Of more than 2,600 US healthcare workers who participated in a nationwide online panel survey from 2022 to 2023, 26% reported symptoms of mental illness, but only 20% said they sought treatment during the previous year, mainly because of difficulty getting time off of work and worries about confidentiality and cost.
The findings, published yesterday in Morbidity and Mortality Weekly Report, highlight the importance of reducing mental-illness stigma, addressing concerns about confidentiality and licensing, and improving supervisor training, say the University of Hawaii–led research team.
Pandemic may have worsened stress, burnout
From September 2022 to May 2023, the researchers surveyed 2,603 primary care physicians, pediatricians, nurse practitioners, and physician assistants who had been in practice for at least 3 years about their mental illness symptoms, care-seeking, and barriers to seeking care.
The team administered the Generalized Anxiety Disorder-2 scale, Patient Health Questionnaire-2 depression scale, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition–indexed Posttraumatic Stress Disorder (PTSD) Primary Care Screen, and one item each from the Centers for Disease Control and Prevention's (CDC's) Health-Related Quality of Life-4 survey and the 2017 CDC Behavioral Risk Factor Surveillance System survey.
"Health care workers experience substantial chronic stress, burnout, and mental distress, and the COVID-19 pandemic might have exacerbated these conditions," the study authors noted.
Workers with more distress less likely to seek care
Slightly less than half (45.4%) of participants said that they didn't need mental healthcare, and 20.3% sought care for their symptoms. One quarter (25.6%) of respondents reported mental distress severe enough to meet diagnostic criteria for mental disorders, 38% of whom said they sought care, with 20.1% indicating that they didn't need care.
The proportion of providers reporting mental distress meeting diagnostic levels was higher among those who didn't seek care than it was among those who said they didn't need care in terms of depression (38.3% vs 18.8%), anxiety (39.1% vs 16.4%), posttraumatic stress (34.5% vs 22.2%), and mentally unwell days per month (37.9% vs 14.6%).
The proportion of respondents reporting symptom severity indicating they met criteria for mental illness was similar for those who sought care and those who didn't. The proportion reporting diagnostic levels of mental distress was lower for those who preferred not to report seeking care than for those who said they didn't need it.
Workers who said they didn't need care had practiced the longest, with a median of 13.0 years. Fewer men sought care (16.0%) than women (26.1%) or those identifying as other than men or women (18.8%). Primary care physicians, 68.7% of whom were men, had the lowest rate of care-seeking (16.4%). Nurse practitioners (33.9%; 81.7% women), physician assistants (27.9%; 68.5% women), and pediatricians (24.4%; 50.1% women) had the highest rate of care-seeking.
Supervisor support helped
The work stressors cited most often were extra stress at work (68.2%), burnout (58.9%), inadequate staffing (58.9%), greater workload or job demands (57.2%), fear of COVID-19 (55.6%), and COVID-19 misinformation (51.3%). Among respondents who did not seek care, the most frequently reported barrier was difficulty getting time off work, followed by concerns about confidentiality, cost, and being perceived as weak.
Organizational human resources practices, supervisor training on managing employee stress, and public health messaging to normalize mental health care–seeking and its effects on licensing might help address gaps in provider care-seeking and improve patient outcomes.
Each increase in the number of work stressors raised the likelihood of meeting diagnostic criteria for mental illness by 9% for the anxiety scale (odds ratio [OR], 1.09), 3% for the depression scale (OR, 1.03), 35% for the posttraumatic stress scale (OR, 1.35), and 12% for number of mentally unwell days (OR, 1.12). But the strength of the link between level of work stressors (low to high) and the odds of meeting diagnostic criteria for mental illness fell as social support from supervisors rose.
Likewise, among respondents who didn't seek care, greater supervisor support lowered the association between increases in barriers to care-seeking and an increased likelihood of meeting diagnostic criteria for a mental illness. Supervisor support didn't affect the chances of meeting the criteria for a mental illness diagnosis of posttraumatic stress.
"Organizational human resources practices, supervisor training on managing employee stress, and public health messaging to normalize mental health care–seeking and its effects on licensing might help address gaps in provider care-seeking and improve patient outcomes," the authors wrote.