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Psychological distress during the acceleration phase of the COVID-19 pandemic: a survey of doctors practising in emergency medicine, anaesthesia and intensive care medicine in the UK and Ireland
  1. Tom Roberts1,2,
  2. Jo Daniels3,
  3. William Hulme4,
  4. Robert Hirst5,
  5. Daniel Horner1,6,
  6. Mark D Lyttle2,7,
  7. Katie Samuel8,
  8. Blair Graham9,10,
  9. Charlie Reynard11,
  10. Michael Barrett12,13,
  11. James Foley14,
  12. John Cronin15,16,
  13. Etimbuk Umana17,
  14. Joao Vinagre18,
  15. Edward Carlton19,20
  16. on Behalf of the collaborators of TERN, RAFT, PERUKI, ITERN, TRIC, and SATARN
    1. 1 TERN, Royal College of Emergency Medicine, London, UK
    2. 2 Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
    3. 3 Department of Psychology, University of Bath, Bath, Somerset, UK
    4. 4 Statistical Consultant, Oxford, UK
    5. 5 Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
    6. 6 Department of Intensive Care and Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK
    7. 7 UWE Faculty of Health and Applied Sciences, Bristol, UK
    8. 8 Department of Anaesthesia, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
    9. 9 Faculty of Health and Human Sciences, University of Plymouth Faculty of Health and Human Sciences, Plymouth, UK
    10. 10 Emergency Department, Derriford Hospital, Plymouth, UK
    11. 11 Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
    12. 12 Department of Emergency Medicine, Our Lady's Children's Hospital, Dublin, Ireland
    13. 13 Department of Women’s and Children’s Health, University College Dublin, Dublin, Ireland
    14. 14 Department of Emergency Medicine, University Hospital Waterford, Waterford, Ireland
    15. 15 Department of Emergency Medicine, St Vincents University Hospital, Dublin, Ireland
    16. 16 Department of Women's and Children's Health, University College Dublin School of Medicine, Dublin, Ireland
    17. 17 Emergency Department, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
    18. 18 College of Anaesthesiologists of Ireland, Dublin, Ireland
    19. 19 Emergency Department, North Bristol NHS Trust, Westbury on Trym, UK
    20. 20 School of Health and Social Care, University of the West of England Bristol, Bristol, UK
    1. Correspondence to Dr Tom Roberts, Royal College of Emergency Medicine, London, UK; tomkieranroberts{at}


    Objective To quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland.

    Methods Initial cross-sectional electronic survey distributed during acceleration phase of the first pandemic wave of COVID-19 in the UK and Ireland (UK: 18 March 2020–26 March 2020 and Ireland: 25 March 2020–2 April 2020). Surveys were distributed via established specialty research networks, within a three-part longitudinal study. Participants were doctors working in emergency, anaesthetic and intensive medicine during the first pandemic wave of COVID-19 in acute hospitals across the UK and Ireland. Primary outcome measures were the General Health Questionnaire-12 (GHQ-12). Additional questions examined personal and professional characteristics, experiences of COVID-19 to date, risk to self and others and self-reported perceptions of health and well-being.

    Results 5440 responses were obtained, 54.3% (n=2955) from emergency medicine and 36.9% (n=2005) from anaesthetics. All levels of doctor seniority were represented. For the primary outcome of GHQ-12 score, 44.2% (n=2405) of respondents scored >3, meeting the criteria for psychological distress. 57.3% (n=3045) had never previously provided clinical care during an infectious disease outbreak but over half of respondents felt somewhat prepared (48.6%, n=2653) or very prepared (7.6%, n=416) to provide clinical care to patients with COVID-19. However, 81.1% (n=4414) either agreed (31.1%, n=2709) or strongly agreed (31.1%, n=1705) that their personal health was at risk due to their clinical role.

    Conclusions Findings indicate that during the acceleration phase of the COVID-19 pandemic, almost half of frontline doctors working in acute care reported psychological distress as measured by the GHQ-12. Findings from this study should inform strategies to optimise preparedness and explore modifiable factors associated with increased psychological distress in the short and long term.

    Trial registration number ISRCTN10666798.

    • psychology
    • psychology
    • staff support
    • intensive care
    • anaesthesia
    • emergency departments

    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data are available on request to chief investigator. All reasonable requests will be considered and provided as deidentified data.

    This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data are available on request to chief investigator. All reasonable requests will be considered and provided as deidentified data.

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    • Handling editor Katie Walker

    • Twitter @ternfellow, @hirstposition, @rcemprof, @mdlyttle, @katie_samuel_, @timecritical, @PEMDUBLIN, @timburg, @eddcarlton

    • Collaborators Trainee Emergency Research Network Collaborators: L Kane, A Hormis, L Mackenzie, R Hannah, S Sharma Hajela, A Corfield, J Phizacklea, J Maney, K Malik, D Metcalfe, N Mathai, S Timmis, A Sattout, C Williams, S Messahel, R Newport, E Fadden, D Bawden, R McQuillan, A Tabner, B O'Hare, H Malik, S Lewis, C Roe, D Bewick, D McConnell, R Taylor, F Taylor, I Hancock Manthalapo, R Ellis, D Ramesh Babu, S Morgan, S Hartshorn, L Barnicott, M Williams, S Foster, A Charlton, J Browning, L Somerset, L McCrae, C Munday, E Godden, A Turner, A Saunders, R Sainsbury, A Lawrence-Ball, E Williams, R House, S Patil, J Muller, R Stewart, I Skene, M Winstanley, M Lim, N Tambe, H Millar, C Magee, A Rai, D Raffo, K Challen, D Mawhinney, S Currie, B Taylor, M Elkanzi, T Hussan, T Perry, G Pells, W Kan, F Barham, L Brown, F Wood, M Cheema, C Szekeres, A Clarey, R Greenhalgh, A Gulati, S Marimuthu, K Webster, R Macfarlane, A Howson, M Alex, R Doonan, B Shrestha, C Magee, L Stanley, A Trimble, J Gumley, C O’Connell, K Thomas, R Wright, M Anderson, E Colley, C Weegenaar, C Rimmer, J Lockwood, S Pintus, T Mohamed, H Jarman, S Ramraj, V Worsnop, M Mackenzie, S Collins, A Robertson, M Colmar, W Niven, N Masood, M Patel, R McLatchie, S Subramaniam, A Peasley, C Holmes, S Rahman, S Bongale, N Mullen, U Bait, L Armstrong, S Nagendran, A Hay, S Rao, R Mills, F Mendes, J Lowe, P Singh, H Raybould, S Subramaniam, A Ali, T Baron, P Cuthbert, C Ponmani, A McKinney, M Depante, S Taylor, R Sneep, V Talwar, A Brookes, Z Al-Janabi, S Williams, C Leech, A Rainey, J Turner, J Brown, L McKechnie, N Marriage, B Mallon, S Manou, J McLaren, S Hart, Y Moulds, M Elsheikh, L Dunlop, L Cocker, F M Burton, M H Elwan, S Keers, K L Vincent, L Robertson, C Nunn, D Craver, N Sarja, N Moultrie, M Viegas, O Williams, S Graham, S Purvis, E Wooffinden, M Clark, C Reynard, C Davies, N Cherian, S Foreman, A Da-Costa, C Ngua, S Duckitt, J Morgan, J Bailey, N Hoskins, L How, J Fryer, T Hine, R Wright, F Ihsan, L Frost, H Abdullah, P Ellis, K Bader, A Mackay, S Pradhan, K Gray, M Manoharan, M Jacobs Musliam, L Kehler, I Veettil Asif, R Muswell, P Amiri, M Bonsano, S Shrivastava, J Evans, F Raza, E Christmas, S Wilson, K Knight, M Riyat, L O'Rourke, H Knott, K Adeboye, M Ramazany, K Iftikhar, S Langston, R Evans, N Abela, R Darke, L Robinson, R Freeman, D Maasdorp, E Grocholski, H Murphy, K Kaur, H Edmundson, H Cooper, R Das, M Mohammad, C Orjioke, L Harwood, D Worley, K Lines, W Collier, C Thomas, J Everson, D Ranasinghe, N Maleki, S Hall, A Stafford, J Wright, S Gokani, S Hall, M Charalambos, N Ali, A Olajide,J Hunt, C Bi, H Ahmad, J Ng, C Ward, S Naeem, M Khan, A Hill,K Holzman, C Boulind, J Ritchie and A Patton. Ireland Trainee Emergency Research Network Collaborators: M Jee Poh Hock, J Lynch, R O'Sullivan, S Gilmartin, S Uí Bhroin, P Fitzpatrick, A Patton, S Kukaswadia, C Prendergast, A Ahmed, C Dalla Vecchia, M Grummell, I Grossi and B MacManus. Research and Audit Federation of Trainees, Trainee Research in Intensive Care and Specialist Anaesthesia Trainee led Audit and Research Network Collaborators: K Samuel, A Boyle, A Waite, B Johnston, J Vinagre, P Turton, D George, C Battle and J Anandarajah.

    • Contributors TR conceived the idea for the study. TR, EC, JD, MDL and BG were responsible for the initial study design, which was refined with the help of KS, CR, RH, MB and WH. Expert advice on psychological assessment scores was provided by JD. WH provided the statistical plan. TR led the dissemination of the study in UK Adult Emergency Departments, MDL led the dissemination of the study in UK and Ireland paediatric EDs, KS led the dissemination of the study in UK anaesthetic and intensive care unit (ICU) Departments, MB led the dissemination of the study in Ireland EDs, along with JC, JF and EU. JV led the dissemination in Ireland ICUs and anaesthetic departments. TR coordinated study set-up, finalisation of the study surveys and finalisations of study protocols. All authors contributed to the final study design and protocol development, critically revised successive drafts of the manuscript and approved the final version. The study management group is responsible for the conduct of the study.

    • Funding The chief investigator is directly funded as a research fellow by the Royal College of Emergency Medicine. The GHQ-12 is being used under licence from GL assessment; the fee for use of this instrument within all three surveys has been waived. EC is a National Institute for Health Research Advanced Fellow. The study has direct funding from RCEM. Grant code: G/2020/1.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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