Hello. I just wanted to thank SCCM to allow me to present today, and I'm so glad to be able to see everyone. And as he said, I'm Allie Hines. I'm an assistant professor of emergency medicine and surgery out at the University of New Mexico. I have nothing to disclose. And so we're going to get into why mental health matters. We're going to talk about who's impacted. And then we're also going to give you solutions to how to combat this. And so we've all been there. We've all worked through the pandemic. And either you, yourself, or you had a colleague sit there and either snap at an individual or blame the patient for not getting vaccinated. You knew that's not who you were or that's not who your colleague was. But what I'm getting at is what our past presidents stated very well is that ICU doctors are experiencing among the highest levels of stress, burnout, and fatigue from COVID-19, perhaps more than any other specialty. And in Boston also stated, burnout among medical staff is a public health crisis that requires urgent action. And so here are some various implications of the pandemic that we're going to get into. And so because of the pandemic, we saw that people were overall sleeping less, they were eating and drinking and smoking more, and they were also exercising less. After the pandemic, we saw that 50% of people were experiencing anxiety-like symptoms. This is compared to pre-pandemic, 13%. And this is important because it has both implications, both at work and physical and economical implications as well. People aren't giving the right treatments to right dosing of treatments. Economically, it's a sixth leading cause of disability. And then you're also not sleeping well and you're having muscle spasms. Peritraumatic distress is also another implication. It is the acute response to both in emotional and psychological distress. Long-term wise, this can lead to PTSD. And in France, after the pandemic, we saw that about a quarter of people were experiencing PTSD symptoms. This is compared to pre-pandemic of 11%. And ultimately, burnout ends up becoming the chronic response to interpersonal stress along with compassion fatigue, which has various domains. And this includes the personal exhaustion domain, depersonalization, and personal sense of accomplishment domain. And all the domains have about 10 to 60% of people having symptoms, emotional, 25 to 61%. Depersonalization, 19 to 46%. Personal accomplishment, 6 to 59%. And overall for burnout, about 50%. This number is compared to 6 to 47% pre-pandemic wise. And depression, 16 to 50% now of ICU healthcare workers are experiencing symptoms of, as compared to only 4% before the pandemic. And unfortunately, in surveys that ask people if they had serious thoughts of suicide ideations, within the last two weeks, about three to 5% of people seriously contemplated suicide. So now that we saw the implications, I think it's important to talk about who's impacted so that way you can identify colleagues that might be at risk. And these are various risk factors associated with low psychiatric scores and well-being scores that we'll be getting into. And so there's various groupings and so there's the demographics, psychological, well-being, and work-related that all lead into mental health. From baseline demographics, the females, from underlying history, you have underlying histories of various psychiatric disorders, various fears, including those that fear catching COVID or transmitting COVID, and you also have basic personality traits such as avoidant personality. And also those who had their sleep disrupted, those are having to take care of their kids or their loved ones at home. And so not only are you trying to fight the pandemic as a frontline, but now you're having nannies all of a sudden quit because they don't want to expose themselves to someone who's a frontline worker. And so now you have to figure out not only how to take care of your loved ones in the hospital but your loved ones at home. And also those who experienced a change in eating and drinking behaviors or those who listened to the crowds and misinformation, they also became at risk. And also being in isolation, that's how we end up coping with things, is talking through things. And so here are various things at work that became risk factors, whether it's various duties related to work. And so whether you were giving the diagnoses or poor diagnoses frequently, whether you thought that you weren't giving good enough care or that the care was complex, whether you had conflicting messages just because there wasn't literature out. And so various services would say one thing, another service would say a separate thing. The long hours, and this isn't just the long hours on the floor, but you now have to sit there and you have to build up your team and to train them. You had high intense environments, you were isolated, you were no longer able to eat with your colleagues at work, you had poor resources, and you had ever-changing protocols. Overall, with people being stretched thin, there was a sense of lack of communication occasionally, or a sense of lack of control, knowledge, or just being uncertain about the pandemic. This ultimately ends up leading to moral distress. And what is moral distress? It's when you have this ethically idea that you want to implement, but you're unable to do so because you have either your own internal barriers, whether you're afraid of transmitting COVID to your loved ones or institutional constraints in the resources. And this is important because moral injury, moral distress, and burnout lead to anxiety and depression. And similarly, anxiety and depression also lead to moral injury, distress, and burnout. So now that we talked about the implications and who's impacted, I'm going to give you some solutions to be able to combat this in the future. And so there's various layers I'm going to go ahead and peel back in the upcoming slides. And so from a hospital standpoint and ways for the hospitals that they're going to communicate, from a leadership standpoint, and also from a staffing standpoint, whether that's coming up with creative solutions to people who are no longer working. Elective cases end up getting canceled in the operating room, and you can certainly leverage the non-critical care trained faculty members who are no longer operating or being the anesthesiologists and use them in the ICU. I think it's important overall to sit there and to have support from the leadership for them to be able to role model. And so you can see here that she's role modeling her PPE, and overall this ends up decreasing fear, anxiety, and stress. Then also having the leadership come and have their boots on the ground. And so having the support, supporting the colleagues, finding out what their needs, that provides a bunch of emotional distress, but it also creates solutions. And so what if his biggest fear was transmitting to his family, and so he was actually going home and hosing off outside before he came inside? The leadership then might be able to come up with a solution of implementing showers at work. And we're going to get into some communication things. And so the idea of providing succinct messages that are authentic and regular interactions ends up also ultimately decreasing uncertainty, fear, mistrust, and helplessness. And we have a lot of stakeholders on teams, whether that's palliative care, but I think it's also important to have mental health care workers on the teams, because they're going to provide a very unique perspective overall. And then they can also help screen for mental health. You can leverage your peers, and so that way you can train. Because who your peers are, they might act differently in front of the leadership compared to their fellow co-workers. And then also just coming to meetings with a psychologically-oriented standpoint. Then providing various resources, whether that's webinars, training, problem-solving skills, or confidential counseling. So overall, just having a positive outlook and building teamwork, those are both important things that a department can do. And from a working standpoint, though, whenever there's things that you can offload, if you're working these long, hard hours, trying to come up with creative ways to offload some of the work. And so maybe that's finding administrators that can help decrease your work that way. Having balanced schedules, that way you're not having to juggle your home life with your work life. And also just scheduling regular break times, that way you're not going through the work day, just going through the grind. Overall involving healthcare workers and strategizing meetings is important. It's clinically effective, as they'll bring their thoughts to the table, and then they'll be able to come up and also bring solutions. It'll boost everyone's self-esteem, both the frontline workers and the non-essential workers. It makes them feel included, builds trust, it provides a positive outlook, and it ultimately decreases job stress, uncertainty, depression, and anxiety. So ways that a department can also do is simple gestures. And so if you're at home and if you're being quarantined, maybe sitting there and providing a pizza at home, feeding them. That's a simple thing. Or arranging communication, and not just between your colleagues, that way you can talk through what's going on at work. But also if your worker is being isolated from their family because they're trying not to transmit COVID, then also even arranging Zoom meetings so that they can talk to their family. All of this ends up decreasing the sense of guilt for being contagious, decreasing self-blame for understaffing, decreasing worries and stress for not performing their work duties and their family duties. And then things that you can sit there and do is including avoiding the avoidant coping mechanism. You can sit there and take a reflective approach, one that you can't change a situation, but you can certainly have a positive outlook going forward. There might have been positive or negative things that happened, but there's always things you can learn from this. And I think it's also important from a social standpoint to normalize that not being okay is okay. This will sit there and this will leverage your colleagues. So if you sit there and talk about how you're on antidepressants, how you're seeking help, and if you're going through struggles, that might give your colleagues around you the power to also seek help. Social interactions also has both direct and indirect effects. They'll give people a sense of mastery, a sense of control, you'll be able to problem solve things, you'll be able to recognize each other, and also gives a sense of prediction and stability. And so overall, the key takeaways are frequent monitoring of psychological well-being, adequate mental support, both at work at home, as this will build resilience and psychological well-being, and additionally optimizing working conditions and decreasing workload.

pandemic impact

mental health

healthcare workers

anxiety

depression