Burnout, anxiety and depression in healthcare workers during the early COVID-19 period in Singapore
Teo, I., Sung, S. C., Cheung, Y. B., Wong, W., Abu Bakar Aloweni, F., Ang, H. G., Ayre, T. C., Chai-Lim, C., Chen, R., Heng, A. L., Nadarajan, G. D., Ong, M., Soh, C. R., Tan, B. H., Tan, K.,
Tan, B. S., Tan, M. H., Tan, P. H., Tay, K., Wijaya, L., … Tan, H. K. (2021). Singapore medical journal. Advance online publication. https://doi.org/10.11622/smedj.2021156
Objective: Our primary aim was to examine rates of burnout, anxiety and depression among Healthcare Workers(HCWs). Our secondary aim was to examine the psychological health impact
of the following factors: initiation of the Circuit Breaker, occupational characteristics (occupation, degree of job exposure to COVID-19, job redeployment), history of being a HCW during the 2003
Severe Acute Respiratory Syndrome (SARS) outbreak, and HCW perceptions about their jobs (perceived job risk, perceived clarity of work protocols).
Methods: Doctors, nurses, allied health professionals, administrative and operations staff from a tertiary, COVID-19-treating public hospital with a 1785-bed capacity, were
invited through work email and/or staff portals to participate. Participants completed the baseline online survey in English, either through a web link or via scanning a QR code. The study was
approved by the National University of Singapore IRB (S-20-081) and exempted from review by the SingHealth Centralized IRB (2020/2160).
Results: A total of 1410 HCWs (15% doctors, 58% nurses, 27% others) completed the survey. It is estimated that 23%, 13% and 10% of the population experienced symptoms of burnout,
anxiety and depression, respectively. Nurses reported the highest burnout, anxiety and depression rates followed by other HCWs and doctors. Compared to HCWs who found work policies and protocols
to be clear, those who found them unclear reported higher rates of burnout (OR=4.86, 95% CI: 2.57-9.21), anxiety (OR=3.75, 95% CI: 1.89-7.43), and depression (OR=4.06, 95% CI: 1.99-8.29). Compared
to doctors, nurses reported higher rates of burnout (OR=1.96, 95% CI: 1.19-3.21) and depression (OR=2.08, 95% CI: 1.00-4.29). Those who were HCWs during the SARS outbreak (OR=2.09, 95% CI:
1.18-3.70) or perceived their job to be high-risk (OR=1.68, 95% CI: 1.08-2.62) reported higher rates of anxiety than those who did not. The initiation of the Circuit Breaker, degree of job
exposure to suspected or confirmed COVID-19 cases, and being redeployed were not associated with burnout, anxiety or depression (p’s> .05).
Conclusions: There are limitations to the current study. Our hospital system is large and the response rate (16%) may not reflect the majority of our HCW population; we dealt with
this by using weighted analyses. Our cross-sectional examination of the baseline data also makes it difficult to draw causal conclusions. Although our measurement tools are validated, they are
short to facilitate assessment over time and mitigate survey fatigue; for instance, we used a one-item burnout question. However, we believe our findings offer information that is useful for
healthcare systems to consider in shaping their disaster and pandemic response and supporting their healthcare workforce during this extraordinary time.
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