Effects of contact with COVID-19 patients on the mental health of workers in a psychiatric hospital.

COVID‐19 has negatively impacted the mental health of people in general, , particularly that of workers treating COVID‐19 on the front lines. , At our psychiatric hospital, COVID‐19 was diagnosed in five inpatients and three workers, and each patient with a confirmed COVID‐19 diagnosis was transferred to the designated medical institution for COVID‐19, but the ward where other patients had had close contact with COVID‐19 patients remained as the COVID‐19 ward. Workers in close contact with COVID‐19 patients were directed to stay at home, while staff from other wards took over their duties in the COVID‐19 ward. With this situation, there was concern that the workers would experience mental health problems related to the nosocomial infection.

Several studies have shown that frontline health‐care workers treating patients were at increased risk of anxiety and depression symptoms. , , However, to the best of our knowledge, there is no research on the effects of nosocomial COVID‐19 infections in a psychiatric hospital on the mental health of workers, and therefore, we aimed to investigate workers' mental health state after dealing with nosocomial COVID‐19 infections in our psychiatric hospital.

Anonymous questionnaires were distributed to all 468 hospital workers composed of doctors, nurses, occupational therapists, psychologists, laboratory technicians, psychiatric social workers, pharmacists, dietitians, and others (e.g., officers), and of these, 426 responded for this study. The characteristics of the participants are shown in Table S1. The questionnaire included items about the workers' sex, age, presence of close contact with COVID‐19 patients, presence of housemates, and hospital instructions (staying at home, no change in work, transfer to the COVID‐19 ward, or transfer to non‐COVID‐19 wards). Anxiety and depression were assessed using the Japanese version of the Generalized Anxiety Disorder‐7 (GAD‐7) and the Japanese version of the Patient Health Questionnaire‐9 (PHQ‐9). , The Mann–Whitney U‐test and Kruskal–Wallis test were applied to compare the severity of each symptom. To determine the potential risk factors, a multiple‐linear regression analysis was performed. Two‐way analysis of variance was applied to determine the interaction between the presence of housemates and close contact. This study was approved by the Ethics Committee of Shichiyama Hospital.

The levels of both anxiety and depression were significantly higher in workers who had been in close contact with COVID‐19 patients and who had been instructed to stay at home than in those who had not (P = 0.013 and P = 0.00006, respectively; Fig. S1). Anxiety and depression levels significantly interacted with the presence of housemates (P = 0.042 and P = 0.031, respectively; Fig. S2). A multiple regression analysis indicated that being female and staying at home (with close contact) increased the degree of both anxiety and depression (GAD‐7: sex, P = 0.022; stay at home, P = 0.010; PHQ‐9: sex, P = 0.010; stay at home, P < 0.001), while the presence of housemates increased anxiety levels only (P = 0.035; Tables 1, 2; also shown in Fig. S2a). Workers without close contact with COVID‐19 patients were divided into three groups: no change in work, transfer to the COVID‐19 ward, and transfer to other wards. These instructions did not affect workers' anxiety or depression levels (P > 0.05, respectively; Fig. S3).

Table 1

Influence of different factors on Generalized Anxiety Disorder‐7 score

	Standardized coefficients		Unstandardized coefficients	T	P
Model	B	Standard error	Beta
(Constant)	1.236	1.344		0.919	0.358
Sex	1.148	0.500	0.110	2.294	0.022*
Age	0.365	0.203	0.088	1.796	0.073
Hospital instruction
No change (reference)	—	—	—	—	—
Stay at home (with close contact)	1.552	0.602	0.133	2.579	0.010*
Transfer to the COVID‐19 ward	−0.277	0.741	−0.019	−0.373	0.709
Transfer to other wards	0.458	1.013	0.022	0.453	0.651
Housemate	1.419	0.670	0.101	2.118	0.035*

Predictors for Generalized Anxiety Disorder‐7 scores of staff by multiple‐linear regression: * P < 0.05.

Table 2

Influence of different factors on Patient Health Qestionnaire‐9 score

	Unstandardized coefficients		Standardized coefficients	T	P
Model	B	Standard error	Beta
(Constant)	3.971	1.378		2.882	0.004**
Sex	1.328	0.513	0.123	2.588	0.010*
Age	−0.090	0.208	−0.021	−0.430	0.667
Hospital instruction
No change (reference)	—	—	—	—	—
Stay at home (with close contact)	2.279	0.617	0.189	3.695	<0.001***
Transfer to the COVID‐19 ward	−0.028	0.760	−0.002	−0.037	0.971
Transfer to other wards	1.430	1.038	0.067	1.378	0.169
Housemate	0.379	0.687	0.026	0.551	0.582

Predictors for Patient Health Qestionnaire‐9 scores of staff by multiple‐linear regression: * P < 0.05, ** P < 0.01, *** P < 0.001.

The finding that the presence of housemates increased workers' anxiety and depression might be due to them being afraid of passing COVID‐19 to their family members during staying at home and being worried about stigma and social ostracism against their family. , We also found that being a female was an independent risk factor for both anxiety and depression, which is consistent with previous research. , These results suggest that, in a psychiatric hospital, mental health care is needed, particularly for female workers who are in close contact with COVID‐19 patients and who live with housemates.

Contrary to our expectation that workers in a psychiatric hospital tend to be nervous due to the lack of knowledge of coping with infectious diseases, being transferred to the COVID‐19 ward did not affect either their level of anxiety or depression. This might be because the inpatients with COVID‐19 infection were transferred to other designated medical institutions within 2 days.

Disclosure statement

The authors declare no conflict of interest.

Figure S1 Anxiety and depression in workers having close contact with COVID‐19 patients. The (a) Generalized Anxiety Disorder‐7 (GAD‐7) score and the (b) Patient Health Qestionnaire‐9 (PHQ‐9) score were significantly higher in the close‐contact group (n = 110) than in the non‐contact group (n = 316) (P = 0.013 and P = 0.00006, respectively). Statistical analyses were performed using the Mann–Whitney U‐test. Bars represent mean ± SEM.

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Figure S2 Interaction between the presence of housemates and close contact with COVID‐19 patients. There was significant interaction between the presence of housemates and close contact with COVID‐19 patients for the (a) Generalized Anxiety Disorder‐7 (GAD‐7) score and the (b) Patient Health Qestionnaire‐9 (PHQ‐9) score (P = 0.042 and P = 0.031, respectively). Statistical analyses were performed using two‐way analysis of variance (ANOVA). Bars represent mean ± SEM. Housemate (−), close contact (−), n = 53. Housemate (−), close contact (+), n = 15. Housemate (+), close contact (−), n = 255. Housemate (+), close contact (+), n = 103.

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Figure S3 Anxiety and depression scores of workers after the directed transfer. There was no significant difference in the (a) Generalized Anxiety Disorder‐7 (GAD‐7) score or the (b) Patient Health Qestionnaire‐9 (PHQ‐9) score among the three groups: no change, transfer to the COVID‐19 ward, and transfer to other wards (P > 0.05, respectively). Statistical analyses were performed using Kruskal–Wallis test. Bars represent mean ± SEM. No change in work (n = 230), transfer to the COVID‐19 ward (n = 58), transfer to non‐COVID‐19 wards (n = 28).

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Table S1 Demographic characteristics of the study sample (n = 426).

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