Effects of Persistent Exposure to COVID-19 on Mental Health and Burnout Outcomes Among Trainees: A Longitudinal Study (Preprint)

BACKGROUND The rapid spread of the Coronavirus disease 2019 (COVID-19) has created considerable strain on the physical and mental health of healthcare workers around the world. The effects have been acute for physician trainees—a unique group functioning simultaneously as learners and care providers with limited autonomy. OBJECTIVE To investigate the longitudinal effects of physician trainee exposure to patients being tested for COVID-19 on stress, anxiety, depression and burnout using three surveys conducted during the early phase of the pandemic. METHODS All physician trainees (N=1375) at an academic medical center were invited to participate in a web-based survey. Multivariable models were used to assess the relationship between repeated exposure to patients being tested for COVID-19 and stress, anxiety, depression and burnout. RESULTS 389 trainees completed the baseline survey (28.3%). Of these, 191 and 136 responded to the ensuing surveys. Mean stress, anxiety and burnout decreased by 21% (95% Confidence Interval (CI): -28% to -12%; P < 0.001), 25% (95% CI: -36% to -11%; P < 0.001) and 13% (95% CI: -18% to -7%; P < 0.001), respectively per survey. However, for each survey time point, there was mean increase in stress, anxiety and burnout per additional exposure: stress [24% (95% CI: +12% to +38%; P < 0.001)], anxiety [22%, (95% CI: +2% to +46%; P = 0.026)], burnout [18%, (95% CI: +10% to +28%; P < 0.001)]. For depression, the association between exposure was strongest for the third survey, where mean depression scores increased by 33% per additional exposure (95% CI: +18% to +50%; P = CONCLUSIONS Training programs should adapt to address the detrimental effects of the “pile up” of distress associated with persistent exposure through adaptive programs that allow flexibility for time off and recovery.