Doctors Experience Long-term Mental Health Effects of COVID-19 

Fabio Turone & Tim Locke

November 03, 2021

The COVID pandemic had a lasting effect on the mental health of doctors, according to University of Exeter-led international research.

The findings are based on a survey of 5275 doctors carried out in two rounds in Italy, Spain, and the UK published in PLOS ONE.

Both anxiety and depression appeared to hit women and younger professionals especially hard.

"Various mental health risk factors have been identified: lack of personal protective equipment (PPE), overwhelming workload, lack of institutional support, and fear of infecting others," the authors wrote.

Two Waves

The researchers surveyed doctors working in Spain, Italy, and the UK in June 2020 – at the end of the first wave – and again in November/December 2020, when both the monthly COVID-19 prevalence and mortality rates had increased in all three areas.

In Catalonia, Spain, COVID-19 cases per 100,000 population increased from 33.3 (June 2020) to 809.6 (November 2020), in Italy from 12.5 (June 2020) to 836.3 (December 2020), and in the UK from 55.6 (June 2020) to 927.1 (November 2020).

COVID-19 deaths per 100,000 population increased during the same period from 2.4 to 22.2 in Catalonia, from 2.2 to 30.7 in Italy, and from 4.4 to 17.8 in the UK.

Six medical organisations distributed the survey to members: the Royal College of Physicians and Surgeons of Glasgow, and Royal College of Surgeons of Edinburgh in the UK, the Barcelona Medical Council and Girona Medical Council in Spain, the Union of physicians and healthcare executives, and Union of general practitioners in Italy.

Survey Details

Researchers collected information on sex, age, household composition, occupation, and specialty for 3025 respondents in the first round (5.5% of those invited), and 2250 (4.1%) in the second round.

In addition, participants were given the self-reported generalised anxiety disorder (GAD-7) questionnaire designed to assess health status during the previous 2 weeks, and the depression module of the patient health questionnaire (PHQ-9), which focuses on the nine diagnostic criteria for DSM-IV depressive disorders.

Overall, prevalence of moderate anxiety in June 2020 was higher in Italy (24.6%) than in Spain (15.9%), and the UK (11.7%).

Italy was also more affected for moderate/above moderate depression (20.1%) than Spain (17.4%), and the UK (13.7%).

Similar rates were recorded during the second wave in November/December 2020.

Since there was no difference in prevalence between the first and second rounds of the survey, the researchers wrote "we cannot discard that the mental health repercussions of the pandemic are persistent".

Anxiety and depression symptoms were more common among women, under-60s, those feeling vulnerable or exposed at work, and those reporting normal/below-normal health as opposed to better health.

The researchers said these associated risk factors might help explain the variation in the prevalence of anxiety and depression across the countries. For example, the percentage of respondents who reported a lack of necessary PPE, and reported feeling vulnerable and exposed at work, was highest in Italy, where rates of anxiety and depression were also highest.

Protecting Mental Health

Co-author and principal investigator Climent Quintana-Domeque, professor of economics, University of Exeter Business School, said in a statement: "The COVID-19 pandemic has been classified as a traumatic event, with healthcare workers arguably having the most direct and longest exposure to this disease.

"Our study identified a high prevalence of anxiety and depression symptoms among medical doctors in both the first and second waves of the pandemic, and the similar patterns across countries suggest that our findings may be applicable to other European settings.

"The results of this study suggest that institutional support for healthcare workers, and in particular doctors, is important in protecting and promoting their mental health in the current and in future pandemics."

The study results were not a surprise for Raffaella Rumiati, professor of cognitive neuroscience at the International School for Advanced Studies, in Trieste, who recently led a similar survey on Italian healthcare professionals, currently in preprint.

"We conducted an online assessment of negative and positive emotions of health workers in Italy during May 2020. The study showed higher levels of stress and anxiety in female or younger respondents. Note that other reports also documented this pattern in the general population" Prof Rumiati told Medscape/Univadis. "That women are more prone to admit emotional discomfort is not new. The higher levels of negative emotions in younger health workers may depend on them being less experienced in coping with stressful events."

Quintana-Domeque C, Lee I, Zhang A, Proto E, Battisti M, Ho A (2021) Anxiety and depression among medical doctors in Catalonia, Italy, and the UK during the COVID-19 pandemic. PLoS ONE 16(11): e0259213. https://doi.org/10.1371/journal.pone.0259213

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