Corona-driven Stress in Healthcare Professionals

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Stress levels experienced by those working in outpatient care were relatively high during the early phase of the Corona pandemic - higher than in medical personnel working in the two other sectors of the healthcare system, i.e. hospital care and prehospital emergency medicine. This was the conclusion of a study led by Associate Professor Dr Marie Ottilie Frenkel at the Institute of Sports and Sports Sciences of Heidelberg University. It is based on data from an online survey carried out in the spring and early summer of 2020 among healthcare professionals treating patients with COVID-19 in Germany. The results of the stress survey show that customised coping strategies are needed to counteract pandemic-driven stressors. The long-term goal of the research is to compare the stress load in healthcare systems internationally and then work toward countering it systematically.

In a cross-discipline and cross-sectoral study, the team of psychologists, physicians, and social scientists investigated which pandemic-driven stress factors have emerged in medical personnel treating COVID-19 patients. They also explored the question of how these factors influenced participants’ psychological experience of stress and what coping strategies they deemed effective. A total of 575 medical professionals participated in the survey between mid-April and the beginning of June 2020. They were employed in the outpatient sector, in hospitals, or in prehospital emergency care.

"Our results revealed that in the first wave of the COVID-19 pandemic, fear of infection, uncertainty, lack of knowledge, and concern for the team were among the latently occurring stress factors," explains sports psychologist Marie Ottilie Frenkel. These factors equally contributed to the psychological stress levels of those working in all three sectors. Those surveyed also expressed fear that the extreme workload would affect their personal lives. Yet according to Dr Stefan Mohr, researcher at the Department of Anesthesiology at Heidelberg University Hospital, stress levels were on average only moderately high - on a scale of 1 (no stress) to 5 (extreme stress), the average score was 3.2. But there were striking differences among those surveyed in the three sectors. During the first wave of the pandemic, those working in outpatient care experienced higher stress levels than hospital workers and professionals in prehospital emergency medicine.

The analysis further showed that those working in prehospital emergency care felt less fatigued than those surveyed in the other two sectors. But they did evidence considerably more concern for their colleagues than the hospital staff group. Erik Popp, Director of the Division of Prehospital Emergency Medicine at Heidelberg University Hospital, characterises the current situation. "In the prehospital care system, it helps that there is enough protective equipment and that personnel know how to use it. It is also good that most have received their third shot. On the other hand, we currently have a very high incidence of infections and therefore a markedly higher probability of encountering patients with COVID-19 in the emergency setting." In clinical care, the daily battle for the survival of seriously ill patients compounds the high levels of physical and mental stress, as Markus Weigand, Medical Director of the Department of Anesthesiology at Heidelberg University Hospital, describes the current situation. In the outpatient sector, for instance in outpatient paediatrics and adolescent medicine, stress levels also continue to be high, according to Benedikt Fritzsching, a private-practice paediatrician based in Heidelberg.

Those surveyed during the first wave of the pandemic found mandatory social distancing and face masks as well as training, experience, and knowledge-sharing to be effective strategies. The results of the study also indicate that healthcare workers benefit from strategies that include the social environment. "The burden on employees is very high, because since the beginning of the pandemic, with the exception of a few weeks, there has been a steady flow of COVID-19 patients needing intensive medical care. Team cohesion has a very important role to play here," reports Uta Merle, Acting Medical Director of the Department for Gastroenterology, Infectious Diseases and Intoxication at Heidelberg University Hospital. While cohesion and knowledge-sharing among colleagues help mitigate psychological stress at the workplace, the research findings also indicate that work schedules should be organised so that employees have enough time to spend with friends and family.

The results of the current study form the basis for further research aimed to better understand decision-making and behaviour of medical first responders in stressful and high-stakes emergency situations and to improve them through suitable interventions. Dr Frenkel: "Especially in light of pandemics, international coordination of resource-strengthening, preventive, and reactive measures for healthcare workers is a critical prerequisite for effective disease control." The research results were published in the journal "PLOS ONE".

M. O. Frenkel, K. M. Pollak, O. Schilling, L. Voigt, B. Fritzsching, C. Wrzus, S. Egger-Lampl, U. Merle, M. A. Weigand, S. Mohr: Stressors faced by healthcare professionals and coping strategies during the early stage of the COVID-19 pandemic in Germany. PLOS ONE (18 January 2022)


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