HEALTH – A study in Chinese doctors shows the mental cost of caring for COVID19 and the fear of violence at work

Hundreds of young Chinese doctors working in hospitals hundreds of kilometers from the epicenter of the coronavirus outbreak and with a few hundred cases to attend to with the entire confined population also experienced a sharp drop in mood, an increase in symptoms of depression and anxiety and their fear of violence in the workplace doubled in just the first month of the COVID-19 pandemic.

According to the new research, published in the JAMA Network Open magazine by an American and Chinese team, they clearly show the potential mental cost of being a front-line health care worker at the time of COVID-19.

The increase in symptoms among 385 first-year medical residents in Shanghai contrasts with data from previous year’s resident promotion members, who participated in the same study from 2018 to 2019.

When this year’s class saw a sharp change in most measures of mental health and workplace violence during the first half of the training year, last year’s class had stable scores at the same point in their training .

Other research in Chinese and American residents has shown that the stress of first-year medical training is related to a sharp increase in depressive symptoms over pre-residency scores.

“Even before this pandemic, the levels of depression and anxiety symptoms among our health workers were high and our findings indicate that they are getting worse,” says Srijan Sen, a psychiatrist and neuroscientist at the University of Michigan who leads the Health Study intern who threw the data.

“As it is clear that this pandemic will accompany us in the immediate future, we must prioritize the well-being of our health workers, not only for them, but also for the patients who will need them in the coming months and years,” adds Sen, who He worked with colleagues at the Michigan Neuroscience Institute, University of Michigan (UM) and Shanghai Jiao Tong University to collect and analyze the data.

Weidong Li, co-first author and co-correspondent for the new article and professor at SJTU, notes that the end of winter is typically a time of high moods in China, due to the celebration of the Lunar New Year.

“Our findings indicate that the negative mental health effects of COVID-19 are not limited to doctors working at the center of the initial outbreak in Wuhan, but spread to other places such as Shanghai, which is 800 kilometers away. “, He says.

“With the many new cases spread around the world, this has important implications for how communities around the world respond to this growing public health crisis,” said Li, deputy director of the Science and Technology Research Center at the Cerebro, and vice dean of the Bio-X Institutes, at SJTU.

For her part, Elena Frank, director of the Intern Health Study, points out that the data provide a strong reminder of the impacts of infectious disease outbreaks on the physical and psychological health of health workers.

“It’s easy to forget that they face many of the same additional stresses as the rest of us: concerns about the elderly or family at risk, the loss of child care, while simultaneously handling a greater clinical workload, and all while being placed at themselves and their families at higher risk of infection, “he says.” The possible consequences for mental health of facing such enormous pressures can not be overlooked. “

When the 385 doctors in the study volunteered for the research project last summer, they were about to start the same intense, sometimes exhausting, training experience that marks the start of a medical career in many countries.

A few weeks ago, cohort data from previous residents was released as a preprint, a report that has not been peer-reviewed by Sen and Li’s colleagues. It shows a similar increase in depression symptoms occurring in 7,000 first-year residents (also called interns) in more than 100 U.S. hospitals and 1,000 Chinese first-year residents in 16 hospitals in Shanghai and Beijing in the three years of the study.

Like study participants before them in the United States and China, members of the Shanghai intern class who entered 12 hospitals in August 2019 agreed to monitor their mood daily on a smartphone app, and each a few months they answer standardized questionnaires about their mental health and whether they have experienced, observed or feared physical or verbal violence in their workplace.

Little did they know that their data would give some of the clearest indication yet of the mental cost of being on the front line of a pandemic.

The new study looks at changes in scores between surveys residents conducted in October and November 2019, and those taken in January and February, when the pandemic peaked in China. It also measures changes in daily mood between those two quarters.

Sen, who is also an associate vice president for research at UM and professor of depression and neuroscience Frances and Kenneth Eisenberg, has participated in mental health programs for residents of Michigan Medicine, the UM academic medical center.

Their decade-long study has focused on first-year residents because they all start and end their training year at the same time and have similar experiences, making them an ideal study population for the question of how intense stress affects Mental health.


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