Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey

Jordi Alonso, Gemma Vilagut, Philippe Mortier, Montse Ferrer, Itxaso Alayo, Andrés Aragón-Peña, Enric Aragonès, Mireia Campos, Isabel D Cura-González, José I Emparanza, Meritxell Espuga, Maria João Forjaz, Ana González-Pinto, Josep M Haro, Nieves López-Fresneña, Alma D Martínez de Salázar, Juan D Molina, Rafael M Ortí-Lucas, Mara Parellada, José Maria Pelayo-Terán, Aurora Pérez-Zapata, José I Pijoan, Nieves Plana, Maria Teresa Puig, Cristina Rius, Carmen Rodríguez-Blázquez, Ferran Sanz, Consol Serra, Ronald C Kessler, Ronny Bruffaerts, Eduard Vieta, Víctor Pérez-Solà, MINDCOVID Working group, Jordi Alonso, Gemma Vilagut, Philippe Mortier, Montse Ferrer, Itxaso Alayo, Andrés Aragón-Peña, Enric Aragonès, Mireia Campos, Isabel D Cura-González, José I Emparanza, Meritxell Espuga, Maria João Forjaz, Ana González-Pinto, Josep M Haro, Nieves López-Fresneña, Alma D Martínez de Salázar, Juan D Molina, Rafael M Ortí-Lucas, Mara Parellada, José Maria Pelayo-Terán, Aurora Pérez-Zapata, José I Pijoan, Nieves Plana, Maria Teresa Puig, Cristina Rius, Carmen Rodríguez-Blázquez, Ferran Sanz, Consol Serra, Ronald C Kessler, Ronny Bruffaerts, Eduard Vieta, Víctor Pérez-Solà, MINDCOVID Working group

Abstract

Introduction: Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain.

Methods: All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders.

Results: 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95).

Conclusions: One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.

Keywords: Adverse Mental Health; COVID-19 pandemic; Disability; Discapacidad; Healthcare Workers; Mental Disorders; Necesidad de atención; Need for Care; Pandemia de COVID-19; Salud mental adversa; Trabajadores de la salud; Trastornos mentales.

Copyright © 2020 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.

Figures

Figure 1
Figure 1
Current prevalence of probable mental disorders among Spanish healthcare workers during the first wave of the COVID-19 pandemic, according to pre-pandemic lifetime mental disorders. MINDCOVID study (n = 9138). Green bar: workers with no pre-pandemic mental disorders (new onset); Red Bar: workers with lifetime history of mental disorders (persistence/recurrence). MDD: Major Depressive Disorder; GAD: Generalized Anxiety Disorder; PTSD: Post-Stress Traumatic Disorder; SUB: Substance Use Disorder.
Figure 2
Figure 2
Current prevalence of any probable mental disorders (disabling and non-disabling) among Spanish healthcare workers during the first wave of the COVID-19 pandemic, according the pre-pandemic lifetime mental disorders and individual characteristics. MINDCOVID study (n = 9138).

References

    1. Holmes E.A., O’Connor R.C., Perry V.H., Tracey I., Wessely S., Arseneault L. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7:547–560. doi: 10.1016/S2215-0366(20)30168-1.
    1. Vindegaard N., Benros M.E. COVID-19 pandemic and mental health consequences: systematic review of the current evidence. Brain Behav Immun. 2020;89:531–542. doi: 10.1016/j.bbi.2020.05.048.
    1. Nguyen L.H., Drew A.D., Graham M.S., Joshi A.D., Guo C.G., Ma W. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet. 2020;5:e475–e483. doi: 10.1016/S2468-2667(20)30164-X.
    1. CDC COVID-19 Response Team Characteristics of health care personnel with COVID-19: United States, February 12–April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:477–481. doi: 10.15585/mmwr.mm6915e6.
    1. Lazzerini M., Putoto G. COVID-19 in Italy: momentous decisions and many uncertainties. Lancet Glob Health. 2020;8:e641–e642. doi: 10.1016/S2214-109X(20)30110-8.
    1. Luo M., Guo L., Yu M., Jiang W., Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public – a systematic review and metaanalysis. Psychiatry Res. 2020;291:113190. doi: 10.1016/j.psychres.2020.113190.
    1. Salázar de Pablo G., Vaquerizo-Serrano J., Catalán A., Arango C., Moreno C., Ferre F. Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis. J Affect Disord. 2020;275:48–57. doi: 10.1016/j.jad.2020.06.022.
    1. Pappa S., Ntella V., Giannakas T., Giannakoulis V.C., Papoutsi E., Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901–907. doi: 10.1016/j.bbi.2020.05.026.
    1. García-Iglesias J.J., Gómez-Salgado J., Martín-Pereira J., Fagundo-Rivera J., Ayuso-Murillo D., Martínez-Riera J.R. Impact of SARS-CoV-2 (Covid-19) on the mental health of healthcare professionals: a systematic review. Rev Esp Salud Publica. 2020;94:e202007088.
    1. García-Fernández L., Romero-Ferreiro V., López-Roldán P.D., Padilla S., Calero-Sierra I., Monzo-García M. Mental health impact of COVID-19 pandemic on Spanish healthcare workers. Psychol Med. 2020;27 doi: 10.1017/S0033291720002019. [Epub ahead of print]
    1. Dosil-Santamaria M., Ozamiz-Etxebarria N., Redondo-Rodríguez I., Jaureguizar-Alboniga-MayorJ, Picaza-Gorrotxategi M. Psychological impact of COVID-19 on a sample of Spanish Health professionals. Rev Psiquiatr Salud Ment. 2020 doi: 10.1016/j.rpsm.2020.05.004. June 2 [Epub ahead of print]
    1. Luceño-Moreno L., Talavera-Velasco B., Garcia-Albuerne Y., Martín-García J. Symptoms of posttraumatic stress, anxiety, depression, levels of resilience and burnout in spanish health personnel during the COVID-19 pandemic. Int J Environ Res Public Health. 2020;17:5514. doi: 10.3390/ijerph17155514.
    1. Ruiz-Fernández M.D., Ramos-Pichardo J.D., Ibáñez-Masero O., Cabrera-Troya J., Carmona-Rega M.I., Ortega-Galan A.M. Compassion fatigue, burnout, compassion satisfaction and perceived stress in healthcare professionals during the COVID-19 health crisis in Spain. J Clin Nurs. 2020 doi: 10.1111/jocn.15469. August 28 [Epub ahead of print]
    1. Salas-Nicas S., Sembajwe G., Navarro A., Moncada S., Llorens C., Buxton O.M. Job insecurity, economic hardship, and sleep problems in a national sample of salaried workers in Spain. Sleep Health. 2020;6:262–359. doi: 10.1016/j.sleh.2020.02.014.
    1. Rodríguez-Menéndez G., Rubio-García A., Conde-Alvarez P., Armesto-Luque L., Garrido-Torres N., Capitan L. Short-term emotional impact of COVID-19 pandemic on Spaniard Health workers. J Affect Dis. 2021;278:390–394. doi: 10.1016/j.jad.2020.09.079.
    1. Díez-Quevedo C., Rangil T., Sánchez-Planell L., Kroenke K., Spitzer R.L. Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosom Med. 2001;63:679–686. doi: 10.1097/00006842-200107000-00021.
    1. Wu Y., Levis B., Riehm K.E., Saadat N., Levis A.W., Azar M. Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis. Psychol Med. 2020;50:1368–1380. doi: 10.1017/S0033291719001314.
    1. Newman M.G., Zuellig A.R., Kachin K.E., Constantino M.J., Przeworski A., Erickson T. Preliminary reliability and validity of the generalized anxiety disorder questionnaire-IV: a revised self-report diagnostic measure of generalized anxiety disorder. Behav Ther. 2002;33:215–233. doi: 10.1016/S0005-7894(02)80026-0.
    1. García-Campayo J., Zamorano E., Ruiz M.A., Pardo A., Pérez-Páramo M., López-Gómez V. Cultural adaptation into Spanish of the generalized anxiety Disorder-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes. 2010;8:8. doi: 10.1186/1477-7525-8-8.
    1. Kessler R.C., Santiago P.N., Colpe L.J., Dempsey C.L., First M.B., Heeringa S.G. Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI-SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Int J Methods Psychiatr Res. 2013;22:303–321. doi: 10.1002/mpr.1398.
    1. Blasco M.J., Castellví P., Almenara J., Lagares C., Roca M., Sesé A. Predictive models for suicidal thoughts and behaviors among Spanish University students: rationale and methods of the UNIVERSAL (University & mental health) project. BMC Psychiatry. 2016;16:122. doi: 10.1186/s12888-016-0820-y.
    1. Weathers F.W., Litz B.T., Keane T.M., Palmieri P.A., Marx B.P., Schnurr P.P. Department of Veterans Affairs; U.S: 2013. The PTSD Checklist for DSM-5 (PCL-5) [accessed 20.05.20]
    1. Zuromski K.L., Ustun B., Hwang I., Keane T.M., Marx B.P., Stein M.B. Developing an optimal short-form of the PTSD Checklist for DSM-5 (PCL-5) Depress Anxiety. 2019;36:790–800. doi: 10.1002/da.22942.
    1. Resick P., Chard K., Monson C. 2020. Cognitive processing therapy for posttraumatic stress disorder (PTSD) [accessed 28.09.20]
    1. Hinkin C.H., Castellon S.A., Dickson-Fuhrman E., Daum G., Jaffe J., Jarvik L. Screening for drug and alcohol abuse among older adults using a modified version of the CAGE. Am J Addict. 2001;10:319–326. doi: 10.1111/j.1521-0391.2001.tb00521.x.
    1. Díez-Martínez S., Martín-Moros J.M., Altisent-Trota R., Aznar-Tejero P., Cebrián-Martín C., Imáz- Pérez F.J. Brief questionnaires for the early detection of alcoholism in primary health care. Aten Primaria. 1991;8:367–370.
    1. Saitz R., Lepore M.F., Sullivan L.M., Amaro H., Samet J.H. Alcohol abuse and dependence in Latinos living in the United States. Validation of the CAGE (4M) questions. Arch Intern Med. 1999;159:718–724. doi: 10.1001/archinte.159.7.71.
    1. López-Maya L., Lina-Manjarrez F., Navarro-Henze S., López L.M.L. Adicciones en anestesiólogos. ¿Por qué se han incrementado? ¿Debemos preocuparnos? Rev Mex Anestesiol. 2012;35:95–106.
    1. Mdege N.D., Lang J. Screening instruments for detecting illicit drug use/abuse that could be useful in general hospital wards: a systematic review. Addict Behav. 2011;36:1111–1119. doi: 10.1016/j.addbeh.2011.07.007.
    1. Leon A.C., Olfson M., Portera L., Farber L., Sheehan D.V. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med. 1997;27:93–105. doi: 10.2190/T8EM-C8YH-373N-1UWD.
    1. Ormel J., Petukhova M., Chatterji S., Aguilar-Gaxiola S., Alonso J., Angermeyer M.C. Disability and treatment of specific mental and physical disorders across the world. Br J Psychiatry. 2008;192:368–375. doi: 10.1192/bjp.bp.107.039107.
    1. Luciano J.V., Bertsch J., Salvador-Carulla L., Tomás J.M., Fernández F., Pinto-Meza A. Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care samplej ep_1211 895.901. J Eval Clin Pract. 2010;16:895–901. doi: 10.1111/j.1365-2753.2009.01211.x.
    1. Kessler R.C., Ustün T.B. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) Int J Methods Psychiatr Res. 2004;13:93–121. doi: 10.1002/mpr.168.
    1. Wittchen H.U., Nelson C.B., Lachner G. Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychol Med. 1998;28:109–126. doi: 10.1017/s0033291797005928.
    1. Alonso J., Vilagut G., Mortier P., Auerbach R.P., Bruffaerts R., Cuijpers P. The role impairment associated with mental disorder risk profiles in the WHO World Mental Health International College Student Initiative. Int J Methods Psychol Res. 2019;28:e1750. doi: 10.1002/mpr.1750.
    1. Benjamini Y., Drai D., Elmer G., Kafkafi N., Golani I. Controlling the false discovery rate in behavior genetics research. Beh Brain Res. 2001;125:279–284. doi: 10.1016/S0166-4328(01)00297-2.
    1. van Buuren S., Groothuis- Oudshoorn K. mice: multivariate imputation by chained equations in R. J Stat Softw. 2011;45:1–67.
    1. van Buuren S. Second Edition. Chapman and Hall/CRC Press; Boca Raton, Florida: 2018. Flexible imputation of missing data.
    1. R Core Team . R Foundation for Statistical Computing; Vienna, Austria: 2017. R: A language and environment for statistical computing []
    1. SAS Institute Inc. SAS Inst. Inc. Mark. Co; 2014. SAS Software 9.4.
    1. Alonso J., Codony M., Kovess V., Angermeyer M.C., Katz S.J., Haro J.M. Population level of unmet need for mental healthcare in Europe. Br J Psychiatry. 2007;190:299–306. doi: 10.1192/bjp.bp.106.022004.
    1. Narrow W.E., Rae D.S., Robins L.N., Regier D.A. Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys’ estimates. Arch Gen Psychiatry. 2002;59:115–123. doi: 10.1001/archpsyc.59.2.11.
    1. Czeisler M.E., Lane R.I., Petrosky E., Wiley J.F., Christensen A., Njai R. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic – United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1049–1057. doi: 10.15585/mmwr.mm6932a1.
    1. Rolland B., Haesebaert F., Zante E., Benyamina A., Haesebaert J., Franck N. Global changes and factors of increase in caloric/salty food intake, screen use, and substance use during the early COVID-19 containment phase in the general population in France: survey study. JMIR Public Health Surveill. 2020;6:e19630. doi: 10.2196/19630.
    1. Kroenke K., Spitzer R.L., Williams J.B. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Sánchez-Villegas A., Schlatter J., Ortuno F., Lahortiga F., Pla J., Benito S. Validity of a self-reported diagnosis of depression among participants in a cohort study using the Structured Clinical Interview for DSM-IV (SCID-I) BMC Psychiatry. 2008;8:43. .

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