Brief mental health support for Ontario healthcare workers during the COVID-19 pandemic

BY Judith M. Laposa and Randi E. McCabe

Remember the early days of the COVID-19 pandemic? Businesses shut down, we were told to stay away from other humans, and people were dying from a disease we did not know or understand. Now imagine that on top of that, you were a healthcare worker (HCW). You perhaps worked in a hospital – one of the businesses that did not shut down, maybe even directly with patients infected with COVID-19. Vaccines to protect against COVID-19 did not exist, personal protective equipment was not always available, you could not access your coping strategies the way you normally would, and you were working long hours, with increased possibility of getting COVID-19 yourself. Would that have impacted your mental health?

There is considerable research now, showing the negative mental health impacts of the COVID-19 pandemic. Across many countries, about one in three people in the general population reported psychological distress. Those at higher risk for being infected with COVID-19 reported more depression and anxiety symptoms. Among HCWs, the impacts were even greater; 84% of HCWs scored higher than the general population on psychological distress.

But the healthcare system needed to keep functioning, as many people were sick and dying. How could HCWs be supported to continue their vital work? The current study looked at whether a brief coping-focused psychotherapy treatment would be associated with positive changes in Ontario HCWs’ mental health during the pandemic.

The study ran between April 2020 and December 2021. HCWs could self-refer for treatment that started within 1-2 weeks and was government funded. The treatment was provided virtually, in individual one hour sessions, for four to eight sessions. Three hundred and thirty-three HCWs received the treatment at three large specialty hospitals in Ontario, Canada. As part of their treatment, HCWs completed questionnaires about symptoms of anxiety, depression, perceived stress, work/social impairment, insomnia, and fear of COVID-19. When their treatment was finished, they completed a satisfaction survey.

The treatment given to HCWs was associated with large improvements in anxiety, depression, perceived stress, insomnia, and fear of COVID-19, and medium improvements in work/social impairment. At the start of treatment, prior mental health diagnosis and treatment were significantly related to levels of depression, anxiety, and work/social impairment. Interestingly, treatment changes for anxiety, depression, perceived stress and work/social impairment were independent of age, gender, occupational setting, profession, and the presence of a previous mental health diagnosis or treatment, with the exception that nurses improved at a slightly greater rate than did other professions on work/social impairment. Treatment was associated with large improvements for a diverse group of HCWs, from various workplace settings and professional backgrounds. HCWs were highly satisfied with the treatment they received. It was noteworthy that HCWs felt much better in a short amount of time. Offering mental health service quickly, and with low barriers to accessing help, was important.

Some limitations to the study included that 89% of HCWs who self-referred for treatment identified as female, making it harder to detect effects based on gender. In addition, the three hospitals offered slightly different treatments and numbers of sessions, although there were no statistical differences in outcomes between hospital sites. Lastly, it would have been unethical at this stage of the pandemic to randomly assign a HCW to receive treatment or not receive treatment. As there was no control group with which to compare the treatment, we cannot definitely say that the treatment caused the improvements in HCW mental health; we can instead conclude that the treatment was associated with improvements in mental health.

In summary, the mental health of HCWs was impacted during the COVID-19 pandemic, even more so than people in the general population. Offering timely and flexible access to a brief coping-based treatment was associated with positive impacts on both symptoms (anxiety, depression, stress, insomnia, fear of COVID-19) and impairment related to symptoms. For the healthcare system to function effectively, it is crucial that HCWs receive rapid access to mental health supports when needed. This study may inform system planning of HCW mental health supports in the case of future healthcare crises.

Article details

A Rapid Access Brief Psychotherapy Intervention to Respond to Healthcare Workers in Ontario Whose Mental Health was Negatively Impacted During the COVID-19 Pandemic: Une brève intervention de psychothérapie à accès rapide pour répondre aux travailleurs de la santé de l'Ontario dont la santé mentale a été affectée négativement pendant la pandémie de COVID-19

Judith M. Laposa, Duncan Cameron, Kim Corace, Natalie Quick, Karen Rowa, Cary Kogan, Stephanie Carter, Irena Milosevic, Sara De La Salle, Vicky Stergiopoulos, Joseph Pellizzari, Erika Haber, Paul Kurdyak and Randi E. McCabe.

DOI: 10.1177/07067437231187462
First Published: July 14, 2023
The Canadian Journal of Psychiatry

About the Author

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Dr. Randi McCabe is a Psychologist and Clinical Director of the Anxiety Treatment and Research Clinic at St. Joseph's Healthcare Hamilton, and a Professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University. She is Ontario Health’s Provincial Clinical Lead, Depression and Anxiety-Related Disorders, in the Mental Health and Addictions Centre of Excellence.

Dr. Judith Laposa is a Psychologist and Associate Scientist in the Mood and Anxiety Service at the Centre for Addiction and Mental Health (CAMH), and an Associate Professor in the Department of Psychiatry at the University of Toronto. She is the CAMH Clinical Lead for Training and Supervision, for the Ontario Structured Psychotherapy program.