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Daily life is now a juggling act for Misty Richards, MD, MS. As the program director of a rigorous child psychiatry fellowship, a psychiatrist caring for women with perinatal psychiatric disorders, and the mother of three young children, Richards tries to view these tasks as an opportunity for growth. But some days it feels as if she's navigating a storm in the middle of the ocean without a life jacket.
In the age of COVID, "the wave of demands has morphed into one giant tidal wave of desperate need," Richards, of the department of psychiatry & biobehavioral sciences, University of California, Los Angeles, Semel Institute of Neuroscience & Human Behavior, said in an interview. "The painfully loud and clear message is that our patients need us, and our children – who have been stripped from healthy routines and peer interactions that nourish social-emotional development – rely on us. We cannot turn our backs for even a moment, or else they will suffer."
Tasked with caring for a much sicker and distressed population, navigating home duties such as child care, online school, and taking care of certain family members, women psychiatrists are feeling the impact of COVID-19.
Many have seamlessly transferred their practices online, maintaining a lifeline with their patients through telehealth visits. Even with this convenience, the emotional labor of being a psychiatrist is still very stressful, Pooja Lakshmin, MD, of the department of psychiatry and behavioral sciences at George Washington University, Washington, said in an interview. Because the nature of work has changed, and many are doing things virtually at home, separating home from work life can be a challenge. "It's harder to disconnect," admitted Lakshmin. "Even my patients tell me that they have no time to themselves anymore."
The pandemic demands that women in the profession "white-knuckle" their way to the finish line – a moving target that remains nowhere in sight, Richards said. "In this process, we are expected to fill the emotional cups of a broken nation, to provide answers that do not exist, and to do so with never-ending gratitude for a demanding system that has no 'off' switch," she noted.
"In Two Places at Once"
COVID-19's physical and emotional toll has swept across the various subspecialties of clinical psychiatry. As some navigate outpatient/telehealth work, inpatient psychiatrists directly interact with COVID patients.
"Our inpatient psychiatry unit regularly takes care of COVID patients, including perinatal patients who are COVID positive," Samantha Meltzer-Brody, MD, MPH, distinguished professor and chair, University of North Carolina, Chapel Hill, department of psychiatry and director of medical school's Center for Women's Mood Disorders, said in an interview. A psychiatry consultation-liaison service also provides psychiatry care to medical and surgical patients, including medically ill COVID patients across the hospital.
"We are on the front lines in the sense that we are dealing with the trauma of the general population and having to be present for that emotional distress," Meltzer-Brody said.
The struggle to balance rising caseloads and home responsibilities makes things difficult, she continued. "There's a never-ending onslaught of patient referrals," reflecting the anxiety and depression issues people are experiencing in the wake of a global pandemic, frenetic political situation in the United States, and job uncertainty.
Child care and elder care responsibilities affect both men and women, yet research shows that caregiving demands disproportionately affect women, observed Meltzer-Brody.
Overall, the stress of caregiving and parenting responsibilities for men and women has been markedly higher during the pandemic. Most clinical psychiatrists "have been extraordinarily busy for a very long time," she added.
Tiffani L. Bell, MD, a psychiatrist in Winston-Salem, N.C., has seen an increase in anxiety and depression in people with no previous history of diagnosed mental illness. "The impact of the pandemic has truly been multifaceted. People are struggling with loss of jobs, loss of wages, and loss of loved ones, along with grieving the loss of the usual way of life," she said in an interview.
Many of her colleagues report feeling overburdened at work with increased admissions and patient loads, decreased time to see each patient, and the feeling of "needing to be in two places at once."
"As a female psychiatrist, I do believe that we can sometimes have an increased mental burden due to the emotional and physical burnout that can occur when our routines are shaken," added Bell, who specializes in adult, child, and adolescent psychiatry, and obesity and lifestyle medicine. Even in the early months of the pandemic, Bell said she heard people joke that "they don't know if they are working from home or living at work."
Physicians aren't the only ones who are overwhelmed. "We're also hearing stories from our patients – those at risk for partner violence, dealing with kids out of school, working full time while providing support at home," Ludmila De Faria, MD, chair of the American Psychiatric Association's Committee on Women's Mental Health, said in an interview.
American mothers in particular spend nearly twice as much time caring for their children and cooking than their spouses, said Bell, citing recent studies. "Even if one is not a mom, if you couple the increased housework at baseline with the added responsibilities of working as a front-line physician and/or working from home while managing a household, it can lead to increased stress for all involved."
Women Leaving the Workforce
Nationally, a growing number of women are either reducing their hours or leaving the workforce in response to the pandemic. Fidelity Investments, which surveyed 1,902 U.S. adults in mid-2020 projected that 4 in 10 women were mulling such options. Among 951 women surveyed, 42% were considering stepping back from their jobs because of their children's homeschooling needs, and 27% cited difficulties of balancing home and job responsibilities.
Interruptions caused by child care affect women more than men, according to a report from the Century Foundation and the Center for American Progress. "Study after study has shown that, in response to school, child care, and camp closings, as well as reduced hours and reduced class sizes, significantly more women than men have reduced their work hours, left work to care for children, and spent more time on education and household tasks," the authors noted.
They estimated that the American economy could incur $64.5 billion per year in lost wages and economic activity from the fallout of these trends. In September 2020, four times as many women as men left the workforce, nearly 865,000 women in comparison to 216,000 men.
Many women psychiatrists have been forced to choose between their careers or child care duties – decisions they don't want to make, but that may be necessary during these unprecedented circumstances. They may be reducing their work hours to assist at home. Others are leaving their jobs, "a terrible situation given the enormous mental health needs of the pandemic" and the fact that so many areas of the United States already suffer from a shortage of clinical psychiatrists, said Meltzer-Brody.
She has personally seen the effects of this in the large academic department she supervises. "I'm seeing women reducing their work hours or leave positions," she continued. In addition to child care needs, these women are tending to aging parents affected by COVID-19 or other illnesses, or dealing with the fact that options for elder care aren't available.
"I have multiple faculty contending with that situation," added Meltzer-Brody. As a result, productivity is going down. "These women are trying to keep all of the balls in the air but find they can't."
Richards believes some changes are in order to take the disproportionate burden off of women in psychiatry, and the workforce as a whole. The health care system "places too much pressure on individuals to compensate for its deficiencies. Those individuals who often step up to the plate are women, and this is not their sole burden to carry."
A move toward telehealth in clinical psychiatry has made it possible for patients and physicians to meet virtually in their respective homes and discuss treatment options. "Even while this is both a blessing and privilege, it comes with the unique challenges of having to manage Zoom calls, child care, meals, distance learning, cleaning, and work responsibilities, while previously there was a clearer delineation to the day for many," Bell said.
Clinical psychiatrists educating the public about the mental stressors of COVID-19 face their own unique challenges.
Lakshmin, who makes appearances in various media and social media outlets, said this adds more pressure to the job. "One of the challenges for me is to figure out how much outward facing I do. That's hard when you're navigating working and living through a pandemic. This is something I do because I enjoy doing it. But it's still a type of work. And it's certainly increased because the media has been paying more attention to mental health" since the pandemic started, she added.
The Dual Stress of Covid and Social Justice
Some women psychiatrists of color are dealing with social justice issues on top of other COVID stressors, De Faria said. The focus on addressing institutionalized racism means that minority women are taking on extra work to advocate for their peers.
Michelle Jacobs-Elliott, MD, of the department of psychiatry and assistant dean of the Office of Diversity and Health Equity at the University of Florida, Gainesville, knows of such responsibilities. "I have been in many discussions either with my coworkers in my department or others who work for the University of Florida" on systemic racism, she said in an interview.
Jacobs-Elliott became a trainer for Bias Reduction in Internal Medicine, a workshop aimed at reducing bias, and prior to 2020 participated in a social justice summit at the University of Florida. "Talking with my medical as well as undergraduate students about their experiences both here in Gainesville and elsewhere, they are all feeling the hurt, disappointment, and disbelief that we are still fighting battles that our grandparents fought in health care, housing, and employment. This adds an extra layer of stress to everyone's life."
The tense social climate has made the apparent racial inequalities in COVID-19 deaths and severity of disease hard to ignore, Bell noted. "It is my sincere hope that the availability of COVID-19 vaccines will help decrease the number of people affected by this horrible disease. The added burden of racism on top of the stressors of this pandemic can feel insurmountable. I hope 2021 will provide a way forward for us all."
Taking Time for Self-care
Amid the endless referrals and increasing demands at home, women psychiatrists often don't have the time to do normal activities, Meltzer-Brody observed. Like most people, COVID restrictions prevent them from traveling or going to the gym or restaurants. De Faria has not been able to visit family in Latin America, a trip she used to make twice a year. "That was once my de-stress time. But now, I can't connect with my roots. My father is elderly and very much at risk."
This is the time to get creative and resourceful – to make time for self-care, several sources said.
"We need to realize that we cannot be all things to all people, at the same time," noted Bell. It's important to prioritize what's most important – and keep assessing your priorities. There's no shame in tending to your own needs. Bell recommended that women in her profession should pick 1 day a week, put it in their calendar, and stick to this goal of self-care.
"Even if it's only 15 minutes, it is important to put time aside. Some quick, cheap ideas are to do a quick meditation session, read a chapter in a book, listen to an audiobook, journal, go for a walk and get fresh air. Eat a healthy meal. Even 10 minutes helps," she urged.
COVID-19 has pushed society to find new ways to do things, Bell continued. Women psychiatrists, in assessing their work-life balance, may need to reassess their goals. Consider work schedules and see if there's a place to scale back a task. Delegate tasks at home to family members, if necessary. Most importantly, exercise self-compassion, she stressed. "During this pandemic, I believe it is vital to keep our cups filled so we can pour into others."
Lakshmin said she has benefited greatly from having a therapist during the pandemic. "It has been so instrumental in forcing me to take that time for myself, to give me a space to take care of me, and remember it's okay to take care of me. It's so important for us as psychiatrists to have that for ourselves. It's not just for our patients – we need it, too."
The APA has resources and numerous support groups that meet regularly to address and discuss the stressors of the pandemic. Its College Mental Health Caucus, for example, holds a monthly, hour-long Zoom meeting. Not surprisingly, women comprise the majority of attendees, De Faria said. "Most women in academic psychiatry are working from home and using telehealth, which isolates people a lot." Maureen Sayres Van Niel, MD, who is head of the APA's Women's Caucus, sends out a regular newsletter that advises on self-care. Women psychiatrists should also contact their local psychiatric organizations to get support from their professional peers.
Sometimes it's wise to leave work behind and engage with friends. De Faria regularly Zooms with a group of friends outside of her profession to de-stress and reconnect. "At least I can talk to them about things other than psychiatry."
Mentally and physically exhausted, Jacobs-Elliott said she looks forward to the day when society can return to meeting with friends and family "without being afraid that we are an asymptomatic carrier who is infecting our loved ones."
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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Cite this: Women Psychiatrists Struggle to Balance Work-Life Demands During COVID-19 - Medscape - Jan 25, 2021.