Health Workers Reported More Burnout and Harassment in 2022 Than in 2018

Health workers were already in a burnout crisis before COVID-19. This CDC Vital Signs report, from the National Institute for Occupational Safety and Health (NIOSH), asks whether the pandemic hit their mental health harder than other workers', and which working conditions made a difference.

In short: from 2018 to 2022, health workers reported more days of poor mental health, more burnout and more harassment. Those who trusted management, got help from supervisors and had enough time to do their work were much less likely to report burnout.

Why health work is hard on the mind

Health occupations — clinicians, but also people in mental health, public health, long-term care and support roles — bring taxing work, exposure to infectious disease, long hours and difficult dealings with coworkers, patients and families. Long exposure to stressful conditions, such as having no say in decisions or no supportive supervision, strains mental health, and during the pandemic it helped drive health workers out of their jobs. Depressive disorders are a leading cause of disability and, for workers, bring more absenteeism and more presenteeism (working while ill). In 2021, one in four U.S. essential workers, health workers included, had been diagnosed with a mental disorder since the pandemic began.

Health workers' rate of work-related injury and illness rose 249% from 2019 to 2020. Staff shortages, heavy patient loads, supply shortages, fatigue and grief deepened burnout — feeling emotionally exhausted and detached, with little sense of accomplishment. Harassment and violence from patients and coworkers also rose, raising the risk of depression, anxiety, post-traumatic stress and suicidal thoughts.

The survey

The data come from the Quality of Worklife module of the nationally representative General Social Survey, asked of adults who had worked in the previous two weeks: 1,443 workers in 2018 (226 health workers) and 1,952 in 2022 (325 health workers), compared with other essential workers and all other workers. Burnout was one question about feeling "used up"; anxiety and depression symptoms, asked only in 2022, came from a standard four-item screening questionnaire.

What changed for health workers, 2018 to 2022

• In 2022 all three groups reported about the same number of poor mental health days (4.1–4.5), but only health workers' count rose significantly.
• 45.6% of health workers felt burnout often or very often in 2022.
• 44.2% were somewhat or very likely to look for a new job — while among all other workers, "very likely" fell from 18.6% to 13.7%.
• Harassment more than doubled.
• Most health workers still agreed or strongly agreed that they trusted management (78.2%) and that conditions supported productivity (81.5%).
• The share who felt very happy did not change significantly for health workers, but fell for other essential workers (33.9% to 20.5%) and all other workers (33.6% to 26.3%).
• Health workers reported less presenteeism in 2022 (27.9%) than other essential workers (43.2%) and all other workers (37.4%).

Working conditions that mattered

Among health workers in 2022, compared with those without each condition:

A psychosocial safety climate is how far management puts workers' psychological health and stress prevention first.

What employers can do

Changing the organisation — for instance more support from managers — works better against job stress than screening for stressors or teaching individuals to manage stress. Training managers in mental health awareness, in supporting workers and in safety culture shows promise. Productivity-friendly conditions and trust in management may be easier to fix than staffing, which is hard where resources are tight. Employers can also improve security against violence, bring workers into decisions and reduce workloads; the International Organization for Standardization publishes guidance on managing psychosocial risks at work.

NIOSH's national campaign Impact Wellbeing gives employers of health workers resources built on prevention: involving workers in decisions, supportive supervision, and making it psychologically safe to ask for help. NIOSH has also developed burnout-prevention training for supervisors of public health workers. As the U.S. Surgeon General's 2022 advisory Addressing Health Worker Burnout also stresses, the aim is to fix the work environment, not to ask workers to be more resilient or to solve the problems themselves.

Limits

The data are cross-sectional, so they cannot show cause; they are self-reported; the 2022 survey mixed in-person, telephone and web interviews where 2018 was in person only; weighting did not adjust for industry, occupation or work setting; the 2022 health-worker sample was small; and anxiety and depression were not measured in 2018.

Sources

• Nigam JAS, Barker RM, Cunningham TR, Swanson NG, Chosewood LC. "Vital Signs: Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health — Quality of Worklife Survey, United States, 2018–2022." MMWR, CDC; posted as an Early Release on October 24, 2023. https://www.cdc.gov/mmwr/volumes/72/wr/mm7244e1.htm
• Graphic: CDC Vital Signs.
• Rewritten in hubnx's own words.