Public Health Workers Still Face PTSD, Other Mental Health Problems

Nearly half of non-federal public health workers surveyed in 2022 experienced symptoms of depression, anxiety, post-traumatic stress disorder (PTSD) or some combination thereof, according to a recent study of their mental health published in Morbidity and Mortality Weekly Report.

And the more time these state, tribal, local, and territorial (STLT) workers spent engaged in COVID-19 response activities, the greater their chance of mental health conditions, especially PTSD. Respondents who spent more than three-quarters of their work hours on COVID-19 activities were more than twice as likely to report symptoms of PTSD.

Drilling down into the data, 48% (95% CI 47.3-48.7) of the public health workers surveyed March 14 to 25 said they experienced symptoms of at least one mental health problem — depression, anxiety or PTSD. That’s a small drop from the 52.8% of respondents who reported experiencing at symptoms of at least one of these conditions in a survey conducted a year prior.

Across 26,069 respondents in 2022, the most common mental health condition was PTSD at 28.4%, then anxiety at 27.9%, followed by depression at 27.7%, and suicidal ideation at 8.1%.

Reported rates of each condition — depression, anxiety and PTSD — also fell slightly in 2022 compared to 2021, down 3.1%, 2.4%, and 8.4%, respectively (P<0.001).

Despite these declines, 48% prevalence overall is “still quite high, ” said Ramona Byrkit, MPH, of the CDC’s COVID-19 Emergency Response Team and a co-author of the study, in an email to MedPage Today.

Individuals belonging to multiple races had the highest rates of symptoms of depression, at 31.4%; anxiety, at 33.5%; and PTSD, at 34.4%.

In addition, public health workers who faced job-related threats or “felt bullied, threatened or harassed” due to their job had the highest rates of PTSD, at 53.3% and 47.7% respectively.

Survey participants who spent at least three-quarters of their time working on COVID-19 response activities were more prone to experiencing depression (prevalence ratio 1.38), anxiety (PR 1.35), and PTSD (PR 2.43), when compared to participants who did not work on COVID-19 activities.

Respondents working more than 60 hours per week were also more likely than those working 40 or fewer hours to experience depression (PR 1.73), anxiety (PR 1.48), PTSD (PR 2.07), and suicidal ideation (PR 1.50).

Survey participants who said they felt overwhelmed by their workload or trying to balance work and family life, were between two and three times as likely to report symptoms of suicidal ideation, anxiety, depression, and PTSD, compared to those not reporting such feelings.

And 27.8% of respondents who left public health or who considered leaving the profession, were twice as likely to report suicidal ideation (PR 2.34) compared with those remaining in the field who said they had not thought of leaving.

And about three-quarters of respondents reported knowing colleagues who have left public health or were considering leaving.

“Public health staff are facing long-term stress and exhaustion, and public health needs to find ways to recruit and retain new staff, and create an environment more conducive to mental health,” said Byrkit.

Importantly, public health workers who could take time off or who “perceived an increase in mental health resources from their employer” were less likely to report mental health symptoms (PR range 0.48-0.55, and 0.58-0.84, respectively) than those who could not take time or did not perceive such support. About three in four public health workers reported that they were able to take time off.

“[I]t’s concerning that over 75% of respondents said their employers had not increased support for mental health since March 2021,” Byrkit said.

Byrkit and her co-authors called on public health agencies to focus on improving work-related factors affecting mental health, by enhancing access to resources that support workers’ mental health.

“Investment in the current and future workforces might include training organizational leaders and supervisors to recognize, understand, and support staff members’ mental health needs,” the authors wrote. They also suggested organizations could reduce the number of hours or share of time public health workers spend on an emergency response as that “might also improve workforce health.”

Among the 25% of respondents who did see increased support from their employers, the most useful resources were “appreciation for staff members’ work,” cited by 63.4%, along with telework options, cited by 58.2%, and flexible work schedules, cited by 55%.

In an email, Byrkit also highlighted strategies to prevent workplace violence, including the implementation of a “zero-tolerance policy” that she said was “[o]ne of the best protections employers can offer their workers.”

“Leaders need to be better trained in this and equipped with resources to support their staff. They should also be able to escalate to law enforcement when needed,” she wrote.

Methods

The authors distributed a “nonprobability-based, self-administered, anonymous, web-based survey” from March 14–25, 2022, to a convenience sample of public health workers employed in U.S. STLT health departments for at least some period of 2021. The survey link was sent via email to national public health membership organizations and shared with roughly 27,000 members.

It included questions regarding demographics, work history, and traumatic events or stressors experienced since March 2021. Respondents were also asked about self-reported mental health symptoms in the 2 weeks prior and employer provided mental health resources. Most survey respondents, 91.4%, had worked in public health for a year or more.

“A similar convenience sample approach, survey instrument, and methodology were used in March 2021,” the authors noted.

Limitations of the study include that while validated instruments were used to “score” respondents mental health symptoms, the survey method cannot equate to a clinical diagnosis of a mental health problem. Data were also subject to recall bias, given that some questions ask respondents to reflect on experiences as far back as March 2021.

Also, because the survey excluded workers in federal public health agencies and was a convenience sample, it may not be generalizable to the entire STLT workforce, Byrkit noted.

That said, she called the number of responses, over 26,000 from all 50 states and several territories, “particularly compelling” given that the survey was available for less than 2 weeks.

“People really want to share, and care that someone is asking about this,” she said.

If you or someone you know is considering suicide, call the 988 Suicide and Crisis Lifeline.