One in 10 healthcare workers experienced thoughts of suicide or self-harm during the coronavirus pandemic, with burnout, isolation and an over-emphasis on ‘self care’ likely causes of the ‘alarming’ levels of vulnerability, according to the authors of a large Australian study.
Led by Professor Marie Bismark of the University of Melbourne’s Centre for Health Policy, the survey conducted in late 2020 also found that most health workers who had thoughts of self-harm did not seek professional help.
“It’s shocking when you walk around a large hospital to think that one in 10 people have that level of psychological distress. However, the findings were in line with what we’ve seen internationally,” Professor Bismark told the limbic.
Research and anecdotal reports from overseas have pointed to higher rates of suicidal ideation among healthcare workers and some deaths by suicide associated with heavier workloads and stress during the pandemic.
The Australian study is believed to be the world’s largest national survey to date to explore not only the mental health impacts on frontline staff but also to investigate possible risk factors and personal and occupational characteristics.
The online survey, conducted between August 27 and October 23, 2020, during the pandemic’s second wave, drew an unusually strong response from more than 9500 healthcare workers.
The non-mandatory question on thoughts of suicide and self-harm was answered by 7795 participants, with 819 (10.5%) revealing they had had suicidal or self-harm thoughts during the preceding two-week period.
Fewer than half (388) of the individuals reporting such thoughts had sought professional support. Those who did seek help tended to be younger or had prior concerns about mental health.
The Australian survey broadened its focus beyond doctors and nurses, to include workers across health-sector roles. Identified by occupation, the participants included 2447 medical practitioners, 3053 nurses, 1564 allied health workers and 730 “others” such as paramedics, pharmacists and support staff.
Of the total, 3079 survey participants were engaged in medical specialty areas, such as general medicine, respiratory medicine, infectious diseases, hospital aged-care, palliative care and other specialties.
Among them, 322 individuals in medical specialties reported “occasional” or “frequent” thoughts of suicide or self-harm, showing a higher prevalence of distress than workers in emergency departments, intensive care and surgical specialties.
Beyond self care
Professor Bismark said the study raised important questions, such as whether the type of support being offered to health workers was the kind of support they needed.
“A lot of the discussion around self-care revolves around things that people do for themselves and by themselves,” she said.
“But actually what our research has found is that maintaining our health and wellbeing is a very relational process and our connections with other people are tremendously important.”
She noted that study was conducted at a time when Melbourne was subject to stage 4 lockdowns. People were starved of personal interactions and hospital workplaces added to a sense of alienation.
“It was very isolating for healthcare workers to be in PPE all day, with tea rooms closed and a loss of a lot of the connection with colleagues at work; to come home at the end of the day and have nobody to talk to and not be able to catch up with friends or family was very hard.
“We could see it both as a risk factor, that people living alone had a higher rate of suicidal ideation, but also as a protective factor; that people who were able to maintain or increase their social connections during the pandemic had lower rates of suicide ideation and self-harm thoughts.”
The findings also suggested that male healthcare workers were not only more likely to have these thoughts and were less likely to seek help.
“Comparing those with no, occasional or frequent thoughts of suicide or self-harm, we observed stepwise increases in the proportion of participants who were male, aged 30 years or younger, living alone, with fair or poor health, previous mental illness, increased income worries, increased alcohol use, friends or family with COVID-19, or exposure to COVID-19 patients,” the study authors wrote.
In addition, those with thoughts of suicide or self-harm were less likely to have maintained or increased exercise or social connections. Only 47% said they had sought professional support – 39% from a doctor and just 11% from an employee assistance program or the like.
Burnout and betrayal
Almost all of those with thoughts of suicide or self-harm reported significantly higher rates of emotional exhaustion, depersonalisation, depression, anxiety and PTSD than their peers, and around half were experiencing symptoms consistent with moderate to severe depression.
Responses to the survey were heavily skewed toward women workers and residents of Victoria, which the authors say reflect the composition of the health workforce and more successful recruitment efforts in the state where the investigators were based.
In studying the pandemic’s impacts, Professor Bismark said it was important to include not only doctors and nurses but others in the health system such as cleaners, hospital kitchen staff, aged-care workers, and community disability workers, many of whom suffered financial stress as they or a partner lost work due to the pandemic.
“Casual nurses spoke about how they felt betrayed; they had done casual work with an organisation for many years, and when elective surgeries stopped they were left with no work, and no support from organisations they had been loyal to for a long time,” she said.
The study is published in the Australian and New Zealand Journal of Psychiatry.