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Public Health Workers Still Face PTSD, Other Mental HEALTH ISSUES

Nearly 1 / 2 of non-federal public health workers surveyed in 2022 experienced outward indications of depression, anxiety, post-traumatic stress disorder (PTSD) or some combination thereof, in accordance with a recent study of these mental health published in Morbidity and Mortality Weekly Report.

And the additional time these state, tribal, local, and territorial (STLT) workers spent engaged in COVID-19 response activities, the higher their potential for mental health issues, especially PTSD. Respondents who spent over three-quarters of these work hours on COVID-19 activities were a lot more than twice as more likely to report outward indications of PTSD.

Drilling into the info, 48% (95% CI 47.3-48.7) of the general public health workers surveyed March 14 to 25 said they experienced outward indications of a minumum of one mental medical condition — depression, anxiety or PTSD. That is clearly a small drop from the 52.8% of respondents who reported experiencing at outward indications of a minumum of one of the conditions in a survey conducted per year prior.

Across 26,069 respondents in 2022, the most typical mental health was PTSD at 28.4%, then anxiety at 27.9%, accompanied by depression at 27.7%, and suicidal ideation at 8.1%.

Reported rates of every condition — depression, anxiety and PTSD — also fell slightly in 2022 in comparison to 2021, down 3.1%, 2.4%, and 8.4%, respectively (P<0.001).

Despite these declines, 48% prevalence overall is “still quite high, ” said Ramona Byrkit, MPH, of the CDC’s COVID-19 Emergency Response Team and a co-author of the analysis, within an email to MedPage Today.

Individuals owned by multiple races had the best rates of outward indications of depression, at 31.4%; anxiety, at 33.5%; and PTSD, at 34.4%.

Furthermore, public health workers who faced job-related threats or “felt bullied, threatened or harassed” because of their job had the best rates of PTSD, at 53.3% and 47.7% respectively.

Survey participants who spent at the very least three-quarters of their own time focusing on COVID-19 response activities were more susceptible to experiencing depression (prevalence ratio 1.38), anxiety (PR 1.35), and PTSD (PR 2.43), in comparison with participants who didn’t focus on COVID-19 activities.

Respondents working a lot more than 60 hours weekly were also much more likely than those working 40 or fewer hours to see depression (PR 1.73), anxiety (PR 1.48), PTSD (PR 2.07), and suicidal ideation (PR 1.50).

Survey participants who said they felt overwhelmed by their workload or attempting to balance work and family life, were between two and 3 x as more likely to report outward indications of suicidal ideation, anxiety, depression, and PTSD, in comparison to those not reporting such feelings.

And 27.8% of respondents who left public health or who considered leaving the profession, were doubly more likely to report suicidal ideation (PR 2.34) weighed against those remaining in the field who said that they had not considered leaving.

And about three-quarters of respondents reported knowing colleagues who’ve left public health or were considering leaving.

“Public health staff are facing long-term stress and exhaustion, and public health must find methods to recruit and retain new staff, and create a host more conducive to mental health,” said Byrkit.

Importantly, public health workers who could devote some time off or who “perceived a rise in mental health resources from their employer” were less inclined to report mental health symptoms (PR range 0.48-0.55, and 0.58-0.84, respectively) than those that could not devote some time or didn’t perceive such support. Around three in four public health workers reported they could actually devote some time off.

“[I]t’s concerning that over 75% of respondents said their employers hadn’t increased support for mental health since March 2021,” Byrkit said.

Byrkit and her co-authors called on public health agencies to spotlight improving work-related factors affecting mental health, by enhancing usage of resources that support workers’ mental health.

“Investment in today’s and future workforces might include training organizational leaders and supervisors to identify, understand, and support staff members’ mental health needs,” the authors wrote. In addition they suggested organizations could decrease the amount of hours or share of time public health workers devote to a crisis response as that “may also improve workforce health.”

On the list of 25% of respondents who did see increased support from their employers, probably the most useful resources were “appreciation for staff members’ work,” cited by 63.4%, alongside telework options, cited by 58.2%, and flexible work schedules, cited by 55%.

Within an email, Byrkit also highlighted ways of prevent workplace violence, like the implementation of a “zero-tolerance policy” that she said was “[o]ne of the greatest protections employers can provide their employees.”

“Leaders have to be better been trained in this and built with resources to aid their staff. They ought to also have the ability to escalate to police when needed,” she wrote.


The authors distributed a “nonprobability-based, self-administered, anonymous, web-based survey” from March 1425, 2022, to a convenience sample of public health workers used in U.S. STLT health departments for at the very least some amount of 2021. The survey link was sent via email to national public health membership organizations and distributed to roughly 27,000 members.

It included questions regarding demographics, work history, and traumatic events or stressors experienced since March 2021. Respondents were also asked about self-reported mental health symptoms in the two 14 days prior and employer provided mental health resources. Most survey respondents, 91.4%, had worked in public areas health for per year or even more.

“An identical convenience sample approach, survey instrument, and methodology were found in March 2021,” the authors noted.

Limitations of the analysis include that while validated instruments were used to “score” respondents mental health symptoms, the survey method cannot mean a clinical diagnosis of a mental medical condition. Data were also at the mercy of recall bias, considering that some questions ask respondents to think about experiences dating back to March 2021.

Also, as the survey excluded workers in federal public health agencies and was a convenience sample, it could not be generalizable to the complete STLT workforce, Byrkit noted.

Having said that, she called the amount of responses, over 26,000 from all 50 states and many territories, “particularly compelling” considering that the survey was designed for less than 14 days.

“People actually want to share, and care that someone is asking concerning this,” she said.

In the event that you or someone you understand is considering suicide, call the 988 Suicide and Crisis Lifeline.

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    Shannon Firth has been reporting on health policy as MedPage Today’s Washington correspondent since 2014. She actually is also an associate of the site’s Enterprise & Investigative Reporting team. Follow

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