The Psychosocial Impact of COVID-19 in Neurology Departments

Leah Croll, MD

Since the beginning of the COVID-19 pandemic, clinicians and researchers have worked countless hours to understand the novel virus and gain knowledge on how to treat patients, all while working to maintain proper protocols to flatten the curve. One aspect of this experience that has gone underreported is the psychosocial impact that the pandemic has had on the hundreds of thousands of front-line healthcare professionals.

Leah Croll, MD, a resident in the neurology department at NYU Langone in New York City, was among many medical trainees who were forced to adapt and take on new roles. She claimed that at times the experience was very stressful, and that fear and anxiety were at a high throughout. In an effort to understand the overall mental health of her peers, she organized a survey that took record of specific psychosocial feelings such as anxiety, fear, and depression. She also asked whether services provided by their institution sufficed in helping calm these feelings.

In part 1 of this interview with NeurologyLive, Croll detailed the findings from the study, as well as her personal experience during the pandemic and why the importance of mental health for clinicians should not go unnoticed.

NeurologyLive: What was the most surprising part of your findings?

Leah Croll, MD: For the physicians in the cities that were first hit by the pandemic, there was this big push to share as much medical knowledge about COVID as we possibly could to help other cities prepare, but what I wasn’t seeing was people sharing information about the medical providers and how it was affecting us and how we were dealing with it. I wanted to send a survey out to understand how people were being affected by this, and how severe it was so that I could share that information with other departments around the country in hopes that it would help them prepare too. I wanted to look at fear, anxiety, and depression. Those were words that were popping up all the time in the hospital for neurologists, doctors, and residents. I thought it was really important to try and get a sense of how many of us were really feeling that burden. I surveyed both faculty and residents in the department, and overall everyone sort of reported increased fear, anxiety, and depression.

The results showed that 79% and 83% of my respondents expressed they were dealing with fear and anxiety, which is a huge number. For depression, 38% of people felt as though they might be struggling with depression as a result of the pandemic. What was most interesting to me is that there was no significant difference between the resident responders and faculty responders. I thought I might see a little bit of a difference on the resident level because we were more likely to be on the front line. A lot of the time we actually seen the consults in the ER or worked as primary providers in the COVID units themselves. But really, there was no significant difference in the amount of fear, anxiety, and depression from both groups. That told me that we’re all in this together. We’re all feeling it in our own ways, and that’s hugely interesting.

Could you describe your own personal experience being on the front lines during the pandemic?

For me personally, as many know, I’m a resident. The role I took on during the pandemic was to head to the COVID ICU’s I spent a couple of months working as a doctor in the COVID ICU, and then took my neurology hat off and became a medical intensivist temporarily. That was hugely intimidating. For me, it was not my normal field, these patients were super sick, and they were sick in a way that we didn’t know what to expect next. On top of that, we didn’t know what the best thing for these patients was. The combination of having this big unknown disease process and being out of my comfort zone as a neurologist was so anxiety provoking.

I also had a lot of fear around getting COVID, and ultimately, I did get COVID. That was another set of fears that would affect me during the pandemic. I saw patients get so sick and would become worrisome that I too would get sick, and possibly spread COVID to my friends, family, or colleagues. I felt a lot of sadness and shock at the amount of death and tragedy that we were seeing. Of course, as doctors we know to expect that patients will have bad outcomes, even if we do the best that we can possibly do for them. But to see the amount of deaths on the scales that we did in the pandemic was beyond words in terms of how that affected each of us individually. It really was an individual experience and each person was affected differently. You’ve heard a bit about my experience but for others they may be a homeschool teacher and have to take care of kids in a different setting. For some other clinicians they may have to see 20 patients on tele visits each day and deal with all the challenges that come with that. That’s just 1 example I can think of off the top of my head of how pervasive the effects of this pandemic really were for every single member in our department.

Do you feel as though the psychological impact on clinicians is underreported?

Most of the information that’s coming out about COVID is patient centered, as it should be. It is primarily our job to treat patients, but I think what gets lost in the shuffle a lot of the time is that we can’t be our best physicians if we’re not taking care of ourselves. It’s kind of like that old adage, “you can’t take care of others before you take care of yourself.” In order to find the strength, agility, and courage to step up to this pandemic, we really do need to make sure that we are recognizing and validating all the challenges and psychological burdens that the pandemic is serving us and also start talking about the ways in which we can respond and try curb those effects or at least support each other as we struggle with them.

Transcript edited for clarity.