Study: New York City nurses experienced anxiety, depression during first wave of COVID-19

Research highlights how hospitals can support nurses during public health crises to protect their mental health

New York nurses caring for COVID-19 patients during the first wave of the pandemic experienced anxiety, depression, and illness—but steps their hospitals took to protect them and support from their coworkers helped buffer against the stressful conditions, according to a study led by researchers at NYU Rory Meyers College of Nursing. 

“A critical part of the public health response to the COVID-19 pandemic should be supporting the mental health of our frontline workers. Our study demonstrates that institutional resources—such as supportive staff relationships, professional development, providing temporary housing, and access to personal protective equipment—were associated with lower levels of anxiety and depression among nurses,” said Christine T. Kovner, RN, PhD, the Mathy Mezey Professor of Geriatric Nursing at NYU Meyers and the study’s lead author.

The COVID-19 pandemic has strained health systems around the world. The public health crisis has subjected nurses—the largest group of healthcare professionals responding to the pandemic—and other frontline workers to situations of unparalleled stress, as routine roles and responsibilities were disrupted. Not only have nurses worked tirelessly to care for very ill patients, many of whom died, but they themselves have been at risk of exposure to a life-threatening disease and worry about bringing it home to their loved ones. 

Research shows that nurses responding to disasters can experience anxiety and depression, but a variety of factors—both personal and in the workplace—can help nurses cope with, adapt to, and recover from stressful conditions. This study, published in Nursing Outlook, examined what factors helped nurses responding to COVID-19 thrive and what factors may have challenged their mental health.  

Kovner and her colleagues surveyed 2,495 nurses across four hospitals in the New York City area that are part of NYU Langone Health. This study was conducted from May through July 2020, during the first wave of the pandemic. 

Key findings include: 

Anxiety and depression were common among nurses during COVID-19’s first wave. 

• Roughly 27 percent of nurses surveyed reported anxiety and 17 percent reported depression. 
• The more that nurses cared for patients with COVID-19, the higher their depression and anxiety.
• Younger nurses were more likely to be anxious and depressed than were older nurses.
• Nurses working in intensive care units were more likely to be depressed than were those in other settings.

Workplace support protected nurses’ wellbeing. 

• When asked what helped the nurses to carry out their care of patients, the most common responses were coworker support (75 percent), followed by support from family and friends (58 percent).
• More than half of the respondents were assigned to a new unit as part of their hospital’s response to the pandemic. Of those, 77 percent felt that they had received sufficient support from staff at the new unit. 
• Less anxiety and depression were associated with more support in the workplace, better physician-nurse work relations, and access to hospital resources (e.g., adequate personal protective equipment, or PPE). Anxiety and depression were higher among those with more organizational constraints.

Nurses experienced COVID-19’s impact not only at work, but in their personal and home lives as well. 

• Thirteen percent of nurses reported having contracted COVID-19 and 24 percent had family or a close friend with the illness. 
• Almost half of the nurses surveyed had to self-isolate and nearly one in five lived in temporary housing provided by the hospital. 
• Conflict between work and home responsibilities was linked to higher levels of depression and anxiety; residing in temporary housing was linked to lower depression and anxiety.

Nurses valued professional development and training tailored to the pandemic.

• Training in the proper donning, doffing, and disposal of PPE was one of the top factors the majority of nurses identified as helping them care for patients with COVID-19. 
• Having a sense of mastery at work was the most protective factor against depression and anxiety.
• Prior education and experience did not necessarily translate to a pandemic with a novel virus: 24 percent of nurses had prior experience with epidemics, and only 23 percent reported that their nursing education was helpful in caring for COVID-19 patients.

“Hospitals can play a role in building and sustaining resiliency in their workforces by understanding the triggers that contribute to stress, depression, and anxiety, and by developing resources to minimize these factors, particularly during crises,” said Kovner.

In addition to Kovner, study authors include Victoria H. Raveis of NYU College of Dentistry; Nancy Van Devanter, Gary Yu, and Kimberly Glassman of NYU Meyers; and Laura Jean Ridge of the University of Michigan School of Nursing. The research was supported by NYU Langone Health.