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Hendrickson RC, McCall CA, Rosser AF, Pagulayan KF, Chang BP, Sano ED, Thomas RG, Raskind MA. The relative contribution of COVID-19 infection versus COVID-19 related occupational stressors to insomnia in healthcare workers. medRxiv 2022:2022.10.27.22281582. [PMID: 36324797 PMCID: PMC9628206 DOI: 10.1101/2022.10.27.22281582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective/Background Healthcare workers have experienced high rates of psychiatric symptom burden and occupational attrition during the COVID-19 pandemic. Identifying contributory factors can inform prevention and mitigation measures. Here, we explore the potential contributions of occupational stressors vs COVID-19 infection to insomnia symptoms in US healthcare workers. Patients/Methods An online self-report survey was collected between September 2020 and July 2022 from N=594 US healthcare workers, with longitudinal follow-up up to 9 months. Assessments included the Insomnia Severity Index (ISI), the PTSD Checklist for DSM-5 (PCL-5), and a 13-item scale assessing COVID-19 related occupational stressors. Results Insomnia was common (45% of participants reported at least moderate and 9.2% reported severe symptoms at one or more timepoint) and significantly associated with difficulty completing work-related tasks, increased likelihood of occupational attrition, and thoughts of suicide or self-harm (all p<.0001). In multivariable regression with age, gender, and family COVID-19 history as covariates, past two-week COVID-related occupational stressors, peak COVID-related occupational stressors, and personal history of COVID-19 infection were all significantly related to past two-week ISI scores (β=1.7±0.14SE, β=0.08±0.03, and β=0.69±0.22 respectively). Although similar results were found for the PCL-5, when ISI and PCL-5 items were separated by factor, COVID-19 infection was significantly related only to the factor consisting of sleep-related items. Conclusions Both recent occupational stress and personal history of COVID-19 infection were significantly associated with insomnia in healthcare workers. These results suggest that both addressing occupational stressors and reducing rates of COVID-19 infection are important to protect healthcare workers and the healthcare workforce.
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Affiliation(s)
- Rebecca C. Hendrickson
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560 Room BB1644, Seattle, WA 98195-6560, USA
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Corresponding Author: ; 1660 S Columbian Way, S116 MRECC, Seattle, WA 98108, USA
| | - Catherine A. McCall
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560 Room BB1644, Seattle, WA 98195-6560, USA
- VA Puget Sound Healthcare System, Department of Pulmonary, Critical Care, and Sleep Medicine, 1660 S. Columbian way, S111 PULM, Seattle, WA 98108, USA
| | - Aaron F. Rosser
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
| | - Kathleen F. Pagulayan
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356490, Seattle, WA, 98195-6560, USA
| | - Bernard P. Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032
| | - Ellen D. Sano
- Department of Emergency Medicine, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032
| | - Ronald G. Thomas
- Department of Biostatistics, University of California, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Murray A. Raskind
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, 1660 S. Columbian Way, S116 MIRECC, Seattle, WA 98108, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560 Room BB1644, Seattle, WA 98195-6560, USA
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Miller EH, Annavajhala MK, Chong AM, Park H, Nobel YR, Soroush A, Blackett JW, Krigel A, Phipps MM, Freedberg DE, Zucker J, Sano ED, Uhlemann AC, Abrams JA. Oral Microbiome Alterations and SARS-CoV-2 Saliva Viral Load in Patients with COVID-19. Microbiol Spectr 2021; 9:e0005521. [PMID: 34643448 PMCID: PMC8515944 DOI: 10.1128/spectrum.00055-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Bacterial-viral interactions in saliva have been associated with morbidity and mortality for respiratory viruses such as influenza and SARS-CoV. However, such transkingdom relationships during SARS-CoV-2 infection are currently unknown. Here, we aimed to elucidate the relationship between saliva microbiota and SARS-CoV-2 in a cohort of newly hospitalized COVID-19 patients and controls. We used 16S rRNA sequencing to compare microbiome diversity and taxonomic composition between COVID-19 patients (n = 53) and controls (n = 59) and based on saliva SARS-CoV-2 viral load as measured using reverse transcription PCR (RT-PCR). The saliva microbiome did not differ markedly between COVID-19 patients and controls. However, we identified significant differential abundance of numerous taxa based on saliva SARS-CoV-2 viral load, including multiple species within Streptococcus and Prevotella. IMPORTANCE Alterations to the saliva microbiome based on SARS-CoV-2 viral load indicate potential biologically relevant bacterial-viral relationships which may affect clinical outcomes in COVID-19 disease.
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Affiliation(s)
- Emily Happy Miller
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Medini K. Annavajhala
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexander M. Chong
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Microbiome and Pathogen Genomics Collaborative Center, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Heekuk Park
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Microbiome and Pathogen Genomics Collaborative Center, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Yael R. Nobel
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ali Soroush
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - John W. Blackett
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Anna Krigel
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Meaghan M. Phipps
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Daniel E. Freedberg
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jason Zucker
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ellen D. Sano
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne-Catrin Uhlemann
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Microbiome and Pathogen Genomics Collaborative Center, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Julian A. Abrams
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Firew T, Sano ED, Lee JW, Flores S, Lang K, Salman K, Greene MC, Chang BP. Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers' infection and psychological distress during the COVID-19 pandemic in the USA. BMJ Open 2020; 10:e042752. [PMID: 33087382 PMCID: PMC7580061 DOI: 10.1136/bmjopen-2020-042752] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has been associated with significant occupational stressors and challenges for front-line healthcare workers (HCWs), including COVID-19 exposure risk. Our study sought to assess factors contributing to HCW infection and psychological distress during the COVID-19 pandemic in the USA. DESIGN We conducted a cross sectional survey of HCWs (physicians, nurses, emergency medical technicians (EMTs), non-clinical staff) during May 2020. Participants completed a 42-item survey assessing disease transmission risk (clinical role, work environment, availability of personal protective equipment) and mental health (anxiety, depression and burn-out). SETTING The questionnaire was disseminated over various social media platforms. 3083 respondents from 48 states, the District of Columbia and US territories accessed the survey. PARTICIPANTS Using a convenience sample of HCWs who worked during the pandemic, 3083 respondents accessed the survey and 2040 participants completed at least 80% of the survey. PRIMARY OUTCOME Prevalence of self-reported COVID-19 infection, in addition to burn-out, depression and anxiety symptoms. RESULTS Participants were largely from the Northeast and Southern USA, with attending physicians (31.12%), nurses (26.80%), EMTs (13.04%) with emergency medicine department (38.30%) being the most common department and specialty represented. Twenty-nine per cent of respondents met the criteria for being a probable case due to reported COVID-19 symptoms or a positive test. HCWs in the emergency department (31.64%) were more likely to contract COVID-19 compared with HCWs in the ICU (23.17%) and inpatient settings (25.53%). HCWs that contracted COVID-19 also reported higher levels of depressive symptoms (mean diff.=0.31; 95% CI 0.16 to 0.47), anxiety symptoms (mean diff.=0.34; 95% CI 0.17 to 0.52) and burn-out (mean diff.=0.54; 95% CI 0.36 to 0.71). CONCLUSION HCWs have experienced significant physical and psychological risk while working during the COVID-19 pandemic. These findings highlight the urgent need for increased support for provider physical and mental health well-being.
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Affiliation(s)
- Tsion Firew
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Office of the Minister, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Ellen D Sano
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan W Lee
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Emergnecy Medicine, Mount Sinai Medical Center, New York, New York, USA
| | - Stefan Flores
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kendrick Lang
- School of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kiran Salman
- General Public Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - M Claire Greene
- Global Mental Health Program, New York State Psychiatric Institute, New York, New York, USA
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
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