Nurses with depression more likely to be hospitalized with COVID-19: Study

Nurses struggling with depression or loneliness showed a greater risk of being hospitalized for COVID-19, according to a new study.

Researchers from the Harvard T.H. Chan School of Public Health examined data from nearly 55,000 female nurses, including more than 3,600 who tested positive for COVID-19, between April 2020 and April 2021.

The study, published in Psychological Medicine, showed those who had reported long-term depression before the pandemic were 72% more likely to be hospitalized after contracting COVID-19.

Nurses who said they had feelings of loneliness were 81% more likely to be hospitalized with COVID-19 than those who did not report similar feelings. Nurses who had likely indicators of depression were 81% more likely to require hospital care after being infected.

In addition, nurses who reported they were very worried about COVID-19 had a 79% increase in risk for hospitalization.

Depression, loneliness and worry about COVID-19 were as closely associated with a higher risk of hospitalization as some well-known physiological risk factors, including high cholesterol and hypertension, the researchers found.

Harvard researchers were surprised to see such a close association between depression and loneliness and patients requiring hospital care for COVID-19, said Siwen Wang, the lead author of the study.

“I think the most important takeaway is how mental health is underrecognized and how it is strongly predictive of your future health,” said Wang, a research fellow at Harvard’s School of Public Health.

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Psychological factors merit attention

The National Institutes of Health financed the study. Valerie Maholmes, chief of the National Institute for Child Health and Human Development’s Pediatric Trauma and Critical Illness Branch, said the study sheds light on the importance of considering the tie between psychological distress and greater health challenges for those with COVID-19.

“It really underscores the importance of looking at not only physical health conditions but looking at the psychological factors that may contribute to poor outcomes and health challenges,” Maholmes said. (While the NIHCD funded the research, Maholmes did not participate in the study itself.)

Andrea Roberts, a senior research scientist at Harvard’s School of Public Health and the leader of the study, said there hasn’t been a great deal of attention paid to psychological factors and their ties to physical illness. The study suggests treating depression could reduce risks of hospitalization for COVID-19, and possibly other illnesses.

“A lot more could be done in this area,” said Roberts.

Nurses, and healthcare workers in general, have struggled mightily since COVID-19 arrived in early 2020. Up to 40% of all nurses have indicated they could walk away from their practice within two years, according to a study published by Mayo Clinic Proceedings. More than 1 in 5 doctors in that same survey said they may leave their practice.

Federal officials have grown increasingly concerned with burnout and the mental health of healthcare workers. Earlier this week, U.S. Surgeon General Vivek Murthy issued an advisory urging health systems to take better care of their staff so the healthcare shortage doesn’t get even worse.

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While the research focused on nurses, Maholmes pointed to the large number of participants, making it a very robust study. She also said the greater risk of hospitalization among those who had not been diagnosed with clinical depression was noteworthy. Health records don’t always indicate signs of depression.

“Sometimes if there’s no clinical diagnosis of depression, there are other signals,” Maholmes said. “There may be some symptomatology or some aspects of loneliness, of sadness.”

“In terms of screening, we need to ask more pointed questions,” she added. Patients could be asked if they feel lonely, for example, to determine if they are struggling with some psychological distress.

Lessons for health leaders

Given the findings involving so many nurses, healthcare leaders should take some lessons from the study, Maholmes said.

Hospital and health system leaders should look at the intensity of the work environment and the hours that nurses are working. Nurses have pushed themselves to the brink, and beyond, working long hours as health systems have grappled with staffing shortages.

“Healthcare leaders need to check in with their staff regularly to determine to what extent the environment is triggering these feelings of loneliness and depression,” Maholmes said.

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Healthcare organizations should utilize peer support groups so nurses and other clinicians can talk openly about their feelings.

Health system leaders also need to send clear messages to their nurses and other healthcare workers that they can seek help when they need it, such as getting a break or accessing mental health services. A recent survey of nurses found many said their mental health was suffering, but a majority aren’t turning to mental health services.

“We need to step away from these kinds of high-intensity experiences to really assess where we are, to take care of ourselves, to release the trauma,” Maholmes said.

“We can’t do the job as front-line workers without attending to our needs.”

Health systems should consider organizational policies to encourage frontline workers who have experienced a great deal of death and trauma to seek a support group or counselors on staff, Maholmes said. “Sometimes you have to put into policy to manage people’s behavior first,” she said.

The researchers of the study hope their work underscores the need for those who are dealing with depression or loneliness to reach out for help.

“We want to increase public awareness of the importance of mental health,” Wang said.

Roberts also said she hopes more research is done on how improving mental health can lead to better physical health.

At the very least, she hopes it leads to more healthcare workers seeking help if they need it.

“If we can find ways people can talk about their health and well-being, that’s helpful for everyone,” Roberts said.