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. 2021 May 16:35:100879.
doi: 10.1016/j.eclinm.2021.100879. eCollection 2021 May.

Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study

Kriti Prasad  1   2 , Colleen McLoughlin  3 , Martin Stillman  2 , Sara Poplau  2 , Elizabeth Goelz  2 , Sam Taylor  3 , Nancy Nankivil  3 , Roger Brown  4 , Mark Linzer  2 , Kyra Cappelucci  3 , Michael Barbouche  5 , Christine A Sinsky  3
Affiliations

Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study

Kriti Prasad et al. EClinicalMedicine. .

Abstract

Background: COVID-19 has put extraordinary stress on healthcare workers. Few studies have evaluated stress by worker role, or focused on experiences of women and people of color.

Methods: The "Coping with COVID" survey assessed US healthcare worker stress. A stress summary score (SSS) incorporated stress, fear of exposure, anxiety/depression and workload (Omega 0.78). Differences from mean were expressed as Cohen's d Effect Sizes (ESs). Regression analyses tested associations with stress and burnout.

Findings: Between May 28 and October 1, 2020, 20,947 healthcare workers responded from 42 organizations (median response rate 20%, Interquartile range 7% to 35%). Sixty one percent reported fear of exposure or transmission, 38% reported anxiety/depression, 43% suffered work overload, and 49% had burnout. Stress scores were highest among nursing assistants, medical assistants, and social workers (small to moderate ESs, p < 0.001), inpatient vs outpatient workers (small ES, p < 0.001), women vs men (small ES, p < 0.001), and in Black and Latinx workers vs Whites (small ESs, p < 0.001). Fear of exposure was prevalent among nursing assistants and Black and Latinx workers, while housekeepers and Black and Latinx workers most often experienced enhanced meaning and purpose. In multilevel models, odds of burnout were 40% lower in those feeling valued by their organizations (odds ratio 0.60, 95% CIs [0.58, 0.63], p< 0.001).

Interpretation: Stress is higher among nursing assistants, medical assistants, social workers, inpatient workers, women and persons of color, is related to workload and mental health, and is lower when feeling valued.

Keywords: Allied health professionals; Burnout; COVID-19; Mental health; Nursing; Occupational stress.

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Conflict of interest statement

Dr. Linzer reports being supported by the American Medical Association during the conduct of the study; and grants from American College of Physicians, National Institutes of Health, Institute for Healthcare Improvement, American Board of Internal Medicine (salary support through Hennepin Healthcare) outside the submitted work; consulting for Harvard University on a grant concerning work conditions and diagnostic accuracy, and has received honoraria from Harvard University and University of Chicago for Medical Grand Rounds. Mr. Barbouche is affiliated with Forward Health Group, Inc. during the conduct of the study. Forward Health Group, Inc. (FHG) is the Technology Partner to the American Medical Association (AMA). FHG supports the AMA and its research partners with data, technology, and analytics support. AMA has a contract with FHG to reimburse FHG's services. Ms. Poplau reports salary support through Hennepin Healthcare from American Medical Association during the conduct of the study; and grants from American College of Physicians, the National Institutes of Health, and the American Board of Internal Medicine outside the submitted work. Dr. Goelz reports salary support paid through Hennepin Healthcare from American Medical Association during the conduct of the study; and salary support through Hennepin Healthcare from the Institute for Healthcare Improvement outside the submitted work. Dr. Stillman is supported for his work on burnout prevention by the AMA (salary support paid through Hennepin Healthcare for studying provider stress and burnout). Ms. McLoughlin, Ms. Nankivil, Ms. Cappelucci and Dr. Sinsky work for the AMA. Mr. Taylor worked for the AMA at the time the study was conducted. Ms. Prasad reports personal fees from Hennepin Healthcare Foundation, during the conduct of the study. Dr. Brown was paid by the AMA for his work on the study. The opinions expressed in this article are those of the authors and should not be interpreted as American Medical Association policy.

Figures

Fig. 1
Fig. 1
Occupational variability in stress scores. Range of stress summary scores (4–16).
Fig. 2
Fig. 2
Conceptual model portraying potential contributors and mitigators of stress and burnout in Coping with COVID survey. Bolded variables assessed in this analysis. R2, or percent variance in burnout explained by structural model = 55%.
See this image and copyright information in PMC

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