COVID-19-Related Trajectories of Psychological Health of Acute Care Healthcare Professionals: A 12-Month Longitudinal Observational Study

Abstract

The COVID-19 pandemic hit healthcare professionals (HCPs) hard, potentially leading to mental health deterioration. This longitudinal study investigated the 1-year evolution of psychological health of acute care HCPs during the COVID-19 pandemic and explored possible differences between high and low resilient HCPs. From April 2020 to April 2021, a convenience sample of 520 multinational HCPs completed an online survey every 3 months, up to five times. We used mixed linear models to examine the association between resilience and the variation of COVID-19-related anxiety, depressiveness, perceived vulnerability, and psychological trauma symptomatology. We demonstrated "u-shaped" trajectories for all mental health symptoms. We also explored differences in the abovementioned variables between front-line and second-line acute care HCPs. In contrast to HCP.s with lower levels of resilience (-1SD), those with higher levels of resilience (+1SD) showed increased COVID-19 anxiety and perceived vulnerability over time. Front-line and second-line HCPs differed in their depressiveness and psychological trauma variation during the 1-year analysis. High and average resilient second-line HCPs showed steeper depressiveness increases with time than high and average resilient front-line HCPs. Acute care HCPs reported their most elevated clinical symptoms of depressiveness (5-7%) and psychological trauma symptomatology (26-46%) in April 2020. During the first year of the COVID-19 pandemic, second-line HCPs with more resilience showed a steeper worsening of their depressiveness than more resilient front-line HCPs. HCPs with low resilience may benefit from interventions at the beginning of a pandemic, whereas HCPs with high resilience might benefit from resilience-enhancing interventions at later phases.

Trial registration: The study protocol was pre-registered with the International Standard Randomised Controlled Trial Number (ISRCTN13694948) published (Fuchs et al., 2020).

Keywords: COVID-19; acute care; healthcare workers; mental health; psychological resilience.

FIGURE 1

Study flowchart. April 2020 (baseline -T0), July 2020 (T1), October 2020 (T2), January 2021 (T3), and April 2021 (T4). All T0 participants were contacted in the remaining four rounds and we accepted for analysis participants who responded at least in four of the five time-points. We did not exclude participants that had not replied to the survey in previous rounds.

FIGURE 2

Trajectories of the mental health of the healthcare professionals across the five measurement points for their resilience levels (red, –1SD; blue, mean; green, + 1SD). Slopes of COVID-19–related anxiety (A), perceived vulnerability (B), depressiveness (C), and psychological trauma symptomatology (D), all by Resilience levels. According to front-line (c1,d1) and second-line (c2,d2) healthcare professionals. Time: 0, April 2020; 1, July 2020; 2, October 2020; 3, January 2021; 4, April 2021. S.F.I., Swine Influenza Anxiety Index; PVD, Perceived Vulnerability to Disease Scale; PHQ, Patient Health Questionnaire; IES, Impact of Event Scale; RISC, Connor-Davidson Resilience Scale.