Psychological symptoms in healthcare workers following the COVID-19 pandemic and relationship to long-term cardiovascular risk

在过去一年，整个世界都被COVID-19大流行所颠覆。截至2021年2月， 全球确诊病例超过1.12亿例，死亡人数超过250万。在纽约市， 美国是大流行的中心，已有超过700，000例病例，超过89，000例住院治疗，超过29，000例 死亡医护人员（HCW）经历了焦虑，压力和失眠的惊人速度，由于 COVID-19疫情可能会持续至疫情结束后。在拟议的工作中，我们将研究 长期心理症状的存在和预测因素以及对心血管健康的后果 在2019冠状病毒病大流行后，急诊科（艾德）医护人员中。这项工作是必要的 了解问题的范围，并告知保护这些前线医务工作者健康的努力， 冒着生命危险保护我们的安全在COVID前，已知艾德卫生工作者的死亡率高于 心理风险高于几乎所有其他临床医生亚组。心理-生理应激因素一直是 在COVID期间急剧放大，在被称为“平行流行病”的 医务工作者面临的精神和身体伤害激增。关键是要了解持续存在的 在治疗COVID患者的HCW中观察到的心理症状，以及下游对 心血管健康我们的初步工作表明，HCW经历了显着的急性心理 在纽约市最初的新冠疫情高峰期间的痛苦。在四月进行的一项医院医务工作者调查中， 2020年，我们发现急性应激障碍（65%）、焦虑（36%）和失眠（70%）的发病率很高。早期证据 表明心理症状持续存在在这些参与者中，25%的人经历了创伤后压力， 在10周的随访中，39%的人患有创伤后应激障碍（PTSD），39%的人患有失眠。在本研究中，我们将（1） 检查提供护理的艾德医务工作者中持续心理症状的患病率和预测因素 在COVID大流行期间;（2）描述心理症状与3年进展的关系 动脉粥样硬化性心血管疾病（ASCVD）风险;和（3）检查潜在的保护因素（即， 弹性应对）在发展新冠病毒相关的心理症状。为达致这些目标，我们会 对暴露于以下物质的艾德卫生工作者的心理和心血管健康进行为期3年的前瞻性研究： 是世界上最高的新冠病毒感染率。在研究基线（第0年）和每次年度随访（第1-3年）时， 我们将进行全面的心理测试，包括新冠肺炎相关的创伤后应激障碍，新冠肺炎， 相关的恐惧失眠和弹性应对每年计算每位受试者的ASCVD风险评分。 我们的主要接触和心理症状的预测因素将是计算出来的“新冠病毒负担”， 量化为2020年3月1日（我院索引病例日期）至研究期间的轮班数 入组，其中COVID入院人数超过艾德患者总数的15%。调查结果将为干预措施提供信息 在我们应对当前和未来的公共卫生危机时，保护医务工作者的身心健康。

Over the past year, the entire world has been upended by the COVID-19 pandemic. As of February 2021, there have been over 112 million confirmed cases and over 2.5 million deaths globally. In New York City, the initial US epicenter of the pandemic, there have been >700,000 cases, >89,000 hospitalizations, and >29,000 deaths. Healthcare workers (HCWs) have experienced alarming rates of anxiety, stress, and insomnia due to COVID-19, which are likely to persist beyond the pandemic. In the proposed work, we will examine the presence and predictors of long-term psychological symptoms and the consequences for cardiovascular health among emergency department (ED) HCWs following the COVID-19 pandemic. This work is necessary to understand the scope of the problem and to inform efforts to protect the health of these frontline HCWs who have risked their lives to ensure our safety. Pre-COVID, ED HCWs were already known to be at greater psychological risk than nearly every other subgroup of clinicians. Psycho-physiologic stress factors have been dramatically magnified during the COVID period, in what has been referred to as a “parallel pandemic” of surging mental and physical harm faced by HCWs. It is critical to understand the presence of sustained psychological symptoms seen in HCWs who treated COVID patients, as well as downstream impacts on cardiovascular health. Our preliminary work showed that HCWs experienced significant acute psychological distress during the initial COVID peak in New York City. In a survey of hospital HCWs conducted in April 2020, we found high rates of acute stress disorder (65%), anxiety (36%), and insomnia (70%). Early evidence points to persistence of psychological symptoms. In these participants, 25% experienced post-traumatic stress disorder (PTSD) and 39% experienced insomnia at a 10 week follow-up. In the proposed study, we will (1) examine the prevalence and predictors of sustained psychological symptoms in ED HCWs who provided care during the COVID pandemic; (2) characterize the relationship of psychological symptoms to 3-year progression of atherosclerotic cardiovascular disease (ASCVD) risk; and (3) examine a potential protective factor (i.e., resilient coping) in the development of COVID-related psychological symptoms. To achieve these aims, we will conduct a prospective 3-year study of psychological and cardiovascular health in ED HCWs exposed to some of the highest COVID case rates in the world. At study baseline (Year 0) and at each annual follow-up (Years 1-3), we will conduct a thorough psychological test battery that includes measures of COVID-related PTSD, COVID- related fear, insomnia, and resilient coping. Each participant’s ASCVD risk score will be computed annually. Our primary exposure and predictor of psychological symptoms will be the computed “Covid burden,” quantified as the number of shifts worked between March 1, 2020 (date of our hospital’s index case) and study enrollment, in which COVID admissions exceeded 15% of total ED patients. Findings will inform interventions to protect mental and physical wellbeing in HCWs as we navigate this and future public health crises.