Survey reveals physical and mental problems among health workers during pandemic

Stress, burnout, pain and poor sleep were some of the most frequent symptoms reported by nursing and other staff who care for patients in a study conducted by researchers at the Federal University of São Carlos in São Paulo state, Brazil.

By Theo Ruprecht  |  Agência FAPESP – Poor physical and mental health was frequent among Brazilian health workers employed in the public sector during the COVID-19 pandemic, according to a study by researchers at the Federal University of São Carlos (UFSCar) in São Paulo state, Brazil. The study showed that 86% reported burnout and 81% suffered from stress. They slept badly, experienced depression and complained of aches and pains. On the other hand, most said they were happy to provide meaningful services to society.

The study is still in progress. An analysis of the initial findings is reported in an article published in the journal Healthcare. The initiative as a whole is supported by FAPESP and is now in the final stage of data collection and analysis.

“The paper offers a snapshot of the situation, and we can’t blame the pandemic for all the problems we found, but we believe the particularly heavy effects of COVID-19 in Brazil contributed to these very negative results,” said Tatiana de Oliveira Sato, a professor of physical therapy at UFSCar’s School of Biological and Health Sciences (CCBS).

“Overwork, tough decisions and dramatic experiences all intensified because of the pandemic, affecting all health workers but especially those on the front line,” Sato said. Brazil has had more deaths of healthcare professionals from COVID-19 than any other country, according to the article. 

“The original idea for the survey arose just before the pandemic. Even outside the context of the pandemic, health workers have to deal with a heavy schedule and burden of responsibility. We wanted to assess the effects of all this on their physical and mental health. However, when the pandemic arrived, we decided to measure the impact of the public health emergency on the well-being of these workers,” Sato said.

Change of course

The researchers initially planned to interview volunteers on the job. They would all be health workers for the SUS, Brazil’s public health service, in São Carlos. However, the formalities required to prepare for the survey (permits, questionnaires, etc.) became irrelevant between late 2020 and early 2021, when the pandemic was raging across Brazil and vaccine rollout was still incipient. 

“Instead, we created an online form and widened the search for respondents throughout the country,” Sato explained. “The criteria for inclusion were working for the SUS, being over 18, and being directly involved in patient care.”

The form was publicized via social media, emails and newspapers. It contained five questionnaires, each designed to quantify an aspect of the respondent’s life. They included the Copenhagen Psychosocial Questionnaire, the Pittsburgh Sleep Quality Index, the Nordic Musculoskeletal Questionnaire, and the Beck Depression Inventory. 

The form was 10 pages long. “We reckoned it took 20-30 minutes to answer all the questions. The questionnaires were only included in the analysis if they were completely filled out,” Sato said. Local respondents also used equipment to measure the amount of physical activity for inclusion in the survey.

Eventually, 125 health workers took part in the study. The first stage of data collection lasted from June 2021 to April 2022. The data published so far constitutes a baseline and does not yet cover physical activity, but the project calls for four more steps to take place three, six, nine and 12 months after the first collection. 

“We called this cohort HEROES. We thought a lot about the name because we didn’t want it to be taken as implying that health workers are superhuman and never get tired or dejected. The name is intended as a homage. We also wanted to call attention to the need to valorize health workers, who were disproportionately affected by the pandemic,” Sato said. Some 60 respondents participated in all stages.

Initial findings

The data presented in the article show a high prevalence of musculoskeletal symptoms: 64% reported neck pain, 62% shoulder pain, 58% upper back pain and 61% lower back pain.

For Sato, all this was certainly due largely to long hours, being on their feet most of the time, lifting patients and working flat out. “But mental stress can also trigger these kinds of pain because of the tension it creates in the body,” she noted.

The frequency of psychosocial problems is striking, according to the authors, with stress affecting 81% of the participants and 86% suffering burnout. Symptoms of mild depression were detected in 22%, moderate depression in 16% and severe depression in 8%. In addition, 74.4% said they slept badly.

It is still necessary to analyze the evolution of the indicators over time, however. According to Sato, prevalence levels tend to be lower in studies of other populations. For example, five meta-analyses mentioned in the article found burnout rates ranging from 25% to 37%, while nine such studies found that between 17% and 57% of the respective samples suffered from stress. These proportions are far lower than those reported in the study by the researchers at UFSCar. 

Workplace climate

Other psychosocial factors were assessed via the Copenhagen questionnaire, with a large majority of respondents giving negative scores to the emotional demands of their work (75%), its pace and intensity (61%), and its unpredictability (47%). These were the psychosocial factors with the worst ratings in the survey.

The proportions who reported offensive behavior were also strikingly high: 15% said they had been the object of unwanted sexual attention or harassment, while 26% had been threatened, 17% bullied, and 9% physically assaulted.

“This is deplorable. All these numbers should be zero. Occurrences of this kind in any workplace are unacceptable,” Sato said. Sexual harassment was reported most by younger women, she noted. Threats of violence came mainly from patients and their relatives, while fellow workers were more often bullies than supervisors.

On the positive side, more than 90% said they believed their work was very meaningful and some 80% said they were committed to their work despite the stress.

Limitations and implications

For Sato, the relatively small number of respondents to the first form (125) and the even smaller number (about 60) remaining in the last stage of the survey were a limitation because they prevented extrapolation and analysis of data for other regions. “Nevertheless, the survey was valuable because of its depth,” she said. 

The information obtained, she added, is sufficient to lobby top management of the SUS and the authorities for improvements to working conditions. Physically and mentally distressed professionals cannot always provide the best patient care.

“This has to lead to increased staffing, better pay, less exhausting hours and proper training,” Sato said. Simple matters such as providing training for staff on the best ways to lift and carry patients without injuring themselves could lead to significant improvements in musculoskeletal terms. Similarly, creation of support networks would help nursing and other staff cope with the emotional impact. “Health workers need a lot of support. They’re people, too,” she said.

The article “Poor health conditions among Brazilian healthcare workers: study design and baseline characteristics of the HEROES cohort” is at: www.mdpi.com/2227-9032/10/10/2096.