Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

Tom Roberts; Jo Daniels; William Hulme; Robert Hirst; Daniel Horner; Mark David Lyttle; Katie Samuel; Blair Graham; Charles Reynard; Michael Barrett; James Foley; John Cronin; Etimbuk Umana; Joao Vinagre; Edward Carlton; TheTrainee Emergency Research Network (TERN); Paediatric Emergency Research in the UK and Ireland (PERUKI); Research and Audit Federation of Trainees (RAFT), Irish Trainee Emergency Research Network (ITERN and Trainee Research in Intensive Care (TRIC)); Ireland Trainee Emergency Research Network (I-TERN) Collaborators; Research and Audit Federation of Trainees (RAFT), Trainee Research in Intensive Care (TRIC) and Specialist Anaesthesia Trainee led Audit and Research Network (SATURN) Collaborators

doi:10.1136/bmjopen-2021-049680

Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

BMJ Open. 2021 Jul 9;11(7):e049680. doi: 10.1136/bmjopen-2021-049680.

Authors

Tom Roberts^{1

2}, Jo Daniels³, William Hulme⁴, Robert Hirst⁵, Daniel Horner⁶, Mark David Lyttle^{2

7}, Katie Samuel⁵, Blair Graham^{8

9}, Charles Reynard¹⁰, Michael Barrett^{11

12}, James Foley¹³, John Cronin¹⁴, Etimbuk Umana¹⁵, Joao Vinagre¹⁶, Edward Carlton¹⁷; TheTrainee Emergency Research Network (TERN); Paediatric Emergency Research in the UK and Ireland (PERUKI); Research and Audit Federation of Trainees (RAFT), Irish Trainee Emergency Research Network (ITERN and Trainee Research in Intensive Care (TRIC)); Ireland Trainee Emergency Research Network (I-TERN) Collaborators; Research and Audit Federation of Trainees (RAFT), Trainee Research in Intensive Care (TRIC) and Specialist Anaesthesia Trainee led Audit and Research Network (SATURN) Collaborators

Collaborators

L Kane, L Mackenzie, S Sharma Hajela, J Phizacklea, K Malik, N Mathai, A Sattout, S Messahel, E Fadden, R McQuillan, B O'Hare, P Turton, S Lewis, D Bewick, R Taylor, I Hancock, L Kane, L Mackenzie, S Sharma Hajela, J Phizacklea, K Malik, N Mathai, A Sattout, S Messahel, E Fadden, R McQuillan, B O'Hare, P Turton, S Lewis, D Bewick, R Taylor, I Hancock, L Kane, L Mackenzie, S Sharma Hajela, J Phizacklea, K Malik, N Mathai, A Sattout, S Messahel, E Fadden, R McQuillan, B O'Hare, P Turton, S Lewis, D Bewick, R Taylor, I Hancock, L Kane, L Mackenzie, S Sharma Hajela, J Phizacklea, K Malik, N Mathai, A Sattout, S Messahel, E Fadden, R McQuillan, B O'Hare, P Turton, S Lewis, D Bewick, R Taylor, I Hancock, D Manthalapo, Ramesh Babu, S Hartshorn, M Williams, A Charlton, L Somerset, C Munday, A Turner, R Sainsbury, E Williams, S Patil, R Stewart, M Winstanley, N Tambe, C Magee, D Raffo, D Mawhinney, B Taylor, T Hussan, G Pells, F Barham, F Wood, C Szekeres, R Greenhalgh, S Marimuthu, R Macfarlane, M Alex, B Shrestha, L Stanley, J Gumley, K Thomas, M Anderson, C Weegenaar, J Lockwood, T Mohamed, S Ramraj, M Mackenzie, A Robertson, W Niven, M Patel, S Subramaniam, C Holmes, S Bongale, U Bait, S Nagendran, S Rao, F Mendes, P Singh, S Subramaniam, T Baron, C Ponmani, M Depante, R Sneep, A Brookes, S Williams, A Rainey, J Brown, N Marriage, S Manou, S Hart, M Elsheikh, L Cocker, M H Elwan, K L Vincent, C Nunn, N Sarja, M Viegas, E Wooffinden, C Reynard, N Cherian, A Da-Costa, S Duckitt, J Bailey, L How, T Hine, F Ihsan, H Abdullah, K Bader, S Pradhan, M Manoharan, C Battle, L Kehler, R Muswell, M Bonsano, J Evans, E Christmas, K Knight, L O'Rourke, K Adeboye, K Iftikhar, R Evans, R Darke, R Freeman, E Grocholski, K Kaur, H Cooper, M Mohammad, L Harwood, K Lines, C Thomas, D Ranasinghe, S Hall, J Wright, S Hall, N Ali, J Hunt, H Ahmad, C Ward, M Khan, K Holzman, J Ritchie, A Hormis, R Hannah, A Corfield, J Maney, D Metcalfe, S Timmis, C Williams, R Newport, D Bawden, A Tabner, H Malik, C Roe, D McConnell, F Taylor, R Ellis, S Morgan, L Barnicott, S Foster, J Browning, L McCrae, E Godden, A Saunders, A Lawrence-Ball, R House, J Muller, I Skene, M Lim, H Millar, A Rai, K Challen, S Currie, M Elkanzi, T Perry, W Kan, L Brown, M Cheema, A Clarey, A Gulati, K Webster, A Howson, R Doonan, C Magee, A Trimble, C O'Connell, R Wright, E Colley, C Rimmer, S Pintus, H Jarman, V Worsnop, S Collins, M Colmar, N Masood, R McLatchie, A Peasley, S Rahman, N Mullen, L Armstrong, A Hay, R Mills, J Lowe, H Raybould, A Ali, P Cuthbert, S Taylor, V Talwar, Z Al-Janabi, C Leech, J Turner, L McKechnie, B Mallon, J McLaren, Y Moulds, L Dunlop, F M Burton, S Keers, L Robertson, D Craver, N Moultrie, O Williams, S Purvis, M Clark, C Davies, S Foreman, C Ngua, D George, J Morgan, D George, N Hoskins, J Fryer, R Wright, L Frost, P Ellis, A Mackay, K Gray, M Jacobs, L Kane, L Mackenzie, S Sharma Hajela, J Phizacklea, K Malik, N Mathai, A Sattout, S Messahel, E Fadden, R McQuillan, B O'Hare, P Turton, S Lewis, D Bewick, R Taylor, I Hancock, D Manthalapo, Ramesh Babu, S Hartshorn, M Williams, A Charlton, L Somerset, C Munday, A Turner, R Sainsbury, E Williams, S Patil, R Stewart, M Winstanley, N Tambe, C Magee, D Raffo, D Mawhinney, B Taylor, T Hussan, G Pells, F Barham, F Wood, C Szekeres, R Greenhalgh, S Marimuthu, R Macfarlane, M Alex, B Shrestha, L Stanley, J Gumley, K Thomas, M Anderson, C Weegenaar, J Lockwood, T Mohamed, S Ramraj, M Mackenzie, A Robertson, W Niven, M Patel, S Subramaniam, C Holmes, S Bongale, U Bait, S Nagendran, S Rao, F Mendes, P Singh, S Subramaniam, T Baron, C Ponmani, M Depante, R Sneep, A Brookes, S Williams, A Rainey, J Brown, N Marriage, S Manou, S Hart, M Elsheikh, L Cocker, M H Elwan, K L Vincent, C Nunn, N Sarja, M Viegas, E Wooffinden, C Reynard, N Cherian, A Da-Costa, S Duckitt, J Bailey, L How, T Hine, F Ihsan, H Abdullah, K Bader, S Pradhan, M Manoharan, C Battle, L Kehler, R Muswell, M Bonsano, J Evans, E Christmas, K Knight, L O'Rourke, K Adeboye, K Iftikhar, R Evans, R Darke, R Freeman, E Grocholski, K Kaur, H Cooper, M Mohammad, L Harwood, K Lines, C Thomas, D Ranasinghe, S Hall, J Wright, S Hall, N Ali, J Hunt, H Ahmad, C Ward, M Khan, K Holzman, J Ritchie, A Hormis, R Hannah, A Corfield, J Maney, D Metcalfe, S Timmis, C Williams, R Newport, D Bawden, A Tabner, H Malik, C Roe, D McConnell, F Taylor, R Ellis, S Morgan, L Barnicott, S Foster, J Browning, L McCrae, E Godden, A Saunders, A Lawrence-Ball, R House, J Muller, I Skene, M Lim, H Millar, A Rai, K Challen, S Currie, M Elkanzi, T Perry, W Kan, L Brown, M Cheema, A Clarey, A Gulati, K Webster, A Howson, R Doonan, C Magee, A Trimble, C O'Connell, R Wright, E Colley, C Rimmer, S Pintus, H Jarman, V Worsnop, S Collins, M Colmar, N Masood, R McLatchie, A Peasley, S Rahman, N Mullen, L Armstrong, A Hay, R Mills, J Lowe, H Raybould, A Ali, P Cuthbert, S Taylor, V Talwar, Z Al-Janabi, C Leech, J Turner, L McKechnie, B Mallon, J McLaren, Y Moulds, L Dunlop, F M Burton, S Keers, L Robertson, D Craver, N Moultrie, O Williams, S Purvis, M Clark, C Davies, S Foreman, C Ngua, D George, J Morgan, D George, N Hoskins, J Fryer, R Wright, L Frost, P Ellis, A Mackay, K Gray, M Jacobs, I Musliam, Veettil Asif, P Amiri, S Shrivastava, F Raza, S Wilson, M Riyat, H Knott, M Ramazany, S Langston, N Abela, L Robinson, D Maasdorp, H Murphy, H Edmundson, R Das, C Orjioke, D Worley, W Collier, J Everson, N Maleki, A Stafford, S Gokani, M Charalambos, A Olajide, C Bi, J Ng, S Naeem, J Anandarajah, A Hill, C Boulind, L Kane, L Mackenzie, S Sharma Hajela, J Phizacklea, K Malik, N Mathai, A Sattout, S Messahel, E Fadden, R McQuillan, B O'Hare, P Turton, S Lewis, D Bewick, R Taylor, I Hancock, D Manthalapo, Ramesh Babu, S Hartshorn, M Williams, A Charlton, L Somerset, C Munday, A Turner, R Sainsbury, E Williams, S Patil, R Stewart, M Winstanley, N Tambe, C Magee, D Raffo, D Mawhinney, B Taylor, T Hussan, G Pells, F Barham, F Wood, C Szekeres, R Greenhalgh, S Marimuthu, R Macfarlane, M Alex, B Shrestha, L Stanley, J Gumley, K Thomas, M Anderson, C Weegenaar, J Lockwood, T Mohamed, S Ramraj, M Mackenzie, A Robertson, W Niven, M Patel, S Subramaniam, C Holmes, S Bongale, U Bait, S Nagendran, S Rao, F Mendes, P Singh, S Subramaniam, T Baron, C Ponmani, M Depante, R Sneep, A Brookes, S Williams, A Rainey, J Brown, N Marriage, S Manou, S Hart, M Elsheikh, L Cocker, M H Elwan, K L Vincent, C Nunn, N Sarja, M Viegas, E Wooffinden, C Reynard, N Cherian, A Da-Costa, S Duckitt, J Bailey, L How, T Hine, F Ihsan, H Abdullah, K Bader, S Pradhan, M Manoharan, C Battle, L Kehler, R Muswell, M Bonsano, J Evans, E Christmas, K Knight, L O'Rourke, K Adeboye, K Iftikhar, R Evans, R Darke, R Freeman, E Grocholski, K Kaur, H Cooper, M Mohammad, L Harwood, K Lines, C Thomas, D Ranasinghe, S Hall, J Wright, S Hall, N Ali, J Hunt, H Ahmad, C Ward, M Khan, K Holzman, J Ritchie, A Hormis, R Hannah, A Corfield, J Maney, D Metcalfe, S Timmis, C Williams, R Newport, D Bawden, A Tabner, H Malik, C Roe, D McConnell, F Taylor, R Ellis, S Morgan, L Barnicott, S Foster, J Browning, L McCrae, E Godden, A Saunders, A Lawrence-Ball, R House, J Muller, I Skene, M Lim, H Millar, A Rai, K Challen, S Currie, M Elkanzi, T Perry, W Kan, L Brown, M Cheema, A Clarey, A Gulati, K Webster, A Howson, R Doonan, C Magee, A Trimble, C O'Connell, R Wright, E Colley, C Rimmer, S Pintus, H Jarman, V Worsnop, S Collins, M Colmar, N Masood, R McLatchie, A Peasley, S Rahman, N Mullen, L Armstrong, A Hay, R Mills, J Lowe, H Raybould, A Ali, P Cuthbert, S Taylor, V Talwar, Z Al-Janabi, C Leech, J Turner, L McKechnie, B Mallon, J McLaren, Y Moulds, L Dunlop, F M Burton, S Keers, L Robertson, D Craver, N Moultrie, O Williams, S Purvis, M Clark, C Davies, S Foreman, C Ngua, D George, J Morgan, D George, N Hoskins, J Fryer, R Wright, L Frost, P Ellis, A Mackay, K Gray, M Jacobs, I Musliam, Veettil Asif, P Amiri, S Shrivastava, F Raza, S Wilson, M Riyat, H Knott, M Ramazany, S Langston, N Abela, L Robinson, D Maasdorp, H Murphy, H Edmundson, R Das, C Orjioke, D Worley, W Collier, J Everson, N Maleki, A Stafford, S Gokani, M Charalambos, A Olajide, C Bi, J Ng, S Naeem, J Anandarajah, A Hill, C Boulind, R O'Sullivan, S Gilmartin, S Uí Bhroin, P Fitzpatrick, A Patton, M Jee Poh Hock, S Graham, S Kukaswadia, C Prendergast, A Ahmed, C Dalla Vecchia, J Lynch, M Grummell, I Grossi, B MacManus, R O'Sullivan, S Gilmartin, S Uí Bhroin, P Fitzpatrick, A Patton, M JeePoh Hock, S Graham, S Kukaswadia, C Prendergast, A Ahmed, C Dalla Vecchia, J Lynch, M Grummell, I Grossi, B MacManus, K Samuel, A Boyle, A Waite, B Johnson, J Vinagre

Affiliations

¹ TERN, The Royal College of Emergency Medicine, London, UK tomkieranroberts@gmail.com.
² Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.
³ Department of Psychology, University of Bath, Bath, UK.
⁴ Statistical Consultant, Oxford, UK.
⁵ Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, UK.
⁶ Department of Intensive Care, Salford Royal Hospitals NHS Trust, Salford, UK.
⁷ Faculty of Health and Applied Science, University of the West of England, Bristol, UK.
⁸ Emergency Department, Plymouth Hospitals NHS Foundation Trust, Plymouth, UK.
⁹ Urgent and Emergency Care, University of Plymouth, Plymouth, UK.
¹⁰ The University of Manchester, Manchester, UK.
¹¹ School of Medicine, University College Dublin, Dublin, Ireland.
¹² Emergency Department, Children's Health Ireland at Crumlin, Crumlin, Ireland.
¹³ Emergency Department, University Hospital Waterford, Waterford, Ireland.
¹⁴ Emergency Department, St Vincent's University Hospital, Dublin, Ireland.
¹⁵ Emergency Department, Connolly Hospital Blanchardstown, Blanchardstown, Ireland.
¹⁶ College of Anaesthesiologists of Ireland, Dublin, Ireland.
¹⁷ Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK.

Abstract

Objectives: The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to the emergence of multiple pandemic waves, longitudinal data on the impact of COVID-19 are vital to ensure an adequate psychological care response. The primary aim was to assess the prevalence and degree of psychological distress and trauma in frontline doctors during the acceleration, peak and deceleration of the COVID-19 first wave. Personal and professional factors associated with psychological distress are also reported.

Design: A prospective online three-part longitudinal survey.

Setting: Acute hospitals in the UK and Ireland.

Participants: Frontline doctors working in emergency medicine, anaesthetics and intensive care medicine during the first wave of the COVID-19 pandemic in March 2020.

Primary outcome measures: Psychological distress and trauma measured using the General Health Questionnaire-12 and the Impact of Events-Revised.

Results: The initial acceleration survey distributed across networks generated a sample of 5440 doctors. Peak and deceleration response rates from the original sample were 71.6% (n=3896) and 56.6% (n=3079), respectively. Prevalence of psychological distress was 44.7% (n=1334) during the acceleration, 36.9% (n=1098) at peak and 31.5% (n=918) at the deceleration phase. The prevalence of trauma was 23.7% (n=647) at peak and 17.7% (n=484) at deceleration. The prevalence of probable post-traumatic stress disorder was 12.6% (n=343) at peak and 10.1% (n=276) at deceleration. Worry of family infection due to clinical work was the factor most strongly associated with both distress (R²=0.06) and trauma (R²=0.10).

Conclusion: Findings reflect a pattern of elevated distress at acceleration and peak, with some natural recovery. It is essential that policymakers seek to prevent future adverse effects through (a) provision of vital equipment to mitigate physical and psychological harm, (b) increased awareness and recognition of signs of psychological distress and (c) the development of clear pathways to effective psychological care.

Trial registration number: ISRCTN10666798.

Keywords: Accident & emergency medicine; COVID-19; adult anaesthesia; adult intensive & critical care; mental health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Cohort Studies
Cross-Sectional Studies
Humans
Ireland / epidemiology
Longitudinal Studies
Pandemics
Prospective Studies
Psychological Distress*
SARS-CoV-2
United Kingdom / epidemiology

Associated data

ISRCTN/ISRCTN10666798