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  • Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

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Mental health
Original research
Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study
  1. Tom Roberts1,2,
  2. Jo Daniels3,
  3. William Hulme4,
  4. Robert Hirst5,
  5. Daniel Horner6,
  6. Mark David Lyttle2,7,
  7. Katie Samuel5,
  8. Blair Graham8,9,
  9. Charles Reynard10,
  10. Michael Barrett11,12,
  11. James Foley13,
  12. John Cronin14,
  13. Etimbuk Umana15,
  14. Joao Vinagre16,
  15. Edward Carlton17,
  16. on behalf of TheTrainee Emergency Research Network (TERN),
  17. Paediatric Emergency Research in the UK and Ireland (PERUKI)
  18. Research and Audit Federation of Trainees (RAFT), Irish Trainee Emergency Research Network (ITERN and Trainee Research in Intensive Care (TRIC))
        1. 1TERN, The Royal College of Emergency Medicine, London, UK
        2. 2Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
        3. 3Department of Psychology, University of Bath, Bath, UK
        4. 4Statistical Consultant, Oxford, UK
        5. 5Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, UK
        6. 6Department of Intensive Care, Salford Royal Hospitals NHS Trust, Salford, UK
        7. 7Faculty of Health and Applied Science, University of the West of England, Bristol, UK
        8. 8Emergency Department, Plymouth Hospitals NHS Foundation Trust, Plymouth, UK
        9. 9Urgent and Emergency Care, University of Plymouth, Plymouth, UK
        10. 10The University of Manchester, Manchester, UK
        11. 11School of Medicine, University College Dublin, Dublin, Ireland
        12. 12Emergency Department, Children's Health Ireland at Crumlin, Crumlin, Ireland
        13. 13Emergency Department, University Hospital Waterford, Waterford, Ireland
        14. 14Emergency Department, St Vincent's University Hospital, Dublin, Ireland
        15. 15Emergency Department, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
        16. 16College of Anaesthesiologists of Ireland, Dublin, Ireland
        17. 17Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
        1. Correspondence to Dr Tom Roberts; tomkieranroberts{at}gmail.com

        Abstract

        Objectives The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.

        Design A prospective online three-part longitudinal survey.

        Setting Acute hospitals in the UK and Ireland.

        Participants Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.

        Primary outcome measures Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.

        Results The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R2=0.06) and trauma (R2=0.10).

        Conclusion Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.

        Trial registration number ISRCTN10666798.

        • Accident & emergency medicine
        • adult anaesthesia
        • adult intensive & critical care
        • COVID-19
        • mental health

        Data availability statement

        Deidentified participant data will be made available for 2 years post publication. Requests for access will require HRA and ethical approval and decisions regarding data sharing will be made after discussion with the study senior authors. Statistical code and study figures are available directly from: https://github.com/wjchulme/TERN-CERA-study/tree/main/outputs

        http://creativecommons.org/licenses/by-nc/4.0/

        This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

        https://doi.org/10.1136/bmjopen-2021-049680

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          Data availability statement

          Deidentified participant data will be made available for 2 years post publication. Requests for access will require HRA and ethical approval and decisions regarding data sharing will be made after discussion with the study senior authors. Statistical code and study figures are available directly from: https://github.com/wjchulme/TERN-CERA-study/tree/main/outputs

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          Supplementary materials

          • Supplementary Data

            This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

          Footnotes

          • Twitter @hirstposition, @mdlyttle, @katie_samuel_, @PEMDublin, @eddcarlton

          • Collaborators TERN: L Kane; L Mackenzie; S Sharma Hajela; J Phizacklea; K Malik; N Mathai; A Sattout; S Messahel; E Fadden; R McQuillan; B O'Hare; P Turton; S Lewis; D Bewick; R Taylor; I Hancock; D Manthalapo; Ramesh Babu; S Hartshorn; M Williams; A Charlton; L Somerset; C Munday; A Turner; R Sainsbury; E Williams; S Patil; R Stewart; M Winstanley; N Tambe; C Magee; D Raffo; D Mawhinney; B Taylor; T Hussan; G Pells; F Barham; F Wood; C Szekeres; R Greenhalgh; S Marimuthu; R Macfarlane; M Alex; B Shrestha; L Stanley; J Gumley; K Thomas; M Anderson; C Weegenaar; J Lockwood; T Mohamed; S Ramraj; M Mackenzie; A Robertson; W Niven; M Patel; S Subramaniam; C Holmes; S Bongale; U Bait; S Nagendran; S Rao; F Mendes; P Singh; S Subramaniam; T Baron; C Ponmani; M Depante; R Sneep; A Brookes; S Williams; A Rainey; J Brown; N Marriage; S Manou; S Hart; M Elsheikh; L Cocker; MH Elwan; K L Vincent; C Nunn; N Sarja; M Viegas; E Wooffinden; C Reynard; N Cherian; A Da-Costa; S Duckitt; J Bailey; L How; T Hine; F Ihsan; H Abdullah; K Bader; S Pradhan; M Manoharan; C Battle; L Kehler; R Muswell; M Bonsano; J Evans; E Christmas; K Knight; L O'Rourke; K Adeboye; K Iftikhar; R Evans; R Darke; R Freeman; E Grocholski; K Kaur; H Cooper; M Mohammad; L Harwood; K Lines; C Thomas; D Ranasinghe; S Hall; J Wright; S Hall; N Ali; J Hunt; H Ahmad; C Ward; M Khan; K Holzman; J Ritchie; A Hormis; R Hannah; A Corfield; J Maney; D Metcalfe; S Timmis; C Williams; R Newport; D Bawden; A Tabner; H Malik; C Roe; D McConnell; F Taylor; R Ellis; S Morgan; L Barnicott; S Foster; J Browning; L McCrae; E Godden; A Saunders; A Lawrence-Ball; R House; J Muller; I Skene; M Lim; H Millar; A Rai; K Challen; S Currie; M Elkanzi; T Perry; W Kan; L Brown; M Cheema; A Clarey; A Gulati; K Webster; A Howson; R Doonan; C Magee; A Trimble; C O’Connell; R Wright; E Colley; C Rimmer; S Pintus; H Jarman; V Worsnop; S Collins; M Colmar; N Masood; R McLatchie; A Peasley; S Rahman; N Mullen; L Armstrong; A Hay; R Mills; J Lowe; H Raybould; A Ali; P Cuthbert; S Taylor; V Talwar; Z Al-Janabi; C Leech; J Turner; L McKechnie; B Mallon; J McLaren; Y Moulds; L Dunlop; FM Burton; S Keers; L Robertson; D Craver; N Moultrie; O Williams; S Purvis; M Clark; C Davies; S Foreman; C Ngua; D George; J Morgan; D George; N Hoskins; J Fryer; R Wright; L Frost; P Ellis; A Mackay; K Gray; M Jacobs; I Musliam; Veettil Asif; P Amiri; S Shrivastava; F Raza; S Wilson; M Riyat; H Knott; M Ramazany; S Langston; N Abela; L Robinson; D Maasdorp; H Murphy; H Edmundson; R Das; C Orjioke; D Worley; W Collier; J Everson; N Maleki; A Stafford; S Gokani; M Charalambos; A Olajide; C Bi; J Ng; S Naeem; J Anandarajah; A Hill; C Boulind-TERNR O'Sullivan; S Gilmartin; S Uí Bhroin; P Fitzpatrick; A Patton; M JeePoh Hock; S Graham; S Kukaswadia; C Prendergast; A Ahmed; C Dalla Vecchia; J Lynch; M Grummell; I Grossi; B MacManus; RAFT/TRIC/SATURNA- K Samuel; A Boyle; A Waite; B Johnson; J Vinagre.

          • Contributors The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. TR conceived the idea for the study. TR, EC, JD, ML and BG were responsible for the initial study design, which was refined with the help of KS, CR, RH, MB, DH and WH. Expert advice on psychological assessment scores was provided by JD. WH provided the statistical plan. TR and DH lead the dissemination of the study in UK Adult Emergency Departments (ED), ML lead the dissemination of the study in UK and Ireland Paediatric EDs, KS lead the dissemination of the study in UK Anaesthetic and ICU Departments, MB lead the dissemination of the study in Ireland EDs, along with JC, JF and EU. JV lead the dissemination in Ireland ICUs and Anaesthetic Departments. TR coordinated study set-up, finalisation of the study surveys and finalisation of study protocols. All authors contributed to the final study design and protocol development, critically revised successive drafts of the manuscript and approved the final version. The study management group is responsible for the conduct of the study.

          • Funding The Chief Investigator is directly funded as a research fellow by the Royal College of Emergency Medicine. The GHQ-12 is being used under licence from GL assessments; the fee for use of this instrument within all three surveys has been waived. EC is a National Institute for Health Research Advanced Fellow. The study has direct funding from RCEM. Grant code: G/2020/1.

          • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or the Royal Colleges involved in survey distribution.

          • Competing interests Many of the authors have been working as frontline clinicians during the COVID-19 pandemic. They have no competing interests to declare.

          • Provenance and peer review Not commissioned; externally peer reviewed.

          • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.