Analysis: new research finds Irish frontline healthcare workers are reporting high rates of anxiety, stress and depression because of the pandemic 

By Laura O'Connor, Cathal Ffrench, Jack Flynn, and Martin O'Reilly, NUI Galway

Since the beginning of the pandemic, Irish healthcare workers have experienced disproportionally high rates of Covid-19 infections (currently estimated to be 10% of total cases). At one time we held the unenviable record of the highest rate of infection amongst healthcare-workers in the world. Last week alone saw 6,500 healthcare-workers unable to work, with the resulting pressure so great that close contacts are being asked to return to work as a 'last resort'.

While the physical risks are well understood, the psychological toll of the pandemic is only beginning to be truly examined. Globally, significant numbers of healthcare-workers are showing signs of deteriorating mental health. As far back as March of 2020, 70% of healthcare-workers surveyed in China reported psychological distress. In the UK, almost half of staff surveyed across 9 intensive care unit displayed warning signs of severe mental health impacts.

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From RTÉ News, healthcare workers on their toughest year ever

Our research team are investigating the impact of working through the pandemic on the mental health of frontline healthcare workers. By identifying the challenges healthcare workers are facing and areas where they need support, we aim to develop clear guidelines that can be used internationally to make sure appropriate help is made available. To understand how experiences may differ across countries, we are collecting data in both Ireland and Italy.

In Ireland, healthcare staff on the frontline are currently reporting high rates of anxiety and depression. Evidence of long-term impacts like post-traumatic stress disorder and adjustment disorders is also emerging.

Some participants in this research expanded on particular issues they are facing. Burnout is frequently mentioned, made worse by the inability to properly escape work through socialising or trips away. There is also a feeling of a dwindling solidarity with a public that are no longer "with them."

From RTÉ One's Claire Byrne Live, Claire hears from doctors, nurses, porters and other heroes on the Covid frontline at Dublin's Mater Hospital

This is on top of redeployments to unfamiliar roles, drastic changes at home to reduce exposure to loved ones, and migrant healthcare workers feeling the strain of being far from home. As a result, many are re-assessing their future within healthcare; considering career breaks or changes, early retirements, or changing roles, all worrying prospects for the already strained healthcare system.

The stress is being felt even more acutely by students and early career staff, who report worse symptoms than their more experienced colleagues. Some responses described the burden of being reassigned into high-responsibility roles to protect other staff who are more at-risk from infection or those with home-caring roles. Additionally, inexperience with caring for seriously ill patients, high rates of patient mortality, and joining the workforce at such a fraught time were all mentioned as sources of stress.

Data from Italy tells much the same story, with the notable exception that healthcare-workers in Ireland are showing higher rates of depression and anxiety than their Italian counterparts, and stronger indications of long term effects. While there are many potential reasons, the preparedness of the healthcare system may be a factor in this difference. Ireland’s comparatively low number of ICU beds in April last year led to large redeployments of staff into critical care roles, and created a risk of demand outstripping supply  faster than in other European countries.  

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From RTÉ Radio 1's Saturday With Katie Hannon, Phil Ní Sheaghdha from the Irish Nurses and Midwives Organisation on the concerns of nursing staff around Covid-19

While these findings are worrying, there are indications that the outcomes are not entirely negative. Healthcare workers are also reporting signs of positive growth, a common response to traumatic experiences. This can take many forms, with the data showing that people are experiencing positive changes in how they see themselves, their relationships with others, and their general outlook on the world.

The rollout of vaccine programmes suggests a return to some form of normality is on the horizon, but the psychological effects on healthcare workers may take time to reveal themselves. The focus going forward must be on robust systems with support extending well into the future.

In March 2020, the World Health Organisation noted the importance of supporting healthcare workers through "a marathon, not a sprint". They gave simple suggestions, highlighting the importance of speaking with colleagues and peers, providing less experienced staff with access to mentorship and guidance, flexible schedules, and rotations in and out of higher stress roles. Researchers and psychologists in the UK use the term "Psychological PPE" to describe straightforward ways to prepare for stress, access to team and individual support, and identify peers at particular risk of distress.

Unlike the PPE which protects our workers' physical health, mental health supports cannot be disposable

With healthcare workers currently pushing themselves to the limit to get us through this period, it may be months or years after things slow down before cracks begin to show. Unlike the PPE which protects our workers’ physical health, mental health supports cannot be disposable. We should provide our healthcare workers with the same level of care and compassion they have shown to so many and ensure that their needs are not forgotten as we shift our focus to a post-Covid world.

The FLoWS Project is led by researchers in NUI Galway and University of Milan-Bicocca with funding from the Health Research Board and the Irish Research Council. Our online survey welcomes responses from frontline healthcare workers

Laura O'Connor, Cathal Ffrench, Jack Flynn, and Martin O'Reilly are researchers in the School of Psychology working on the Health Research Board – Irish Research Council co-funded FLoWS Project at NUI Galway

The views expressed here are those of the author and do not represent or reflect the views of RTÉ