Dublin hospital staff report high levels of PTSD, low mood, suicidal thinking and moral injury during COVID-19

Findings from a research study exploring the mental health of Dublin's general hospital staff during the COVID-19 pandemic reveal significant impacts on doctors, nurses and radiographers, including high levels of symptoms of post-traumatic stress disorder (PTSD), depression and suicidal thinking.

The COWORKER Study, developed to investigate the mental health impact of the pandemic on Dublin general hospital staff and help inform appropriate responses, involved researchers from Trinity, St Patrick's Mental Health Services and RCSI University of Medicine and Health Services. It was led by Declan McLoughlin, Research Professor of Psychiatry at Trinity and Consultant Psychiatrist at St Patrick's Mental Health Services.

Staff in three large Dublin general hospitals (St James's Hospital, Tallaght University Hospital and Beaumont Hospital) were invited to participate, with the study also aiming to provide an opportunity for doctors, nurses and radiographers to recognize if they have been experiencing mental health difficulties during the pandemic and to seek support if required.

Among the key findings, which came from a cross-sectional anonymous survey of 377 Dublin health care staff during the third wave of the COVID-19 pandemic in early 2021, are:

• 45% of respondents reported moderate or severe symptoms of post-traumatic stress disorder (PTSD)
• 52% of respondents reported low mood
• 13% of respondents reported thinking of ending their life over the previous week and 5% reported planning to end their life

The high levels of post-traumatic symptoms found in this study are higher than the current best international estimate for health care workers.

Staff also reported high levels of moral injury, which is the psychological distress experienced when one is forced to witness or perform acts that go against one's ethical beliefs.

This concept arose in military mental health research but has gained importance in research studying health care worker mental health due to COVID-19-related scenarios. For example, health care workers may have had no option but to ration care when resources were scarce, or they may have had to stop family from visiting their loved-ones due to restrictions.

Researchers also examined whether there were any differences in the levels of mental health difficulties between staff based on their roles. The findings show that doctors were significantly less likely to report symptoms of PTSD, low mood and moral injury than nurse or radiographers, while radiographers were significantly more likely to report low mood.

Speaking about the impact of the findings, Declan McLoughlin, Research Professor of Psychiatry at Trinity and Consultant Psychiatrist at St Patrick's Mental Health Services, said:

"The pandemic has presented immense challenges for hospitals, their staff, patients and families. While there have been many studies internationally examining the psychological impact on hospital staff, this is the first to examine the impacts on those working in Dublin hospitals.

"We hope that the study's findings will highlight potential areas of concern for hospital management and staff so that they can address this and seek support as required."

Lead author of the study, Dr. Conan Brady, Trinity, said:

"The results of the COWORKER study have shown the significant mental health impacts of the pandemic for those working in hospitals. While we do not know the full extent of the mental health experiences for hospital staff before COVID-19, there are many pandemic-related factors that may have impacted on this cohort's mental health.

"In addition to the restrictions we've all faced, other reasons could be job stress or concerns about stigma from working in environments with high levels of COVID-19. There are few data on suicidal ideation in hospital staff internationally, and this warrants more investigation."

The results of the peer-reviewed study have been published as an open access paper in the Irish Journal of Medical Science.