key: cord-0731002-7auounlr
authors: Hall, Charlotte E.; Milward, Joanna; Spoiala, Cristina; Bhogal, Jaskiran K.; Weston, Dale; Potts, Henry W.W.; Caulfield, Tristan; Toolan, Michael; Kanga, Kate; El-Sheikha, Sarah; Fong, Kevin; Greenberg, Neil
title: The mental health of staff working on Intensive Care Units over the COVID-19 winter surge of 2020 in England: a cross sectional survey.
date: 2022-03-24
journal: Br J Anaesth
DOI: 10.1016/j.bja.2022.03.016
sha: 11c576e6dc8eefcb8c3d55bea686fee64a1e409e
doc_id: 731002
cord_uid: 7auounlr

BACKGROUND: The COVID-19 pandemic generated a surge of critically ill patients greater than the NHS’ capacity. Additionally, there have been multiple well-documented impacts associated with the national COVID-19 pandemic surge on intensive care unit (ICU) staff, including an increased prevalence of mental health disorders on a scale potentially sufficient to impair high-quality care delivery. We investigated the prevalence of five mental health outcomes; explore demographic and professional predictors of poor mental health outcomes; describe the prevalence of functional impairment; and, explore demographic and professional predictors of functional impairment in ICU staff over the 2020/2021 winter covid surge in England. METHODS: English ICU staff were surveyed before, during and after the winter 2020/2021 surge using a survey which comprised of validated measures of mental health. RESULTS: 6080 surveys were completed, by ICU nurses (57.5%), doctors (27.9%), and other healthcare staff (14.5%). Reporting probable mental health disorders increased from 51% (prior to), to 64% (during) and then dropped to 46% (after). Younger, less experienced and nursing staff were most likely to report probable mental health disorders. Additionally, during and after the winter, over 50% of participants met threshold criteria for functional impairment. Staff who reported probable post-traumatic stress disorder, anxiety or depression were more likely to meet threshold criteria for functional impairment. CONCLUSIONS: The winter of 2020/2021 was associated with an increase in poor mental health outcomes and functional impairment amongst ICU staff during a period of peak caseload. These effects are likely to impact on patient care outcomes and the longer-term resilience of the healthcare workforce.

An online cross-sectional survey was designed and run in 56 English ICUs, which 143 experienced a surge in adult patients, above their formally commissioned baseline. Collection 144 occurred across three time points: before the peak -19 th November to 17 th December 2020; The following measures, for which binary outcomes were set following cut-off scores to 182 indicate a case, were used; the 9-item Patient Health Questionnaire (PHQ-9) with a score of 183 >9 indicating probable moderate depression and >19 probable severe depression; 17 the 6-item Beyond the common mental health disorders, our study includes a self-report measure of 309 PTSD symptoms, the PCL-6. We identified that a sizeable fraction of respondents met or 310 exceeded the threshold for probable PTSD at all three time points. Whilst there are no robust 311 pre-pandemic data from ICU staff against which to compare this finding, we note these rates are more likely to report poor wellbeing. 22, 24-27 However, the risk of reporting AMD was also 317 increased by being a nurse, particularly a junior nurse. This finding matches our previous 318 study, carried out in June/July 2020, which also concluded that nurses were more at risk than 

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