Psychological support for health care workers during the COVID-19 pandemic
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* Molyn Leszcz
* Robert Maunder
* Jon Hunter

We read with great interest the article by Wu and colleagues on mitigating the psychological effects of coronavirus disease 2019 (COVID-19) on health care workers.1 In our work providing psychological support to health care colleagues during this pandemic, we have found the following 5 principles helpful in organizing our responses.

1.  Pandemics can cause enduring distress in health care workers and even disengagement from the profession.2 Concerns include capacity to care effectively, access to personal protective equipment (PPE) and personal safety, risk to family, (re)deployment, ethics of care dilemmas, moral distress, stigma, loss and grief.

2.  Social integration reduces stress and strengthens morale, particularly with physical distancing and PPE use.3 Group support, in person or online, should focus on safety enhancement, calming, efficacy of individuals and the team, connectedness, and realistic hope for the present and the future.4 We aim to ensure any individual’s confidentiality but secure permission to use broad themes for advocacy and system change.

3.  Severe stress impairs the capacity to recall how to cope and maintain personal well-being. Make the implicit more explicit.5 Consider coping as 3 foci with matching aims and strategies: problem-focused coping — fix what is fixable, learn about stress management and self-care, and improve interpersonal communication; emotion-focused coping — use social support and emotional ventilation; and meaning-focused coping — engage health care workers’ moral purpose and spirituality.6

4.  Leadership must demonstrate the organization’s valuing of health care workers. Trust is built on organizational justice — how decisions are made and how people are treated. Leadership presence, competence, integrity and benevolence promote trust. Timely, relevant and transparent communication reduces fear and mistrust.

5.  This unprecedented crisis reflects both danger and opportunity. The capacity to hold both in mind promotes individual and organizational resilience. Fostering psychological safety today enhances health care workers’ engagement and future well-being. It builds our capacity to “be better after.”

## Footnotes

*   **Competing interests:** None declared.

## References

1.  Wu PE, Styra R, Gold WL. Mitigating the psychological effects of COVID-19 on health care workers. CMAJ 2020;192:E459–60.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTkyLzE3L0U0NTkiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTkyLzI0L0U2NjAuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Maunder R, Hunter J, Vincent L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168:1245–51.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTY4LzEwLzEyNDUiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTkyLzI0L0U2NjAuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  Southwick SM, Southwick FS. The loss of social connectedness as a major contributor to physician burnout: applying organizational and teamwork principles for prevention and recovery. JAMA Psychiatry 2020 Feb. 19 [Epub ahead of print]. doi: 10.1001/jamapsychiatry.2019.4800.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1001/jamapsychiatry.2019.4800&link_type=DOI) 

4.  Hobfoll SE, Watson P, Bell CC, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry 2007;70:283–315, discussion 316–69.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1521/psyc.2007.70.4.283&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=18181708&link_type=MED&atom=%2Fcmaj%2F192%2F24%2FE660.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000252236600001&link_type=ISI) 

5.  Maunder RG, Leszcz M, Savage D, et al. Applying the lessons of SARS to pandemic influenza: an evidence-based approach to mitigating the stress experienced by healthcare workers. Can J Public Health 2008;99:486–8.
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=19149392&link_type=MED&atom=%2Fcmaj%2F192%2F24%2FE660.atom) 

6.  Folkman S, Greer S. Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other. Psychooncology 2000;9:11–9.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1002/(SICI)1099-1611(200001/02)9:1<11::AID-PON424>3.0.CO;2-Z&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10668055&link_type=MED&atom=%2Fcmaj%2F192%2F24%2FE660.atom)