Anxiety levels among health-care workers during COVID-19 linked to inadequate PPE

Study by OHCOW, with IWH support, draws on survey of 4,000 workers during April 2020

Published: May 23, 2020

Nearly six in 10 surveyed health-care workers in Canada reported anxiety at levels surpassing an accepted threshold for clinical screening for the condition, according to a survey of 4,000 workers conducted in April.

Analysis of survey responses found anxiety levels were associated with the availability of personal protective equipment (PPE): workers who reported more unmet PPE needs also reported higher levels of anxiety.

The Healthcare Worker Pandemic Experience survey was conducted by the Occupational Health Clinic for Ontario Workers (OHCOW) with analytical support from Institute for Work & Health (IWH) Scientific Co-Director Dr. Peter Smith. Preliminary findings were shared by lead researcher John Oudyk at the first of OHCOW’s month-long May Day, May Day webinar series.

Conducted between April 6 and 30, the survey asked health-care workers about their need for, and access to, a range of PPE such as gloves, gowns, eye protection, face shields, surgical masks, N95 masks and respirators. It found 18 per cent of workers said all their PPE needs were met, while 35 per cent said more than half their needs were met and 38 per cent said less than half their needs were met. The remaining eight per cent said none of their PPE needs were met.

The study also asked health-care workers about nine policies and practices related to COVID-19 prevention. (Examples included patient-screening policies, house-cleaning practices, and the use of masks for symptomatic patients.) The breakdown of responses was similar to that of the PPE questions: 16 per cent said the policies and practices at their workplaces met all their needs, 39 per cent had more than half their needs met, 30 per cent had less than half their needs met and 12 per cent had none of their needs met. 

Participants were also asked two questions from the Generalised Anxiety Disorder screener (GAD-2), and two questions from the Patient Health Questionnaire screener (PHQ-2). For both these questionnaires, scores of 3 and higher indicated the potential for anxiety and depression, respectively.

In the survey, those reporting none of their PPE needs were met were the most anxious, with 65 per cent reporting anxiety levels higher than the cut-off score of 3. In comparison, of the 18 per cent of the respondents who said all their PPE needs were met, only 43 per cent scored higher than 3. Anxiety levels also increased as workers reported inadequate COVID-19 policies and practices, but less steeply.  

A similar pattern was seen for depression: 38 per cent of responding health-care workers who had all their PPE needs met reported depression scores higher than 3, whereas 56 per cent of those who said none of their PPE needs were met scored higher than the threshold. 

“We expected to see heightened anxiety and depression during this pandemic, but we didn’t expect to see levels this high,” says Oudyk. “What’s notable is that, if PPE protection and infection control policies and practices are adequate, then this mental health burden can be reduced.”

As with any survey where recruitment is done by word of mouth, results could be over-represented by people motivated to report negative experiences, Smith notes. “However, while this may lead to higher levels of anxiety and depression in the survey population compared to the health-care worker population at large, it is less likely to affect outcomes showing the relationship between PPE and policy and procedure needs,” he adds.

Oudyk credits the ongoing relationships among stakeholders and researchers for the speed with which this study was launched. Oudyk, who had partnered previously with Smith on research related to psychosocial work conditions, has also been involved in a research network with several health-care unions since the 2003 SARS-1 outbreak. It was this latter group that saw, in January and February of this year, a need and an opportunity to conduct this study—in time, says Oudyk, “to capture health-care workers’ perceptions and experiences of the risks as events were unfolding.”

The health-care survey is still open, as is a similar survey for non-health-care workers. Oudyk’s presentation on preliminary findings from the health-care survey can be found at: He's also presenting early findings from the non-health-care survey on the final installment of OHCOW's May Day, May Day series, on May 29.