Recharge rooms were created across the Health System in one of many initiatives informed by surveys of front-line staff.

Front-line staff who were already feeling burnout showed the most signs of mental distress during the height of the COVID-19 pandemic, while those who fared best had an active social network and felt supported by their supervisors. These were among the many lessons learned by a team of Mount Sinai researchers based on two surveys of front-line Mount Sinai staff in 2020.

“The main takeaway is what most people would expect—that if you’re involved in health care during a pandemic, it’s going to take its toll,” says Jonathan Ripp, MD, MPH, Dean for Well-Being and Resilience and Chief Wellness Officer at the Icahn School of Medicine at Mount Sinai. “But beyond that, we were able to identify what types of things may put you at greater or lesser risk of these mental health outcomes, and inform how we can try to mitigate them.”

The results were used in real time to develop programs to help Mount Sinai staff handle the pressures of the pandemic, Dr. Ripp says, and they are being shared with other institutions through journal publications and a Well-Being Toolkit developed by the Office of Well-Being and Resilience.

The three mental health outcomes studied were depression, anxiety, and post-traumatic stress disorder related to the COVID-19 pandemic. Among the more than 3,000 front-line staff members who responded to an initial survey in April and May 2020, 39 percent screened positive for at least one of these outcomes. The most significant factor predicting mental health symptoms was the presence of pre-pandemic burnout, according to studies published by the Mount Sinai team in The Journal of Clinical Psychiatry and Chronic Stress.

At the start of the pandemic, Mount Sinai focused on meeting the basic needs of front-line staff, such as providing free or subsidized food onsite.

“This means that if you already felt exhausted, fatigued, and detached from your work, you were more likely to develop these mental health symptoms during the pandemic,” says investigator Lauren Peccoralo, MD, MPH, Senior Associate Dean for Faculty Well-Being and Development, and Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai. The research team emphasized that burnout is distinct from other mental health issues in that it is more a function of the work environment, and can be remedied by strategies that support workers.

In the earliest days of the COVID-19 pandemic, the Office of Well-Being and Resilience assembled a group of researchers with backgrounds in psychology, psychiatry, survey design, and statistical analysis to examine its mental health consequences on the workforce, in an effort initiated by Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System.

The group sent surveys to more than 6,000 physicians, nurses, social workers, chaplains, and other front-line staff at The Mount Sinai Hospital during the height of the pandemic’s first wave in April and May 2020 and again seven months later. In the first survey, more than 3,000 respondents answered questions from three diagnostic series: the General Anxiety Disorder 7, the Personal Health Questionnaire 8, and the Post Traumatic Stress Disorder checklist. In the self-screening for depression, for example, about 26 percent of respondents reported that on more than half the days of the week, they felt such symptoms as taking little interest or pleasure in doing things, feeling hopeless, losing their appetite, having trouble staying or falling asleep, or difficulty concentrating.

The survey also asked open-ended questions about the respondents’ concerns. “There were a lot of infection-related worries. People were worried about PPE, about infecting colleagues or bringing COVID-19 home to their family members,” says Jordyn Feingold, MD, an investigator in the study, who graduated from Icahn Mount Sinai in May 2020 and is now a psychiatry resident. “There were worries about basic needs like getting food at work, and existential worries like ‘When is this going to end?’ and ‘When is life going to return back to normal?’”

The aid facilitated by the research team fell into three categories: providing basic needs like food and the proper personal protective equipment (PPE) and other materials; providing up-to-date information through channels including web sites and system-wide email broadcasts; and creating well-being spaces and onsite mental health and peer support to reduce the stress experienced by health care workers.

A Second Survey Finds an Increase in Burnout

The surveys also asked questions related to resilience, Dr. Ripp says. Specific factors that were found to be protective against mental health symptoms included getting enough sleep and exercise, having social emotional support, not using substances to cope, having sufficient PPE, and feeling supported by hospital leadership and valued by supervisors.

Simply feeling heard was also important, Dr. Feingold says. “Whether or not we have it in our control to fix all of these things right away,” she says, “just validating the concerns and letting people know that they’re not experiencing this in isolation, I think was really powerful.”

In the second survey, conducted from November 2020 to January 2021, more than 1,600 responded and of those, 786 staff provided follow-up responses on their mental health and well-being. The results indicate that mental health symptoms have declined, but the prevalence of burnout has increased, Dr. Peccoralo says. “We are still analyzing the data, but one thought is that the traumatic situation has largely gone away, but the work hasn’t. We’re all still working really hard, maybe even harder than we have ever worked before,” she says. “So we have to think about how we can tell if we are pushing people too much, and what we can do about it.”

The surveys have served an important role in helping Mount Sinai take care of its own, and in advancing knowledge of the mental health consequences of responding to a pandemic, Dr. Ripp says.

The needs identified in the surveys have informed the development of new initiatives, including the launch of the Center for Stress, Resilience, and Personal Growth, says its Clinical and Research Director, Jonathan DePierro, PhD, Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai. The Center is an innovative service supporting the resilience and psychological health of all Mount Sinai faculty, staff, and trainees through a series of evidence-based resilience workshops, a resilience-promoting app available for download on Sinai Central, ongoing outreach efforts, and up to 14 treatment sessions in its confidential faculty practice.

“Let’s hope that it’s a very long time before something like this pandemic happens again, but should it happen, I think the lessons that we’ve learned can apply,” Dr. Ripp says. “And then of course we can share those lessons, so that other institutions that haven’t had the opportunity to study this trajectory can learn from our experience.”