The government public health workforce and frontline workers reported a higher prevalence of COVID-19-related posttraumatic stress (PTSS) than other US adults, and leaders should invest in systems-level interventions to address the drivers of and potential long-term consequences of PTSS.

Government public health and frontline workers played an essential role in responding to the COVID-19 pandemic, and their mental health suffered in the process. The de Beaumont Foundation and the COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) research team aim to explain and understand these workforces’ experiences with our recently published brief in the Journal of Public Health Management & Practice, “Symptoms of Posttraumatic Stress During the COVID-19 Pandemic in the Governmental Public Health Workforce and General Population.” In the article, we compare the prevalence of COVID-19-related posttraumatic stress symptoms (PTSS) among government public health and frontline workers with estimates in the US general adult population in 2021.

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Using the Public Health Workforce Interest and Needs Survey (PH WINS) and the CLIMB study, which are representative of the public health workforce and the US adult population, respectively, we explore the mental health of the workforce responsible for responding to the COVID-19 pandemic. Our research estimates the prevalence of COVID–19–related PTSS in the government public health workforce and in US adults, assesses differences in reporting PTSS within subgroups, and evaluates whether frontline workers reported higher levels of PTSS than people in other jobs. Using the 4-item Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) to assess symptoms of posttraumatic stress due to the COVID-19 pandemic, we found that state and local government public health workers were more likely to report COVID-related PTSS than the general adult population. Similarly, frontline workers, including home health aides, first responders, social workers, childcare workers, and teachers, were also more likely to report experiencing PTSS than the general public.

WHAT WE FOUND:

• In 2021, 21.1% of adults and 24.7% of the government public health workforce reported three or more posttraumatic stress symptoms, indicating probable PTSD.
• Personal care and service frontline workers had 4.3 times the odds of reporting symptoms of PTSS relative to non-frontline workers.
• Among government public health workers, there were higher odds of reported PTSS among women, young people, and supervisors.

Addressing the mental health of the general public and the public health workforce in particular will not only reduce overall burden of population-level mental illness but will also insulate the country from future traumatic events. Staff turnover in the government public health and frontline workforce remains a top concern for effective operations. One study using PH WINS data predicted that, should current separation trends continue, more than half of the governmental public health workforce will leave their organization by 2025. Moreover, a healthy, robust workforce is critical to public health’s role in advancing health equity; the workforce’s commitment to community engagement while ensuring access to quality care has laid the foundation for public health departments to be at the forefront of advancing equity. Finally, the pandemic is a prime example of how the nation’s safety, security, and economic prosperity depend on a strong health care and public health system. The pandemic resulted in long-term mental and physical ailments, increased mortality, and educational losses that could total trillions of dollars. The public health workforce played a critical role in preventing even more death and disability from occurring, and they will be critical in effective responses to future traumatic events.

Despite the COVID-19 emergency declaration expiring in May 2023, the mental health effects of the pandemic remain and require vigilance to ensure the country is ready to address the next health crisis. Given significant departures in the government public health workforce during the pandemic, workforce planning will need to account for the impact of mental health on workforce size during pandemics and how staff departures could exacerbate mental health challenges. Mental health assessments, treatment, and recovery must be part of preparedness planning moving forward. In addition, public health and health care leaders should invest in systems-level interventions to promote a healthy workplace environment and culture. Addressing and elevating the mental health of the public health workforce will be one step in ensuring a robust response to future large-scale events.

Part of this blog was previously published on the de Beaumont Foundation’s website. To learn more, read our full research brief, “Symptoms of Posttraumatic Stress During the COVID-19 Pandemic in the Governmental Public Health Workforce and General Population” in the January 2024 issue of the JPHMP.

Emma Dewhurst, MPP, is a Research Associate at the de Beaumont Foundation. Her work focuses primarily on the public health workforce. Emma earned her MPP with a concentration in program evaluation and policy analysis from George Washington University and holds a BA in political science from the University of Cincinnati.

Catherine K. Ettman, PhD, is an Assistant Professor in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health. Her work explores population mental health, assets, and policies. Dr. Ettman received her PhD at Brown University and her AB at Princeton University.