ABSTRACT
Study Objective: The COVID-19 pandemic has placed an unprecedented psychological burden on emergency medicine (EM) providers who have experienced anxiety, depression, isolation, burnout, and poor self-care. ACEP along with 44 medical organizations issued a statement in support of clinician health in the post-pandemic period calling for the removal of barriers to mental health care and using non-clinical mental health support, specifically peer support, to foster resilience and recovery. While physicians prefer to seek support from colleagues, formal peer support interventions are not well studied. The objectives of the study were to determine feasibility, receptivity, and effect of physician peer support groups on symptoms of acute distress, anxiety, depression, and burnout. Methods: A quasi-experimental design was used to determine pre-post intervention changes in anxiety and depression (primary outcomes) using the Patient Health Questionnaire (PHQ-4);provider burnout using the Maslach Burnout Inventory;and distress symptoms (fatigue, trouble sleeping, nervousness, feeling down, anger, helplessness, guilt, difficulty concentrating) using the SPADE Symptom Screener and PROMIS measure. The Participant-rated Global Impression of Change was used to monitor whether feeling better at the end of each session compared to the beginning. Receptivity was assessed using a net promoter score question. The study population was emergency physicians serving 10 academic and community hospitals who self-identified as having any mental health challenge during the pandemic. Three groups of 8 providers were recruited via departmental email listservs to participate in eight 1-hour virtual, peer support group sessions via Zoom Health. The visit structure was based on the National Alliance of Mental Illness (NAMI) peer support model and adapted for use in the clinician population. Three physicians were trained to cofacilitate with a NAMI support group leader. Data were collected using the Zoom polling function. Change analysis was conducted using dependent t-tests in SPSS. A sample size of 16 clinicians was needed to provide 80% power for two-sided tests at an alpha of 0.05 to detect a large effect size of 1.0 (3-point absolute change) for the PHQ-4. Results: Of the 24 participating physicians, the majority were faculty physicians, white, female, and in practice 5 years or less. Average attendance was 6.5 sessions with 83% of physicians reaching the attendance goal of 6 out of 8 sessions. On average, participants reported feeling better at the end compared to the beginning of each session. Eighty six percent of physicians reported they would recommend peer support groups to a friend or colleague. Positive effect sizes showed improvement in 8 of 11 distress symptoms, and marginal significance (p<.10) for guilt and anxiety. Conclusions: High levels of attendance, feeling better at the end of sessions, and willingness to recommend peer support groups to friends or colleagues demonstrate high physician receptivity to peer support and feasibility of implementation. Positive effect sizes show promising signs of improvement in the majority of anxiety, depression, distress, and burn out symptoms in this pilot study. Attention is needed to tailor strategies to male providers who may be hesitant to participate. Further research of this model with a larger samples and more robust design is planned. [Formula presented]