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

Elie Azoulay, Alain Cariou, Fabrice Bruneel, Alexandre Demoule, Achille Kouatchet, Danielle Reuter, Virginie Souppart, Alain Combes, Kada Klouche, Laurent Argaud, François Barbier, Mercé Jourdain, Jean Reignier, Laurent Papazian, Bertrand Guidet, Guillaume Géri, Matthieu Resche-Rigon, Olivier Guisset, Vincent Labbé, Bruno Mégarbane, Guillaume Van Der Meersch, Christophe Guitton, Diane Friedman, Frédéric Pochard, Michael Darmon, Nancy Kentish-Barnes, Elie Azoulay, Alain Cariou, Fabrice Bruneel, Alexandre Demoule, Achille Kouatchet, Danielle Reuter, Virginie Souppart, Alain Combes, Kada Klouche, Laurent Argaud, François Barbier, Mercé Jourdain, Jean Reignier, Laurent Papazian, Bertrand Guidet, Guillaume Géri, Matthieu Resche-Rigon, Olivier Guisset, Vincent Labbé, Bruno Mégarbane, Guillaume Van Der Meersch, Christophe Guitton, Diane Friedman, Frédéric Pochard, Michael Darmon, Nancy Kentish-Barnes

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.

Keywords: ICU; anxiety; coronavirus; depression; pneumonia.

Figures

Figure 1.
Figure 1.
Violin plots depicting the probability density of anxiety, depression, and peritraumatic dissociation across different categories of healthcare providers.
Figure 2.
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 3.
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 4.
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.

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