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Stress of pandemic has come down particularly hard on health care workers

One study found 71% of clinicians reported insomnia and 65% experienced loneliness

Patricia Eshaghian, MD, worked every day during the early months of the COVID-19 pandemic. The pulmonary and critical care specialist, who spends many hours in the Intensive Care Unit, cared for some of the pandemic’s sickest patients. Her husband, Matthew Dartt, RRT-ACCS, RCP, assistant director of respiratory care services at UCLA, also was on the front lines of the pandemic.

The couple worried about exposure to the virus and protecting their two young children from infection. It was overwhelming and exhausting, Dr. Eshaghian says.

“Doctors and nurses are used to dealing with stress and are used to dealing with people who are dying,” she says, “but the range of emotions that has come along with this particular infection is so broad and complex.”

The pandemic has changed the lives of most Americans, but perhaps no occupation has borne the stress of the pandemic more than health care professionals. The speed with which the pandemic unfolded, the sheer volume of sick people and the many questions surrounding the novel virus – what symptoms it causes and how to treat it – alarmed health care workers who bore the responsibility of saving lives.

“There is an incredible amount of uncertainty and anxiety during this time for our students, faculty and for nurses in the clinical setting,” says Linda Sarna, PhD, RN, dean of the UCLA School of Nursing. “The issue with COVID-19 is we’d never seen it before. We didn’t know what to expect.”

Since family members cannot visit, nurses have assumed the taxing role of providing emotional support for hospitalized patients, she notes.

Anxiety is common, as health care professionals grapple with the mysteries of the virus, Dr. Eshaghian adds. And sometimes there is frustration at society’s response to the pandemic.

“We feel: How can people not wear masks when they’re risking other people’s lives?” she says.

Recent surveys reveal the mental health impact of the pandemic on health care professionals. A study published in June, in the journal General Hospital Psychiatry, found that more than half of health care workers in New York City experienced high levels of acute stress and depressive symptoms. The study, conducted by New York-Presbyterian/Columbia University, found 71% of the clinicians reported insomnia and 65% reported loneliness.

Another study, published July 21 in the journal Academic Emergency Medicine, surveyed stress levels among 426 emergency medical workers in California, Louisiana and New Jersey and found many reported moderate to severe anxiety at work and home. On a scale of 1 to 7, male physicians ranked their stress at 5 and female physicians at 6, on average. The authors, from UC San Francisco, called stress among these physicians “pervasive” and said measures to mitigate stress “should be enacted universally.”

UCLA is doing just that. Dr. Sarna has joined Andrew Leuchter, MD, Professor and Executive Vice Chair of the Department of Psychiatry and Biobehavioral Sciences and Associate Director of the Semel Institute for Neuroscience and Human Behavior at UCLA, to address the mental health needs of health care workers. They have launched a study that assesses the usefulness of a mindfulness meditation app called Headspace. The project builds on ongoing collaborations between the School of Nursing and Semel Institute.

“We are not seeing large increases in health care providers who are suffering from a major depressive disorder or generalized anxiety disorder,” Dr. Leuchter says. “But we are seeing a surge in symptoms of mental distress – sadness, hopelessness, and feeling overwhelmed, anxious or unsettled. Those are understandable emotional reactions in this crisis.”

Health care workers who are experiencing distress can benefit from psychological support and stress-reducing activities, he says.

“Any time individuals are dealing with overwhelming emotions it is valuable to try to reach out and get resources to help with that,” Dr. Leuchter says.

The Headspace study at UCLA will help advance the science of mindfulness meditation. Headspace, based in Santa Monica, is a company focusing on mindfulness and meditation apps and online content.

Mindfulness meditation is a way to become more attuned to the present moment which, in turn, can lessen the psychological impact of what’s going on in the larger world. Techniques to achieve mindfulness usually include finding a quiet space to sit, breathing deeply and staying focused on the present. The Headspace app, which is free to the UCLA health care workers participating in the study, guides users with exercises and suggestions.

“It helps people center themselves, reduces anxiety and gets them in a peaceful place,” Dr. Sarna says of mindfulness meditation. “It helps us develop skills on how to deal with anxious situations. Meditation is not new. But this app makes it easy and fun.”

The study will evaluate how the app affects symptoms of psychological distress in health care workers, Dr. Sarna says.

“There is a growing body of literature that mindfulness meditation can be helpful in dealing with overwhelming emotions and feelings of hopelessness, helplessness, anxiety, sadness and difficulty sleeping,” Dr. Leuchter says. However, he notes, more research is needed about how an app such as Headspace can benefit specific populations on a broader scale.  It is particularly important to include people living in resource-poor communities that have been hard hit during the pandemic.

Now, five months into the pandemic, Dr. Eshaghian says she thinks more about how to strengthen her coping skills and protect her health. UCLA coworkers lean on each other for support, she says. Apps like Headspace and other free programs for health care workers, such as those provided by UCLA’s Spiritual Care department, are valuable tools for self-care, she says.

“Health care workers should be aware that there are free services for anybody who needs more support,” she says. “You can be doing this for 40 years, but this particular illness has been nothing like we’ve ever seen.”

Dr. Eshaghian says she recently scheduled a week for a long-delayed vacation.

“I told my husband, we have to take a week off in August,” she says. “Even if it’s just for a mental health break and we sit at home in the backyard, that’s fine. People have to take care of themselves.”


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