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12/01/2021 - Covid-19

Almost half of Spanish healthcare professionals are at a high risk of mental disorder as a result of COVID-19

The main symptoms are depression, anxiety, panic attacks, post-traumatic stress disorder, and substance abuse.

Almost half of Spain's healthcare professionals have a high risk of suffering a mental disorder after the first wave of the COVID-19 pandemic. In addition, 3.5% are experiencing suicidal thoughts (presence of a death wish and persistent thoughts of wanting to die). This is the conclusion of two studies (MINDCOVID project) that surveyed staff in eighteen hospitals across six autonomous regions of Spain (Andalusia, the Basque Country, Castile and Leon, Catalonia, Madrid and the Community of Valencia), led by researchers from the Hospital del Mar Medical Research Institute (IMIM), the CIBER in Epidemiology and Public Health (CIBERESP), and the CIBER in Mental Health (CIBERSAM), in addition to doctors from the Hospital del Mar. The data has been published by the Revista de Psiquiatría y Salud Mental and the journal Depression & Anxiety.

Both papers are based on a series of anonymous online surveys of healthcare professionals in the eighteen centres that took part. 9,138 individuals participated, answering questions about their work during the first wave of the pandemic, family relationships, the personal impact of COVID-19 as well as its effect on their family, social and work environment, and a series of specific indicators for detecting possible mental disorders. "The information from the first wave of the pandemic indicates a much higher prevalence of disabling mental health problems in Spanish healthcare professionals than expected. We will have to monitor the risk of these problems persisting and, at the same time, take into account the factors identified in our study to try to minimise this issue", says Dr Jordi Alonso, the study's principal author, director of the Epidemiology Programme at IMIM-Hospital del Mar and scientific co-director of the CIBER in Epidemiology and Public Health (CIBERESP). 

According to the work published in the Revista de Psiquiatría y Salud Mental, 80% of those surveyed were directly involved in the care of COVID-19 patients, although only 43% remained in contact for almost the entire time. 17.4% contracted the disease and 112 required hospitalisation. In 13.4% of the cases a member of the direct family was infected and in 1 out of 4 instances the healthcare worker had to be placed in isolation or quarantined. 4 out of 10 reported having suffered some kind of mental disorder prior to the pandemic.

Impact of the pandemic on the mental health of healthcare professionals

Of the total number of participants, 45.7% are at high risk of suffering some kind of mental disorder, in other words, they need a professional evaluation to confirm the presence of a mental disorder.  Meanwhile, 1 in 7, 14.5%, present a disabling mental disorder, with clear negative repercussions on their professional and social life. 28.1% are experiencing depression, 22.5% have an anxiety disorder, almost 1 in 4 are suffering from panic, 22.2% have post-traumatic stress disorder, and just over 6% are suffering substance abuse. Additionally, having developed a mental disorder prior to the pandemic doubles the risk of suffering again as a result of COVID-19.

"The results of the study are not surprising, but they are worrying. They are very much in line with our clinical experience. Many healthcare workers have been treated for acute stress, exhaustion and anxiety. Particularly those who had previously experienced mental health problems. As in other institutions, we set up an emotional support programme at our centre, the One2One programme, which provided a multi-channel approach to healthcare professionals", explains Dr. Víctor Pérez, the final author of the paper, Director of the Institute of Neuropsychiatry and Addictions at Hospital del Mar (INAD), coordinator of the Mental Health Research Group at IMIM-Hospital del Mar and a researcher in the CIBER de Salud Mental (CIBERSAM).

The prevalence of mental health disorders is highest among young, unmarried women born outside Spain. The greatest impact is seen in the group of female healthcare assistants. Two out of three of these nursing auxiliaries are at a high risk for mental disorders, as are half of all nurses. At the same time, there is an elevated prevalence in practitioners exposed to COVID-19 patients, and among those who have suffered from the disease or whose family members have been infected.

Given these results, the authors recommend monitoring healthcare professionals with previous mental disorders, as well as those with elevated exposure to COVID-19 patients, any who have suffered the infection or have been isolated, with special attention being paid to healthcare assistants.

Active suicidal thoughts

Besides the elevated prevalence of mental disorders, the MINDCOVID study also documented a high frequency of active suicidal thoughts (3.5%) and suicide attempts (0.1%) during the first wave of the pandemic, as revealed in the work published in Depression & Anxiety. This figure contrasts with the 0.7-0.9% estimated for the general population prior to the pandemic. "This is worrying, especially given the already increased risk of suicide among healthcare professionals before the emergence of the pandemic. The MINDCOVID study has shown that this increased risk of suicidal thoughts is partly explained by the pressure suffered by healthcare centres in terms of coordination and staffing during the first wave", explains Dr. Philippe Mortier, a postdoctoral researcher at the IMIM-Hospital del Mar, a member of the CIBER in Epidemiology and Public Health (CIBERESP), and an author of both papers.

According to the authors, the data highlights the need for social efforts to avoid contagion and prevent health systems from being overwhelmed. Another important stress factor for suicidal thinking identified by the study is financial stress, including the fear of income or job loss due to the pandemic. A series of simulations revealed that action to increase hospital preparedness and decrease financial insecurity among healthcare workers can lead to a substantial reduction in suicidal thoughts of up to 75%.

In addition to IMIM and the Hospital del Mar, the following institutions have participated and collaborated in the MINDCOVID study: the Barcelona Public Health Agency, the IDIAPJGol, the Catalan Medical Emergency System (SEM), the Primary Care Biomedical Research and Innovation Foundation of the Community of Madrid, Donostia University Hospital and Vall d'Hebron University Hospital, the Hospital de la Santa Cruz y San Pablo Research Institute and Hospital Clínico in Barcelona, University Hospital Araba-Santiago, General University Hospital Gregorio Marañón, University Hospital 12 de Octubre and University Hospital Príncipe de Asturias in Madrid, University Hospital Torrecárdenas in Almería, University Hospital Clínico in Valencia, Hospital el Bierzo in León, and University Hospital de Cruces in Bilbao.

The studies were funded by the Carlos III Health Institute (Spanish Ministry of Science and Innovation) / ERDF COV20 / 00711, Sara Borrell, CD18 / 00049) and the Catalan Government (2017SGR452).

Image (from left to right): Gemma Vilagut, Jordi Alonso, Philippe Mortier and Víctor Pérez. Source: IMIM. 

Reference articles

Jordi Alonso, Gemma Vilagut, Philippe Mortier, Montse Ferrer, Itxaso Alayo, Andrés Aragón-Peña, Enric Aragonès, Mireia Campos, Isabel del Cura-González, José I. Emparanza, Meritxell Espuga, M. Joao Forjaz, Ana González Pinto, Josep M. Haro, Nieves López Fresneña, Alma Martínez de Salázar, Juan D. Molina, Rafael M. Ortí Lucas, Mara Parellada, José Maria Pelayo-Terán, Aurora Pérez Zapata, José I. Pijoan, Nieves Plana, Teresa Puig, Cristina Rius, Carmen Rodriguez-Blazquez, Ferran Sanz, Consol Serra, Ronald C. Kessler, Ronny Bruffaerts, Eduard Vieta, Víctor Pérez-Solá, MINDCOVID Working group. Mental Health Impact of the First Wave of COVID-19 Pandemic on Spanish Healthcare Workers: a Large Cross-sectional Survey. Rev. Psiq. Salud Mental. Epub ahead of print. 10.27.20220731; doi: https://doi.org/10.1016/j.rpsm.2020.12.001

Mortier P, Vilagut G, Ferrer M, et al. Thirty?day suicidal thoughts and behaviors among hospital workers during the first wave of the Spain COVID?19 outbreak. Depression and Anxiety. 2020;1-17. https://doi.org/10.1002/da.23129

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