Childcare at hospitals during shifts, providing healthcare workers with free parking, nutritional meals and coffee, and additional psychological support services and interventions such as a time out room with mindfulness activities. These are just some of the strategies that could help support frontline healthcare workers to cope with working in high stress environments, according to a nursing researcher.

The calls follow a global study undertaken by a team of researchers from the University of Wollongong (UOW), St George Hospital and the Illawarra Health and Medical Research Institute (IHMRI), which found that healthcare workers including nurses and doctors experienced high levels of anxiety and depression during the pandemic.

Researchers found depression was more common among doctors, while nurses experienced greater anxiety. The prevalence of depression among doctors was 40.4%, with between 17% and 19.8% reporting symptoms of anxiety.

The prevalence of depression was lower among nurses than doctors, yet still high at 28%. However, nurses were more likely to experience symptoms of anxiety than doctors were, with the prevalence of anxiety among nurses between 22.8% and 27%.

Authors say the results point to the urgent need to develop and implement strategies to reduce anxiety and depression among frontline healthcare workers.

The study, a comprehensive umbrella review of research conducted around the world, analysed data from 10 systematic reviews and 100 unique studies which included 169,157 healthcare workers from 35 countries.

The study’s lead author, Professor Ritin Fernandez, from UOW’s School of Nursing, and St George Hospital, said the review demonstrated greater support is needed for frontline healthcare workers, particularly nurses and doctors.

“The study’s results highlight the need for nurses and doctors to be provided with urgent support to assist them with coping while working in high stress environments, especially during disaster conditions,” Professor Fernandez argued. 

“Healthcare workers need to be well supported with time away from the workplace, as this review has demonstrated that their mental wellbeing is suffering. This could lead to burnout and mass exit from the profession if staff wellbeing is not addressed.

“Nurses and doctors are not robots and are prone to psychological distress, just like any other worker. Strategies need to be implemented to reduce their fear of social stigma which is still attached to saying that mental health support is needed.”

While anxiety increased among the general population during the pandemic, frontline healthcare workers experienced heightened emotional responses as they were more frequently exposed to the virus and to very sick people, Professor Fernandez says.

Nurses and doctors experienced many challenges in accessing personal protective equipment (PPE), felt added job stress due to increased work demands and lack of effective treatment, and were working under rapidly changing COVID-19 protocols.

“Frontline health workers were witnessing a decline in their own immunity as a result of physical and mental exhaustion. Those looking after the sick were getting sick,” Professor Fernandez added.

“In this regard, healthcare workers need to be acknowledged for the work that they did and are still doing.”

Importantly, Professor Fernandez offered some strategies to support frontline healthcare workers.

“Most healthcare workers also have families, some are trying to juggle home schooling and work commitments. To know that their children could be cared for at the hospital during their shifts would alleviate some of their stress,” she said, for example.

“Providing healthcare workers with free parking, nutritional meals and coffee, as well as monetary benefits, would also assist in a practical way.

“Additionally, having psychological support services readily available and other interventions such as a time out room with mindfulness activities and a place for them to express how they feel would also assist healthcare workers.” 

Professor Fernandez described the different responses of doctors, who were more likely to experience symptoms of depression, compared to nurses, who were more likely to experience high levels of anxiety, as surprising.

“For doctors, this may be due to an overwhelming sense of duty and feeling the burden of responsibility to make sick people well again,” Professor Fernandez said.

“Research from Beyond Blue in 2019, prior to the pandemic, showed that doctors reported substantially higher rates of psychological distress and suicidal thoughts compared to both the Australian population and other Australian professionals. The COVID-19 pandemic has only heightened the distress.

“Nurses, on the other hand, are in constant contact with COVID-19 patients placing them at higher risk for infection, with the potential of them infecting their family members. Hence, their heightened anxiety.”

Read the study, Anxiety and depression among healthcare workers during the COVID-19 pandemic, a systematic umbrella review of the global evidence, here