Throughout the COVID-19 pandemic, communities have faced mental health challenges associated with morbidity, mortality and infection mitigation efforts, including physical and social isolation. Medical professionals are at heightened risk, according to Beri Ridgeway, MD.
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Dr. Ridgeway, who has been named Chief of Staff at Cleveland Clinic beginning January 1, is concerned that already exhausted healthcare professionals may experience increased levels of psychological distress this winter.
“We’re rounding the corner of an entire year of COVID-19. On the whole, I’d say healthcare workers are physically and mentally exhausted. We keep showing up for work every day without the usual release of going home and having normal social activities. Now, when we go home we are faced with more than usual caregiving stress – we attend to our children who are learning remotely and our loved ones who may be feeling increasingly isolated. There’s no time to relax and decompress,” Dr. Ridgeway says.
Depression and anxiety rates soar
Rates of depression and anxiety have increased significantly as a result of the COVID-19 pandemic. By June 2020, the prevalence of depression had quadrupled compared to the second quarter of 2019, according to a study from the U.S. Centers for Disease Control and Prevention (N = 5,412). The prevalence of anxiety disorder in the general population was 3x higher over the same time period. Overall, 40.9% of U.S. adults report a mental or behavioral health condition. These include symptoms of anxiety disorder, depressive disorder, trauma and increased substance use.
“Under normal circumstances, we would turn to friends and loved ones to reduce stress, but physical distancing has put a damper on how we normally connect with others and find respite. Additionally, other typical outlets to decrease stress, like recreational activities and group exercise, are also curtailed. While we are working hard to practice social and physical distancing for the good of our communities, this can further contribute to feelings of isolation, loneliness and depression,” Dr. Ridgeway says.
Pre-existing burnout inflamed
Even before the pandemic, the burnout rate among physicians was consistently above 40%. Now, nearly a year into a global pandemic, physicians are reporting dramatically increased stress and burnout. In a recent survey of U.S. physicians in June and July of 2020, approximately two-thirds of physicians said that their burnout had increased, 44% said that their relationships at home are more stressed, 46% were more lonely.
Learning from the past
There are several risk factors that make clinicians more vulnerable to psychological distress during a crisis, according to a recent meta-analysis. The study reviewed 59 papers related to the psychological effects on clinicians working to manage novel viral outbreaks, including severe acute respiratory syndrome (SARS), coronavirus disease 2019 (COVID-19), Middle East respiratory syndrome (MERS), Ebola, influenza A virus subtype H1N1, and influenza A virus subtype H7N9. Caregivers who had dependent children at home, and/or had an infected family member were more vulnerable to psychological distress. Social isolation exacerbated this distress, as did pre-existing psychological or physical conditions. Frequent breaks, adequate time off from work, family support, feeling sufficiently trained, having adequate supplies of PPE, and access to psychological interventions were protective.
Tips for safeguarding mental health
If your feelings become overwhelming or difficult to manage, remember how critical it is to seek out the care you require to ensure your own well-being and your ability to care for others. Here are some ways that caregivers can help protect themselves from psychological distress during this difficult period:
- Take frequent breaks from clinical duties. During these breaks, take time to care for yourself. Eat well, rest, meditate, wash your face, etc. Take time for video contact or phone calls with family and friends.
- Use health and wellness apps, including guided meditation recordings and exercise apps.
- Judiciously maximize the usefulness of social media as a means of connecting to friends and colleagues, but create boundaries – don’t use it at bedtime, take social media breaks when needed, turn off notifications, etc.
- Express gratitude. Let people know you appreciate when they go the extra mile. It can make a huge difference in your outlook whether you are the giver or the receiver.
- Actively monitor your colleagues for signs of burnout or psychological distress.
- Do not allow anything, including misplaced concerns about stigma or shame, stop you from reaching out for help and support.
- Use the emotional support resources made available to you by your employer. Cleveland Clinic established a 24/7 emotional support line that is staffed by licensed behavioral health clinicians who offer confidential emotional support services over the phone.
Above all, be kind to yourself, says K. Kelly Hancock, DPN, RN, NE-BC, FAAN, Chief Caregiver Officer at Cleveland Clinic.
“You aren’t in this alone. There’s strength in numbers and it is important to reach out and connect with others, to express how you are feeling. Also, it is important to have some sort of outlet: go for a walk, get some exercise, practice yoga, work in your garden or take up a new hobby. Now more than ever we need to find new ways of relieving stress and staying positive,” Dr. Hancock advises.
Finally, Dr. Ridgeway adds, “There is hope. Vaccinations have started in the U.S. and with widespread vaccination, there is a clear path to move beyond the pandemic in 2021. Until then, we must take care of ourselves and each other.”