The Mental Health of Healthcare Workers in COVID-19

If you are a healthcare worker and are concerned about your mental health, go to mhanational.org/frontline to be screened and find resources and support. If you are experiencing a mental health crisis, call 1-800-273-TALK (8255) to reach a 24-hour crisis center, or text MHA to 741741 to reach a trained Crisis Counselor 24/7.

Throughout the COVID-19 pandemic, Mental Health America (MHA) has witnessed increasing numbers of anxiety, depression, loneliness, and other mental health concerns. COVID-19 has had a profound negative effect on the mental health of the nation, especially among those who are faced with combating the virus.

While many throughout the U.S. are coping with the fear and uncertainty of COVID-19 from their homes, essential workers, including healthcare workers, must expose themselves to the virus every day. Healthcare workers are also experiencing conditions that have been compared to a war zone, continuously witnessing the direct effects of the pandemic as it spreads throughout communities. It is essential that we provide resources to help healthcare workers cope with the mental health impact of their work.

From June-September 2020, MHA hosted a survey on mhascreening.org to listen to the experiences of healthcare workers during COVID-19 and to create better resources to help support their mental health as they continue to provide care.

The responses collected from the 1,119 healthcare workers surveyed indicated that they are:

Stressed out and stretched too thin: 93% of health care workers were experiencing stress, 86% reported experiencing anxiety, 77% reported frustration, 76% reported exhaustion and burnout, and 75% said they were overwhelmed.
Worried about exposing loved ones: 76% of healthcare workers with children reported that they were worried about exposing their child to COVID-19, nearly half were worried about exposing their spouse or partner, and 47% were worried that they would expose their older adult family member(s).
Emotionally and physically exhausted: Emotional exhaustion was the most common answer for changes in how healthcare workers were feeling over the previous three months (82%), followed by trouble with sleep (70%), physical exhaustion (68%) and work-related dread (63%). Over half selected changes in appetite (57%), physical symptoms like headache or stomachache (56%), questioning career path (55%), compassion fatigue (52%) and heightened awareness or attention to being exposed (52%). Nurses reported having a higher exposure to COVID-19 (41%) and they were more likely to feel too tired (67%) compared to other healthcare workers (63%).
Not getting enough emotional support: 39% of healthcare workers said that they did not feel like they had adequate emotional support. Nurses were even less likely to have emotional support (45%).
Struggling with parenting: Among people with children, half reported they are lacking quality time or are unable to support their children or be a present parent.

Demographics

The following analysis is based on the responses of 1,119 healthcare workers surveyed on MHA Screening (mhascreening.org) from June 1-September 1, 2020.

The majority (76 percent) of respondents were young adults ages 18-44.

Age	Count	Percentage
18-24	241	21.54%
25-34	354	31.64%
35-44	258	23.06%
45-54	136	12.15%
55-64	101	9.03%
65+	29	2.59%
Grand Total	1,119	100.00%

Most (70 percent) of the respondents were White, followed by Black or African American (10 percent), and Hispanic or Latino (8 percent).

Race/Ethnicity	Count	Percentage
White (non-Hispanic)	778	69.53%
Black or African American (non-Hispanic)	113	10.10%
Hispanic or Latino	88	7.86%
Asian or Pacific Islander	65	5.81%
More than one of the above	47	4.20%
Other	18	1.61%
Native American or American Indian	10	0.89%
Grand Total	1,119	100.00%

The largest groups of respondents were other healthcare staff (30 percent) and nurses (22 percent). Nineteen percent of respondents identified their position as “Other,” which included mental health professionals, social workers, and pharmacy staff, among others.

What is your title or position?	Count	Percentage
Other patient care (CAN, lab technician, X-ray, therapist, front desk, etc.)	335	29.94%
Nurse	245	21.89%
Other	207	18.50%
Community-based healthcare workers	89	7.95%
Doctor	81	7.24%
Support staff (janitor, food service staff, administrative, etc.)	81	7.24%
EMT/Paramedic	50	4.47%
Physician’s Assistant or Nurse Practitioner	31	2.77%
Grand Total	1,119	100.00%

Fifty-two percent of healthcare workers surveyed did not have direct known exposure to COVID-19 patients but had the potential for exposure. Twenty-eight percent were working directly with COVID-19 patients.

Nurses were more likely to report having exposure to COVID-19 patients than the general population of healthcare respondents. Among nurses, 41 percent reported they were working directly with COVID-19 patients, and 49 percent reported they had potential exposure.

Among Nurses: Are you working directly with COVID-19 patients?	Count	Percentage
No, but I have potential exposure to COVID-19. (e.g. in COVID-19 patient rooms, work on same floor as COVID-19 patients, use same cafeteria, etc.)	119	48.57%
Yes	100	40.82%
No, I have no exposure to COVID-19 while at work	26	10.61%
Grand Total	245	100.00%

However, most (73 percent) respondents to the Healthcare Workers survey had not previously contracted COVID-19 at the time of surveying. 10 percent either had confirmed or suspected cases of COVID-19, and 17 percent were unsure.

Experiences of Healthcare Workers During COVID-19

MHA asked healthcare workers, “In the last three months, which of the following feelings have you been regularly experiencing? Check all that apply.”

Stress was the most commonly reported feeling, with 93 percent of healthcare workers indicating that they had regularly experienced stress in the last three months. This was followed by anxiety (86 percent), frustration (77 percent), exhaustion or burnout (76 percent), and feeling overwhelmed (75 percent). Gratitude, hope, and pride were reported by fewer people, although nearly a third (31 percent) reported that they regularly felt gratitude.

In the last three months, which of the following feelings have you been regularly experiencing? Check all that apply.	Count	Percentage
Stress	1038	92.76%
Anxiety	963	86.06%
Frustration	861	76.94%
Exhaustion/Burn-out	850	75.96%
Overwhelmed	844	75.42%
Sadness	751	67.11%
Unappreciated	670	59.87%
Anger	631	56.39%
Fear	618	55.23%
Loneliness	611	54.60%
Powerless	566	50.58%
Disconnected	552	49.33%
Grief	374	33.42%
Gratitude	347	31.01%
Hope	310	27.70%
Pride	220	19.66%

MHA also asked healthcare workers, “In the last three months, have you experienced an increase in any of the following? Check all that apply.”

Healthcare workers were most likely to report that they had increases in emotional exhaustion in the last three months (82 percent). This was followed by trouble with sleep (70 percent), physical exhaustion (68 percent), and work-related dread (63 percent). Over half of healthcare workers also reported experiencing changes in appetite (57 percent), physical symptoms like headache or stomachache (56 percent), questioning their career path (55 percent), compassion fatigue (52 percent), and heightened awareness, worry or attention to being exposed (52 percent).

In the last three months, have you experienced an increase in any of the following? Check all that apply.	Count	Percentage
Emotional exhaustion	919	82.13%
Trouble with sleep (difficulty falling or staying asleep)	785	70.15%
Physical exhaustion	764	68.28%
Work-related dread	703	62.82%
Change in appetite (overeating or undereating)	634	56.66%
Physical symptoms - headache, stomachache, etc.	623	55.67%
Questioning career path	617	55.14%
Compassion fatigue	584	52.19%
Heightened awareness/worry/attention to being exposed	580	51.83%
Lower self-esteem	499	44.59%
Upsetting thoughts, images and/or dreams	475	42.45%
Racing thoughts	452	40.39%
More likely to smoke, drink, and/or use substances	430	38.43%

Emotional Support for Healthcare Workers

When asked about emotional support, the largest group (39 percent) of healthcare workers indicated that they did not feel they had adequate emotional support. Another 26 percent were unsure if they were receiving adequate emotional support.

Nurses were even less likely to report that they had adequate emotional support than other healthcare workers. Among the nurses surveyed, 45 percent reported that they did not have adequate emotional support and 24 percent were not sure.

Over half of healthcare workers were receiving emotional support from family (57 percent) and friends (53 percent). Many healthcare workers also reported receiving emotional support from their same-level coworkers (38 percent).

From whom do you receive emotional support? Check all that apply.	Count	Percentage
Family	634	56.66%
Friends	593	52.99%
Significant other	437	39.05%
Same level co-workers	430	38.43%
Supervisor	171	15.28%
Therapist	169	15.10%
No one	136	12.15%
Support group (live virtual group or social media group)	57	5.09%
Roommate(s)	41	3.66%
Other	33	2.95%

Work-Related Stressors

When asked to select their top three work-related stressors, 61 percent reported uncertainty about when things will settle down or return to normal, and 54 percent reported experiencing burnout. Nearly half (49 percent) also reported that their heavy or increased workload was a major stressor in the previous three months.

What are your top three work-related stressors over the last three months? Check all that apply.	Count	Percentage
Uncertainty about when things will settle down/return to normal	678	60.59%
Burnout	599	53.53%
Heavy/increased workload	544	48.61%
Concern of getting sick myself	484	43.25%
Concern of spreading COVID-19	396	35.39%
Insufficient communication from leadership	337	30.12%
Insufficient PPE	289	25.83%
Working too many hours	271	24.22%
Job security/employment status	253	22.61%
Insufficient training	142	12.69%
Distress about how to effectively treat COVID-19 patients	136	12.15%
Inappropriate role designation	127	11.35%
Working at a new location	121	10.81%
Witnessing high number of deaths	101	9.03%
Other	55	4.92%
Treating coworkers with COVID-19	29	2.59%

Fear of Exposure and Increased Stress at Home

Most healthcare workers reported that they were worried about exposing the people they lived with to COVID-19. Forty-seven percent reported being worried about exposing their older adult family, and 45 percent were worried about exposing their spouse or partner. Seventy-six percent of healthcare workers with children reported they were worried about exposing their children. Nearly half (45 percent) selected more than one option.

Are you worried about exposing the people you live with to COVID-19? If yes, who? Check all that apply.	Count	Percentage
Exposing my child	358	75.80%*
Exposing my older adult family	521	46.56%
Exposing my spouse or partner	509	45.49%
I'm not worried about exposing my household members	170	15.19%
I live alone	158	14.12%
Exposing my roommate	111	9.92%

*Percent determined from the number of respondents who reported having children, as opposed to the whole population of respondents.

When asked about their top three home-related stressors, the majority of respondents (63 percent) reported that they were too tired when they got home from work to do home-related tasks such as cooking and chores. Nurses were even more likely to report feeling too tired after work than other healthcare workers (67 percent). Forty-one percent of healthcare workers reported loneliness as a significant stressor, and over 40 percent reported financial stress.

Among healthcare workers who indicated that they had children, 34 percent indicated that not being able to support children or be a present parent was a major stressor, and 32 percent reported a lack of quality time with their children as a result of COVID-19.

What are your top three personal/home-related stressors over the last three months?	Count	Percentage
I am too tired when I get home to cook, do chores, etc.	700	62.56%
Loneliness	464	41.47%
Financial stress	453	40.48%
Worry and/or guilt about infecting household members	410	36.64%
Taking stress out on my family	384	34.32%
Lack of quality time with partner(s)	341	30.47%
My partner doesn't understand the stress I'm under	279	24.93%
Inconsistent work hours/coordinating schedules	262	23.41%
Other family member(s) needing to take over my responsibilities	112	10.01%

Among people who reported having children:
Being able to support children/being a present parent	150	34.25%
Lack of quality time with children	142	32.42%
Homeschooling	125	28.54%
Childcare	96	21.92%

Half (50 percent) of healthcare workers indicated they were the primary caretaker within their homes. Another 5 percent normally would be the primary caretaker but had shifted responsibility as a result of COVID-19.

Among the healthcare workers who responded to this survey, 61 percent did not have children at home. However, among those who did report having children at home, 46 percent reported that their children either did not understand or were not concerned about them being a healthcare worker. Forty percent reported that their children were concerned but no more than expected, and 14 percent indicated that their children were extremely concerned.

For resources and supports for healthcare workers, please visit mhanational.org/frontline

The Healthcare Worker Survey was made possible by the generous support of the Johnson & Johnson Foundation.