From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (K.A.); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (K.A., E.E.C., S.P., S.C., P.J.S., H.C.M.); Johns Hopkins School of Nursing, Baltimore, Maryland (S.S.-F.); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (L.G.K., J.T.); Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland (L.G.K.); Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (T.G.V.); and Center for Health Security, Johns Hopkins University, Baltimore, Maryland (T.G.V.).
J Occup Environ Med. 2023 Sep 1;65(9):e593-e603. doi: 10.1097/JOM.0000000000002909. Epub 2023 Jun 23.
Despite a growing literature on mental health among clinical staff during COVID-19, factors shaping distress for nonclinical staff are understudied and may be driven by inequalities at work. We aimed to discuss the role of workplace factors in shaping psychological distress for a diverse group of clinical, nonclinical, and other health and hospital workers (HHWs).
This convergent parallel mixed-methods study with HHWs in a US hospital system included an online survey ( n = 1127) and interviews ( n = 73) collected from August 2020 to January 2021. We thematically analyzed interviews; findings informed log binomial regression estimating risk factors for severe psychological distress (Patient Health Questionnaire - 4 item version [PHQ-4] scores of 9 or greater).
Qualitatively, day-to-day stressors fostered fear and anxiety, and concerns about work environments manifest as betrayal and frustration with leadership. Distress was associated with burnout, financial concerns, and feeling betrayed or unsupported by the institution and leadership. Staff in service versus clinical roles had higher risk for severe distress (adjusted prevalence ratio = 2.04, 95% confidence interval = 1.13-2.66); HHWs receiving workplace mental health support had lower risk (adjusted prevalence ratio = 0.52, 95% confidence interval = 0.29-0.92.
Our mixed-methods study underscores how the pandemic brought inequalities to the surface to increase distress for vulnerable HHWs. Workplace mental health activities can support HHWs now and during future crises.
尽管有越来越多的文献研究了 COVID-19 期间临床工作人员的心理健康问题，但对于非临床工作人员的困扰因素的研究还很不足，而且这些因素可能是由工作中的不平等造成的。我们旨在讨论工作场所因素在塑造不同临床、非临床以及其他卫生和医院工作者（HHW）的心理困扰方面的作用。
这项在美国医院系统中进行的临床和非临床混合方法研究包括一项在线调查（n=1127）和访谈（n=73），调查于 2020 年 8 月至 2021 年 1 月进行。我们对访谈进行了主题分析；研究结果为使用患者健康问卷-4 项版本（PHQ-4）评估严重心理困扰（得分 9 或更高）的风险因素的逻辑二项回归提供了信息。
定性分析表明，日常压力源会助长恐惧和焦虑，而对工作环境的担忧则表现为对领导层的背叛和失望。困扰与倦怠、财务问题以及对机构和领导层的背叛或不支持有关。服务而非临床角色的员工出现严重困扰的风险更高（调整后患病率比=2.04，95%置信区间=1.13-2.66）；接受工作场所心理健康支持的 HHWs 风险较低（调整后患病率比=0.52，95%置信区间=0.29-0.92）。
我们的混合方法研究强调了大流行如何使不平等现象浮出水面，从而增加了弱势 HHW 的困扰。工作场所心理健康活动可以为 HHWs 提供现在和未来危机期间的支持。
