Ensuring the mental health and well-being of the healthcare workforce globally, especially women healthcare workers (HCWs), is an ongoing challenge that has been accentuated by the novel coronavirus (COVID-19) pandemic. Already at high risk of experiencing symptoms of stress, burnout, and depression, women HCWs are now also facing the psychosocial impacts of the COVID-19 pandemic. Although different types of mental health interventions have been introduced to support HCW well-being, the current needs of women HCWs have not been emphasized and replicable processes for developing and implementing specific emotional support services for women HCWs have not yet been well-described in the literature. Therefore, in this perspective, we discuss the approach our institution (University of California, Los Angeles) took for developing emotional support services for women HCWs that incorporate aspects of disaster behavioral health models and address various barriers to support and treatment. In addition, we describe and illustrate the process that we utilized to develop individual-level and institutional-level emotional support services. Finally, based on our institution's experience, we share recommendations for developing emotional support services for women HCWs during the COVID-19 pandemic and other future crises.
Psychological Distress Among Women Healthcare Workers: A Health System's Experience Developing Emotional Support Services During the COVID-19 Pandemic
[This is an excerpt.] Creating healthy, high-performing fire/EMS departments is a shared responsibility that requires commitment from department leaders and members alike. Fire service leaders who understand the link between the well-being of their members and the performance and success of the department take comprehensive steps to create a positive environment that supports and promotes good health and optimal functioning. In short, they create a psychologically healthy fire department (PHFD). Creating a healthy, high-performing department requires more than simply promoting awareness of health issues or offering wellness activities. Done well, principles of health and well-being become ingrained in the very norms, values, and beliefs that are part of the department’s culture. Core to this approach is a multi-dimensional view of well-being that includes mental health. The PHFD: Implementation Toolkit is based on American Psychological Association’s (APA) Psychologically Healthy Workplace model and adapted to fit the unique characteristics of the fire service. [To read more, click View Resource.]
Psychologically Healthy Fire Departments: Implementation Toolkit
While the health impacts of the COVID-19 pandemic on frontline health care workers have been well described, the effects of the COVID-19 response on the U.S. public health workforce, which has been impacted by the prolonged public health response to the pandemic, has not been adequately characterized. A cross-sectional survey of public health professionals was conducted to assess mental and physical health, risk and protective factors for burnout, and short- and long-term career decisions during the pandemic response. The survey was completed online using the Qualtrics survey platform. Descriptive statistics and prevalence ratios (95% confidence intervals) were calculated. Among responses received from 23 August and 11 September 2020, 66.2% of public health workers reported burnout. Those with more work experience (1–4 vs. <1 years: prevalence ratio (PR) = 1.90, 95% confidence interval (CI) = 1.08−3.36; 5–9 vs. <1 years: PR = 1.89, CI = 1.07−3.34) or working in academic settings (vs. practice: PR = 1.31, CI = 1.08–1.58) were most likely to report burnout. As of September 2020, 23.6% fewer respondents planned to remain in the U.S. public health workforce for three or more years compared to their retrospectively reported January 2020 plans. A large-scale public health emergency response places unsustainable burdens on an already underfunded and understaffed public health workforce. Pandemic-related burnout threatens the U.S. public health workforce’s future when many challenges related to the ongoing COVID-19 response remain unaddressed.
Public Health Workforce Burnout in the COVID-19 Response in the U.S.
[This is an excerpt.] To date, over 710,000 Americans have died due to COVID-19. Nurses report increased levels of stress, exhaustion, and burnout, while healthcare organizations struggle with new surges and growing staffing shortages. As a continuation of the Pulse on the Nation’s Nurses Survey Series, and a follow-up to the first and second Mental Health and Wellness surveys conducted in Spring and Winter of 2020 and the COVID Impact survey conducted in Winter 2021, the American Nurses Foundation has fielded another non-incentivized survey. The goal was to determine any changes and further impact of the pandemic on the mental health and wellness of nurses, with additional enquiries concerning emotional health, post-traumatic stress, resiliency, and stigma around seeking professional mental health support. Between August 20 - September 2, 2021, 9,572 nurses completed or partially completed this survey. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Measuring Well-Being & Accountability).
Pulse of the Nation’s Nurses Survey Series: Mental Health and Wellness
[This is an excerpt.] In 2019, 91.0% of office-based physicians spent time outside normal office hours documenting clinical care: 17.0% spent <1 hour, 41.4% spent 1–2 hours, 24.0% spent >2 hours–4 hours, and 8.6% spent >4 hours per day. The percentage of primary care physicians who spent no hours per day documenting clinical care (5.3%) was lower than the percentage of specialist care physicians (12.3%) who spent no hours per day documenting clinical care. In other time categories, there was no statistically significant difference between primary care and specialist care physicians. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).
QuickStats: Distribution of Hours per Day That Office-Based Primary Care and Specialist Care Physicians Spent Outside Normal Office Hours Documenting Clinical Care in Their Medical Record System — United States, 2019
BACKGROUND AND OBJECTIVES: Personal care, home health, and nursing aides provide the majority of care to chronically ill and disabled older adults. This workforce faces challenging working conditions, resulting in high turnover and workforce instability that affect the quality of care for older adults. We examine financial security, work-life balance, and quality of life of Black, Hispanic, and workers of other race/ethnicity compared to White workers. RESEARCH DESIGN AND METHODS: We hypothesize that Black and Hispanic workers experience greater financial insecurity, spend more time on work-related activities and have less time available for leisure activities, and have a lower quality of life compared to White workers. To test these hypotheses, we analyze the American Time Use Survey using descriptive analyses and multivariable and compositional regression. RESULTS: Black and Hispanic individuals were 2-3 times more likely to live in poverty than White individuals. The time use analysis indicated that Black and Hispanic workers spent more time on work-related activities and less time on nonwork-related activities, including longer work commutes and less time exercising. In analyses of aggregated paid/unpaid work and leisure, Black workers were the only group that spent significantly more time working and less time on leisure activities compared to White workers. This may explain the lower quality of life that we only observed in Black workers. DISCUSSION AND IMPLICATIONS: Racial/ethnic disparities in well-being among direct care workers may affect the care older adults receive and contribute to widening inequities in this workforce and society. Policymakers should direct efforts toward securing funding for workers, incentivizing employer provisions, and implementing racial equity approaches.
Racial Disparities in Financial Security, Work and Leisure Activities, and Quality of Life Among the Direct Care Workforce
A nationwide survey conducted by the National Commission to Address Racismin Nursing demonstrates that racism in the nursing profession is a problem
This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Improving Diversity, Equity, & Inclusion).
Racism's Impact in Nursing
OBJECTIVE: Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout. DESIGN: RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control. RESULTS: Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (-5.27 (95% CI: -10.44, -0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (-6.3% (95% CI: -11.6%, -1.0%); p = 0.008), and secondary outcomes depression (-5.2% (95%CI: -10.8, -0.4); p = 0.022) and work-life integration (-11.8% (95%CI: -17.9, -6.1); p < 0.001). Improvements endured at 6 months. CONCLUSION: WISER appears to durably improve HCW well-being.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Stress/Trauma & Resilience).
Randomized Controlled Trial of the "WISER" Intervention to Reduce Healthcare Worker Burnout
The current landscape of mental health services reflects both tremendous challenges and opportunities. With the impact of COVID-19 front and center in the national discourse, and the planning for a system involving a 988-crisis response, there is much work ahead. This paper, Ready to Respond, is the umbrella paper for the 2021 technical assistance coalition series developed through the National Association of State Mental Health Program Directors in partnership with the Substance Abuse and Mental Health Services Administration. It aims to lay out a roadmap as states emerge from the pandemic and need, more than ever, a full continuum of psychiatric care. As an outgrowth of a policy framework looking “beyond beds” within inpatient state hospitals as a single solution to improving mental health outcomes, the current discourse centers around access to crisis services. Yet, in order to best respond to demand, an entire array of services is needed both to prevent crises in the first place and to provide longer term supports beyond a crisis period for diverse populations of all ages with mental illness and substance use disorders, as well as those with co-occurring complex conditions. These services will require coordinated funding and planning with a broad group of stakeholders to address among other things equity and reducing the likelihood of suicide, overdose, criminal legal entanglements, homelessness, unemployment, or other untoward outcomes. The paper reviews recent behavioral health system demands and highlights seven key priority areas for consideration to build a sustainable, robust and more complete psychiatric care continuum.
Ready to Respond: Mental Health Beyond Crisis and COVID-19
BACKGROUND: Healthcare work is known to be stressful and challenging, and there are recognised links between the psychological health of staff and high-quality patient care. Schwartz Center Rounds® (Rounds) were developed to support healthcare staff to re-connect with their values through peer reflection, and to promote more compassionate patient care. Research to date has focussed on self-report surveys that measure satisfaction with Rounds but provide little analysis of how Rounds 'work' to produce their reported outcomes, how differing contexts may impact on this, nor make explicit the underlying theories in the conceptualisation and implementation of Rounds. METHODS: Realist evaluation methods aimed to identify how Rounds work, for whom and in what contexts to deliver outcomes. We interviewed 97 key informants: mentors, facilitators, panellists and steering group members, using framework analysis to organise and analyse our data using realist logic. We identified mechanisms by which Rounds lead to outcomes, and contextual factors that impacted on this relationship, using formal theory to explain these findings. RESULTS: Four stages of Rounds were identified. We describe how, why and for whom Schwartz Rounds work through the relationships between nine partial programme theories. These include: trust safety and containment; group interaction; counter-cultural/3rd space for staff; self-disclosure; story-telling; role modelling vulnerability; contextualising patients and staff; shining a spotlight on hidden stories and roles; and reflection and resonance. There was variability in the way Rounds were run across organisations. Attendance for some staff was difficult. Rounds is likely to be a 'slow intervention' the impact of which develops over time. We identified the conditions needed for Rounds to work optimally. These contextual factors influence the intensity and therefore degree to which the key ingredients of Rounds (mechanisms) are activated along a continuum, to produce outcomes. Outcomes included: greater tolerance, empathy and compassion for self and others; increased honesty, openness, and resilience; improved teamwork and organisational change. CONCLUSIONS: Where optimally implemented, Rounds provide staff with a safe, reflective and confidential space to talk and support one another, the consequences of which include increased empathy and compassion for colleagues and patients, and positive changes to practice.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Stress/Trauma & Resilience).
Realist Evaluation of Schwartz Rounds® for Enhancing the Delivery of Compassionate Healthcare: Understanding How They Work, for Whom, and in What Contexts
BACKGROUND: The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. OBJECTIVE: The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. METHODS: We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. RESULTS: We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. CONCLUSIONS: We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post–COVID-19 reality.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Using Technology to Improve Workflows)
Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review
While long-term care (LTC) facilities serving older adults have long struggled with low employee morale and high rates of staff turnover, the COVID-19 pandemic brought unprecedented challenges to these facilities and the frontline staff working in them. This study aimed to explore factors that influenced the personal and professional wellbeing of care providers working in LTC facilities across New York City (NYC) during the pandemic. Fourteen semi-structured qualitative interviews were conducted with frontline care providers working in LTC facilities across NYC. Interviews were audio-recorded, transcribed, and systematically coded according to both pre-existing and emergent topics. Four main themes emerged from the data: the toll of the virus; home and work-life balance stressors; workplace stressors; and participants’ recommendations for facility leadership. Findings from this study may inform strategies for supporting the wellbeing of frontline care providers in LTC environments, especially during future public health emergencies.
Reflections From the “Forgotten Front Line”: A Qualitative Study of Factors Affecting Wellbeing Among Long-Term Care Workers in New York City During the COVID-19 Pandemic
BACKGROUND: Nursing practice is highly demanding and has been related to risk of substance use (SU) and SU disorders (SUDs). Despite this, education on registered nurse (RN) SUDs is extremely limited, and this knowledge gap has been related to nurses’ inability to address SU problems among colleagues. PURPOSE: We assessed whether practicing nurses recognized signs of SUDs, what actions they would take if a colleague had a SUD, and their knowledge of RN SUDs interventions. We examined these findings in relation to demographic and work characteristics. METHODS: A mixed modes survey (online, mailed) was conducted between November 2020 and February 2021, with randomly selected RNs in nine states being contacted up to six times. Balanced stratified sampling (balanced to the U.S. RN population), a technique that aims to obtain a nationally representative sample, was used. Measures of potential workplace signs of SUD (seven items), actions one would take (seven items), and attitudes toward RN SUD interventions (10 items) were assessed, and prevalence of these items is described. Logistic regression models were used to assess associations between each item and demographic and work characteristics. RESULTS: Of the 1,215 surveys returned (31% response rate), 1,170 were included in the analyses. Most RNs (82%) correctly selected frequent medication errors, medication wasting, and frequent absences/breaks as potential signs of SU problems, yet only half felt confident in their ability to identify an colleague with a SUD. Although the majority (93%) would tell a supervisor, higher proportions of younger (aged < 45 years) and Asian nurses reported feeling unsure of what to do and were more afraid to get involved with nurse SU problems than older nurses and nurses of other races/ethnicities. Variation in recognition and actions were also found for workplace factors. Charge nurses were more likely to think that nurses with a potential SUD should have their license revoked than those in the reference group (educators/researchers) (adjusted OR = 1.89; 95% CI = 1.03, 3.49). CONCLUSIONS: Findings suggest nurses can benefit from clear guidelines and educational initiatives to address RN SU problems. A culture of safety and accountability could help nurses feel more comfortable addressing these issues.
Registered Nurses’ Awareness of Workplace Signs, Actions, and Interventions for Nurses with Substance Use Disorder
BACKGROUND: In health care, burnout remains a persistent and significant problem. Evidence now exists that organizational initiatives are vital to address health care worker (HCW) well-being in a sustainable way, though system-level interventions are pursued infrequently. METHODS: Between November 2018 and May 2020, researchers engaged five health system and physician practice sites to participate in an organizational pilot intervention that integrated evidence-based approaches to well-being, including a comprehensive culture assessment, leadership and team development, and redesign of daily workflow with an emphasis on cultivating positive emotions. RESULTS: All primary and secondary outcome measures demonstrated directionally concordant improvement, with the primary outcome of emotional exhaustion (0–100 scale, lower better; 43.12 to 36.42, p = 0.037) and secondary outcome of likelihood to recommend the participating department’s workplace as a good place to work (1–10 scale, higher better; 7.66 to 8.20, p = 0.037) being statistically significant. Secondary outcomes of emotional recovery (0–100 scale, higher better; 76.60 to 79.53, p = 0.20) and emotional thriving (0–100 scale, higher better; 76.70 to 79.23, p = 0.27) improved but were not statistically significant. CONCLUSION: An integrated, skills-based approach, focusing on team culture and interactions, leadership, and workflow redesign that cultivates positive emotions was associated with improvements in HCW well-being. This study suggests that simultaneously addressing multiple drivers of well-being can have significant impacts on burnout and workplace environment.
This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Organizational Infrastructure for Well-Being).
Results from the National Taskforce for Humanity in Healthcare's Integrated, Organizational Pilot Program to Improve Well-Being
BACKGROUND: Interventions to decrease burnout and increase well-being in health care workers (HCWs) and improve organizational safety culture are urgently needed. This study was conducted to determine the association between Positive Leadership WalkRounds (PosWR), an organizational practice in which leaders conduct rounds and ask staff about what is going well, and HCW well-being and organizational safety culture. METHODS: This study was conducted in a large academic health care system in which senior leaders were encouraged to conduct PosWR. The researchers used data from a routine cross-sectional survey of clinical and nonclinical HCWs, which included a question about recall of exposure of HCWs to PosWR: "Do senior leaders ask for information about what is going well in this work setting (e.g., people who deserve special recognition for going above and beyond, celebration of successes, etc.)?"—along with measures of well-being and safety culture. T-tests compared work settings in the first and fourth quartiles for PosWR exposure across SCORE (Safety, Communication, Operational Reliability, and Engagement) domains of safety culture and workforce well-being. RESULTS: Electronic surveys were returned by 10,627 out of 13,040 possible respondents (response rate 81.5%) from 396 work settings. Exposure to PosWR was reported by 63.1% of respondents overall, with a mean of 63.4% (standard deviation = 20.0) across work settings. Exposure to PosWR was most commonly reported by HCWs in leadership roles (83.8%). Compared to work settings in the fourth (< 50%) quartile for PosWR exposure, those in the first (> 88%) quartile revealed a higher percentage of respondents reporting good patient safety norms (49.6% vs. 69.6%, p < 0.001); good readiness to engage in quality improvement activities (60.6% vs. 76.6%, p < 0.001); good leadership accessibility and feedback behavior (51.9% vs. 67.2%, p < 0.001); good teamwork norms (36.8% vs. 52.7%, p < 0.001); and good work-life balance norms (61.9% vs. 68.9%, p = 0.003). Compared to the fourth quartile, the first quartile had a lower percentage of respondents reporting emotional exhaustion in themselves (45.9% vs. 32.4%, p < 0.001), and in their colleagues (60.5% vs. 47.7%, p < 0.001). CONCLUSION: Exposure to PosWR was associated with better HCW well-being and safety culture.
This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.
Safety Culture and Workforce Well-Being Associations with Positive Leadership Walkrounds
In this cross-sectional quantitative study, we employed survey research to examine the differences in school counselors' (N = 327) burnout, job stress, and job satisfaction based on their student caseload size. The results indicated that higher caseloads were associated with higher degrees of burnout and job stress, along with lower job satisfaction. The results produced small to medium effect sizes. We discussed how such factors relate to the effectiveness of providing student services and school leaders' support for school counselors.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).
School Counselor Burnout, Job Stress, and Job Satisfaction by Student Caseload
BACKGROUND: During the COVID-19 pandemic, health care workers are sharing their challenges, including sleep disturbances, on social media; however, no study has evaluated sleep in predominantly US frontline health care workers during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to assess sleep among a sample of predominantly US frontline health care workers during the COVID-19 pandemic using validated measures through a survey distributed on social media. METHODS: A self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days (August 31 to September 15, 2020), targeting health care workers who were clinically active during the COVID-19 pandemic. Study participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), and they reported their demographic and career information. Poor sleep quality was defined as a PSQI score ≥5. Moderate-to-severe insomnia was defined as an ISI score >14. The Mini-Z Burnout Survey was used to measure burnout. Multivariate logistic regression tested associations between demographics, career characteristics, and sleep outcomes. RESULTS: A total of 963 surveys were completed. Participants were predominantly White (894/963, 92.8%), female (707/963, 73.4%), aged 30-49 years (692/963, 71.9%), and physicians (620/963, 64.4%). Mean sleep duration was 6.1 hours (SD 1.2). Nearly 96% (920/963, 95.5%) of participants reported poor sleep (PSQI). One-third (288/963, 30%) reported moderate or severe insomnia. Many participants (554/910, 60.9%) experienced sleep disruptions due to device use or had nightmares at least once per week (420/929, 45.2%). Over 50% (525/932, 56.3%) reported burnout. In multivariable logistic regressions, nonphysician (odds ratio [OR] 2.4, 95% CI 1.7-3.4), caring for patients with COVID-19 (OR 1.8, 95% CI 1.2-2.8), Hispanic ethnicity (OR 2.2, 95% CI 1.4-3.5), female sex (OR 1.6, 95% CI 1.1-2.4), and having a sleep disorder (OR 4.3, 95% CI 2.7-6.9) were associated with increased odds of insomnia. In open-ended comments (n=310), poor sleep was mapped to four categories: children and family, work demands, personal health, and pandemic-related sleep disturbances. CONCLUSIONS: During the COVID-19 pandemic, nearly all the frontline health care workers surveyed on social media reported poor sleep, over one-third reported insomnia, and over half reported burnout. Many also reported sleep disruptions due to device use and nightmares. Sleep interventions for frontline health care workers are urgently needed.
Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study
This study builds on the existing research in the field of interprofessional collaboration (IPC) and burnout among social workers. The authors sampled field instructors from a mid-Atlantic school of social work, comparing self-reported burnout scores among social workers on interprofessional teams with those of social workers who do not work on interprofessional teams, and completed a regression analysis of the relationship between burnout and participation in interprofessional teams, perceptions of IPC, and several individual and practice factors. Findings suggest that although members of interprofessional teams reported lower burnout scores, there was no significant relationship between working in an interprofessional team and burnout when controlling for other factors. Although the study provides an interesting first look at burnout among social workers in interprofessional teams, further research with a larger, more representative sample is needed.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Optimizing Teams).
Social Work Burnout in the Context of Interprofessional Collaboration
BACKGROUND: Healthcare workers are at increased risk of adverse mental health outcomes during the COVID-19 pandemic. Studies are warranted that examine socio-ecological factors associated with these outcomes to inform interventions that support healthcare workers during future disease outbreaks. METHODS: We conducted an online cross-sectional study of healthcare workers during May 2020 to assess the socio-ecological predictors of mental health outcomes during the COVID-19 pandemic. We assessed factors at four socio-ecological levels: individual (e.g., gender), interpersonal (e.g., social support), institutional (e.g., personal protective equipment availability), and community (e.g., healthcare worker stigma). The Personal Health Questionnaire-9, Generalized Anxiety Disorder-7, Primary Care Post-Traumatic Stress Disorder, and Alcohol Use Disorders Identification Test-Concise scales assessed probable major depression (MD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and alcohol use disorder (AUD), respectively. Multivariable logistic regression models were used to assess unadjusted and adjusted associations between socio-ecological factors and mental health outcomes. RESULTS: Of the 1,092 participants, 72.0% were female, 51.9% were frontline workers, and the mean age was 40.4 years (standard deviation = 11.5). Based on cut-off scores, 13.9%, 15.6%, 22.8%, and 42.8% had probable MD, GAD, PTSD, and AUD, respectively. In the multivariable adjusted models, needing more social support was associated with significantly higher odds of probable MD, GAD, PTSD, and AUD. The significance of other factors varied across the outcomes. For example, at the individual level, female gender was associated with probable PTSD. At the institutional level, lower team cohesion was associated with probable PTSD, and difficulty following hospital policies with probable MD. At the community level, higher healthcare worker stigma was associated with probable PTSD and AUD, decreased satisfaction with the national government response with probable GAD, and higher media exposure with probable GAD and PTSD. CONCLUSIONS: These findings can inform targeted interventions that promote healthcare workers’ psychological resilience during disease outbreaks.
Socio-Ecological Predictors of Mental Health Outcomes Among Healthcare Workers During the COVID-19 Pandemic in the United States
[This is an excerpt.] States are increasingly engaging in efforts to address behavioral health workforce shortages. Relatively low wages and high caseloads, elevated stress and burnout levels, and an aging workforce have contributed to these persistent shortages, which have been exacerbated by the COVID-19 pandemic. To address these disparities, state policymakers are exploring opportunities to improve behavioral health outcomes among BIPOC communities, and to address the systemic factors that foster disparities, including the lack of diversity among providers. A behavioral health workforce that more closely aligns to the community it serves may alleviate some of these factors, as working alliances have been shown to be stronger when clinicians and clients are of the same ethnic background. Building on existing work to expand behavioral health workforce capacity, states are focusing on policies that foster equity and inclusion in recruitment and retention efforts, looking to increase workforce capacity and workforce diversity at all levels. This brief explores existing state strategies that target increasing engagement of BIPOC across the workforce. NASHP is including lessons learned from states that have implemented programs and policies to address disparities in behavioral health workforce in particular, as well as strategies for workforce diversity more generally that may be applicable for behavioral health workforce. [To read more, click View Resource.]
