Mental Health Outcomes Among Italian Health Care Workers During the COVID-19 Pandemic
Authors: Rodolfo Rossi, Valentina Socci, Tommaso Benedetto Jannini, Francesca Pacitti, Alberto Siracusano, Alessandro Rossi, Giorgio Di Lorenzo
Journal: JAMA Network Open (2021)

<h3>Importance</h3> 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. <h3>Objective</h3> To evaluate the mental health outcomes among Italian HCWs 14 months after the beginning of the COVID-19 pandemic. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Frontline vs second-line position, job type, hospitalization for COVID-19, and colleagues or family members affected by COVID-19. <h3>Main Outcomes and Measures</h3> 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. <h3>Results</h3> 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%). <h3>Conclusions and Relevance</h3> 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.