COVID-19 Reveals Mental Health Crisis Among Healthcare Professionals
Suicide is a growing problem among Americans and especially healthcare professionals in the COVID-19 pandemic. Why and what can be done about it?
COVID-19 (novel coronavirus disease 2019) is not only affecting the physical health of the nation but also its mental health, including among frontline healthcare professionals.
Because it is a new illness caused by a new virus, there is no cure or vaccine for COVID-19. Because it is spread mainly by person to person, the best way to prevent its spread is to limit such contact through social distancing—wearing surgical-style masks and keeping at least six feet away from other people.
Authorities fear a repeat of the devastation of the 1918 flu pandemic, which killed an estimated 675,000 Americans and as many as 30 million people worldwide. Then, as now, there was no vaccine or treatment, not even penicillin or other antibiotics.
This fear has forced most people to live as hermits (except for those they live with) and many to lose—at least temporarily—their jobs. Exceptions include those who can perform their jobs via computer and phone and those whose work is deemed “essential” such as physicians and nurses.
Some healthcare work can be handled electronically, and non-essential medical procedures have been suspended. However, those on the frontline of the COVID-19 pandemic, including physicians and nurses, have to continue working. They must face not only the risk of infection but of trying to save lives when they have no effective treatments.
Rates of mental health issues, such as substance abuse and suicide, have been on the rise in recent decades, including among medical personnel, but COVID-19 is a new level and may have lasting consequences after the virus is under control.
Rates of Mental Illness
Life in the time of COVID-19 has constricted the world for most people and in a manner that may make the risks of mental illness greater.
Confinement at home, even if one is still working by teleconferencing, increases depression and anxiety, two of the main triggers for substance abuse and suicide.
Not that the pandemic is the only reason. The rates of mental health issues—including depression, anxiety, trauma, substance abuse, and suicide—have been quietly increasing since long before COVID-19.
In 2017, the drug overdose death rate was 21.7 out of 100,000—70,237 Americans—up almost 10% from the previous year. (It did decrease—for the first time in 30 years—to 67,367 in 2018.)
Between 40 and 60% of people with a substance use disorder also have a mental health issue, known as co-occurring disorders or dual diagnosis. Even if one condition is caused by the other (and it may not be easy to determine which came first), both conditions need to be addressed for recovery.
In 2018, 48,000 Americans committed suicide or 14.2 deaths per 100,000, a 35% increase since 1999. Overall, suicide is the 10th leading cause of death, as well as the second leading cause of death for ages 10–34, and the fourth leading cause for ages 35–54.
Anecdotal evidence suggests calls and texts to suicide hotlines have greatly increased since the emergence of COVID-19. One study by a nonprofit behavioral therapy center in Michigan warns that in the aftermath of the COVID-19 pandemic, suicide rates could increase by 32% in the state. First responders and healthcare workers are most at risk.
Deaths of Despair
One common cause of suicide and perhaps substance abuse is a growing sense of despair as people experienced stagnant wages (even as the stock market and big business profits boomed) and increased social isolation from too much time spent facing electronic screens rather than other humans.
Some analysts say the loss of life from the Opioid Overdose Crisis are deaths of despair—a feeling of never-ending hopelessness, according to the American Psychological Association—as is the rise in suicides. Among the factors driving these mortality rates are:
- Money troubles (low, static wages, inability to pay rent or mortgage, loss of employment).
- Fatigue and stress caused by long hours, irregular schedules, overwork, being on call 24/7 electronically.
- Health problems (a serious medical diagnosis, lack of adequate health insurance).
- Clinical depressionor major depressive disorder.
- Other mental health problems (anxiety disorders, bipolar disorder, borderline personality disorder).
- Feeling lonely or socially isolated.
- Substance use disorders.
- Negative political climate.
- Suicide contagion or copycat suicides when famous people kill themselves
The Mental Health of Healthcare Professionals
It should be no surprise then that healthcare workers on the frontline of essential workers risking infection are experiencing higher rates of suicide than others.
In general, more women attempt suicide than men but fewer succeed (6.2% vs. 22.8%), although their rate of success is increasing twice as fast (55% vs.28%). An exception to this rule is female physicians.
Practicing physicians of either gender have a 40% higher suicide risk than the general public, as studies have found an increased suicide risk among practicing physicians over the general population, but female physicians are more than three times as likely as males (130% vs.40%).
Doctors and nurses have long been stress trained by long hours in the classroom and on the job. First-year residents and Interns are subject to shifts that can last up to 28 hours, with 80-hour weeks and as little as one day off (averaged over four weeks).
Lack of sleep can cloud judgment, retard response time, and lead to mental health problems such as substance abuse. Some specialties are especially at risk, including emergency physicians, psychiatrists, and anesthesiologists. They also face higher rates of suicide.
Healthcare workers have always had higher rates of substance abuse and suicide. While the rate had been declining in Europe, not in the US. Reasons include:
- Heavy workload
- Long shifts
- Unpredictable hours
- Sleep deprivation
- Stress from dealing with life-and-death emergencies
- Easy access to means of committing suicide
Even more widespread of a problem is burnout, which may be epidemic among at least some medical workers. While 20% of physicians show signs of depression, 74% show signs of burnout.
Burnout refers to three simultaneous symptoms resulting from chronic work-related stress:
- Emotional exhaustion
- Feelings of inefficacy
Contributors to burnout include:
- Mood disorders. Examples include anxiety and depression.
- Compassion fatigue. Healthcare workers may see more tragedy and trauma than in any profession.
- Less time with patients.Corporate medical practices require physicians to spend less time with each client.
- Marriage and other family issues.Medical doctors and nurses have spousal, parental, and other relationship issues.
- Prescription meds are easier for them to obtain, but they face other compulsions, too (alcohol, gambling, electronic devices).
How COVID-19 Makes Mental Health Worse
That’s when there isn’t a pandemic. The COVID-19 pandemic is likely to exacerbate these causes and increase these rates. Physicians, nurses, and other healthcare practitioners are not immune and may be harder hit.
Their usual reward for their hard work is to save lives, but that is more often denied them. Without effective treatments and no preventive vaccine, many individuals are dead before they get out of the ambulance. Even in the hospital, the nurses and physicians cannot do much. After expediting their time and energy to save a life, to see it lost is more than heartbreaking; it is soul-shattering.
In ordinary times, healthcare workers who lose a patient may be traumatized. The numbers and uncertainty they now face are akin to combat. When the pandemic is finally over, they will likely suffer from burnout, at best, if not post-traumatic stress disorder (PTSD) akin to that experienced by military veterans.
Medical professionals may even be denied the comfort of loved ones. Many who daily expose themselves to the risk of COVID-19 infection sequester themselves away from family lest they infect them.
Solving the Problem
The mental health problems facing physicians and nurses are not new. How much worse COVID-19 will make them won’t be known for months, probably years, but in April, at least two frontline medical workers took their own lives due to the stresses of the pandemic.
In May, CVS Health through its Aetna Foundation donated more than $1 million to organizations that support the mental health of frontline health workers and essential workers, including the Americares COVID-19 Mental Health and Psychosocial Support Project and the Crisis Text Line and For The Frontlines.
Lifestyle changes as simple as getting some exercise can help. If they don’t have a home gym (public workout centers are likely closed now), then take a walk or run. Physical exercise produces endorphins that boost mood.
Meditation and mindfulness also make people feel good by reducing levels of anxiety and depression. They’re not the same thing. Meditation is focusing on your thoughts without outside distraction, while mindfulness is a keen awareness of your body and environs in the moment.
Both practices can also help them cope with the isolation of life under COVID-19 social distancing and social isolation.
Here are some resources for healthcare workers and others at risk for burnout, stress, addiction, and suicide:
- American Psychiatric Association lists a number of Well-being Resources–to fight burnout, depression, and substance abuse, external and internal, for individuals and organizations–from apps to TED Talks, applicable to frontline physicians and other healthcare workers.
- American Medical Association has articles on how to prevent and cope with physician burnout and stress, most related to COVID-19, including:
- Managing mental health during COVID-19
- Share your COVID-19 story to improve doctors’ safety, well-being
- 6 ways to address physician stress during COVID-19 pandemic
- Peer support program strives to ease distress during pandemic
- Caring for our caregivers during COVID-19
- Well-being resources should extend beyond a crisis to include PTSD
- Creating a resilient organization for health care workers during a crisis
- 5 wellness task force tactics designed to prioritize physician health
- 5 resources built to provide emotional support in times of crisis
- How Henry Ford Hospital is working to prevent physician burnout
- Centers for Disease Control and Prevention has a document not specifically geared towards healthcare workers: Employees: How to Cope with Job Stress and Build Resilience During the COVID-19 Pandemic
- PTSD: National Center for PTSD, US Department of Veterans Affairs – Managing Healthcare Workers’ Stress Associated with the COVID-19 Virus Outbreak
- The Center to Advance Palliative Care – “We Are in a War”: Mitigating Burnout in COVID-19
- The National Academy of Medicine – Resources to Support the Health and Well-Being of Clinicians During the COVID-19 Outbreak
- World Health Organization – Mental health and psychosocial considerations during the COVID-19 outbreak
- National Alliance on Mental Illness – COVID-19 Resource and Information Guide
- National Suicide Prevention Lifeline. Call 800-273-TALK (8255) to speak with a trained crisis counselor 24/7.
- Crisis Text Line. Text TALK to 741741 to speak with a crisis counselor 24/7.
- The Trevor Project. A national organization providing support for LGBTQ youth, including suicide prevention. Call 866-951-2978, text “START” to 678678 or instant message a counselor 24/7.
- The American Foundation for Suicide Prevention. Online resources for suicide prevention during COVID-19.
- Grief Share. A grief recovery support group.
- cdc.gov – What you should know about COVID-19 to protect yourself and others
- cdc.gov – 1918 Pandemic (H1N1 virus)
- virus.stanford.edu – The Influenza Pandemic of 1918
- nami.org – Dual Diagnosis (Substance Use Disorders)
- cdc.gov – Increase in Suicide Mortality in the United States, 1999–2018
- ncbi.nlm.nih.gov – The Role of Alcohol, Drugs, and Deaths of Despair in the U.S.’s Falling Life Expectancy
- wilx.com – Study predicts increase in suicide rates among COVID-19 frontline workers
- drugabuse.gov – Opioid Overdose Crisis
- ncbi.nlm.nih.gov – Physician Suicide: A Call to Action
- psnet.ahrq.gov – Duty Hours and Patient Safety
- corporatewellnessmagazine.com – Addressing the Alarming Trends in Suicides Among Healthcare Professionals
- mayoclinic.org – Post-traumatic stress disorder (PTSD)
- ncbi.nlm.nih.gov – Prevention of Physicians’ Suicide
- providencejournal.com – CVS to provide more than $1M to support mental health of healthcare workers, others
- americares.org – Mental Health
- webmd.com – Exercise and Depression
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