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Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic

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Abstract

Background

Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs).

Objective

To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout.

Design

A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022.

Participants

Frontline HCWs at an urban tertiary care hospital in New York City.

Main Measures

Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout.

Key Results

Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced “quite-a-bit to extreme” SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001).

Conclusions

Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.

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Data Availability

The datasets generated during this research are not publicly available due to the confidential nature of the data with respect to mental health outcomes and their relationship to work but may be available upon reasonable request from the corresponding author.

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Acknowledgements

The authors wish to thank all the participants at the Mount Sinai Hospital who completed the survey as well as the Office of the Dean who supported this work.

Funding

This study was supported by internal funding devoted to COVID-19-related projects from the Icahn School of Medicine at Mount Sinai.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Michelle Tong MD, MS, Alicia Hurtado MD, Adriana Feder MD & Jordyn H. Feingold MD, MAPP, MSCR

  2. Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA

    Michelle Tong MD, MS, Alicia Hurtado MD, Celestine He BA, Carly Kaplan BS, Sabrina Kaplan BA, Saadia Akhtar MD, Jonathan A. Ripp MD, MPH & Lauren A. Peccoralo MD, MPH

  3. Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Richa Deshpande MPH

  4. Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA

    Richa Deshpande MPH

  5. U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA

    Robert H. Pietrzak PhD, MPH

  6. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Robert H. Pietrzak PhD, MPH

  7. Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA

    Robert H. Pietrzak PhD, MPH

  8. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Saadia Akhtar MD

  9. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Jonathan A. Ripp MD, MPH & Lauren A. Peccoralo MD, MPH

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  1. Michelle Tong MD, MS
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Corresponding author

Correspondence to Lauren A. Peccoralo MD, MPH.

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Conflict of Interest

Dr. Lauren Peccoralo received honoraria for speaking engagements at a number of academic medical centers and medical societies. Dr. Jonathan Ripp received honoraria for numerous speaking engagements at professional societies, academic medical centers, healthcare institutions; worked as a consultant for the well-being program at the NYU School of Medicine Long Island; served as a nonfiduciary board member of the Lorna Breen Foundation; and served on a temporary advisory board established by PEPSICO to inform employee well-being efforts. Dr.’s Peccoralo and Ripp are currently investigators on a HRSA training grant. Dr Jordyn Feingold recieved a TL1 grant, consults with BetterUp Coaching and receives royalties for her book. Dr Adriana Feder is an investigator on two CDC-Niosh grants, Dr Robert Pietrzak is a paid consultant to the Office of Well-Being and Resilience at the Icahn School of Medicine at Mount Sinai. All other authors report no conflicts of interests for this work.

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This work was presented at the International Conference of Physician Health in Orlando, FL, on October 14, 2022.

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Tong, M., Hurtado, A., Deshpande, R. et al. Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic. J GEN INTERN MED 39, 450–459 (2024). https://doi.org/10.1007/s11606-023-08422-x

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