Poor physical and mental health is common among Brazilian health workers employed in the public sector during the COVID-19 pandemic, according to a study by researchers at the Federal University of São Carlos (UFSCar) in São Paulo state, Brazil. The survey found that 86% reported burnout and 81% suffered from stress. They slept poorly, became depressed and complained of pain. On the other hand, most said they were happy to provide meaningful services to society.
The study is still ongoing. An analysis of the initial findings is reported in an article published in the journal Healthcare. The initiative as a whole is supported by FAPESP and is now in the final stages of data collection and analysis.
“The paper offers a snapshot of the situation and we cannot blame the pandemic for all the problems we found, but we believe that the particularly severe effects of COVID-19 in Brazil contributed to these very negative results,” said Tatiana de Oliveira Sato, professor of physical therapy in UFSCar’s School of Biological and Health Sciences (CCBS).
“Fatigue, difficult decisions and dramatic experiences have increased due to the pandemic, affecting all healthcare workers, but especially those on the front lines,” Sato said. Brazil has had more health care deaths from COVID-19 than any other country, according to the article.
“The initial idea for the study arose just before the pandemic. Even outside the context of the pandemic, healthcare workers have to deal with a heavy schedule and burden of responsibility. We wanted to assess the effects of all this on their physical and mental health. However, when the pandemic hit, we decided to measure the impact of the public health emergency on the well-being of these workers,” Sato said.
Change course
Initially, the researchers planned to interview volunteers at work. They will all be health workers for SUS, the Brazilian Public Health Service, in São Carlos. However, the formalities needed to prepare for the study (permits, questionnaires, etc.) became irrelevant between late 2020 and early 2021, when the pandemic was raging in Brazil and the vaccine rollout was still in its infancy .
“Instead, we created an online form and expanded our search for respondents across the country,” explained Sato. “Inclusion criteria were working for SUS, over 18 years of age and direct involvement in patient care.”
The form was publicized through social media, emails and newspapers. It contains five questionnaires, each designed to quantify an aspect of the respondent’s life. These include the Copenhagen Psychosocial Questionnaire, the Pittsburgh Sleep Quality Index, the Scandinavian Musculoskeletal Questionnaire, and the Beck Depression Inventory.
The form was 10 pages long. “We estimated it took 20-30 minutes to answer all the questions. Questionnaires were only included in the analysis if they were fully completed,” Sato said. Local respondents also used equipment to measure the amount of physical activity for inclusion in the survey.
Ultimately, 125 healthcare workers took part in the study. The first stage of data collection ran from June 2021 to April 2022. The data published so far represents a baseline and does not yet cover physical activity, but the project calls for four more steps to be completed at three, six, nine and 12 months after the first collection.
“We called this cohort HEROES. We thought a lot about the name because we didn’t want it to be assumed that healthcare workers are superhuman and never get tired or discouraged. The name is intended as a tribute. We also wanted to draw attention to the need to valorize healthcare workers who have been disproportionately affected by the pandemic,” Sato said. About 60 respondents participated in all stages.
Initial findings
The data presented in the article showed a high prevalence of musculoskeletal symptoms: 64% reported neck pain, 62% shoulder pain, 58% upper back pain, and 61% lower back pain.
For Sato, all of this was surely due in large part to the long hours where he was on his feet most of the time, picking up patients and working smoothly. “But mental stress can also cause these types of pain because of the tension it creates in the body,” she noted.
The frequency of psychosocial problems was striking, according to the authors, with stress affecting 81% of participants and 86% suffering from burnout. Symptoms of mild depression were found in 22%, moderate depression in 16% and severe depression in 8%. In addition, 74.4% said they slept poorly.
However, it is still necessary to analyze the development of indicators over time. According to Sato, prevalence rates tend to be lower in studies of other populations. For example, five meta-analyses mentioned in the article found burnout rates ranging from 25% to 37%, while nine such studies found that between 17% and 57% of the respective samples suffered from stress. These proportions are much lower than those reported in the UFSCar researchers’ study.
Workplace climate
Other psychosocial factors were assessed using the Copenhagen Questionnaire, with a large proportion of respondents giving negative ratings to the emotional demands of their work (75%), its pace and intensity (61%) and its unpredictability (47%). These are the psychosocial factors with the worst ratings in the survey.
The proportions reporting abusive behavior were also strikingly high: 15% said they had been the subject of unwanted sexual attention or harassment, while 26% had been threatened, 17% harassed and 9% physically assaulted.
“That’s unfortunate. All these numbers must be zero. Incidents of this kind are unacceptable in any workplace,” Sato said. Younger women report the most sexual harassment, she noted. Threats of violence mainly come from patients and their relatives, while colleagues are more often perpetrators than supervisors.
On the positive side, more than 90% said they found their work very meaningful, and about 80% said they were committed to their work despite the stress.
Limitations and implications
For Sato, the relatively small number of respondents in the first form (125) and the even smaller number (about 60) remaining in the final stage of the survey are limitations because they prevent extrapolation and analysis of data for other regions. “However, the study was valuable because of its depth,” she said.
The information received, she added, is sufficient to lobby the management of SUS and the authorities to improve working conditions. Physically and mentally challenged professionals cannot always provide the best patient care.
“This should lead to increased staffing, better pay, less grueling hours and proper training,” Sato said. Simple things like providing training to staff on the best ways to lift and carry patients without injuring themselves can lead to significant improvements in musculoskeletal outcomes. Similarly, creating support networks would help nursing and other staff cope with the emotional impact. “Health workers need a lot of support. They are people too,” she said.
About the São Paulo Research Foundation (FAPESP)
The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting research in all fields of knowledge by providing scholarships, fellowships and grants to researchers affiliated with higher education and research institutions in the state of São Paulo, Brazil. FAPESP is aware that the best research can only be done by working with the best researchers internationally. It has therefore established partnerships with funding agencies, higher education, private companies and research organizations in other countries known for the quality of their research, and encourages scientists funded by its grants to continue to develop their international collaborations. You can learn more about FAPESP at www.fapesp.br/en and visit the FAPESP news agency at www.agencia.fapesp.br/en to keep up to date with the latest scientific discoveries that FAPESP helps achieve through its many programs, awards and research centers. You can also subscribe to the FAPESP news agency at
Subject of research
people
Title of the article
Poor health among Brazilian healthcare workers: Study design and baseline characteristics of the HEROES cohort
Date of publication of the article
October 20, 2022
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