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Publication Briefs

Study Shows Impact of COVID-19 Pandemic on Healthcare Workers and First Responders

Little published data are available regarding the factors driving or modulating the risk of increased attrition or decreased occupational functioning among healthcare workers (HCW) and first responders (FR) during the COVID-19 pandemic. This observational, self-report study examined the relationships between COVID-19 related occupational stressors (CROS), psychiatric symptoms, and occupational outcomes (likelihood of leaving current field and occupational functioning). Investigators assessed CROS using a custom 17-item questionnaire. PTSD, depression, insomnia, and generalized anxiety symptoms were also assessed. The study included 301 healthcare workers (60 physicians, 188 nurses) and 200 first responders (162 EMS personnel, 54 firefighters and 19 law enforcement officers). Subjects were recruited through targeted outreach and advertisements on Facebook. Responses spanned 47 states.


  • Findings from this study are consistent with previous demonstrations of high levels of psychiatric symptoms and distress in healthcare workers during the COVID-19 pandemic.
  • Half of the healthcare workers in this study – and 59% of all nurses – indicated a decreased likelihood of staying in their current occupation due to the pandemic.
  • Nurses and emergency medical service workers reported the greatest burdens: more than 40% had PTSD symptoms and more than 80% had depression symptoms.
  • Among all respondents, more than one-third (38%) had PTSD symptoms, and nearly three-quarters had depression (74%) and anxiety (75%) symptoms. More than 15% of participants reported thoughts of suicide or self-harm in the preceding two weeks.
  • More than 18% of respondents reported trouble completing work-related tasks.
  • The volume of critically ill patients, risk of COVID-19 exposure, and factors promoting demoralization were associated with psychiatric distress. Distress was associated with increased odds of planning to leave the profession. Demoralizing factors (e.g., feeling unsupported by one’s workplace, being asked to take unnecessary risks) were most strongly associated with distress.


  • Healthcare staffing shortages are in and of themselves a COVID-19 stressor, so turnover could exponentially worsen HCW’s wellbeing and professional retention. Leaders should proactively ensure access to mental health treatment, including outreach to those more likely in distress (e.g., nurses), and build trusting, collaborative relationships with frontline staff to center their needs.


  • Due to recruitment methods, the sample may not be representative. The relationships characterized in this study are observational and cross-sectional, and cannot be assumed to represent unidirectional, causal relationships.

Dr. Hendrickson is supported by a CSR&D Career Development Award. Dr. Hoerster and Ms. Monty are part of HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care in Seattle, WA.

Hendrickson R, Slevin R, Hoerster K, Chang B, Sano E, McCall C, Monty G, Thomas R, and Raskind M. The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention among Health Care Workers and First Responders. Journal of General Internal Medicine. December 16, 2021. Online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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