Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: A prospective longitudinal survey cohort study

Tom Roberts; Jo Daniels; William  Hulme; Robert Hirst; Daniel Horner; Mark David Lyttle; Katie Samuel; Blair Graham; Charles Reynard; Michael Barrett; James Foley; John  Cronin; Etimbuk Umana; Joao Vinagre; Edward Carlton

doi:10.1136/bmjopen-2021-049680

Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: A prospective longitudinal survey cohort study

Tom Roberts, Jo Daniels, William Hulme, Robert Hirst, Daniel Horner, Mark David Lyttle, Katie Samuel, Blair Graham, Charles Reynard, Michael Barrett, James Foley, John Cronin, Etimbuk Umana, Joao Vinagre, Edward Carlton

Department of Psychology

Research output: Contribution to journal › Review article › peer-review

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Abstract

Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.

Design A prospective online three-part longitudinal survey.

Setting Acute hospitals in the UK and Ireland.

Participants Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.

Primary outcome measures Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.

Results The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R²=0.06) and trauma (R²=0.10).

Conclusion Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.

Original language	English
Article number	e049680
Journal	BMJ Open
Volume	11
Issue number	7
Early online date	9 Jul 2021
DOIs	https://doi.org/10.1136/bmjopen-2021-049680
Publication status	Published - 9 Jul 2021

Bibliographical note

Funding Information:
Funding The Chief Investigator is directly funded as a research fellow by the Royal College of Emergency Medicine. The GHQ-12 is being used under licence from GL assessments; the fee for use of this instrument within all three surveys has been waived. EC is a National Institute for Health Research Advanced Fellow. The study has direct funding from RCEM. Grant code: G/2020/1.

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

Emergency department
distress
trauma

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Roberts, T., Daniels, J., Hulme, W., Hirst, R., Horner, D., Lyttle, M. D., Samuel, K., Graham, B., Reynard, C., Barrett, M., Foley, J., Cronin, J., Umana, E., Vinagre, J., & Carlton, E. (2021). Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: A prospective longitudinal survey cohort study. BMJ Open, 11(7), Article e049680. https://doi.org/10.1136/bmjopen-2021-049680

Roberts, T, Daniels, J, Hulme, W, Hirst, R, Horner, D, Lyttle, MD, Samuel, K, Graham, B, Reynard, C, Barrett, M, Foley, J, Cronin, J, Umana, E, Vinagre, J & Carlton, E 2021, 'Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: A prospective longitudinal survey cohort study', BMJ Open, vol. 11, no. 7, e049680. https://doi.org/10.1136/bmjopen-2021-049680

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title = "Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: A prospective longitudinal survey cohort study",

abstract = " Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.Design A prospective online three-part longitudinal survey.Setting Acute hospitals in the UK and Ireland.Participants Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.Primary outcome measures Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.Results The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).Conclusion Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.",

keywords = "Emergency department, distress, trauma",

author = "Tom Roberts and Jo Daniels and William Hulme and Robert Hirst and Daniel Horner and Lyttle, {Mark David} and Katie Samuel and Blair Graham and Charles Reynard and Michael Barrett and James Foley and John Cronin and Etimbuk Umana and Joao Vinagre and Edward Carlton",

note = "Funding Information: Funding The Chief Investigator is directly funded as a research fellow by the Royal College of Emergency Medicine. The GHQ-12 is being used under licence from GL assessments; the fee for use of this instrument within all three surveys has been waived. EC is a National Institute for Health Research Advanced Fellow. The study has direct funding from RCEM. Grant code: G/2020/1. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

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T1 - Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland

T2 - A prospective longitudinal survey cohort study

AU - Roberts, Tom

AU - Daniels, Jo

AU - Hulme, William

AU - Hirst, Robert

AU - Horner, Daniel

AU - Lyttle, Mark David

AU - Samuel, Katie

AU - Graham, Blair

AU - Reynard, Charles

AU - Barrett, Michael

AU - Foley, James

AU - Cronin, John

AU - Umana, Etimbuk

AU - Vinagre, Joao

AU - Carlton, Edward

N1 - Funding Information: Funding The Chief Investigator is directly funded as a research fellow by the Royal College of Emergency Medicine. The GHQ-12 is being used under licence from GL assessments; the fee for use of this instrument within all three surveys has been waived. EC is a National Institute for Health Research Advanced Fellow. The study has direct funding from RCEM. Grant code: G/2020/1. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/7/9

Y1 - 2021/7/9

N2 - Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.Design A prospective online three-part longitudinal survey.Setting Acute hospitals in the UK and Ireland.Participants Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.Primary outcome measures Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.Results The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).Conclusion Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.

AB - Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.Design A prospective online three-part longitudinal survey.Setting Acute hospitals in the UK and Ireland.Participants Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.Primary outcome measures Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.Results The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).Conclusion Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.

KW - Emergency department

KW - distress

KW - trauma

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U2 - 10.1136/bmjopen-2021-049680

DO - 10.1136/bmjopen-2021-049680

M3 - Review article

SN - 2044-6055

VL - 11

JO - BMJ Open

JF - BMJ Open

IS - 7

M1 - e049680

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Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: A prospective longitudinal survey cohort study

Abstract

Bibliographical note

Keywords

UN SDGs

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