Perceptions of Anxiety and Depression Among Pediatric Frontline Healthcare Providers During the COVID-19 Pandemic

Background: Our frontline nurses and physicians seemed to have increased anxiety at the beginning of the COVID-19 pandemic and increased depression as the year progressed. Perceptions of anxiety and depression coincided with concern for one’s own health, limited knowledge of how to care for patients during a pandemic, limited personal protective equipment (PPE), and/or financial constraints. To date, there are no studies looking at pediatric frontline healthcare providers and their rates of anxiety and depression over the course of a pandemic. Furthermore, nurses and physicians have distinct roles in the emergency setting that affect their perceptions of anxiety and depression. Currently, there are limited studies comparing nurse and physician anxiety and depression rates during a pandemic. The purpose of this study was to determine if there was a difference in perceptions of anxiety and depression among our Pediatric Emergency and Urgent Care frontline providers during the COVID-19 pandemic.

Methods: This was a prospective cross-sectional study at a large quaternary level 1 trauma center including 3 emergency departments and 7 urgent care sites. We used the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-2 (PHQ-2), both standardized validated screening tools for identifying anxiety and depressive disorders, respectively. The GAD-7 scores range from 0-21 points, with 0-4 considered minimal anxiety, 5-9 mild anxiety, 10-14 moderate anxiety, and 15-21 severe anxiety. PHQ-2 scores range from 0-6 points with 3-6 considered likely major depressive disorder. We surveyed healthcare providers including physicians and nurses twice with the GAD-7, once at the beginning of the pandemic in Spring 2020 and again after vaccine implementation in Spring 2021. We surveyed healthcare providers once after vaccine implementation with the PHQ-2.

Results: 396 surveys were distributed in Spring 2020 and 466 surveys were distributed in Spring 2021, with one-third physician and two-thirds nurse response each time. Table 1 shows the average GAD-7 and PHQ-2 scores for healthcare providers by role. The average GAD-7 score decreased for both nurses and physicians from the beginning of the pandemic to after vaccine implementation. Nurses on average had higher anxiety scores with mild score range compared to minimal score range for physicians. Nurses on average had higher depression scores compared to physicians but both roles had scores in the low likelihood range.

Conclusion: Many healthcare providers perceived higher anxiety and depression levels during the pandemic. The anxiety levels appeared to decrease after vaccine implementation although hospital-wide pandemic relief efforts may have played a role in improved perceptions. Even though nurses had higher anxiety scores, the difference in the score is unlikely to be clinically significant. Our data supports rigorous mental health infrastructure during pandemic preparedness to support the sudden feelings of anxiety and depression in frontline healthcare providers.