Depressão e insônia entre trabalhadores da atenção terciária à saúde durante a epidemia de COVID-19

Abstract

Introduction: The health sector has a large contingent of workers, employing more than 4% of formal workers in Brazil. Depression affects 30 to 40% and insomnia 10 to 30% of the population and health workers are among the most affected by these pathologies. Objective: The present study aims to evaluate depression and insomnia among tertiary health care workers when facing COVID-19 in the city of Pelotas/RS, as well as the sociodemographic, behavioral and occupational factors associated with these morbidities. Methods: A cross-sectional study was carried out in a Teaching Hospital (HE) of the Unified Health System (SUS), a reference for the treatment of COVID-19, in a medium-sized city in the south of the country after the first peak of COVID-19 in the municipality. Data collection took place between October and December 2020, including all workers who worked in person during the period of the COVID-19 pandemic. The analysis of factors associated with the depressive episode was carried out using the PHQ-9 instrument (Patient Health Questionnaire-9) and Insomnia using the ISI (Insomnia Severity Index), the analysis was carried out using Poisson regression with backward selection. A systematic review was also carried out on insomnia among frontline workers in health emergency situations, with a meta-analysis on the prevalence of insomnia. Results: A sample of 1159 workers was obtained. The prevalence of major depressive episode (MDE) was 15.4% (95%CI 13.4-17.6) and was higher among young, white, female workers with a family history of depression, residents, nursing professionals, workers who were exposed to three or more situations of moral dilemma and those who had to postpone some physiological need for later. Having a risk factor for COVID-19, being a smoker and being physically inactive were also positively associated with EDM. The prevalence of insomnia was 31.2% (95%CI 28.6-33.9) and it was higher among female workers; those who did not have a partner; professionals with higher education and graduate degrees compared to those without higher education; other health professionals, nursing technicians/assistants, nurses and residents compared to physicians. Active work and high-demand work were associated with a higher prevalence of insomnia. A meta-analysis carried out found a general prevalence of insomnia of 47% (CI 41-53%, I^2 97.09%, p <0.01) and of moderate to severe insomnia of 14% (CI 11-16%, I^ 2 95.05%, p<0.01), no significant difference was observed between professions. Conclusion: The prevalence of mental health problems among health workers is important and is related to several aspects of the work process. Thus, it is necessary to make changes in the organization of work, such as reducing the work demand and expanding control, else than to encourage social support for workers. In addition, it is necessary to guarantee access to health care, in particular mental health care, providing early detection, comprehensive care and prevention of chronic problems that may result from facing the health emergency of COVID-19.