Posttraumatic Stress in Emergency Department Health Care Workers During the COVID-19 Outbreak in Brooklyn, New York

ABSTRACT

Study Objectives: Emergency department (ED) health care workers (HCW) have experienced extensive mental health burden in the fight against COVID-19. This study measured symptoms of post-traumatic stress disorder (PTSD) in ED HCW in Brooklyn, New York, experienced during the peak of the COVID-19 pandemic. Methods: An email-distributed survey of ED HCW at Maimonides Medical Center was conducted September 8–December 31, 2020, with reference period March–May 2020. Posttraumatic stress symptoms were measured by the PTSD checklist for DSM-5 (PCL-5). A PCL-5 score >32 was deemed clinically relevant. Our main predictor was HCW status, which was dichotomized as clinical (MD/DO, nurses, ED technicians) vs non-clinical. Covariates included sex, age, race, SARS-CoV-2 testing status (not tested vs +test vs -test), social support (range 0- >4 people to talk to), number of COVID-related home problems (range 0-9), mental health care disruption during COVID-19 (yes/no), 3-item Loneliness Brief Survey (LBF) score (range 3-9), and survey date. General linear regression and logistic regression analyses were used to predict PCL-5 score (β-coefficient, p-value) and clinically relevant posttraumatic stress symptoms (odds ratio (OR), 95% confidence interval (95% CI)), respectively. A p-value<0.05 was considered significant. Results: Among 247 HCW respondents, 67.1% were between 25-44 years old, 56.8% were White, 51.4% were male, 79.7% were clinical HCW (30.5% MD/DO, 22.7% nurses, 25.2% ED technicians), and 63.2% had been tested for SARS-CoV-2. The median PCL-5 score was 10. A higher mean PCL-5 score was observed for clinical vs non-clinical HCW (p<0.0001). Lower PCL-5 scores were observed for males (β=-4.31, p=0.05), while higher scores were observed in association with an increased number of COVID-19-related home problems (β=2.13, p=0.04), LBF score (β= 4.09, p<0.0001) and higher number of people to talk to (β=6.97, p=0.04). A clinically relevant PTSD symptom burden was reported by 16.6% of HCW - 18.3% of clinical HCW vs 3.6% of non-clinical HCW (p=0.0048). Higher odds of clinically relevant PTSD symptoms were observed for ED technicians compared to non-clinical HCW (OR 16.16, 95% CI 1.53-170.46). A clinically relevant PTSD symptom burden was also observed among those reporting increasing COVID-19-related home problems (OR 1.69, 95% CI 1.01-2.83) and LBF score (OR 1.83, 95% CI 1.38-2.44). Conclusions: Almost one in five clinical HCW experienced a clinically relevant PTSD symptom burden during the peak of the COVID-19 pandemic. To deepen our understanding of mental health outcomes, create effective interventions, and promote mental health-related policy changes, such as expanding insurance coverage for mental health care and developing more effective wellness programs for HCW, temporal associations between mental health outcomes and associated factors must continue to be investigated.