Characterizing the mental health and functioning of Canadian respiratory therapists during the COVID-19 pandemic

ABSTRACT Introduction: Healthcare professionals (HCPs) appear to be at increased risk for negative psychological outcomes [e.g. depression, anxiety, post-traumatic stress disorder (PTSD), moral distress] and associated impacts on functioning throughout the COVID-19 pandemic. HCPs working on designated COVID-19 units may be further impacted than their colleagues not on these units given added demands of patient care and risk of contracting COVID-19. Little is known, however, about the mental health and functioning of specific professional groups beyond nurses and physicians, including respiratory therapists (RTs), over the course of the pandemic. Accordingly, the purpose of the present study was to characterize the mental health and functioning of Canadian RTs and compare profiles between RTs working on and off designated COVID-19 units. Methods: Canadian RTs completed an online survey between February and June 2021, including demographic information (e.g. age, sex, gender,) and measures of depression, anxiety, stress, PTSD, moral distress and functional impairment. Descriptive statistics, correlation analyses and between-groups comparisons were conducted to characterize RTs and compare profiles between those on and off COVID-19 units. Results: Two hundred and eighteen (N = 218) RTs participated in this study. The estimated response rate was relatively low (6.2%) Approximately half of the sample endorsed clinically relevant symptoms of depression (52%), anxiety (51%) and stress (54%) and one in three (33%) screened positively for potential PTSD. All symptoms correlated positively with functional impairment (p's < .05). RTs working on COVID-19 units reported significantly greater patient-related moral distress compared to those not on these units (p < .05). Conclusion: Moral distress and symptoms of depression, anxiety, stress and PTSD were prevalent among Canadian RTs and were associated with functional impacts. These results must be interpreted with caution given a low response rate, yet raise concern regarding the long-term impacts of pandemic service among RTs. HIGHLIGHTS Research on RTs’ mental health prior to and during the COVID-19 pandemic is scant, especially in comparison to other HCPs. RTs in the present study reported experiencing moral distress and clinically significant symptoms of depression, anxiety and PTSD, with associated functional impairment. One in three RTs screened positive for likely PTSD on the PCL-5. There is a need to provide RTs with adequate mental health supports and to understand the long-term impacts of pandemic service among RTs.

[1]  C. Petrişor,et al.  Association of Moral Distress with Anxiety, Depression, and an Intention to Leave among Nurses Working in Intensive Care Units during the COVID-19 Pandemic , 2021, Healthcare.

[2]  P. Poudyal,et al.  Anxiety, Depression and Functional Impairment among Health Care Workers during COVID-19 Pandemic: A Crosssectional Online Survey. , 2021, Kathmandu University medical journal.

[3]  Kyle J. Rehder,et al.  Prevalence of Burnout Among Respiratory Therapists Amid the COVID-19 Pandemic , 2021, Respiratory Care.

[4]  J. Pugin,et al.  Mental health outcomes of ICU and non-ICU healthcare workers during the COVID-19 outbreak: a cross-sectional study , 2021, Annals of Intensive Care.

[5]  M. Candel,et al.  Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study , 2021, BMC Medical Ethics.

[6]  Lisa A. Best,et al.  Evaluating the mental health and well-being of Canadian healthcare workers during the COVID-19 outbreak , 2021, Healthcare management forum.

[7]  G. Bonanno,et al.  Depression, Anxiety, and Stress Among Healthcare Workers During the COVID-19 Outbreak and Relationships With Expressive Flexibility and Context Sensitivity , 2021, Frontiers in Psychology.

[8]  R. Kaplan,et al.  The association between witnessing patient death and mental health outcomes in frontline COVID‐19 healthcare workers , 2021, Depression and anxiety.

[9]  I. Forthun,et al.  Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway , 2021, Nursing ethics.

[10]  Pratibha Todur,et al.  Knowledge, confidence, and perception of respiratory therapists as frontliners in managing COVID-19 cases – A questionnaire survey , 2021 .

[11]  R. Lanius,et al.  Impacts of morally distressing experiences on the mental health of Canadian health care workers during the COVID-19 pandemic , 2021, medRxiv.

[12]  A. Latimer Hospital Nurses' Moral Distress and Coping during COVID-19: A Pilot Study , 2021 .

[13]  S. Lowe,et al.  A hybrid inductive-abductive analysis of health workers’ experiences and wellbeing during the COVID-19 pandemic in the United States , 2020, PloS one.

[14]  G. Loas,et al.  Mental Health Outcomes in Healthcare Workers in COVID-19 and Non-COVID-19 Care Units: A Cross-Sectional Survey in Belgium , 2021, Frontiers in Psychology.

[15]  A. Priori,et al.  Early Psychiatric Impact of COVID-19 Pandemic on the General Population and Healthcare Workers in Italy: A Preliminary Study , 2020, Frontiers in Psychiatry.

[16]  Kyle J. Rehder,et al.  Resilience and Burnout Resources in Respiratory Care Departments , 2020, Respiratory Care.

[17]  Varun R Nayak,et al.  Respiratory therapists: the unnoticed warriors during COVID-19 pandemic in India , 2020, Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR.

[18]  M. Qorbani,et al.  The mental health of healthcare workers in the COVID-19 pandemic: A systematic review , 2020, Journal of Diabetes & Metabolic Disorders.

[19]  M. Di Tella,et al.  Traumatic Stress in Healthcare Workers During COVID-19 Pandemic: A Review of the Immediate Impact , 2020, Frontiers in Psychology.

[20]  D. El-Shafei,et al.  Occupational stress, job satisfaction, and intent to leave: nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt , 2020, Environmental Science and Pollution Research.

[21]  H. Tamim,et al.  Prevalence and predictors of anxiety among healthcare workers in Saudi Arabia during the COVID-19 pandemic , 2020, Journal of Infection and Public Health.

[22]  M. Di Tella,et al.  Mental health of healthcare workers during the COVID-19 pandemic in Italy. , 2020, Journal of evaluation in clinical practice.

[23]  H. Hall The effect of the COVID-19 pandemic on healthcare workers' mental health. , 2020, JAAPA : official journal of the American Academy of Physician Assistants.

[24]  M. Di Tella,et al.  Mental health of healthcare workers during the COVID-19 pandemic in Italy. , 2020, Journal of evaluation in clinical practice.

[25]  P. Katsaounou,et al.  Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis , 2020, Brain, Behavior, and Immunity.

[26]  Zhi-lei Shang,et al.  Posttraumatic stress symptoms of health care workers during the corona virus disease 2019 , 2020, Clinical psychology & psychotherapy.

[27]  Vijay K. Sharma,et al.  A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak , 2020, Brain, Behavior, and Immunity.

[28]  Yeen Huang,et al.  Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey , 2020, Psychiatry Research.

[29]  T. Shanafelt,et al.  Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. , 2020, JAMA.

[30]  Han-i Wang,et al.  Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study , 2020, Psychiatry Research.

[31]  M. Zhang,et al.  Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan , 2020, General Hospital Psychiatry.

[32]  Min Chen,et al.  Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study , 2020, Brain, Behavior, and Immunity.

[33]  Yongfang Jiang,et al.  Psychological Impact and Coping Strategies of Frontline Medical Staff in Hunan Between January and March 2020 During the Outbreak of Coronavirus Disease 2019 (COVID-19) in Hubei, China , 2020, Medical science monitor : international medical journal of experimental and clinical research.

[34]  Scott H Penfil,et al.  Occupational-Induced Secondary Traumatic Stress and Posttraumatic Stress Disorder in Respiratory Therapists , 2020, Respiratory Care.

[35]  Shao-hua Hu,et al.  Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019 , 2020, JAMA network open.

[36]  Paul A. Harris,et al.  The REDCap consortium: Building an international community of software platform partners , 2019, J. Biomed. Informatics.

[37]  A. Hamric,et al.  Enhancing Understanding of Moral Distress: The Measure of Moral Distress for Health Care Professionals , 2019, AJOB empirical bioethics.

[38]  K. Mahan Death and Dying: Tools to Help Respiratory Therapists Handle Frequent Exposure to End of Life Care. , 2019, Journal of allied health.

[39]  Kevin P. Collins,et al.  Attitudes toward Death Anxiety and Dying Among Respiratory Therapy Students: A Pilot Study , 2015, Internet Journal of Allied Health Sciences and Practice.

[40]  E. Wong,et al.  Peer educator vs. respiratory therapist support: which form of support better maintains health and functional outcomes following pulmonary rehabilitation? , 2014, Patient education and counseling.

[41]  Stef van Buuren,et al.  MICE: Multivariate Imputation by Chained Equations in R , 2011 .

[42]  J. Khubchandani,et al.  Do respiratory therapists receive training and education in smoking cessation? A national study of post-secondary training programs. , 2011, Patient education and counseling.

[43]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[44]  E. Mahabee-Gittens,et al.  Development of a Web-based tobacco cessation educational program for pediatric nurses and respiratory therapists. , 2011, Journal of continuing education in nursing.

[45]  N. Wenger,et al.  An intervention to improve respiratory therapists' comfort with end-of-life care. , 2010, Respiratory care.

[46]  T. B. Üstün,et al.  Measuring health and disability : manual for WHO Disability Assessment Schedule : WHODAS 2.0 , 2010 .

[47]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[48]  Donna D. Gardner,et al.  A Randomized, Controlled Study to Evaluate the Role of an In-Home Asthma Disease Management Program Provided by Respiratory Therapists in Improving Outcomes and Reducing the Cost of Care , 2009, The Journal of asthma : official journal of the Association for the Care of Asthma.

[49]  K. J. Schwenzer,et al.  Assessing moral distress in respiratory care practitioners* , 2006, Critical care medicine.

[50]  D. Cook,et al.  Canadian nurses' and respiratory therapists' perspectives on withdrawal of life support in the intensive care unit. , 2005, Journal of critical care.

[51]  L. Goodfellow Respiratory therapists and critical-thinking behaviors: a self-assessment. , 2001, Journal of allied health.

[52]  P. Lovibond,et al.  Manual for the Depression Anxiety Stress Scales. 2 , 1995 .

[53]  R. Little A Test of Missing Completely at Random for Multivariate Data with Missing Values , 1988 .