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A new study by researchers in China has demonstrated the prevalence of insomnia, stress, and associated mental health issues for hospital staff, including frontline medical staff, during the COVID-19 outbreak.
The research, which now appears in the journal Frontiers in Psychiatry, highlights the effects of the pandemic not only on people’s physical health, but also on their mental health.
The rapid spread of SARS-CoV-2 has put severe pressure on health systems around the world. Understandably, there has been much emphasis on the effect of the pandemic on the health of the population, as well as the consequences of the potential loss of life from overwhelmed public health systems.
The effects on frontline medical practitioners have also been severe. Healthcare workers are one of the groups at greater risk of infection. However, the negative psychological effects of working on the frontline of the pandemic have also been significant.
Dr. Bin Zhang, the corresponding author of the article, and his colleagues describe the extremely difficult conditions that healthcare workers experienced during the height of the outbreak in China.
“After brief training,” they write, “medical staff were incorporated into the frontline battle against COVID-19. Additionally, it was not possible to set up isolation rooms consisting of an anteroom and clean zone because of insufficient equipment once the hospital rapidly became a designated COVID-19 center.”
“Medical staff must be equipped with full-body protective equipment under negative pressure for more than 12 [hours], including double-layer protective equipment, double-face masks, double-layer gloves, isolation caps, foot covers, and protective glasses.”
“To avoid being infected while removing protective equipment, staff members cannot eat, drink, or use the bathroom during working hours. Many of them are dehydrated due to excessive sweating, and some develop cystitis and a rash. Medical staff working in the quarantine area must always maintain close contact with [people with the infection].”
“Under these dangerous conditions, medical staff become mentally and physically exhausted, and therefore experience an increased risk of insomnia due to high stress.”
– Dr. Bin Zhang
The authors note that this may create a vicious cycle, wherein high levels of stress cause insomnia, and extensive insomnia causes more stress.
The study authors were particularly interested in the prevalence of insomnia among healthcare workers responding to the height of the outbreak in China, as well as the relationship between insomnia and other mental health issues.
To investigate, they recruited medical staff from across China by accessing WeChat medical groups. Once they had checked the participants to ensure that they were all medical staff, the researchers had a sample size of 1,563 participants.
These participants filled in a questionnaire to evaluate their levels of insomnia, depression, anxiety, and traumatic response.
The researchers found that 564 of the participants (36.1%) experienced insomnia while working in response to the COVID-19 outbreak. In general, those who experienced insomnia had worse anxiety, depression, and trauma. This rate of insomnia was consistent with that during the 2002 SARS-CoV outbreak.
The researchers found various factors that correlated with the prevalence of insomnia. According to Dr. Zhang, “The most important factor was having very strong uncertainty regarding effective disease control among medical staff.”
Other risk factors included:
- having a lower level of education
- experiencing more isolation while working
- having a greater concern about developing COVID-19
- having a perception that information on the outbreak provided by the news or social media was not supportive
The study compared doctors and nurses and found that being a doctor was a protective factor against insomnia. The authors believe that this may be because doctors typically do not work during the night and have a less disrupted circadian cycle.
They also tend to have less contact with patients. Researchers have previously associated more patient contact with a greater traumatic response.
The authors write: “Doctors often work in the daytime, so that they can get good sleep at night, while nurses may have to work the whole night with frequent night shifts. Nurses are more likely to have circadian rhythm dysfunctions induced by irregular and frequent night shifts. Additionally, doctors tend to have a higher level of education.”
In contrast, nurses typically work night shifts and have more contact time with patients.
The study authors also note that the relative levels of education and the sex balance between the doctors and nurses may also have been contributing factors. A greater number of nurses in the study were female, and previous studies that the authors cite in their paper have shown that females are more susceptible to insomnia.
The study authors hope that their research will help develop interventions to support medical staff with insomnia and related mental health issues.
They also suggest that cognitive behavioral therapy for insomnia may be a valuable skill to train staff in. It may also help if hospital administrations become generally more attentive to other risk factors, such as the experience of isolation during healthcare work.
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