Document text
Principal Investigator: Bernard P. Chang
Organization: COLUMBIA UNIVERSITY HEALTH SCIENCES
Fiscal Year: 2024
Award: $756,453
Funding agency: National Heart Lung and Blood Institute
Over the past year, the entire world has been upended by the COVID-19 pandemic. As of February 2021, there
have been over 112 million confirmed cases and over 2.5 million deaths globally. In New York City, the initial
US epicenter of the pandemic, there have been >700,000 cases, >89,000 hospitalizations, and >29,000
deaths. Healthcare workers (HCWs) have experienced alarming rates of anxiety, stress, and insomnia due to
COVID-19, which are likely to persist beyond the pandemic. In the proposed work, we will examine the
presence and predictors of long-term psychological symptoms and the consequences for cardiovascular health
among emergency department (ED) HCWs following the COVID-19 pandemic. This work is necessary to
understand the scope of the problem and to inform efforts to protect the health of these frontline HCWs who
have risked their lives to ensure our safety. Pre-COVID, ED HCWs were already known to be at greater
psychological risk than nearly every other subgroup of clinicians. Psycho-physiologic stress factors have been
dramatically magnified during the COVID period, in what has been referred to as a “parallel pandemic” of
surging mental and physical harm faced by HCWs. It is critical to understand the presence of sustained
psychological symptoms seen in HCWs who treated COVID patients, as well as downstream impacts on
cardiovascular health. Our preliminary work showed that HCWs experienced significant acute psychological
distress during the initial COVID peak in New York City. In a survey of hospital HCWs conducted in April
2020, we found high rates of acute stress disorder (65%), anxiety (36%), and insomnia (70%). Early evidence
points to persistence of psychological symptoms. In these participants, 25% experienced post-traumatic stress
disorder (PTSD) and 39% experienced insomnia at a 10 week follow-up. In the proposed study, we will (1)
examine the prevalence and predictors of sustained psychological symptoms in ED HCWs who provided care
during the COVID pandemic; (2) characterize the relationship of psychological symptoms to 3-year progression
of atherosclerotic cardiovascular disease (ASCVD) risk; and (3) examine a potential protective factor (i.e.,
resilient coping) in the development of COVID-related psychological symptoms. To achieve these aims, we will
conduct a prospective 3-year study of psychological and cardiovascular health in ED HCWs exposed to some of
the highest COVID case rates in the world. At study baseline (Year 0) and at each annual follow-up (Years 1-3),
we will conduct a thorough psychological test battery that includes measures of COVID-related PTSD, COVID-
related fear, insomnia, and resilient coping. Each participant’s ASCVD risk score will be computed annually.
Our primary exposure and predictor of psychological symptoms will be the computed “Covid burden,”
quantified as the number of shifts worked between March 1, 2020 (date of our hospital’s index case) and study
enrollment, in which COVID admissions exceeded 15% of total ED patients. Findings will inform interventions
to protect mental and physical wellbeing in HCWs as we navigate this and future public health crises.
Terms: <Accident and Emergency department><Active Follow-up><Acute><Acute Stress Disorders><Acute crisis reaction><Acute reaction to stress><Acute stress reaction><Address><Admission><Admission activity><American Heart Association><Anxiety><Atherosclerosis><Atherosclerotic Cardiovascular Disease><Buffers><COVID burden><COVID crisis><COVID epidemic><COVID infected patient><COVID pandemic><COVID patient><COVID positive patient><COVID-19><COVID-19 burden><COVID-19 crisis><COVID-19 disease burden><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health burden><COVID-19 health crisis><COVID-19 infected patient><COVID-19 pandemic><COVID-19 patient><COVID-19 period><COVID-19 positive patient><COVID-19 public health crisis><COVID-19 related burden><COVID-19 therapy><COVID-19 treatment><COVID-19 years><COVID19 patient><COVID19 positive patient><CV-19><Cardiovascular><Cardiovascular Body System><Cardiovascular Diseases><Cardiovascular Organ System><Cardiovascular system><Caring><Cessation of life><Coronavirus Infectious Disease 2019><Data><Data Bases><Databases><Death><Development><Disease Outbreaks><ED patient><ER patient><Emergency Department><Emergency Department patient><Emergency Room patient><Emergency room><Enrollment><Ensure><Environment><Exposure to><Fear><Fright><Future><Health Care Providers><Health Personnel><Health protection><Healthcare Providers><Healthcare worker><Heart Vascular><Hospital Admission><Hospitalization><Hospitals><Hour><Individual><Insomnia><Insomnia Disorder><Intervention><Intervention Strategies><Life Expectancy><Link><Long COVID><Long COVID-19><Long coronavirus disease><Long coronavirus disease 2019><Measures><Mental Health><Mental Hygiene><New York><New York City><Outbreaks><PTSD><Participant><Personal Satisfaction><Physicians><Physiologic><Physiologic Psychology><Physiological><Physiological Psychology><Policies><Post-Traumatic Neuroses><Post-Traumatic Stress Disorders><Posttraumatic Neuroses><Prevalence><Psyche structure><Psychic shock><Psychologic Stress><Psychologic Tests><Psychological Health><Psychological Stress><Psychological Tests><Psychophysiological><Psychophysiology><Public Health><Risk><SARS-CoV-2 burden><SARS-CoV-2 disease burden><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 infected patient><SARS-CoV-2 infection burden><SARS-CoV-2 pandemic><SARS-CoV-2 patient><SARS-CoV-2 positive patient><SARS-CoV-2 therapy><SARS-CoV-2 treatment><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Safety><Schedule><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Sleeplessness><Societies><Specialty><Specific qualifier value><Specified><Stress><Subgroup><Survey Instrument><Surveys><Symptoms><Testing><Vaccines><Work><active followup><acute care><acute traumatic stress disorder><atheromatosis><atherosclerotic disease><atherosclerotic vascular disease><cardiovascular disease risk><cardiovascular disorder><cardiovascular disorder risk><cardiovascular health><cardiovascular risk><cardiovascular risk factor><chronic COVID><chronic COVID-19><chronic novel coronavirus disease 2019><circulatory system><coping><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 infected patient><coronavirus disease 2019 pandemic><coronavirus disease 2019 patient><coronavirus disease 2019 positive patient><coronavirus disease 2019 public health crisis><coronavirus disease 2019 therapy><coronavirus disease 2019 treatment><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease infected patient><coronavirus disease pandemic><coronavirus disease patient><coronavirus disease positive patient><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus disease-19 patient><coronavirus infectious disease-19><coronavirus patient><data base><day shift><developmental><enroll><experience><follow up><follow-up><followed up><followup><gross stress reaction><healing><health care personnel><health care worker><health provider><health workforce><healthcare personnel><indexing><infection rate><interventional strategy><long haul COVID><long haul COVID-19><long haul coronavirus disease><long haul coronavirus disease 2019><long-hauler COVID><long-hauler COVID-19><long-hauler coronavirus disease 2019><long-hauler syndrome><long-term COVID><long-term COVID-19><long-term coronavirus disease><long-term coronavirus disease 2019><longterm COVID><longterm COVID-19><longterm coronavirus disease><longterm coronavirus disease 2019><medical personnel><medical specialties><mental><night shift><night work><pandemic><pandemic disease><pandemic effect><pandemic impact><pandemic outcome><pandemic repercussions><patient infected with COVID><patient infected with COVID-19><patient infected with SARS-CoV-2><patient infected with coronavirus disease><patient infected with coronavirus disease 2019><patient infected with severe acute respiratory syndrome coronavirus 2><patient with COVID><patient with COVID-19><patient with COVID19><patient with SARS-CoV-2><patient with coronavirus disease><patient with coronavirus disease 2019><patient with severe acute respiratory distress syndrome coronavirus 2><persistent COVID-19><physical conditioning><physical health><physiopsychology><post COVID syndrome><post COVID-19 syndrome><post acute COVID syndrome><post acute COVID-19><post acute COVID-19 syndrome><post acute SARS-CoV-2><post acute coronavirus disease 2019><post acute coronavirus disease 2019 syndrome><post acute coronavirus disease syndrome><post acute severe acute respiratory syndrome coronavirus 2><post coronavirus disease 2019 syndrome><post coronavirus disease syndrome><post-acute phases of COVID-19><post-trauma stress disorder><posttrauma stress disorder><prolonged COVID-19 symptoms><prospective><protective factors><psycho-physiological><psychologic><psychological><psychological distress><psychological outcomes><psychological symptom><rate of infection><recruit><resilience><resilient><safety net><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><severe acute respiratory syndrome coronavirus 2 infected patient><severe acute respiratory syndrome coronavirus 2 patient><severe acute respiratory syndrome coronavirus 2 positive patient><severe acute respiratory syndrome coronavirus 2 therapy><severe acute respiratory syndrome coronavirus 2 treatment><shift work><shiftwork><traumatic neurosis><treat COVID-19><treat SARS-CoV-2><treat coronavirus disease 2019><treat severe acute respiratory syndrome coronavirus 2><treatment provider><well-being><wellbeing>