Symptoms of Anxiety, Depression, and Peritraumatic Dissociation in Critical Care Clinicians Managing Patients with COVID-19. A Cross-Sectional Study

Elie Azoulay (1) , Alain Cariou (2) , Fabrice Bruneel (3) , Alexandre Demoule (4, 5) , Achille Kouatchet (6) , Danielle Reuter (7) , Virginie Souppart (1) , Alain Combes (8, 5) , Kada Klouche (9, 10) , Laurent Argaud (11) , François Barbier (12) , Mercé Jourdain (13) , Jean Reignier (14) , Laurent Papazian (15) , Bertrand Guidet (16, 17) , Guillaume Géri (18) , Matthieu Resche-Rigon (1) , Olivier Guisset (19) , Vincent Labbé (20) , Bruno Mégarbane (21, 22) , Guillaume van Der Meersch (23) , Christophe Guitton (24) , Diane Friedman (25) , Frédéric Pochard (1) , Michael Darmon (1) , Nancy Kentish-Barnes (1)

1 AP-HP - Hopital Saint-Louis [AP-HP]
2 Hôpital Cochin [AP-HP]
3 CHV - Centre Hospitalier de Versailles André Mignot
4 UMRS 1158 - Neurophysiologie Respiratoire Expérimentale et Clinique
5 CHU Pitié-Salpêtrière [AP-HP]
6 CHU Angers - Centre Hospitalier Universitaire d'Angers
7 Centre Hospitalier Sud Francilien
8 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
9 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
10 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
11 Hôpital Edouard Herriot [CHU - HCL]
12 HLSO - Hôpital La Source [Orléans]
13 RTD - Recherche translationnelle sur le diabète - U 1190
14 CHU Nantes - Centre Hospitalier Universitaire de Nantes
15 APHM - Assistance Publique - Hôpitaux de Marseille
16 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
17 CHU Saint-Antoine [AP-HP]
18 Hôpital Ambroise Paré [AP-HP]
19 Groupe hospitalier Saint-André
20 CHU Tenon [AP-HP]
21 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
22 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
23 Hôpital Avicenne [AP-HP]
24 Centre Hospitalier Le Mans (CH Le Mans)
25 Hôpital Raymond Poincaré [AP-HP]

Rationale: Frontline healthcare providers (HCPs) during the coronavirus disease (COVID-19) pandemic are at high risk of mental morbidity. Objectives: To assess the prevalence of symptoms of anxiety, depression, and peritraumatic dissociation in HCPs. Methods: This was a cross-sectional study in 21 ICUs in France between April 20, 2020, and May 21, 2020. The Hospital Anxiety and Depression Scale and the Peritraumatic Dissociative Experience Questionnaire were used. Factors independently associated with reported symptoms of mental health disorders were identified. Measurements and Main Results: The response rate was 67%, with 1,058 respondents (median age 33 yr; 71% women; 68% nursing staff). The prevalence of symptoms of anxiety, depression, and peritraumatic dissociation was 50.4%, 30.4%, and 32%, respectively, with the highest rates in nurses. By multivariable analysis, male sex was independently associated with lower prevalence of symptoms of anxiety, depression, and peritraumatic dissociation (odds ratio of 0.58 [95% confidence interval, 0.42–0.79], 0.57 [95% confidence interval, 0.39–0.82], and 0.49 [95% confidence interval, 0.34–0.72], respectively). HCPs working in non–university-affiliated hospitals and nursing assistants were at high risk of symptoms of anxiety and peritraumatic dissociation. Importantly, we identified the following six modifiable determinants of symptoms of mental health disorders: fear of being infected, inability to rest, inability to care for family, struggling with difficult emotions, regret about the restrictions in visitation policies, and witnessing hasty end-of-life decisions. Conclusions: HCPs experience high levels of psychological burden during the COVID-19 pandemic. Hospitals, ICU directors, and ICU staff must devise strategies to overcome the modifiable determinants of adverse mental illness symptoms.

Mots clés: coronavirus; ICU; pneumonia; depression; anxiety; coronavirus

Domaines: Médecine humaine et pathologie

Elie Azoulay, Alain Cariou, Fabrice Bruneel, Alexandre Demoule, Achille Kouatchet, et al.. Symptoms of Anxiety, Depression, and Peritraumatic Dissociation in Critical Care Clinicians Managing Patients with COVID-19. A Cross-Sectional Study. American Journal of Respiratory and Critical Care Medicine, 2020, 202 (10), pp.1388-1398. ⟨10.1164/rccm.202006-2568OC⟩. ⟨hal-03104212⟩