Depression in healthcare workers: Results from a French nationwide survey
I am Medical Doctor and Professor of Public Health at Aix-Marseille University (AMU) and Assistance Publique-Hôpitaux de Marseille (APHM). More precisely, I am director the Department of Medical Information (in charge of the electronic medical record and the datawarehouse) at APHM and I co-lead the CEReSS-Health Services Research and Quality of Life Center at AMU. I am also leader of the ECO-MENTAL trans-thematic network at the FondaMental Fondation, workpackage leader on real-world data at F-PSYNET (French Psychosis Network, INSERM) and PROPSY (precision in psychiatry) workpackage leader on validation of stratification biomarkers in real-world data sets and clinical trials (French priority research program, 80 ME). I am member of the Physical And meNtal Health thematic working group (PAN-Health TWG) from the European College of Neuropsychopharmacology (ECNP). I specialize in Health Services Research (HSR) and Quality of Life, with a particular emphasis on mental health. My work encompasses developing and utilizing patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs), integrating the viewpoints of patients to inform health policy decisions. I also analyze real-world data to study the organization of care and the quality of care using French national medical-administrative databases (PMSI, SNDS). Additionally, I conduct systematic literature reviews and meta-analyses. I've led several national and European projects, including EHDEN and THCS. I pioneered the development of a digital platform to measure PREMs and PROMs using computerized adaptive testing, which has been instrumental in gaining insights into patient experiences, treatment efficacy, and overall quality of care. I spearheaded the most extensive French study on the well-being of Healthcare workers, known as AMADEUS. Together with my team, we have rolled out innovative healthcare interventions in underserved communities, such as the Housing First model. I have established research programs with international collaborations, notably with Germany (Prof. Christoph Corel), Canada (Prof. Marco Solmi), Chile (Prof. A Caqueo-Urizar), South Korea (Prof. Dong Keon Yon), and Vietnam (Prof. Bach Tran), leading to publications in top-tier journals. I have over 400 publications (H-index=54). I am Deputy Editor of the French Journal of Public Health: Journal of Population Health and Epidemiology. I teach courses on patient reported outcomes, epidemiology and meta-analysis (Master of Public Health and Medical Studies).
There is now a wealth of evidence showing that work is a major determinant of physical and mental health. Recent studies have suggested increased rates of depression in healthcare workers (HCWs) in the context of the Covid-19 pandemic, with direct impact on care quality and productivity.
The objective of this study was to determine the rate of clinical depression in a national sample of HCWs in France during the post-Covid-19 area and to identify related factors (professional, individual and health-related risk behaviors) using a structural equation modeling analysis.
We performed a survey comprising a number of standardized scales that was sent to public and private national healthcare facilities through the mail or disseminated through emails from professional associations and social networks. We used structural equation modeling (SEM), which is a useful statistical procedure, to test a theory involving non-straightforward relationships and is therefore well suited to the management of cross-sectional data for inferential purposes. A total of 10,325 participants were recruited; 3122 (30.2%, 95% confidence interval [29.4-31.1]) met likely diagnostic criteria for clinical depression. Professional factors had the largest total effect (β = 0.57) (burn-out: β = 0.74, sustained bullying at the workplace β = 0.48 and decision-making latitude β = -0.47), followed by individual factors (β = 0.30) (the main individual factor was recurrent major depression, path coefficient = 0.67). Professional factors had both a direct (path coefficient = 0.38) and indirect (through health risk behaviors, path coefficient = 0.19) effect on depression. Individual factors had a direct (path coefficient 0.21) and indirect (through health risk behaviors (path coefficient = 0.09) effect on depression. Health risk behaviors had a direct effect on depression (path coefficient = 0.31). In conclusion, these results provide potential explanations for the likely causes of poor psychological health among HCWs. We propose several potential interventions related to professional factors and health risk behaviors.
Our results suggest that improving organizational issues, reducing exposure to potentially morally injurious events, promoting brief naps at work and provision of evidence-based prevention approaches have been reported to be helpful in supporting the mental health of hospital staff (not only relaxation or stress management but training in leadership aspects, increasing the knowledge and practice of giving efficient performance feedback, reducing conflicting demands and peer support programs such as Trauma Risk Management.
Our data suggest that developing caregivers reported experience and outcome measures (CREMs/CROMs) would be helpful to monitor work environment and its effect on depression in healthcare workers.