responders abuse alcohol in typical circumstances. Caregivers who provided direct patient care or who were in supervisory positions were at greatest risk, according to the researchers. They say offering these workers preventative education and alcohol abuse treatment is vital.

Surprisingly, health care workers in this study felt less anxious as they treated more COVID-19 cases.

“As these health care professionals heard about cases elsewhere before COVID-19 was detected in their communities, their anxiety levels likely rose in anticipation of having to confront the disease,” Smith says. “But when the disease started trickling in where they were, perhaps it grounded them back to their mission and purpose. They saw the need and they were in there fighting and working hard to make a difference with their knowledge and skills, even at risk to themselves.”

Among the study’s limitations are its small sample size. It was also conducted early in the pandemic in a region that wasn’t as affected by the disease as other areas with higher infection and death rates.

Moving forward, the researchers are in the final stages of a similar but larger study conducted in late 2020 that they hope will build on these findings.

“This pandemic, as horrific as it is, offers us the opportunity to better understand the extraordinary mental stress and strains that health care providers are dealing with right now,” Smith says. “With that understanding, perhaps we can develop ways to mitigate these problems and help health care workers and emergency responders better cope with these sorts of challenges in the future.”

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In addition to Smith, Hannah M. Wright, Tiffany M. Love and Scott A. Langenecker of University of Utah Health contributed to this study. The study, “Pandemic-related mental health risk among front line personnel,” was published in the Journal of Psychiatric Research.