Frontline healthcare workers in China report high rates of anxiety, stress, depression, and insomnia since the coronavirus outbreak began

• A new study of 1,257 healthcare workers in 34 hospitals in China found that many people treating patients with the new coronavirus experienced symptoms of depression, anxiety, and insomnia.
•  71% of all participants showed signs of distress. Women and nurses, who made up the majority of participants, tended to experience the most distress.
• During the 2003 SARS outbreak, healthcare workers reported similar levels of stress, anxiety, and depression, and many still had symptoms years later.
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Healthcare workers trying to contain the COVID-19 outbreak may not just be risking their lives on the front lines — they're also risking their mental health. A new study of 1,257 healthcare workers in 34 hospitals and fever clinics across China found that almost three-quarters of participants were experiencing some kind of psychological distress.

Half of the participants showed symptoms of depression, 44% showed symptoms of anxiety, and 34% showed symptoms of insomnia. Some 71% of all participants showed signs of psychological distress, with the most severe mental health symptoms seen among nurses, women, and frontline healthcare workers in Wuhan, China, where the outbreak began.

"They're experiencing extremely high levels of psychological distress, but if you are a nurse on the front lines, depression, anxiety, insomnia… these are normal responses to that," Christine Carter, a sociologist at UC Berkeley's Greater Good Science Center, told Insider. "We expect our caregivers to be able to compartmentalize more than is realistic for human beings."

On average, women experienced more distress than men, and frontline workers experienced more distress than second-line workers. Health workers in Wuhan and Hubei, where cases proliferated, showed more distress than workers in other regions.

The study chalked the distress up to a combination of the increasing number of suspected and confirmed coronavirus cases, an overwhelming workload, constant media coverage, and feeling a lack of emotional support.

The study's data were gathered in six days, and analyzed in four weeks. There are limitations: the researchers did not record participants' previous mental health conditions, nor whether this distress was the result of living in the midst of an outbreak or being a healthcare worker amidst an outbreak.

Regardless, experts say, the study shows countries around the world should be aware of the stress healthcare workers face in the pandemic, and be braced to support them during the outbreak and for years after.

The study found women and nurses are suffering the most stress, depression, and anxiety

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Some estimates say 70% of all healthcare workers are female. In Hubei, China, where the new coronavirus outbreak began, 90% of healthcare workers are women.

In the study, 76% of the participants were women, and most of the participants were married nurses, aged 25 to 40.

"Our study indicated that being a woman and having an intermediate technical title  were associated with experiencing severe depression, anxiety, and distress," the study authors concluded.

Jen Horney, an epidemiologist at the University of Delaware, told Insider that other disaster studies also found that women were more likely to develop anxiety and depression than men. "When exposed to disaster, women are more likely to manifest symptoms of emotional distress than men," she told Insider, adding that women are also more likely than men to blame themselves when things go wrong and "portray a negative self-image."

In China's Hubei province, 90% of its healthcare workers are women. 

The study authors theorized that nurses had worse mental health outcomes than doctors, in part because frontline nurses have the highest risk of infection due to the amount of close, frequent contact they have with patients. It is usually the nurse's job to draw blood and perform physical exams.

"They also had fewer years of work experience, so they're going to be less sure of themselves, and all of that adds up to greater feelings of uncertainty and lack of control," Carter told Insider. "It's completely normal to feel that way."

Anxiety and depression rates rose among healthcare workers during the 2003 SARS outbreak, and stayed high for years after

Studies of healthcare workers on the front lines of the 2003 SARS outbreak showed that healthcare workers reported similar stress levels.

One 2007 study found that a year after the outbreak, healthcare workers who were on the front lines of SARS were still experiencing higher stress levels, as well as signs of depression and anxiety. A 2012 study found that three years after the SARS outbreak, almost a quarter of the Beijing hospital employees surveyed were still experiencing depressive symptoms.

The studies showed the workers feared infection, which did happen to a number of healthcare workers. They also felt stigmatized, isolated, and worried about transmitting the infection to family and friends. Other SARS healthcare workers reported feeling a lack of control and a desire to resign.

Carter says people currently on the frontlines of COVID-19 may experience the same long-term outcomes as healthcares workers during SARS. "In the future when they're not still on the front line, there is an increased likelihood that this will be an actual disorder," she said. "We should be planning to take care of these people. They are going to need more mental health care when this was all over."

Sonia Bishop, an assistant professor of psychology at UC Berkeley, added that these results are consistent with what studies discovered about early responders at the World Trade Centre. She told Insider that having dedicated mental health phone lines for hospital workers, as China has implemented, along with easy access to groceries and childcare, could reduce the burden placed on our health-care workers.

In a commentary released along with the study, Roy Perlis, of Massachusetts General Hospital, wrote: "[T]hese findings, consistent with those observed in the 2003 SARS epidemic, may help to guide strategies for responding to mental health sequelae of this and future epidemics."

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