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. 2021 Apr;38(4):468-479.
doi: 10.1002/da.23140. Epub 2021 Feb 5.

The association between witnessing patient death and mental health outcomes in frontline COVID-19 healthcare workers

Mariela Mosheva  1   2 , Raz Gross  1   2 , Nimrod Hertz-Palmor  1   3 , Ilanit Hasson-Ohayon  4 , Rachel Kaplan  1 , Rony Cleper  2 , Yitshak Kreiss  1   2 , Doron Gothelf  1   2 , Itai M Pessach  1   2
Affiliations

The association between witnessing patient death and mental health outcomes in frontline COVID-19 healthcare workers

Mariela Mosheva et al. Depress Anxiety. 2021 Apr.

Abstract

Background: Healthcare workers (HCW) treating coronavirus disease 2019 (COVID-19) patients face high levels of psychological stress. We aimed to compare mental health outcomes, risk and protective factors for posttraumatic stress symptoms (PTSS), probable depression, and anxiety between HCW working in COVID-19 and non-COVID-19 wards.

Methods: A self-report survey, administered in a large tertiary hospital in Israel during the peak of the COVID-19 outbreak was completed by 828 HCW (42.2% physicians, 57.8% nurses. Patient-Reported Outcomes Measurement Information System; the Patient Health Questionnaire-9; the Primary Care-Post Traumatic Stress Disorder Screen for DSM-5 (PC-PTSD-5) were used for assessing anxiety, depression, and PTSS, respectively. Pandemic-related stress factors, negative experiences, and potential protective factors were also assessed.

Results: Median PC-PTSD scores differed significantly between study teams (χ2 [5] = 17.24; p = .004). Prevalence of probable depression and anxiety were similar in both groups. Risk factors for mental health outcomes included mental exhaustion, anxiety about being infected and infecting family. Overall, higher proportion of the COVID-19 team witnessed patient deaths as compared to the non-COVID-19 team (50.2% vs. 24.7%). Witnessing patient death at the COVID-19 wards was associated with a four-fold increased likelihood of PTSS (odds ratio [OR] = 3.97; 95% confidence interval [CI], 1.58-9.99; p = .0007), compared with the non-COVID-19 wards (OR 0.91; 95% CI, 0.51-1.61; p = .43).

Conclusions: Witnessing patient death appears to be a risk factor for PTSS unique to HCW directly engaged in treating patients with COVID-19. Our findings suggest that helping HCW cope with COVID-19 related deaths might reduce their risk of posttraumatic stress.

Keywords: COVID-19; PTSD; anxiety; depression; mental health; stress.

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Conflict of interest statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Total deaths and age at death in the coronavirus disease 2019 (COVID‐19) versus non‐COVID‐19 wards. (a) Mean and median age at time of death in the COVID‐19 versus non‐COVID‐19 wards during March–April 2020. (b) Number of deaths in COVID‐19 versus non‐COVID‐19 wards during March–April in 2019 and 2020. (c) Age at death, by age categories in COVID‐19 and non‐COVID‐19 wards
See this image and copyright information in PMC

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