Mental health of ICU staff should be immediate priority, new study shows

Results from a study of ICU healthcare workers, published today in Occupational Medicine, shows the stark impact of working in critical care during the COVID-10 pandemic. The researchers found poor mental health was common in many ICU clinicians although they were more pronounced in nurses than in doctors or other healthcare professionals.

Lead author, Professor Neil Greenberg, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London said:

'Our results show a substantial burden of mental health symptoms being reported by ICU staff towards the end of the first wave in July and July 2020. The severity of symptoms we identified are highly likely to impair some ICU staffs ability to provide high quality care as well as negatively impacting on their quality of life.

'The high rate of mortality amongst COVID-19 patients admitted to ICU, coupled with difficulty in communication and providing adequate end-of-life support to patients, and their next of kin because of visiting restrictions, are very likely to have been highly challenging stressors for all staff working in ICUs.'

709 healthcare workers, from nine ICUs in England, completed anonymous web-based surveys in June and July 2020 comprising 291 (41 per cent) doctors, 344 (49 per cent) nurses, and 74 (10 per cent) other healthcare staff.

Over half (59 per cent) reported good wellbeing, however 45 per cent met the threshold for probable clinical significance for at least one of: severe depression (6 per cent), PTSD (40 per cent), severe anxiety (11 per cent) or problem drinking (7 per cent). Worryingly more than one in eight respondents (13 per cent) reported frequent thoughts of being better off dead, or of hurting themselves in the past two weeks.

Professor Greenberg continues 'Whilst these results are in some ways not surprising, they should serve as a stark reminder to NHS managers of the pressing need to protect the mental health of ICU workers now in order to ensure they can deliver vital care to those in need.'

ICU staff have faced a particularly challenging time frequently working in areas where the perceived risk of COVID-19 exposure is high for long periods, wearing PPE, with the challenges of managing staff and equipment shortages on a daily basis especially during the first wave. They have also had to deal with ethically challenging decisions as well as potentially being fearful of catching COVID-19 themselves and potentially passing it on to their loved ones.

Professor Greenberg adds 'Evidence-based mechanisms should be in place so all healthcare workers, including ICU staff, can promptly access treatment for mental health issues. If we protect the mental health of healthcare workers during the COVID-19 pandemic, staff will be better able to sustainably deliver high quality care to the large numbers of patients seriously unwell with COVID-19.'

Further work is needed to better understand the real level of clinical need amongst ICU staff as self-report questionnaires can overestimate the rate of clinically relevant mental health symptoms.

Professor Greenberg concludes: 'Our results highlight the potential profound impact that COVID-19 has had on the mental health of frontline UK staff and indicate an urgent need for a national strategy to protect staff mental health and decrease the risk of functional impairment of ICU staff while they carry out their essential work during COVID-19 and beyond.'

This research was a collaboration between King's College London and University College London with important contributions from the Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England and the University of Oxford.

The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University.