What Interventions Can Help Healthcare Workers Cope with Stress During Disasters?

What you need to know

• Healthcare workers face increased risks of mental health issues like PTSD, anxiety and depression during disasters like pandemics
• Cognitive behavioral therapy and other evidence-based approaches show promise for reducing symptoms
• Comprehensive programs that combine mental health support with organizational measures appear most effective
• More high-quality research is urgently needed on the best ways to support healthcare workers’ wellbeing during crises

The mental health toll on healthcare workers

Healthcare workers worldwide have faced unprecedented demands and stresses during the COVID-19 pandemic. They’ve had to cope with heavy workloads, separation from family, fears of infection, ethical dilemmas, and witnessing high levels of suffering and death.

This takes a major toll on mental health. Studies have found elevated rates of post-traumatic stress disorder (PTSD), depression, anxiety, insomnia and burnout among frontline healthcare staff during pandemics and other disasters.

There’s a critical need to find effective ways to support the mental wellbeing of healthcare workers during these crises. Not only is this important for the workers themselves, but maintaining a psychologically healthy workforce is crucial for health systems to be able to respond to the extraordinary demands placed on them during disasters.

Reviewing the evidence on interventions

To help determine what approaches might work best, researchers conducted a systematic review of studies on psychosocial interventions for healthcare workers before, during and after disasters. They looked at interventions aimed at preventing or reducing adverse mental health outcomes or promoting resilience.

The review included 14 studies covering a range of disasters including disease outbreaks like Ebola and SARS, natural disasters like earthquakes and hurricanes, and terrorist attacks. The interventions were delivered at various timepoints - some during the acute crisis and others in the weeks and months after.

Key findings on intervention effectiveness

While the overall quality of evidence was limited, the review did identify some promising approaches:

Cognitive behavioral therapy (CBT) shows benefits

Interventions based on CBT principles were among the most effective, particularly for reducing symptoms of PTSD and anxiety. For example:

• A randomized controlled trial of 12 weekly CBT sessions for healthcare workers involved in the 9/11 World Trade Center response found large reductions in PTSD symptoms.

• A 6-week group CBT program for Ebola treatment center staff in Sierra Leone led to significant and reliable improvements in anxiety.

Comprehensive programs appear most effective

The most promising interventions combined mental health support with broader organizational measures like:

• Infection control training
• Provision of personal protective equipment
• Deployment of additional staff
• Promoting team cohesion and social support

For instance, a comprehensive program in Taiwan that integrated mental health support with these types of organizational measures led to significant reductions in depression and anxiety among hospital staff during the SARS outbreak.

Single-session interventions show limited benefits

Brief, one-off interventions like psychological debriefing or resilience workshops generally showed limited effectiveness for improving mental health outcomes.

Timing and targeting of interventions matters

Interventions delivered after the acute crisis phase allowed for better identification and treatment of the most severely affected workers. Group-based interventions delivered at this stage showed particular promise.

Conclusions and recommendations

• Evidence-based approaches like CBT should be prioritized over single-session or generic “wellbeing” workshops
• Mental health support should be integrated into comprehensive programs that also address organizational factors
• A “screen-and-treat” approach to identify and support the most affected workers may be beneficial
• Digital delivery of interventions may help overcome barriers to access
• Much more high-quality research is urgently needed, particularly on interventions delivered during the acute phase of a crisis

The mental health of healthcare workers is crucial both for their own wellbeing and for health systems to be able to respond effectively to disasters. While more evidence is needed, this review highlights some promising directions for providing much-needed support to these vital workers during times of crisis.