Mental Health of Emergency Department Healthcare Workers During COVID-19 in Brooklyn, New York

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Deborah R. Gustafson Recai Yucel Samuel Apple Gianna Cirrone Haoyuan Gao Aaron Huang Xinrui Ma Ayesha Saad Jeremy Wilson Sarah Kabariti Sergey Motov


Background. Maintaining good mental health among Emergency Department healthcare workers (ED HCW) is paramount to well-functioning healthcare. We measured mental health and COVID-19 symptoms in ED HCW at a COVID-19 epicenter.

Methods. A cross-sectional, convenience sample of adult (>18 years) ED HCW in Brooklyn, New York, USA, who were employed at >50% of a full-time effort, was surveyed September–December, 2020 with reference period March-May 2020. An anonymous email-distributed survey assessed gender, age, race, healthcare worker status (clinical versus non-clinical), SARS-CoV-2 testing, number of people to talk to, COVID-19-related home problems, mental health care interruption during COVID-19, loneliness, and survey date. Outcomes included symptoms of depression, psychological distress, perceived stress, post-traumatic stress disorder (PTSD), anxiety, and resilience measured using validated scales.

Results. Of 774 HCW, 247 (31.9%) responded (mean age 38.2±10.8 years; 59.4% White; 52.5% men; 80.1% clinical; 61.6% SARS-CoV-2 tested). Average mental health scores were significantly higher among clinical vs non-clinical HCW (P’s<0.0001-0.019). The proportion reporting a clinically-relevant psychological distress symptom burden was higher among clinical vs non-clinical HCW (35.8% vs 13.8%, p=0.019); and suggested for depression (53.9% clinical vs 35.7% non-clinical, p=0.072); perceived stress (63.6% clinical vs 44.8% non-clinical, p=0.053); and PTSD (18.2% clinical vs 3.6% non-clinical, p=0.064). Compared to non-clinical staff, Medical Doctors and Doctors of Osteopathy reported 4.8-fold higher multivariable-adjusted odds of clinically-relevant perceived stress (95%CI 1.8-12.9, p=0.002); Emergency Medical Technicians reported 15.5-fold higher multivariable-adjusted odds of clinically-relevant PTSD (95%CI 1.6-150.4, p=0.018). Increasing age, number of COVID-19-related home problems and people to talk to, loneliness and mental health care interruption were adversely associated with mental health; being male and SARS-CoV-2 testing were beneficial.

Conclusions. COVID-19-related mental health burden was high among ED HCW in Brooklyn. Mental health support services are essential for ED HCW.

Article Details

How to Cite
GUSTAFSON, Deborah R. et al. Mental Health of Emergency Department Healthcare Workers During COVID-19 in Brooklyn, New York. Medical Research Archives, [S.l.], v. 10, n. 7, july 2022. ISSN 2375-1924. Available at: <>. Date accessed: 08 aug. 2022. doi:
Research Articles


1. Carmassi C, Foghi C, Dell'Oste V, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Res. Oct 2020;292:113312. doi:10.1016/j.psychres.2020.113312
2. Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian J Psychiatr. Jun 2020;51:102119. doi:10.1016/j.ajp.2020.102119
3. Thompson CN, Baumgartner J, Pichardo C, et al. COVID-19 Outbreak - New York City, February 29-June 1, 2020. MMWR Morb Mortal Wkly Rep. Nov 20 2020;69(46):1725-1729. doi:10.15585/mmwr.mm6946a2
4. Bennett CL, Sullivan AF, Ginde AA, et al. National Study of the Emergency Physician Workforce, 2020. Ann Emerg Med. Dec 2020;76(6):695-708. doi:10.1016/j.annemergmed.2020.06.039
5. Emergency/Trauma/Transport Nursing Workforce Study. Executive Summary (Human Resources Research Organization) (2019).
6. Moutier CY, Myers MF, Feist JB, Feist JC, Zisook S. Preventing Clinician Suicide: A Call to Action During the COVID-19 Pandemic and Beyond. Acad Med. May 1 2021;96(5):624-628. doi:10.1097/ACM.0000000000003972
7. Palosky C. KFF/Post survey reveals the serious mental health challenges facing frontline health care workers a year into the COVID-19 pandemic. 2021. April 6, 2021.
8. Alghamdi BS, Alatawi Y, Alshehri FS, Tayeb HO, AboTaleb H, Binsalman A. Psychological Distress During COVID-19 Curfews and Social Distancing in Saudi Arabia: A Cross-Sectional Study. Front Public Health. 2021;9:792533. doi:10.3389/fpubh.2021.792533
9. Ayalew M, Deribe B, Abraham Y, Reta Y, Tadesse F, Defar S. Post-traumatic Stress Disorder Symptoms and Its Predictors Among Healthcare Workers Following COVID-19 Pandemic in Southern Ethiopia: A Cross-Sectional Study. Front Psychiatry. 2021;12:818910. doi:10.3389/fpsyt.2021.818910
10. Carmassi C, Cerveri G, Bertelloni CA, et al. Mental health of frontline help-seeking healthcare workers during the COVID-19 outbreak in the first affected hospital in Lombardy, Italy. Psychiatry Res. Apr 2021;298:113763. doi:10.1016/j.psychres.2021.113763
11. Fari G, de Sire A, Giorgio V, et al. Impact of COVID-19 on the mental health in a cohort of Italian rehabilitation healthcare workers. J Med Virol. Jan 2022;94(1):110-118. doi:10.1002/jmv.27272
12. Hurst KT, Ballard ED, Anderson GE, et al. The mental health impact of contact with COVID-19 patients on healthcare workers in the United States. Psychiatry Res. Feb 2022;308:114359. doi:10.1016/j.psychres.2021.114359
13. Pappa S, Chen J, Barnett J, et al. A systematic review and meta-analysis of the mental health symptoms during the Covid-19 pandemic in Southeast Asia. Psychiatry Clin Neurosci. Feb 2022;76(2):41-50. doi:10.1111/pcn.13306
14. Halms T, Strasser M, Kunz M, Hasan A. How to Reduce Mental Health Burden in Health Care Workers During COVID-19?-A Scoping Review of Guideline Recommendations. Front Psychiatry. 2021;12:770193. doi:10.3389/fpsyt.2021.770193
15. World Population Review. Brooklyn Population 2022. World Population Review. Accessed June 24, 2022.
16. Basic Information about the Built Environment. United States Environmental Protection Agency. Updated June 21, 2022. Accessed June 24, 2022.
17. Chokshi DA, Katz MH. Emerging Lessons From COVID-19 Response in New York City. JAMA. May 26 2020;323(20):1996-1997. doi:10.1001/jama.2020.7310
18. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. Jul 2019;95:103208. doi:10.1016/j.jbi.2019.103208
19. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. Apr 2009;42(2):377-81. doi:10.1016/j.jbi.2008.08.010
20. D'Souza G, Springer G, Gustafson D, et al. COVID-19 symptoms and SARS-CoV-2 infection among people living with HIV in the US: the MACS/WIHS combined cohort study. HIV Res Clin Pract. Oct 2020;21(5):130-139. doi:10.1080/25787489.2020.1844521
21. Hughes AJ, Patel K, Fitzgerald KC, Brown A, Gromisch ES, Mowry EM. Reliability and validity of the multiple sclerosis resiliency scale (MSRS). J Neurol Sci. Nov 15 2020;418:116983. doi:10.1016/j.jns.2020.116983
22. Lewinsohn PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging. Jun 1997;12(2):277-87. doi:10.1037//0882-7974.12.2.277
23. Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. Feb 2003;60(2):184-9. doi:10.1001/archpsyc.60.2.184
24. Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. Dec 2015;28(6):489-98. doi:10.1002/jts.22059
25. Hays RD, Schalet BD, Spritzer KL, Cella D. Two-item PROMIS(R) global physical and mental health scales. J Patient Rep Outcomes. 2017;1(1):2. doi:10.1186/s41687-017-0003-8
26. Sinclair VG, Wallston KA. The development and psychometric evaluation of the Brief Resilient Coping Scale. Assessment. Mar 2004;11(1):94-101. doi:10.1177/1073191103258144
27. Zhang W, O'Brien N, Forrest JI, et al. Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS One. 2012;7(7):e40793. doi:10.1371/journal.pone.0040793
28. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. Dec 1983;24(4):385-96.
29. Warttig SL, Forshaw MJ, South J, White AK. New, normative, English-sample data for the Short Form Perceived Stress Scale (PSS-4). J Health Psychol. Dec 2013;18(12):1617-28. doi:10.1177/1359105313508346
30. The PTSD Checklist for DSM-5 (PCL-5) (U.S. Department of Veterans Affairs) (2013).
31. Shechter A, Diaz F, Moise N, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. Sep - Oct 2020;66:1-8. doi:10.1016/j.genhosppsych.2020.06.007
32. Civantos AM, Byrnes Y, Chang C, et al. Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: National study. Head Neck. Jul 2020;42(7):1597-1609. doi:10.1002/hed.26292
33. Weibelzahl S, Reiter J, Duden G. Depression and anxiety in healthcare professionals during the COVID-19 pandemic. Epidemiol Infect. Feb 9 2021;149:e46. doi:10.1017/S0950268821000303
34. Sasaki N, Asaoka H, Kuroda R, Tsuno K, Imamura K, Kawakami N. Sustained poor mental health among healthcare workers in COVID-19 pandemic: A longitudinal analysis of the four-wave panel survey over 8 months in Japan. J Occup Health. Jan 2021;63(1):e12227. doi:10.1002/1348-9585.12227
35. New York Times. Tracking Coronavirus in New York: Latest Map and Case Count. New York Times.
36. Bernstein CA, Bhattacharyya S, Adler S, Alpert JE. Staff Emotional Support at Montefiore Medical Center During the COVID-19 Pandemic. Jt Comm J Qual Patient Saf. Mar 2021;47(3):185-189. doi:10.1016/j.jcjq.2020.11.009
37. Mellins CA, Mayer LES, Glasofer DR, et al. Supporting the well-being of health care providers during the COVID-19 pandemic: The CopeColumbia response. Gen Hosp Psychiatry. Nov - Dec 2020;67:62-69. doi:10.1016/j.genhosppsych.2020.08.013
38. Richmond JS, Dragatsi D, Stiebel V, Rozel JS, Rasimas JJ. American Association for Emergency Psychiatry Recommendations to Address Psychiatric Staff Shortages in Emergency Settings. Psychiatr Serv. Apr 1 2021;72(4):437-443. doi:10.1176/
39. Ilhan B, Kupeli I. Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study. Am J Emerg Med. Feb 2022;52:99-104. doi:10.1016/j.ajem.2021.11.051
40. Wong AH, Pacella-LaBarbara ML, Ray JM, Ranney ML, Chang BP. Healing the Healer: Protecting Emergency Health Care Workers' Mental Health During COVID-19. Ann Emerg Med. Oct 2020;76(4):379-384. doi:10.1016/j.annemergmed.2020.04.041
41. Dykes N, Johnson O, Bamford P. Assessing the psychological impact of COVID-19 on intensive care workers: A single-centre cross-sectional UK-based study. J Intensive Care Soc. May 2022;23(2):132-138. doi:10.1177/1751143720983182
42. Choi HJ, Yang CM, Lee SY, Lee HJ, Jang SH. Mental Health and Quality of Life for Healthcare Workers in a University Hospital Under COVID-19. Psychiatry Investig. Feb 2022;19(2):85-91. doi:10.30773/pi.2021.0307
43. Diaz F, Cornelius T, Bramley S, et al. The association between sleep and psychological distress among New York City healthcare workers during the COVID-19 pandemic. J Affect Disord. Feb 1 2022;298(Pt A):618-624. doi:10.1016/j.jad.2021.10.033
44. Feingold JH, Hurtado A, Feder A, et al. Posttraumatic growth among health care workers on the frontlines of the COVID-19 pandemic. J Affect Disord. Jan 1 2022;296:35-40. doi:10.1016/j.jad.2021.09.032
45. Hendrickson RC, Slevin RA, Hoerster KD, et al. The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders. J Gen Intern Med. Feb 2022;37(2):397-408. doi:10.1007/s11606-021-07252-z
46. Lange M, Joo S, Couette PA, Le Bas F, Humbert X. Impact on mental health of the COVID-19 outbreak among general practitioners during the sanitary lockdown period. Ir J Med Sci. Feb 2022;191(1):93-96. doi:10.1007/s11845-021-02513-6
47. Niederkrotenthaler T, Laido Z, Kirchner S, et al. Mental health over nine months during the SARS-CoV2 pandemic: Representative cross-sectional survey in twelve waves between April and December 2020 in Austria. J Affect Disord. Jan 1 2022;296:49-58. doi:10.1016/j.jad.2021.08.153
48. Sobregrau Sangra P, Aguilo Mir S, Castro Ribeiro T, et al. Mental health assessment of Spanish healthcare workers during the SARS-CoV-2 pandemic. A cross-sectional study. Compr Psychiatry. Jan 2022;112:152278. doi:10.1016/j.comppsych.2021.152278
49. Sridevi PN, Selvameena M, Priya S, Saleem M, Saran R. A cross sectional study on psychological impact of covid19 on post graduate doctors and Compulsory Rotatory Residential interns in COVID isolation ward of a tertiary care centre, Madurai. Clin Epidemiol Glob Health. Jan-Feb 2022;13:100928. doi:10.1016/j.cegh.2021.100928
50. Van Steenkiste E, Schoofs J, Gilis S, Messiaen P. Mental health impact of COVID-19 in frontline healthcare workers in a Belgian Tertiary care hospital: a prospective longitudinal study. Acta Clin Belg. Jun 2022;77(3):533-540. doi:10.1080/17843286.2021.1903660
51. Marton G, Vergani L, Mazzocco K, Garassino MC, Pravettoni G. 2020s Heroes Are Not Fearless: The Impact of the COVID-19 Pandemic on Wellbeing and Emotions of Italian Health Care Workers During Italy Phase 1. Front Psychol. 2020;11:588762. doi:10.3389/fpsyg.2020.588762
52. Chen C, Guan Z, Sun L, Zhou T, Guan R. COVID-19 exposure, pandemic-related appraisals, coping strategies, and psychological symptoms among the frontline medical staff and gender differences in coping processes. Appl Cogn Psychol. Jan-Feb 2022;36(1):111-120. doi:10.1002/acp.3902
53. Carmassi C, Dell'Oste V, Bui E, et al. The interplay between acute post-traumatic stress, depressive and anxiety symptoms on healthcare workers functioning during the COVID-19 emergency: A multicenter study comparing regions with increasing pandemic incidence. J Affect Disord. Feb 1 2022;298(Pt A):209-216. doi:10.1016/j.jad.2021.10.128
54. Chatterjee SS, Bhattacharyya R, Bhattacharyya S, Gupta S, Das S, Banerjee BB. Attitude, practice, behavior, and mental health impact of COVID-19 on doctors. Indian J Psychiatry. May-Jun 2020;62(3):257-265. doi:10.4103/psychiatry.IndianJPsychiatry_333_20
55. Catabay CJ, Stockman JK, Campbell JC, Tsuyuki K. Perceived stress and mental health: The mediating roles of social support and resilience among black women exposed to sexual violence. J Affect Disord. Dec 1 2019;259:143-149. doi:10.1016/j.jad.2019.08.037
56. Suryavanshi N, Kadam A, Dhumal G, et al. Mental health and quality of life among healthcare professionals during the COVID-19 pandemic in India. Brain Behav. Nov 2020;10(11):e01837. doi:10.1002/brb3.1837
57. De Sio S, Buomprisco G, La Torre G, et al. The impact of COVID-19 on doctors' well-being: results of a web survey during the lockdown in Italy. Eur Rev Med Pharmacol Sci. Jul 2020;24(14):7869-7879. doi:10.26355/eurrev_202007_22292
58. Hagland M. Washington Post/KFF Survey: Fully 29 percent of healthcare workers might leave the field. Hea!thcare Innovation. Nashville2021.
59. Gnanapragasam SN, Hodson A, Smith LE, Greenberg N, Rubin GJ, Wessely S. COVID-19 survey burden for health care workers: literature review and audit. Public Health. May 2022;206:94-101. doi:10.1016/j.puhe.2021.05.006
60. Zhang Q, Dong G, Meng W, Chen Z, Cao Y, Zhang M. Perceived Stress and Psychological Impact Among Healthcare Workers at a Tertiaty Hospital in China During the COVID-19 Outbreak: The Moderating Role of Resilience and Social Support. Front Psychiatry. 2021;12:570971. doi:10.3389/fpsyt.2021.570971
61. Eroglu U, Balci M, Coser S, et al. Impact of the COVID-19 Pandemic on the Psychosexual Functions of Healthcare Workers. J Sex Med. Feb 2022;19(2):182-187. doi:10.1016/j.jsxm.2021.11.013
62. Lopez Steinmetz LC, Herrera CR, Fong SB, Godoy JC. A Longitudinal Study on the Changes in Mental Health of Healthcare Workers during the COVID-19 Pandemic. Psychiatry. Spring 2022;85(1):56-71. doi:10.1080/00332747.2021.1940469