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Letters to the Editor
Published Online: 1 February 2021

Anxiety Levels Among Physician Mothers During the COVID-19 Pandemic

Elizabeth Linos, Ph.D., Meghan C. Halley, Ph.D., Urmimala Sarkar, M.D., Christina Mangurian, M.D., M.A.S., Hala Sabry, D.O., Kristan Olazo, M.P.H., Kusum S. Mathews, M.D., Lisa Diamond, Ph.D., Monika K. Goyal, M.D., M.S.C.E., Eleni Linos, M.D., Dr.P.H., and Reshma Jagsi, M.D., D.Phil. [email protected]Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 178, Number 2
https://doi.org/10.1176/appi.ajp.2020.20071014
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To the Editor: Physicians experience burnout and anxiety in the course of their work. Public health emergencies may exacerbate burnout and anxiety. Recent research from China has found that anxiety among health care workers during the COVID-19 pandemic was disproportionately experienced by women (1). Previous studies consistently demonstrate higher levels of burnout among women (2). Scholars have emphasized the importance of investigating the experiences of women and mothers (3) because work-related and childcare disruptions from the pandemic may disproportionately affect women.
To quantify the mental health impact of the COVID-19 pandemic on a predominantly U.S. cohort of physician mothers, we surveyed the Physician Moms Group on Facebook from April 18 to April 29, 2020, after receiving approval from the institutional review board at Stanford University. We used standard scoring for the Generalized Anxiety Disorder 7-item scale (GAD-7) and defined frontline workers as those who had cared in person for a patient with presumed or confirmed SARS-CoV-2 infection within the last 14 days.
In a multivariable linear regression model of anxiety, we included the following theoretically relevant covariates: frontline worker status, whether the respondent was an informal caregiver (defined as having provided regular care or assistance to a friend or family member who had a health problem or disability in the past 30 days), and key demographic variables (race, ethnicity, age, child younger than age 6, age of youngest child, and medical specialty).
Of 1,809 participants, 41% scored above the cutoff points for moderate or severe anxiety as measured by the GAD-7, with 18% reporting severe anxiety. The median GAD-7 score was 8.0 (interquartile range=6.0–13.0). Multivariable analysis revealed that anxiety was higher among frontline workers than among those who were not frontline workers (46% compared with 37%, respectively; β=0.80, p=0.01) and informal caregivers (β=0.873, p=0.02) and lower among Asian respondents (β=−1.1, p<0.004). No other key demographic variables were associated with differences in anxiety levels.
In summary, rates of anxiety among physician mothers in this study appear substantial; for context, in the general U.S. population in normal circumstances, about 19% of adults had any anxiety disorder in the past year (4).
Although this study is limited by the possibility of bias due to nonresponse and its focus on an online group of physician mothers, it offers intriguing evidence to motivate further research. More research is necessary to determine anxiety among nonparents and other genders during the COVID-19 pandemic. Nevertheless, given that half of the U.S. medical student class is now female and that women constitute the majority of young U.S. physicians in most racial groups (5), this study calls attention to the mental health needs of physician mothers, particularly in a time of public health crisis.

Acknowledgments

The authors thank Vanessa Nava and Nick Riano for technical support and Rochelle D. Jones for administrative support.

Footnotes

The content of this letter is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
Drs. Eleni Linos and Reshma Jagsi are joint senior authors.

References

1.
Lai J, Ma S, Wang Y, et al: Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020; 3:e203976
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2.
National Academy of Medicine: Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC, National Academy of Sciences, 2019. https://nam.edu/wp-content/uploads/2019/10/CR-report-highlights-brief-final.pdf
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3.
Wenham C, Smith J, Morgan R, et al: COVID-19: the gendered impacts of the outbreak. Lancet 2020; 395:846–848
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4.
National Comorbidity Survey. Boston, Harvard Medical School, 2007. https://www.hcp.med.harvard.edu/ncs/ftpdir/table_ncsr_12monthprevgenderxage.pdf
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5.
Association of American Medical Colleges: Diversity in Medicine: Facts and Figures 2019. Washington, DC, AAMC, 2020. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019
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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 178 • Number 2 • February 01, 2021
Pages: 203 - 204

History

Accepted: 28 September 2020
Published online: 1 February 2021
Published in print: February 01, 2021

Keywords

  1. Coronavirus
  2. COVID-19
  3. Health Care Workplace
  4. Women
  5. Stress
  6. Anxiety Disorders

Authors

Affiliations

Elizabeth Linos, Ph.D.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
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Meghan C. Halley, Ph.D.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
View all articles by this author
Urmimala Sarkar, M.D.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
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Christina Mangurian, M.D., M.A.S.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
View all articles by this author
Hala Sabry, D.O.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
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Kristan Olazo, M.P.H.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
View all articles by this author
Kusum S. Mathews, M.D.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
View all articles by this author
Lisa Diamond, Ph.D.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
View all articles by this author
Monika K. Goyal, M.D., M.S.C.E.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
View all articles by this author
Eleni Linos, M.D., Dr.P.H.
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
View all articles by this author
Reshma Jagsi, M.D., D.Phil. [email protected]
Goldman School of Public Policy, University of California, Berkeley, Berkeley (Elizabeth Linos); Center for Biomedical Ethics, Stanford University, Stanford, Calif. (Halley); Division of General Internal Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco (Sarkar, Olazo); Department of Psychiatry and Behavioral Sciences and Department of Epidemiology and Biostatistics, Weill Institute for Neurosciences, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (Mangurian); Vituity, Emeryville, Calif., Physician Moms Group, and Physician Digital Services (Sabry); Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York (Mathews); Department of Psychiatry and Behavioral Sciences and Department of Medicine, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York (Diamond); Department of Pediatrics and Department of Emergency Medicine, Children’s National Hospital, George Washington University, Washington, D.C. (Goyal); Department of Dermatology, Stanford University, Stanford, Calif. (Eleni Linos); Department of Radiation Oncology and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor (Jagsi).
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Notes

Send correspondence to Dr. Jagsi ([email protected]).

Funding Information

Dr. Sarkar is supported by NIH grant CA-212294; she has received grant funding from the Agency for Healthcare Research and Quality, Blue Shield of California Foundation, the California Health Care Foundation, the Commonwealth Fund, the Gordon and Betty Moore Foundation, NIH, and the U.S. Food and Drug Administration. Dr. Mangurian is supported by NIMH grant MH-112420 and by grants from the California Health Care Foundation, the Doris Duke Charitable Foundation (grant 2015211), and Genentech. Dr. Mathews is supported by NIH grants HL-130648 and HL-122998. Dr. Diamond is supported by NIH grants CA-008748 and CA-184037. Dr. Goyal is supported by NIH grants HD-070910 and MD-011654. Dr. Eleni Linos is supported by NIH grants CA-225433 and AR-075060.Dr. Sarkar is supported by an unrestricted gift from the Doctors Company Foundation and holds contract funding from AppliedVR, InquisitHealth, and Somnology; she serves as an uncompensated scientific or expert adviser for HealthTech 4 Medicaid and HopeLab; and she has been a clinical adviser for Omada Health and an advisory board member for Doximity. Dr. Mangurian has received speakers honoraria from Uncommon Bold and is an uncompensated founding member of TIME’S UP Healthcare. Dr. Sabry is founder of the Physician Moms Group. Dr. Diamond receives book royalties from Multilingual Matters. Dr. Jagsi has stock options as compensation for her advisory board role in Equity Quotient; she has received personal fees from Amgen and Vizient and grants from Blue Cross Blue Shield of Michigan for the Michigan Radiation Oncology Quality Consortium, the Doris Duke Charitable Foundation, the Greenwall Foundation, the Komen Foundation, and NIH; she has a contract to conduct an investigator-initiated study with Genentech; she has served as an expert witness for Sherinian and Hasso and Dressman Benzinger LaVelle; she is an uncompensated founding member of TIME’S UP Healthcare; and she is a member of the Board of Directors of the American Society of Clinical Oncology. The other authors report no financial relationships with commercial interests.

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