Resilience and Mental-Health Symptoms in ICU Healthcare Professionals Facing Repeated COVID-19 Waves

Abstract

Rationale: Psychological resilience (the ability to thrive in adversity) may protect against mental-health symptoms in healthcare professionals during coronavirus disease (COVID-19) waves. Objectives: To identify determinants of resilience in ICU staff members. Methods: In this cross-sectional survey in 21 French ICUs, staff members completed the 10-item Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Impact of Event Scale-Revised (for post-traumatic stress disorder [PTSD]). Factors independently associated with resilience were identified. Measurements and Main Results: The response rate was 73.1% (950 of 1,300). The median 10-item Connor-Davidson Resilience Scale score was 29 (interquartile range, 25-32). Symptoms of anxiety, depression, and PTSD were present in 61%, 39%, and 36% of staff members, respectively. Distress associated with the COVID-19 infodemic was correlated with symptoms of depression and PTSD. More resilient respondents less often had symptoms of anxiety, depression, and PTSD. Greater resilience was independently associated with male sex, having provided intensive care during the early waves, having managed more than 50 patients with COVID-19, and, compared with earlier waves, working longer hours, having greater motivation, and more often involving families in end-of-life decisions. Independent risk factors for lower resilience were having managed more than 10 patients who died of COVID-19, having felt frightened or isolated, and greater distress from the COVID-19 infodemic. Conclusions: This study identifies modifiable determinants of resilience among ICU staff members. Longitudinal studies are needed to determine whether prior resilience decreases the risk of mental ill health during subsequent challenges. Hospital and ICU managers, for whom preserving mental well-being among staff members is a key duty, should pay careful attention to resilience.

Keywords: acute respiratory distress syndrome; coronavirus; post-traumatic growth; post-traumatic stress disorder; vulnerability.

Figure 1.

Intensity of unidimensional variables (this wave is exhausting, frightening, frustrating, isolating, or motivating) assessed using visual analog scales with two anchors: 0 (no symptom/lowest rating) and 10 (most intense symptom/highest rating) among healthcare professionals with (green) and without (red) symptoms of anxiety, depression, and PTSD. PTSD = post-traumatic stress disorder. **** indicates P < 0.001.

Figure 2.

Regression surface plots. (A). Regression surface plot describing the relationships of anxiety, depression, and post-traumatic stress disorder with resilience assessed using the 10-item Connor-Davidson Resilience Scale as the response variable. (B) Regression surface plot describing the relationships of anxiety, depression, and resilience with distress ascribed to the coronavirus disease (COVID-19) infodemic as the response variable. The height of the surface represents the value of the response variable (resilience in A and infodemic-related distress in B).

Figure 3.

Forest plot showing the results of the multivariate linear regression analysis with CD-RISC 10 score as the dependent variable. Consensual end-of-life decisions were defined as shared between healthcare professionals and the family. CD-RISC 10 = 10-item Connor-Davidson Resilience Scale; CI = confidence interval; COVID-19 = coronavirus disease.