Mental Health Outcomes Among Italian Health Care Workers During the COVID-19 Pandemic.

IMPORTANCE

Health care workers (HCWs) exposed to COVID-19 have high rates of mental health issues. However, longitudinal data on the evolution of mental health outcomes in HCWs are lacking.

OBJECTIVE

To evaluate the mental health outcomes among Italian HCWs 14 months after the beginning of the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study collected data from March 1 to April 30, 2020 (T1) and from April 1 to May 31, 2021 (T2), from 2856 Italian HCWs aged 18 years or older who responded to an online questionnaire. Participants were also recruited via snowballing, a technique in which someone who receives the invitation to participate forwards it to his or her contacts.

EXPOSURES

Frontline vs second-line position, job type, hospitalization for COVID-19, and colleagues or family members affected by COVID-19.

MAIN OUTCOMES AND MEASURES

Outcomes are depression symptoms, anxiety symptoms, insomnia symptoms, and posttraumatic stress symptoms (PTSSs). Four different trajectories are described for each condition: resilient, remittent, incident, and persistent.

RESULTS

Of the 2856 HCWs, 997 (34.9%) responded to the follow-up assessment (mean [SD] age, 42.92 [10.66] years; 816 [82.0%] female). Depression symptoms (b = -2.88; 95% CI, -4.05 to -1.71), anxiety symptoms (b = -2.01; 95% CI, -3.13 to -0.88), and PTSSs (b = -0.77; 95% CI, -1.13 to -0.42) decreased over time; insomnia symptoms increased (b = 3.05; 95% CI, 1.63-4.47). Serving as a frontline HCW at T1 was associated with decreased symptoms of depression (b = -1.04; 95% CI, -2.01 to -0.07), and hospitalization for COVID-19 was associated with increased depression symptoms (b = 5.96; 95% CI, 2.01-9.91); younger age (b = -0.36; 95% CI, -0.70 to -0.03) and serving as a frontline HCW at T1 (b = -1.04; 95% CI, -1.98 to -0.11) were associated with decreased anxiety symptoms. Male sex was associated with increase in insomnia symptoms (b = 1.46; 95% CI, 0.39-2.53). Serving as a frontline HCW at T1 (b = -0.42; 95% CI, -0.71 to -0.13) and being a physician (b = -0.52; 95% CI, -0.81 to -0.24) were associated with a decrease in PTSSs, whereas younger age (b = 0.35; 95% CI, 0.09-0.61) and male sex (b = 0.12; 95% CI, 0.01-0.22) were associated with an increase in PTSSs. Depression trajectories were 629 resilient (65.5%), 181 remittent (18.8%), 58 incident (6.0%), and 92 persistent (9.6%). Anxiety trajectories were 701 resilient (73.3%), 149 remittent (15.6%), 45 incident (4.7%), and 61 persistent (6.4%). Insomnia trajectories were 858 resilient (88.9%), 77 remittent (8.0%), 20 incident (2.1%), and 10 persistent (1.0%). The PTSS trajectories were 363 resilient (38.5%), 267 remittent (28.3%), 86 incident (9.1%), and 226 persistent (24.0%).

CONCLUSIONS AND RELEVANCE

In this cohort study, relative to the beginning of the COVID-19 pandemic, mental health among HCWs has improved. Factors associated with change in mental health outcomes could help in the design of prevention strategies for HCWs.