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Mental/behavioural healthcare / Critical care

Call for UK strategy to protect mental health of ICU staff, as study shows huge toll

By Andrew Sansom 13 Jan 2021 0

Almost half of critical care workers in the UK have endured mental health distress as a consequence of the first wave of the Covid-19 pandemic, a new analysis suggests, prompting calls for a national strategy to safeguard the psychological wellbeing of ICU staff and ensure they are able to provide high-quality patient care.

Results from a study of ICU healthcare workers, published in Occupational Medicine, show that nearly half of critical care staff are likely to meet the threshold for post-traumatic stress disorder (PTSD), severe anxiety or problem drinking during the pandemic.

Researchers from King’s College London found poor mental health was common in many ICU clinicians, although they were more pronounced in nurses than in doctors or other healthcare professionals. A total of 709 healthcare workers (291 doctors – 41 per cent; 344 nurses – 49 per cent; and 74 other healthcare staff – 10 per cent), from nine ICUs in England, completed anonymous web-based surveys in June and July last year.

While more than half (59 per cent) reported good wellbeing, 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). More than one in eight respondents (13 per cent) reported frequent thoughts of being better off dead, or of hurting themselves in the two weeks prior to them completing the survey.

Lead author Professor Neil Greenberg, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, warned that the severity of symptoms experienced by some critical care workers are highly likely to impair their ability to provide high-quality care, as well as negatively impacting on their quality of life.

He says: “The high rate of mortality amongst COVID-19 patients admitted to ICU, coupled with difficulty in communication and providing adequate end-of-life support for 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.”

He continues: “While 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 uncomfortable 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 the anxiety of catching Covid-19 themselves and potentially passing it on to their loved ones.

Professor Greenberg argues for evidence-based mechanisms to be put in place so all healthcare workers can gain prompt access to treatment for mental health issues. He cautions, too, that further work is needed to better understand the real level of clinical need among ICU staff, as self-report questionnaires can overestimate the rate of clinically relevant mental health symptoms.

He 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.”

The research was a collaboration between King’s College London and University College London with contributions from the Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England and the University of Oxford. It 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 and in collaboration with the University of East Anglia and Newcastle University.

The study, ‘The mental health of staff working in intensive care during Covid-19’, authored by Greenberg et al is published in Occupational Medicine.

Organisations involved