Abstract
BackgroundThe COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact.ObjectiveThis study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress.MethodsHCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally.ResultsA total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial.ConclusionsHigh resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic.
Highlights
MethodsIncreasing rates of SARS-CoV-2 infections and hospitalizations, growing workloads, and concern regarding personal protective equipment have resulted in a large psychological burden on health care workers (HCWs) [1]
Quality of life, and resilience were associated with decreased longitudinal stress (P
Clinical trainees had higher baseline resilience compared to clinical nontrainees (P=.03) and staff (P=.01), higher optimism (P=.04) and emotional support (P=.01) compared to staff, and higher emotional support compared to clinical nontrainees (P=.01) (Table S2, Multimedia Appendix 1)
Summary
Increasing rates of SARS-CoV-2 infections and hospitalizations, growing workloads, and concern regarding personal protective equipment have resulted in a large psychological burden on health care workers (HCWs) [1]. Prior pandemics have had psychological effects on HCWs, increasing posttraumatic stress, depression, and anxiety [1,2,3]. Cross-sectional studies have demonstrated that frontline HCWs are at a high risk of depression, anxiety, insomnia, and distress compared to the general population [4,5,6]. The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact
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