The relative contribution of COVID-19 infection versus COVID-19 related occupational stressors to insomnia in healthcare workers

Objective/BackgroundHealthcare workers have experienced high rates of psychiatric symptom burden and occupational attrition during the COVID-19 pandemic. Identifying contributory factors can inform prevention and mitigation measures. Here, we explore the potential contributions of occupational stressors vs COVID-19 infection to insomnia symptoms in US healthcare workers. Patients/MethodsAn online self-report survey was collected between September 2020 and July 2022 from N=594 US healthcare workers, with longitudinal follow-up up to 9 months. Assessments included the Insomnia Severity Index (ISI), the PTSD Checklist for DSM-5 (PCL-5), and a 13-item scale assessing COVID-19 related occupational stressors. ResultsInsomnia was common (45% of participants reported at least moderate and 9.2% reported severe symptoms at one or more timepoint) and significantly associated with difficulty completing work-related tasks, increased likelihood of occupational attrition, and thoughts of suicide or self-harm (all p<.0001). In multivariable regression with age, gender, and family COVID-19 history as covariates, past two-week COVID-related occupational stressors, peak COVID-related occupational stressors, and personal history of COVID-19 infection were all significantly related to past two-week ISI scores ({beta}=1.7{+/-}0.14SE, {beta}=0.08{+/-}0.03, and {beta}=0.69{+/-}0.22 respectively). Although similar results were found for the PCL-5, when ISI and PCL-5 items were separated by factor, COVID-19 infection was significantly related only to the factor consisting of sleep-related items. ConclusionsBoth recent occupational stress and personal history of COVID-19 infection were significantly associated with insomnia in healthcare workers. These results suggest that both addressing occupational stressors and reducing rates of COVID-19 infection are important to protect healthcare workers and the healthcare workforce.

The impact of working during the Covid-19 pandemic on health care workers and first responders: mental health, function, and professional retention

BackgroundThe COVID-19 pandemic has greatly affected front line health care workers (HCW) and first responders (FR). The infection risk from SARS CoV-2, the high mortality of hospitalized COVID-19 patients and the duration of the pandemic have created sustained and often traumatic stressors affecting HCW and FR. ObjectivesTo assess the relationship of COVID-19 stressor frequency scores to psychiatric rating scale scores amongst HCW and FR. To determine if psychiatric rating scale scores mediate stressor effects on perceived work function and likelihood of remaining in current occupation. DesignObservational, self-report in a convenience sample. Participants118 HCW and FR caring for COVID-19 patients in the United States. Main MeasureCOVID-19 related stressor frequencies were assessed using a 17-item questionnaire. Psychiatric symptoms were assessed with the PTSD Checklist 5 (PCL5), the Patient Health Questionnaire 9 (for depression) (PHQ9), the Insomnia Severity Index (ISI), and the General Anxiety Disorder 7 (GAD7). Key ResultsStressor frequency scores correlated significantly with PCL5 scores (R=.57, p<1e-8), PHQ scores (R=.35, P<.001), ISI scores (R=.38, p<1e-4), and GAD7 scores (R=.39, p<.001), likelihood of staying in current occupation (R=-.39,p<1e-4), and trouble doing usual work (R=.33,p<.001). 51% of HCW and 44% of FR indicated decreased likelihood of staying in their current occupation. PCL5 scores substantially mediated the association between stress frequency scores and work function impairment. ConclusionsThese results direct attention to recognizing potentially treatable psychiatric symptoms, particularly those of PTSD, in HCW and FR experiencing COVID-19 related stressors. They also suggest that mitigating COVID-19 related stressors when possible, such as by providing adequate personal protective equipment, can improve HCW and FR mental health, work function and retention in the health care work force. Strengths and Limitations of this StudyO_LIDetailed assessments of participants exposure to covid-19 related occupational stressors, current psychiatric symptoms, and self-reported occupational functioning and likelihood of remaining in their current field (functional outcomes). C_LIO_LIAssessment of the dose-response relationship between exposure to covid-19 related occupational stressors and current psychiatric symptoms and functional outcomes. C_LIO_LIMediation analysis quantifying the potential for current psychiatric symptoms to mediate the relationship between exposure to covid-19 related occupational stressors and functional outcomes. C_LIO_LILimitations: convenience sample, limited numbers of first responder participants C_LI

Characterization and Clinical Course of 1000 Patients with COVID-19 in New York: retrospective case series

ObjectiveTo characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs). DesignRetrospective manual medical record review. SettingNewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC. ParticipantsThe first 1000 consecutive patients with laboratory-confirmed COVID-19. MethodsWe identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record. Main outcome measuresWe describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. ResultsAmong the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital. ConclusionsHospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.