The mental health problems of public health center staff during the COVID-19 pandemic in Japan.

During the COVID-19 pandemic, frontline medical professionals, such as clinical doctors and nurses who are responding to infected patients, have been found to have high risk of mental health problems such as depression, anxiety, insomnia, and posttraumatic stress reactions (PTSR) (Lai et al., 2020). Besides medical staff working in hospitals, public health center staff have been heavily burdened with responsibilities relevant to COVID-19. As of April 2020, there were 469 main centers and 121 branches of public health centers in Japan, which are administrative bodies supporting the health and hygiene of residents in local government districts. With the spread of COVID-19, public health centers have increased tasks, such as responding to telephone consultations from residents and local medical institutions, coordinating the hospitalization of infected persons, contact tracing, arranging tests for close contacts, and health observation. This study aimed to clarify the mental health problems of public health center staff, which has not yet been examined.

We conducted a web questionnaire survey among frontline staff of public health centers in Miyagi Prefecture who had been involved in telephone consultations related to COVID-19 responses. Participants were recruited from nine public health centers from September to November 2020, and 23 individuals completed the questionnaire. In addition, we obtained qualitative data on difficulties they experienced during the telephone consultation service and what should be improved or considered to protect the physical and mental health of staff engaged in telephone consultation services. The study protocol was reviewed and approved by the Ethics Committee of Tohoku University Graduate School of Medicine.

We categorized participants as being at high risk of mental health problems using the following cut-off points: Kessler 6 ≥ 5; Patient Health Questionnnaire-9 ≥ 10; Generalized Anxiety Disorder-7 ≥ 10; Posttraumatic Stress Disorder Checklist-Specific≥30; Athens Insomnia Scale≥6; Alcohol Use Disorders Identification Test for Consumption≥5 for men and ≥4 for women. The most common mental health problem was insomnia (69.6 %). Nearly half of the participants reported a high risk of psychological distress (56.5 %) and PTSR (45.5 %). Participants at high risk for depression comprised 31.8 %, those with anxiety comprised 17.4 %, and those with problematic drinking comprised 18.2 % (Table 1), which were comparable to other healthcare workers during the COVID-19 outbreak (Pappa et al., 2020; Parthasarathy et al., 2021).

Table 1

Basic statistics of the study participants and the frequencies of individuals at high risk for mental health problems.

Mental health problems	Scale	n	Median	Mean	SD	Not high risk n (%)	High risk n (%)
Psychological distress	K6	23	8.00	6.83	4.98	10 (43.5)	13 (56.5)
Depression	PHQ-9	22	5.00	7.45	6.37	15 (68.2)	7 (31.8)
Anxiety	GAD-7	23	5.00	6.04	4.21	19 (82.6)	4 (17.4)
PTSR	PCL-S	22	28.50	31.77	10.84	12 (54.5)	10 (45.5)
Insomnia	AIS	23	7.00	6.78	3.10	7 (30.4)	16 (69.6)
Problematic drinking	AUDIT-C	22	1.00	1.59	1.68	18 (81.8)	4 (18.2)

Psychological distress was assessed with the Japanese version of Kessler 6 (K6) (Furukawa et al., 2008); depression was assessed with the Japanese version of the Patient Health Questionnnaire-9 (PHQ-9) (Muramatsu et al., 2018); anxiety was assessed with the Japanese version of the Generalized Anxiety Disorder-7 (GAD-7) (Muramatsu, 2014); posttraumatic stress reactions (PTSR) was assessed with the Japanese version of the Posttraumatic Stress Disorder Checklist-Specific (PCL-S) (Suzuki et al., 2017); insomnia was assessed with the Japanese version of the Athens Insomnia Scale (AIS) (Okajima et al., 2013); problem drinking was assessed with the Japanese version of the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) (Osaki et al., 2014). K6 scores ranged from 0 to 24, PHQ-9 scores ranged from 0 to 27, GAD-7 scores ranged from 0 to 21, PCL scores ranged from 17 to 85, AIS scores ranged from 0 to 24, and AUDIT-C scores ranged from 0 to 12.

In addition, we classified the description of difficulties in telephone consultation service regarding COVID-19 using the KJ method (Scupin, 1997). There were three major difficulties associated with telephone consultations: (1) staff often needed to listen to complaints regarding the administrative system, unreasonable reprimands or aggression rather than performing the original role of health consultations; (2) difficulty in determining whether or not the Polymerase Chain Reaction test for COVID-19 was applicable to each case and arranging facilities for tests or treatments; and (3) the physical and mental burden were heavy, and there were few allowances and support systems for staff (Fig. S1).

As for the type of stress, staff often confronted negative feelings in callers such as anxiety and anger, probably due to people’s emotional responses including fear and uncertainty about emergencies from imperceptible threats (Shigemura et al., 2020). Their stress experienced through telephone consultation seemed to be different from that of healthcare professionals in hospitals, possibly because callers had more varied backgrounds and complaints, and were mostly anonymous.

Considering that this survey was conducted during the transitional period from the second to the third wave of infection spread in Japan, the mental health conditions could have been worse if these surveys were conducted at the height of COVID-19 infections. Regardless of these limitations, the results indicated the importance of implementing stress care management in public health centers at the organizational and individual levels, the replenishment of staff, and the implementation of standardized countermeasures for callers with various needs and situations. This study also suggested the necessity to disseminate information about psychological distress among public health center staff to the general public and to urge people to consider the manner in which they communicate with public health center staff.

Funding

This work was supported by a grant from the [grant number 202012006] (to Yasuto Kunii) and Core Research Cluster of Disaster Science, Tohoku University, Japan. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Declaration of Competing Interest

The authors report no declarations of interest.