Introduction
The COVID-19 pandemic has presented healthcare providers with a unique set of challenges. While all healthcare providers have some exposure risk, it is particularly pronounced in those caring for patients undergoing mucosal or aerosol-generating procedures.1-3 At baseline, there are increased risks of acute respiratory infections among health care workers during procedures such as tracheal intubation, tracheotomy, non-invasive ventilation, and manual ventilation.4 Anecdotal reports from Wuhan, China report higher rates of COVID-19 infection specifically among otolaryngologists, likely due to the frequent use of those high-risk procedures in their typical, often non-elective, practice.5-9 This risk of exposure can be mitigated through the use of personal protective equipment (PPE); however, this essential resource is already becoming scarce.10Additionally, they are being faced with increasing numbers of positive cases, unfamiliar hospital roles, and concern for safety of themselves, their loved ones, and their patients. Thus, beyond the risk to their physical health, there is also great risk to their mental wellbeing.
A review of prior outbreaks demonstrates a history of a mental burden on health care providers during similar times. A number of studies conducted during the 2003 SARS and 2014 Ebola crises used surveys and in-depth interviews to demonstrate increased symptoms of stress, anxiety, depression, insomnia, and distress among health care workers.11-17 In certain situations, investigators still found increased psychiatric morbidity one to three years after the 2003 SARS outbreak, though it is unclear whether these can be directly attributable to SARS.18-20 There are now similar concerns for the health care workers during the COVID-19 pandemic. Studies from COVID-19 in Wuhan, China, where it was first detected, as well as in Singapore and India have already shown an increased mental strain on healthcare workers, reflected through validated surveys on anxiety, depression, insomnia, and distress.21-23 This collection of prior evidence suggests a need to provide early support and intervention in the hopes of preventing any immediate or long-lasting implications.
Despite the history of increased psychiatric symptoms in health care workers during outbreaks and the increased infection risk among providers exposed to aerosolization, to the best of our knowledge, no study has characterized the impact on the mental health of this specific population. This study aims to assess mental health symptoms among Otolaryngology physicians during the COVID-19 pandemic by measuring symptoms of burnout, anxiety, depression, and distress.