Health care personnel under the pressure of COVID-19 - a prospective 2-year cohort study

COVID-19 challenged health care personnel from spring 2020 to the introduction of vaccines. This prospective cohort study evaluated the psychological impact of cumulated exposure to COVID-19 frontline work and COVID-19-related potentially traumatic events (PTEs) on all hospital personnel.

PTEs, posttraumatic stress disorder (PTSD) symptoms, psychological distress, insomnia, anxiety and depression symptoms were assessed with screening tools monthly during the first year and later bimonthly in this study among HUS Helsinki University Hospital personnel who participated in this study. The initial number of participants was N = 4910 (19% of the hospital personnel), 85% of whom reparticipated in some of the 16 follow ups and N = 1128 at 24 months (last follow up).

The most important PTE before PTSD symptoms was strong anxiety due to fear of one's own or a close one's infection (odds ratio, OR 2.39, 95% confidence interval, CI 1.92-2.98), followed by exceptionally disturbing or distressing pandemic work assignments (OR 1.69, 95% CI 1.41-2.02). Frontline work and direct exposure to pandemic patients alone did not statistically significantly increase PTSD risk (OR 1.05, 95% CI 0.89-1.23). Accumulation of PTEs (OR 1.07 per PTE, 95% CI 1.03-1.12) and prolonged frontline work (OR 1.05, 95% CI 1.01-1.10) over time were risk factors for psychological distress.

Accumulated exposures to PTEs and frontline work constitute an additional risk of distress and stress-related disorders. The subjective nature of the most prominent risk, PTE (fear of infections), suggests that workplace interventions and emotional support might prevent distress during a pandemic.