What is the mental health toll of COVID-19 on health care workers?


Millions of health care workers around the world have been put into extremely stressful situations because of COVID-19. A new research letter examines how the pandemic impacted the mental health of Italian health care workers.

COVID-19 has presented many challenges and the long-term effects of the pandemic may be unknown for years. One of the most pressing challenges that could have a severe ripple effect is the toll of the pandemic on the mental health of the health care workers. A research letter in JAMA Network Open looks at the mental health outcomes for health care workers in Italy.1

Investigators used an online questionnaire that was spread by social networks and sponsored social network advertisements. The data were collected between March 27, 2020, and March 31, 2020, which corresponded to the time immediately prior to the COVID-19 contagion peak in Italy. The questionnaire determined if the health care worker was frontline or second-line, the characteristics of the workplace, and if there had been direct consequences from COVID-19 such as a colleague becoming infected or dying from the disease. The Italian versions of Global Psychotrauma Screen (GPS), the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), the 7-item Insomnia Severity Index (ISI), and the 10-item Perceived Stress Scale (PSS) were used to assess key mental health outcomes such as perceived stress, insomnia, anxiety, depression, and posttraumatic stress symptoms (PTSS).

The questionnaire was completed by 1379 health care workers and 681 endorsed PTSS; 341 symptoms of depression; 302 had high perceived stress; 273 symptoms of anxiety; and 114 had insomnia. Eighteen participants were excluded because of missing data. Being female and a younger age were linked to all the investigated outcomes excluding insomnia. Being a frontline health care worker was linked to PTSS and general practitioners were more likely to endorse PTSS than other health care workers. Nurses and health care assistants were more likely to indicate insomnia. Having a colleague who had died was linked with PTSS, symptoms of depression, and insomnia. A hospitalized colleague was tied to PTSS as well as higher perceived stress, and a quarantined colleague was linked to PTSS, higher perceived stress, and symptoms of depression. Exposure to contagion was linked to symptoms of depression.

The researchers concluded that their results were similar to reports from China about the pandemic’s impact on health care workers. The results indicate that further monitoring is needed to prevent long-term mental health harms.


1.    Rossi R, Socci V, Pacitti F, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Netw Open. 2020;3(5):e2010185. doi: 10.1001/jamanetworkopen.2020.10185

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