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

在过去的一年里，新冠肺炎大流行颠覆了整个世界。截至2021年2月，有 全球已有超过1.12亿确诊病例和超过250万人死亡。在纽约市，首字母 美国是疫情的中心，已有70万例病例，8.9万人住院，2.9万人 死亡。医护人员(HCW)经历了令人震惊的焦虑、压力和失眠，原因是 新冠肺炎，它们很可能会持续到大流行之后。在建议的工作中，我们会研究 长期心理症状的存在和预测因素及其对心血管健康的影响 在新冠肺炎大流行后的急诊科(ED)卫生工作者中。这项工作是必要的，以 了解问题的范围，并为保护这些前线卫生工作者的健康提供信息 冒着生命危险来确保我们的安全。在冠状病毒感染之前，埃德·霍普金斯大学的医务工作者已经知道 心理风险比几乎所有其他临床医生小组都要高。心理-生理压力因素一直是 在COVID期间被戏剧性地放大，在被称为“平行大流行”的 卫生工作者面临的精神和身体伤害激增。了解持续病毒的存在至关重要 治疗COVID患者的医务人员出现的心理症状以及对 心血管健康。我们的初步工作表明，医务工作者经历了显著的急性心理 在纽约市最初的COVID高峰期的痛苦。在4月份对医院卫生工作者进行的一项调查中 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%经历了创伤后应激障碍 精神障碍(PTSD)和39%的患者在10周的随访中经历了失眠。在建议的研究中，我们会：(1) 提供护理的急诊科医务人员持续性心理症状的患病率及其预测因素 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；以及(3)检查潜在的保护因素(即， 弹性应对)在COVID相关心理症状的发展中的作用。为了实现这些目标，我们将 开展一项为期3年的前瞻性研究，调查暴露于某些有害物质的ED医务人员的心理和心血管健康状况 世界上最高的COVID病例比率。在研究基线(第0年)和每次年度随访(第1-3年)时， 我们将进行一系列彻底的心理测试，包括与COVID相关的创伤后应激障碍、COVID- 相关的恐惧、失眠和弹性应对。每位参与者的ASCVD风险评分将每年计算一次。 我们对心理症状的主要暴露和预测将是计算出的“Covid负担”， 量化为2020年3月1日(本院确诊病例之日)至研究期间的工作班次 登记，其中COVID入院人数超过ED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，保护卫生工作者的身心健康。

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.