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Mental Health Outcomes Among Italian Health Care Workers During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the mental health outcomes among Italian health care workers during the COVID-19 pandemic?

Findings  In this longitudinal cohort study of 2856 health care workers in Italy during the COVID-19 pandemic the prevalence of depression symptoms, anxiety symptoms, insomnia symptoms, and posttraumatic stress symptoms decreased among Italian health care workers 14 months after the beginning of the COVID-19 pandemic. Prolonged work with patients with COVID-19 was significantly associated with mental health outcomes, whereas quitting work as a frontline health care worker was significantly associated with decrease in mental health issues.

Meaning  These findings help to identify the potential risk factors for health care workers exposed to direct contact with patients with COVID-19 and could help inform better preventive policies regarding mental health in this particular population.

Abstract

Importance  Health care workers (HCWs) exposed to COVID-19 have high rates of mental health issues. However, longitudinal data on the evolution of mental health outcomes in HCWs are lacking.

Objective  To evaluate the mental health outcomes among Italian HCWs 14 months after the beginning of the COVID-19 pandemic.

Design, Setting, and Participants  This longitudinal cohort study collected data from March 1 to April 30, 2020 (T1) and from April 1 to May 31, 2021 (T2), from 2856 Italian HCWs aged 18 years or older who responded to an online questionnaire. Participants were also recruited via snowballing, a technique in which someone who receives the invitation to participate forwards it to his or her contacts.

Exposures  Frontline vs second-line position, job type, hospitalization for COVID-19, and colleagues or family members affected by COVID-19.

Main Outcomes and Measures  Outcomes are depression symptoms, anxiety symptoms, insomnia symptoms, and posttraumatic stress symptoms (PTSSs). Four different trajectories are described for each condition: resilient, remittent, incident, and persistent.

Results  Of the 2856 HCWs, 997 (34.9%) responded to the follow-up assessment (mean [SD] age, 42.92 [10.66] years; 816 [82.0%] female). Depression symptoms (b = −2.88; 95% CI, −4.05 to −1.71), anxiety symptoms (b = −2.01; 95% CI, −3.13 to −0.88), and PTSSs (b = −0.77; 95% CI, −1.13 to −0.42) decreased over time; insomnia symptoms increased (b = 3.05; 95% CI, 1.63-4.47). Serving as a frontline HCW at T1 was associated with decreased symptoms of depression (b = −1.04; 95% CI, −2.01 to −0.07), and hospitalization for COVID-19 was associated with increased depression symptoms (b = 5.96; 95% CI, 2.01-9.91); younger age (b = −0.36; 95% CI, −0.70 to −0.03) and serving as a frontline HCW at T1 (b = −1.04; 95% CI, −1.98 to −0.11) were associated with decreased anxiety symptoms. Male sex was associated with increase in insomnia symptoms (b = 1.46; 95% CI, 0.39-2.53). Serving as a frontline HCW at T1 (b = −0.42; 95% CI, −0.71 to −0.13) and being a physician (b = −0.52; 95% CI, −0.81 to −0.24) were associated with a decrease in PTSSs, whereas younger age (b = 0.35; 95% CI, 0.09-0.61) and male sex (b = 0.12; 95% CI, 0.01-0.22) were associated with an increase in PTSSs. Depression trajectories were 629 resilient (65.5%), 181 remittent (18.8%), 58 incident (6.0%), and 92 persistent (9.6%). Anxiety trajectories were 701 resilient (73.3%), 149 remittent (15.6%), 45 incident (4.7%), and 61 persistent (6.4%). Insomnia trajectories were 858 resilient (88.9%), 77 remittent (8.0%), 20 incident (2.1%), and 10 persistent (1.0%). The PTSS trajectories were 363 resilient (38.5%), 267 remittent (28.3%), 86 incident (9.1%), and 226 persistent (24.0%).

Conclusions and Relevance  In this cohort study, relative to the beginning of the COVID-19 pandemic, mental health among HCWs has improved. Factors associated with change in mental health outcomes could help in the design of prevention strategies for HCWs.

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Article Information

Accepted for Publication: September 30, 2021.

Published: November 24, 2021. doi:10.1001/jamanetworkopen.2021.36143

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Rossi R et al. JAMA Network Open.

Corresponding Author: Rodolfo Rossi, MD, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy (rudy86.rossi@gmail.com).

Author Contributions: Dr Rossi had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: R. Rossi, Pacitti, A. Rossi, Di Lorenzo.

Acquisition, analysis, or interpretation of data: R. Rossi, Socci, Jannini, Pacitti, Siracusano, Di Lorenzo.

Drafting of the manuscript: R. Rossi, Pacitti, Di Lorenzo.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: R. Rossi, Di Lorenzo.

Obtained funding: Pacitti, A. Rossi, Di Lorenzo.

Administrative, technical, or material support: Jannini, Pacitti, A. Rossi, Di Lorenzo.

Supervision: Pacitti, Siracusano, A. Rossi, Di Lorenzo.

Conflict of Interest Disclosures: None reported.

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