Healthcare workers reported increasing numbers of poor mental health days and increasing feelings of burnout from 2018 to 2022, although these issues were less common among those who trusted management and had help from their supervisor, a CDC study found.
“While usually health workers care diligently for others in time of need, it’s now health workers who are suffering, and we must act,” said Deborah Houry, MD, MPH, the CDC’s chief medical officer, on a phone call with reporters Tuesday.
The Vital Signs report analyzed data from the General Social Survey Quality of Worklife Module. The module contains questions on working and mental health conditions and is administered to respondents aged ≥18 years who report having been employed during the preceding 2 weeks.
L. Casey Chosewood, MD, and colleagues at the National Institute of Occupational Safety and Health (NIOSH) compared self-reported mental health symptoms among U.S. adult workers from 2018 (1,443 respondents, including 226 health workers) and 2022 (1,952 respondents, including 325 health workers). Workers were divided into three categories: health workers, other essential workers, and all other workers.
To assess how respondents perceived their working conditions, they were asked:
- Whether they trusted management
- Whether they were harassed at work
- Whether there was enough time to accomplish their work
- Whether working conditions supported productivity
- Whether supervisors were helpful
They also were asked how often there were enough staff members present to complete work, and whether the respondent participated in decision-making. And respondents were asked questions about general happiness, frequency of sleep problems, days of poor mental health during the previous 30 days — defined as stress, feeling depressed, and problems with emotions — and their intent to find a new job in the next year. The researchers used logistic regression to examine associations between health workers’ reported perceptions of working conditions and anxiety, depression, and burnout.
Although the overall number of poor mental health days in the previous 30 days in 2022 was similar across all three groups of workers (4.1-4.5 days), health workers reported a significant increase in poor mental health days in the previous 30 days, going from 3.3 days in 2018 to 4.5 days in 2022. The percentage of workers who reported feeling burned out very often increased from 11.6% to 19.0% during the same period, and the percentage of health workers who reported being very likely to look for a new job increased from 11.1% to 16.5%. On the other hand, the percentage of health workers reporting feeling very happy did not change significantly during this time period.
“Data such as those presented in this Vital Signs report are giving us crucial and concerning information,” Chosewood said on the phone call. “To label our current and long-standing challenge a ‘crisis’ is an understatement.”
“Many of our nation’s healthcare systems are at their breaking point,” he said. “Staffing crises, lack of supportive leadership, long hours of work and excessive demands and inflexibilities in our nation’s health systems all must be addressed. We’re calling on employers to take this information to heart and take immediate preventive action.”
How can the issue be addressed? The study found that health workers were less likely to report burnout if they trusted management (odds ratio [OR]=0.40), had supervisor help (OR=0.26), had enough time to complete work (OR=0.33), and felt that their workplace supported productivity (OR=0.38) compared with those who did not. Conversely, harassment at work was associated with increased odds of anxiety (OR=5.01), depression (OR=3.38), and burnout (OR=5.83).
“NIOSH is actively working to help address this issue through the new Health Worker Mental Health Initiative,” Houry said. “One goal of the initiative is to raise awareness of health workers’ mental health issues, particularly on the role that work conditions play and what the employer can do. As part of this initiative, this fall, NIOSH will be launching a national campaign for hospital leaders focusing on providing them resources to help them think differently about how to identify and remove barriers to health worker well-being.”
One tool that health leaders can use to help them get started in this area is NIOSH’s Worker Well-Being Questionnaire, Chosewood said. “It’s really a first-of-its-kind measure to look at many aspects of worker well-being, including their physical health, workplace climate, and their interactions with peers, co-workers, and managers. It’s a very simple 15-minute 68-question survey that gives organizations a lot of very valuable information. We would recommend that as a very good starting place to measure the well-being of health workers in any environment.”
The researchers did not adjust the results according to industry, occupation, or work setting. However, Chosewood told MedPage Today, “We do know that some jobs in healthcare are more challenging than others. Those that tend to be most challenging are those that have longer hours, so 12-hour shift workers generally have more challenges than those who work 8-hour shifts. Folks who have little or no flexibility in their work have poorer outcomes — forced overtime, for example, or very little choice of when you take time off, or when there’s very little recovery time between shifts — all of those can increase poor health outcomes, including mental health outcomes.”
Limitations of the study included that the data are cross-sectional, therefore causation cannot be inferred, and alternative explanations for the findings are possible, the authors noted. In addition, data were self-reported and subject to biases associated with recall and social desirability, and measures of symptoms for anxiety and depression were not available in 2018, which precludes prepandemic comparisons, they said.
The authors reported no conflicts of interest.
Morbidity and Mortality Weekly Report
Source Reference: Nigam, J et al “Health worker-perceived working conditions and symptoms of poor mental health — Quality of Worklife Survey, United States, 2018–2022” MMWR 2023; DOI: 10.15585/mmwr.mm7244e1.