Introduction
The COVID-19 pandemic has presented healthcare providers with a unique
set of challenges. While all healthcare providers have some exposure
risk, it is particularly pronounced in those caring for patients
undergoing mucosal or aerosol-generating
procedures.1-3 At baseline, there are increased risks
of acute respiratory infections among health care workers during
procedures such as tracheal intubation, tracheotomy, non-invasive
ventilation, and manual ventilation.4 Anecdotal
reports from Wuhan, China report higher rates of COVID-19 infection
specifically among otolaryngologists, likely due to the frequent use of
those high-risk procedures in their typical, often non-elective,
practice.5-9 This risk of exposure can be mitigated
through the use of personal protective equipment (PPE); however, this
essential resource is already becoming scarce.10Additionally, they are being faced with increasing numbers of positive
cases, unfamiliar hospital roles, and concern for safety of themselves,
their loved ones, and their patients. Thus, beyond the risk to their
physical health, there is also great risk to their mental wellbeing.
A review of prior outbreaks demonstrates a history of a mental burden on
health care providers during similar times. A number of studies
conducted during the 2003 SARS and 2014 Ebola crises used surveys and
in-depth interviews to demonstrate increased symptoms of stress,
anxiety, depression, insomnia, and distress among health care
workers.11-17 In certain situations, investigators
still found increased psychiatric morbidity one to three years after the
2003 SARS outbreak, though it is unclear whether these can be directly
attributable to SARS.18-20 There are now similar
concerns for the health care workers during the COVID-19 pandemic.
Studies from COVID-19 in Wuhan, China, where it was first detected, as
well as in Singapore and India have already shown an increased mental
strain on healthcare workers, reflected through validated surveys on
anxiety, depression, insomnia, and distress.21-23 This
collection of prior evidence suggests a need to provide early support
and intervention in the hopes of preventing any immediate or
long-lasting implications.
Despite the history of increased psychiatric symptoms in health care
workers during outbreaks and the increased infection risk among
providers exposed to aerosolization, to the best of our knowledge, no
study has characterized the impact on the mental health of this specific
population. This study aims to assess mental health symptoms among
Otolaryngology physicians during the COVID-19 pandemic by measuring
symptoms of burnout, anxiety, depression, and distress.