A new study highlighted in The Nation’s Health, a publication of the American Public Health Association, calls attention to a critical subset of the U.S. workforce during the ongoing COVID-19 pandemic – frontline public health workers (PHWs).
The report, “Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic — United States, March–April 2021,” was published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR).
While there have been multiple studies that have investigated the well-being of health care providers during the pandemic, the MMWR study is one of a select few to capture its impact on the mental health of public health responders.
PHWs who participated in the study completed a self-administered, online, anonymous survey in the period of March 29–April 16, 2021. These included more than 26,100 state, tribal, local, and territorial PHWs, 53% of which reported symptoms of at least one mental health condition in the preceding two weeks.
The results were telling, suggesting significant adverse impacts on PHWs as prevalence of symptoms of depression, anxiety, PTSD, and suicidal ideation were 32.0%, 30.3%, 36.8%, and 8.4%, respectively. The highest prevalence of symptoms of a mental health condition or suicidal ideation were among respondents 29 years of age or younger, and amongst transgender or nonbinary individuals of all ages.
The issue of time was a recurring theme amongst respondents. More than 90% were working directly on COVID-19 response, with the majority working 41 hours or more in a typical week since March 2020. According to the authors, PHWs who were unable to take time off from work when they needed it were nearly twice as likely to report symptoms of an adverse mental health condition as were those who could take time off. The most cited reasons for not opting to take time were concerns about falling behind on work, no work coverage, feeling guilty, and simply not “being allowed” to take time off.
Additional findings were equally troubling. Survey respondents reported experiencing varying traumatic events/stressors since March 2020, such as feeling overwhelmed by workload or family/work balance (72.0%), receiving job-related threats because of work (11.8%), and feeling bullied, threatened, or harassed because of work (23.4%).
One in five (19.6%) respondents reported needing, though not receiving, mental health counseling/services in the last four weeks. Further, while employee assistance programs were available to about 66% of the respondents, only 11.7% accessed these services.
“We were feeling from our members a level of distress that we’d never seen before — a demoralization,” said Lori Tremmel Freeman, MBA, CEO of the National Association of County and City Health Officials, which worked with study investigators to help disseminate the surveys to PHWs through thousands of local health departments across the country.
“We knew we’d see some signals of impact to mental health, but we weren’t prepared for the extent of signals,” added Freeman. “The rates of PTSD and suicidal thoughts are significant enough that those findings alone need to be addressed with action. This is serious.”
The authors posit that unchecked adverse mental health symptoms that impact the wellbeing of PWHs could, over time, also degrade the overall effectiveness of public organizations during emergencies. They go on to offer several strategies to reverse such a trend such as expanding staff size, recruiting “surge personnel,” instituting flexible schedules, plus evaluating, enhancing, and promoting the utilization of employee assistance programs.
“Furthermore, strengthening work systems to encourage behavior changes that promote mental health, such as building awareness of symptoms of mental health conditions and developing sustainable coping strategies, might improve mental health conditions, particularly for public health workers who are at increased risk, including those who are younger or transgender or nonbinary persons,” explained the authors.
Source: The Nation’s Health (American Public Health Association), September 2021