Depression in Emergency Department Healthcare Workers During the COVID-19 Outbreak in Brooklyn, NY

ABSTRACT

Study Objectives: emergency department (ED) health care workers (HCW) have experienced extensive mental health burdens in the fight against COVID-19. This study measured depressive symptoms in ED HCW in Brooklyn, New York, at the peak 2020 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. Depressive symptoms were measured by the 10- item depressive symptom scale, Centers for Epidemiologic Studies-Depression (CES-D). CES-D items were summed, with a possible total score of 0-30. A CES-D score >10 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 analysis were used to predict CES-D score (β- coefficient, p-value) and clinically relevant depressive symptoms (Odds Ratio (OR), 95% Confidence Interval (95% CI)), respectively. A p-value<0.05 was considered significant. Results: Among 222 HCW respondents, the mean age was 38.2±10.8y;and 59.4% were White, 52.5% were male, 80.1% were clinical HCW (38.5% MD/DO, 29.7% nurses, 31.8% ED technicians), and 61.6% tested for SARS-CoV-2. The mean CES-D score was 11.8±8.2. A clinically relevant depressive symptom burden was reported by 51.6% of HCW-55.4% of clinical HCW vs 36.4% of non-clinical HCW (p=0.024). There was no difference in the odds of clinically relevant depressive symptoms by type of clinical HCW (MD/DO, nurses, ED technicians) compared to non-clinical HCW;and no difference in mean CES-D score by clinical vs non-clinical HCW status. Increasing CES-D scores were also observed with increasing age (β=0.12, p=0.01), number of COVID-19-related home problems (β=0.99, p=0.035), and LBF score (β= 2.17, p<0.0001). A clinically-relevant depressive symptom burden was also observed with increasing age (OR 1.07, 95% CI 1.03-1.11), among those who reported increasing COVID-19-related home problems (OR 1.46, 95% CI 1.01-2.11), and LBF score (OR 2.08, 95% CI 1.63-2.65). Conclusions: Over half of clinical HCW experienced a clinically relevant depressive symptom burden during the peak of the COVID-19 pandemic. Age, number of COVID-19-related home problems, and loneliness were also associated with higher depressive symptom burden. 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, temporal associations between mental health outcomes and associated factors must continue to be investigated.