In line with recent findings of increased anxiety and depression in healthcare workers, , this study found healthcare workers in the Argentinian municipality of Vicente Lopez used a significantly higher number of psychiatric sick leave during the first eight months of COVID-19 pandemic, with the largest increase occurring in April 2020, when uncertainty surrounding COVID-19 was at its highest globally. Similarly to other outbreaks such as SARS in 2003, the uncertainty surrounding COVID-19 including lack of information about transmission, treatment, or mortality rates likely led to healthcare workers feeling higher rates of stress, leading to them utilizing psychiatric sick leave.
A number of different factors impacted providers’ use of psychiatric leave differentially, such as the higher rates of psychiatric sick leave used by female healthcare workers compared to their male counterparts. These replicate findings of personal and work-related burnout as well as higher rates of reported psychological symptoms in female healthcare workers. It is possible that, due to traditional gender roles, these female healthcare workers may have been primarily responsible for childcare as well as elder care, which may have increased their levels of stress and resulted in more psychiatric sick leave being used. Parenting responsibilities have been reported as stressors during the current COVID-19 pandemic, as well as in the SARS outbreak in 2003. Alternatively, it is also possible that impact of masculinity on healthcare avoidance may have resulted in men using similar amount of leave, but labeling it differently compared to their female counterparts, .
Increased used of either general and psychiatric sick leave reflect challenges experienced by healthcare workers individually, and for the healthcare system as a whole. On an individual level, while removing the overall stressor of the pandemic is impossible, there are interventions for anxiety and depression, particularly during crises, such as Psychological First Aid and Skills for Psychological Recovery, that could result in fewer days used in the long-term as healthcare workers develop skills to help cope with the increased stress. For healthcare teams, increases in sick leave mean staff shortages during peak-capacity times, resulting in increased demand and unplanned shifts for the workers there. This increased burden can then increase the risk of that individual needing their own leave in the future, continuing to leave the team short-staffed. Relatedly, without intervention, systems can begin to buckle under the weight of an overburdened healthcare force. There are a number of potential interventions healthcare systems could implement to aid healthcare workers. Telehealth, for example, has increased during the pandemic to approximately 1 billion appointments a year, compared to the originally projected 36 million appointments prior to COVID-19 (Coombs, 2020). Strategic use of telehealth appointments, both for outpatient appointments that can be conducted via telehealth fairly easily (e.g., mental health appointments) as well as to triage care via telehealth from overstretched hospitals in a virus hotspot to other facilities would allow for more even work flow, and may prevent healthcare workers from feeling burnout as rapidly. Additionally, allowing providers to telework from home when possible could result in lower levels of anxiety related virus exposure.
This study has a number of limitations important to consider when interpreting the results. First, many countries do not have different categories of leave, preventing comparison of our results with samples internationally. Even with the categorizing of psychiatric versus general leave in our sample, we do not know the individual episodes or diagnoses associated with the use of the leave. Within this sample, we also do not know which hospitals or units these healthcare workers were associated with or the level of exposure of patients with COVID-19, preventing us from looking at the direction relationship between caring for individuals with COVID-19 and the use of healthcare worker psychiatric leave. Lastly, age of the healthcare workers was not available for this project. As other projects have found that younger healthcare workers have reported higher rates of mental health problems during the pandemic26, this would have been interesting to replicate in our sample.
Despite these limitations, this study adds important information about how healthcare workers have been responding to the COVID-19 pandemic. As expected, healthcare workers utilized higher rates of psychiatric leave while struggling with increased stress as a result of personal, institutional, and global factors. For healthcare workers that experience stress, individual interventions such as Psychological First Aid could provide coping skills. However, beyond the individual level, there are a number of system changes a healthcare system could make, including using telehealth as a way to reduce burden on overstretched hospitals as well as for anxious healthcare providers, resulting fewer days of psychiatric leave being taken.
Future proposals
Data shows a flip in October, the difference within sexes, towards male health workers. It would be interesting to see if this pattern continues in the following months till the end of 2020 and the beginning of 2021.