Sameer Hassamal, MD; Fanglong Dong, PhD; Sunita Hassamal, MD; Carol Lee, MD; Dotun Ogunyemi, MD; Michael M. Neeki, DO


Western J Emerg Med. 2021;22(2):346-352. 

In This Article

Abstract and Introduction


Introduction: The coronavirus 2019 (COVID-19) pandemic has created a mental health crisis among hospital staff who have been mentally and physically exhausted by uncertainty and unexpected stressors. However, the mental health challenges and complexities faced by hospital staff in the United States has not been fully elucidated. To address this gap, we conducted this study to examine the prevalence and correlates of depression and anxiety among hospital staff in light of the COVID-19 pandemic.

Methods: The design is a single-center, cross-sectional, online survey evaluating depression and anxiety among all hospital employees (n = 3,500) at a safety-net hospital with a moderate cumulative COVID-19 hospitalization rate between April 30–May 22, 2020. We assessed depression with the Patient Health Questionnaire-9. Anxiety was measured with the Generalized Anxiety Disorder-7 scale. Logistic regression analyses were calculated to identify associations with depression and anxiety.

Results: Of 3,500 hospital employees, 1,246 (36%) responded to the survey. We included 1,232 individuals in the final analysis. Overall, psychological distress was common among the respondents: 21% and 33% of staff reported significant depression and anxiety, respectively, while 46% experienced overwhelming stress due to COVID-19. Notably, staff members overwhelmed by the stress of COVID-19 were seven and nine times more likely to suffer from depression and anxiety, respectively. In addition to stress, individuals with six to nine years of work experience were two times more likely to report moderate or severe depression compared to those with 10 or more years of work experience. Moreover, ancillary staff with direct patient contact (odds ratio [OR] 8.9, confidence interval (CI), 1.46, 173.03) as well as administrative and ancillary staff with indirect patient contact (OR 5.9, CI, 1.06, 111.01) were more likely to be depressed than physicians and advanced providers.

Conclusion: We found that a considerable proportion of staff were suffering from psychological distress. COVID-19-associated depression and anxiety was widespread among hospital staff even in settings with comparatively lower COVID-19 hospitalization rates. Ancillary staff, administrative staff, staff with less job experience, and staff overwhelmed by the stress of COVID-19 are particularly susceptible to negative mental health outcomes. These findings will help inform hospital policymakers on best practices to develop interventions to reduce the mental health burden associated with COVID-19 in vulnerable hospital staff.


In December 2019, a cluster of idiopathic pneumonia cases linked to a seafood market emerged in Wuhan, China.[1] Genomic sequencing analysis revealed that a novel coronavirus strain, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was the causative agent that resulted in coronavirus disease 2019 (COVID-19).[2] Epidemiological investigations determined that SARS-CoV-2 is highly contagious and primarily spread through person-to-person contact.[3] The virus spread at an alarming rate infecting millions of people, and as a result governments around the world enforced lockdown measures to mitigate community transmission. On March 11, 2020, the World Health Organization declared COVID-19 a pandemic, signaling that the viral illness was a global emergency.[4]

The COVID-19 pandemic has created a parallel mental health crisis in the United States (US). Preliminary results indicate that prevalence rates of depression and anxiety have tripled in the US since the inception of the pandemic.[5] In particular, healthcare workers have been psychologically burdened by high levels of work-related COVID-19 stress.[6,7] Emerging data suggests that up to 50% of healthcare workers will experience moderate to severe depression and anxiety.[8] Moreover, healthcare workers are at a heightened risk of developing stress-related disorders due to experiencing or witnessing human suffering and trauma. Initial studies project that up to 60% of healthcare workers treating patients with COVID-19 will develop symptoms of acute stress disorder.[9] Factors contributing to mental health distress range from psychological and social stressors intrinsic to a novel pandemic to shortages of personal protective equipment.[10] The demands of COVID-19 will undoubtedly further strain the mental health wellbeing of healthcare workers. For this reason, expert panels have requested a call for action to understand the psychological effects of COVID-19.[11]

A handful of observational studies have examined the psychological consequences of COVID-19. A meta-analysis reported that the prevalence of anxiety ranged between 22.6–36.3% and depression between 16.5–48.3% in healthcare workers.[12] The studies included in the meta-analysis primarily focused on healthcare workers providing care in regions of China severely affected by the pandemic. It is important to bear in mind that mental health outcomes among healthcare workers may differ based on region, infection rate, and COVID-19-associated hospitalization rates. Nevertheless, it is likely that the untoward psychological effects of COVID-19 are systemic across the entire health workforce. To date, little is known about the mental health needs of healthcare workers in light of the unprecedented pressures faced by hospitals. To address this gap, we sought in this study to understand the scope of depression and anxiety among staff at a safety-net hospital with a moderate cumulative COVID-19 hospitalization rate. We aimed to determine the prevalence of depression and anxiety, and to elucidate associations between sociodemographic variables, depression, and anxiety.