New study shows mental health of ICU staff should be immediate priority

January 12, 2021

New research from King's College London shows nearly half of Intensive Care Unit (ICU) staff are likely to meet the threshold for PTSD, severe anxiety or problem drinking during the COVID-19 pandemic.

Results from a study of ICU healthcare workers, published today in Occupational Medicine, shows the stark impact of working in critical care during the COVID-10 pandemic. The researchers found poor mental health was common in many ICU clinicians although they were more pronounced in nurses than in doctors or other healthcare professionals.

Lead author, Professor Neil Greenberg, from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London said:

'Our results show a substantial burden of mental health symptoms being reported by ICU staff towards the end of the first wave in July and July 2020. The severity of symptoms we identified are highly likely to impair some ICU staffs ability to provide high quality care as well as negatively impacting on their quality of life.

'The high rate of mortality amongst COVID-19 patients admitted to ICU, coupled with difficulty in communication and providing adequate end-of-life support to patients, and their next of kin because of visiting restrictions, are very likely to have been highly challenging stressors for all staff working in ICUs.'

709 healthcare workers, from nine ICUs in England, completed anonymous web-based surveys in June and July 2020 comprising 291 (41 per cent) doctors, 344 (49 per cent) nurses, and 74 (10 per cent) other healthcare staff.

Over half (59 per cent) reported good wellbeing, however 45 per cent met the threshold for probable clinical significance for at least one of: severe depression (6 per cent), PTSD (40 per cent), severe anxiety (11 per cent) or problem drinking (7 per cent). Worryingly more than one in eight respondents (13 per cent) reported frequent thoughts of being better off dead, or of hurting themselves in the past two weeks.

Professor Greenberg continues 'Whilst these results are in some ways not surprising, they should serve as a stark reminder to NHS managers of the pressing need to protect the mental health of ICU workers now in order to ensure they can deliver vital care to those in need.'

ICU staff have faced a particularly challenging time frequently working in areas where the perceived risk of COVID-19 exposure is high for long periods, wearing PPE, with the challenges of managing staff and equipment shortages on a daily basis especially during the first wave. They have also had to deal with ethically challenging decisions as well as potentially being fearful of catching COVID-19 themselves and potentially passing it on to their loved ones.

Professor Greenberg adds 'Evidence-based mechanisms should be in place so all healthcare workers, including ICU staff, can promptly access treatment for mental health issues. If we protect the mental health of healthcare workers during the COVID-19 pandemic, staff will be better able to sustainably deliver high quality care to the large numbers of patients seriously unwell with COVID-19.'

Further work is needed to better understand the real level of clinical need amongst ICU staff as self-report questionnaires can overestimate the rate of clinically relevant mental health symptoms.

Professor Greenberg concludes: 'Our results highlight the potential profound impact that COVID-19 has had on the mental health of frontline UK staff and indicate an urgent need for a national strategy to protect staff mental health and decrease the risk of functional impairment of ICU staff while they carry out their essential work during COVID-19 and beyond.'
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This research was a collaboration between King's College London and University College London with important contributions from the Behavioural Science Team, Emergency Response Department Science & Technology, Public Health England and the University of Oxford.

The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University.

The mental health of staff working in intensive care during COVID-19 - Greenberg et al is published in Occupational Medicine doi: https://doi.org/10.1093/occmed/kqaa220

For further information please contact Cathy Beveridge, Interim Senior Press Officer, IoPPN: cathy.beveridge@kcl.ac.uk / +44 +44 7776181945

About The National Institute for Health Research (NIHR)

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

* Funds, supports and delivers high quality research that benefits the NHS, public health and social care

* Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research

* Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future

* Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services

* Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government. http://www.nihr.ac.uk/

About King's College London


King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2018/19) and among the oldest in England. King's has more than 31,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff.

The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) which is the premier centre for mental health and related neurosciences research in Europe. It produces more highly cited outputs (top 1% citations) on mental health than any other centre (SciVal 2019) and on this metric we have risen from 16th (2014) to 4th (2019) in the world for highly cited neuroscience outputs. World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness and other conditions that affect the brain. https://www.kcl.ac.uk/ioppn @KingsIoPPN

About UCL - London's Global University


UCL is a diverse community with the freedom to challenge and think differently.

Our community of more than 41,500 students from 150 countries and over 12,500 staff pursues academic excellence, breaks boundaries and makes a positive impact on real world problems.

We are consistently ranked among the top 10 universities in the world and are one of only a handful of institutions rated as having the strongest academic reputation and the broadest research impact.

We have a progressive and integrated approach to our teaching and research - championing innovation, creativity and cross-disciplinary working. We teach our students how to think, not what to think, and see them as partners, collaborators and contributors.

For almost 200 years, we are proud to have opened higher education to students from a wide range of backgrounds and to change the way we create and share knowledge.

We were the first in England to welcome women to university education and that courageous attitude and disruptive spirit is still alive today. We are UCL.

http://www.ucl.ac.uk| Follow @uclnews on Twitter | Watch our YouTube channel | Listen to UCL podcasts on SoundCloud | Find out what's on at UCL Minds | #MadeAtUCL

Find out how UCL is helping lead the global fight against COVID-19 http://www.ucl.ac.uk/covid-19-research

King's College London

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