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Am J Perinatol 2022; 29(14): 1596-1604
DOI: 10.1055/s-0042-1748315
Original Article

Stress and the Psychological Impact of the COVID-19 Pandemic on Frontline Obstetrics and Gynecology Providers

Kelly C. Bogaert 
1   Division of Hospital Medicine, University of California San Francisco, San Francisco, California
,
Whitney E. Lieb
2   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
3   Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
4   Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
5   Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
,
Kimberly B. Glazer 
2   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
3   Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
4   Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
,
Eileen Wang
6   Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
,
Joanne L. Stone
2   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
3   Blavatnik Family Women's Health Research Institute, Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Elizabeth A. Howell
6   Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract

Objective The coronavirus disease 2019 (COVID-19) pandemic rapidly overwhelmed global health care systems in 2020, with New York City (NYC) marking the first epicenter in the United States. High levels of stress amongst health care workers have been reported in pandemics, but less is known about stress amongst Obstetrics and Gynecology (OB/GYN) providers. We sought to describe levels of stress, anxiety, depression, and other aspects of mental health among OB/GYN health care workers during the first wave of the COVID-19 pandemic.

Study Design We conducted an anonymous cross-sectional electronic survey of a wide range of OB/GYN clinicians in a large NYC hospital system in the spring of 2020. We used both original survey questions and validated screening tools to assess stress, anxiety, depression, and burnout. We calculated median scores for these tools and compared median score between provider types. We also adapted questions on pandemic-related stressors from the MERS and SARS pandemics to fit the context of the COVID-19 pandemic and OB/GYN providers.

Results A total of 464 providers met study inclusion criteria, and 163 providers completed the survey (response rate = 35.1%). Approximately 35% of providers screened positive for anxiety and 21% for depression. Scores for depression, burnout, and fulfillment varied by provider type, with nurses scoring higher than physicians (p <0.05). The majority of respondents reported stress from pandemic and OB-specific stressors, including the possibility of transmitting COVID-19 to friends and family (83.9%, [95% confidence interval or CI 78.0–89.8%]), uncertainty regarding the pandemic's trajectory (91.3% [86.7–95.8%]), and frequent policy changes on labor and delivery (72.7% [65.1–80.3%]).

Conclusion OB/GYN providers reported high levels of stress during the COVID-19 pandemic. The stress of caring for laboring patients during a pandemic may disproportionately affect nurses and trainees and highlights the need to provide interventions to ameliorate the negative impact of a pandemic on the mental health of our OB/GYN health care workers.

Key Points

  • COVID-19 led to stress amongst OB/GYN providers.

  • Some stressors were unique to providing obstetric care.

  • Nurses and trainees were more affected by this stress.

Keywords

anxiety - burnout - COVID-19 - depression - OB/GYN - pandemic - psychological distress - stressors


Publication History

Received: 28 March 2021

Accepted: 18 February 2022

Article published online:
31 May 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. (JHU). COVID-19 Dashboard. Accessed October 25, 2021 at: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
    PubMedGoogle Scholar
  • 2 Kang L, Li Y, Hu S. et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020; 7 (03) e14
    CrossrefPubMedGoogle Scholar
  • 3 Maunder RG, Lancee WJ, Balderson KE. et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis 2006; 12 (12) 1924-1932
    CrossrefPubMedGoogle Scholar
  • 4 Nickell LA, Crighton EJ, Tracy CS. et al. Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. CMAJ 2004; 170 (05) 793-798
    CrossrefPubMedGoogle Scholar
  • 5 Tam CWC, Pang EPF, Lam LCW, Chiu HFK. Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: stress and psychological impact among frontline healthcare workers. Psychol Med 2004; 34 (07) 1197-1204
    CrossrefPubMedGoogle Scholar
  • 6 Khalid I, Khalid TJ, Qabajah MR, Barnard AG, Qushmaq IA. Healthcare workers emotions, perceived stressors and coping strategies during a MERS-CoV outbreak. Clin Med Res 2016; 14 (01) 7-14
    CrossrefPubMedGoogle Scholar
  • 7 Schwartz R, Sinskey JL, Anand U, Margolis RD. Addressing postpandemic clinician mental health : a narrative review and conceptual framework. Ann Intern Med 2020; 173 (12) 981-988
    CrossrefPubMedGoogle Scholar
  • 8 Lai J, Ma S, Wang Y. et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020; 3 (03) e203976
    CrossrefPubMedGoogle Scholar
  • 9 COVID-19 FAQs for Obstetrician-Gynecologists. Obstetrics. Accessed July 11, 2020 at: https://www.acog.org/en/ClinicalInformation/PhysicianFAQs/COVID19FAQsforObGynsObstetrics
    PubMedGoogle Scholar
  • 10 Ellington S. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status—United States, January 22–June 7, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (25) 769-775
    CrossrefPubMedGoogle Scholar
  • 11 Winkel AF, Hughes F, Blank SV. Nonreassuring status: improving obstetrician-gynecologist wellness. Obstet Gynecol 2017; 130 (05) 1042-1046
    CrossrefPubMedGoogle Scholar
  • 12 Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166 (10) 1092-1097
    CrossrefPubMedGoogle Scholar
  • 13 Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003; 41 (11) 1284-1292
    CrossrefPubMedGoogle Scholar
  • 14 Trockel M, Bohman B, Lesure E. et al. A brief instrument to assess both burnout and professional fulfillment in physicians: reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Acad Psychiatry 2018; 42 (01) 11-24
    CrossrefPubMedGoogle Scholar
  • 15 Evanoff BA, Strickland JR, Dale AM. et al. Work-related and personal factors associated with mental well-being during the COVID-19 response: survey of health care and other workers. J Med Internet Res 2020; 22 (08) e21366
    CrossrefPubMedGoogle Scholar
  • 16 Bruschwein H, Gettle LS. Multipronged intervention for reducing burnout and increasing resiliency in an interdisciplinary care team. BMJ Open Qual 2020; 9 (04) e001015
    CrossrefPubMedGoogle Scholar
  • 17 Matsuishi K, Kawazoe A, Imai H. et al. Psychological impact of the pandemic (H1N1) 2009 on general hospital workers in Kobe. Psychiatry Clin Neurosci 2012; 66 (04) 353-360
    CrossrefPubMedGoogle Scholar
  • 18 Ha GQ, Go JT, Murayama KM, Steinemann S. Identifying Sources of Stress Across Years of General Surgery Residency. Hawaii J Health Soc Welf 2020; 79 (03) 75-81
    PubMedGoogle Scholar
  • 19 Yalçın Bahat P, Aldıkaçtıoğlu Talmaç M, Bestel A, Topbas Selcuki NF, Karadeniz O, Polat I. Evaluating the effects of the COVID-19 pandemic on the physical and mental well-being of obstetricians and gynecologists in Turkey. Int J Gynaecol Obstet 2020; 151 (01) 67-73
    CrossrefPubMedGoogle Scholar
  • 20 Semaan A, Audet C, Huysmans E. et al. Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic. BMJ Global Health 2020; 5 (06) e002967
    CrossrefPubMedGoogle Scholar
  • 21 Wong TW, Yau JKY, Chan CLW. et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med 2005; 12 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 22 Rigby FB, Bynum B, Santen SA, Anabazhagan A, Karjane N. Burnout in OB/GYN students and residents. Clin Obstet Gynecol 2019; 62 (03) 413-431
    CrossrefPubMedGoogle Scholar
  • 23 Holmes EG, Connolly A, Putnam KT. et al. Taking care of our own: a multispecialty study of resident and program director perspectives on contributors to burnout and potential interventions. Acad Psychiatry 2017; 41 (02) 159-166
    CrossrefPubMedGoogle Scholar
  • 24 Rochelson B, Nimaroff M, Combs A. et al. The care of pregnant women during the COVID-19 pandemic—response of a large health system in metropolitan New York. J Perinat Med 2020; 48 (05) 453-461
    CrossrefPubMedGoogle Scholar
  • 25 New Mental Health Platform Provides Support for Healthcare Workers - Penn Medicine. Accessed February 7, 2021 at: https://www.pennmedicine.org/news/news-releases/2020/may/new-mental-health-platform-provides-support-for-healthcare-workers
    PubMedGoogle Scholar
  • 26 Halbesleben JRB, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manage Rev 2008; 33 (01) 29-39
    CrossrefPubMedGoogle Scholar