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 Oct 21;10(10):e042752. doi: 10.1136/bmjopen-2020-042752.


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.

Keywords: COVID-19; anxiety disorders; epidemiology; occupational & industrial medicine; public health.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Betacoronavirus*
  • Burnout, Professional / epidemiology
  • Burnout, Professional / prevention & control*
  • Burnout, Professional / psychology
  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / psychology
  • Cross-Sectional Studies
  • Female
  • Health Personnel / psychology*
  • Humans
  • Male
  • Mental Health*
  • Pandemics*
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / psychology
  • Prevalence
  • Psychological Distress*
  • SARS-CoV-2
  • Surveys and Questionnaires
  • United States / epidemiology