Nurses with Inadequate PPE Have Increased Mental Health Symptoms

Nurses working without proper personal protective equipment (PPE) during the COVID-19 pandemic have higher rates of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms, reports a study in the November Journal of Occupational and Environmental Medicine.

“Healthcare organizations should be aware of the magnitude of mental health problems among nurses and vigilant in providing them with adequate PPE as the pandemic continues,” according to the new research by Judith E. Arnetz, PhD, MPH, of Michigan State University College of Human Medicine and colleagues.

To assess the impact of PPE shortages on the mental health of US nurses, the researchers analyzed survey responses from 695 members of Michigan nursing organizations. The survey was performed early in the pandemic, when Michigan was among the states with the highest numbers of COVID-19 deaths.

About 40 percent of nurses responding to the survey reported being in frequent contact with COVID-19 patents. Twenty-five percent said that their workplace did not provide them with adequate PPE.

Lack of PPE was associated with increased mental health symptoms. After adjustment for other factors, nurses with inadequate PPE were nearly twice as likely to report symptoms depression or PTSD and two-thirds more likely to report anxiety symptoms.

Frequent exposure to COVID patients was an additional risk factor for anxiety and PTSD symptoms. Younger nurses were also more likely to report anxiety and PTSD, even after adjustment for COVID exposure and PPE availability.

From the start of the pandemic, PPE shortages have compounded the challenges of caring for patients with COVID-19. The new study adds to previous reports from China and Italy showing increased mental health risks among nurses caring for COVID-19 patients.

“These findings point to a need for an organized strategy to survey mental health among nurses and proactively identify those in high-risk groups and in need of support,” Dr. Arnetz and coauthors conclude. “Providing them with appropriate and adequate PPE is a concrete measure that can enable them to work safely and prevent and/or mitigate mental health disorders.”
About the Author
Dr. Arnetz may be contacted for interviews at
ACOEM (, an international society of 4,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.
About the Journal of Occupational and Environmental Medicine
The Journal of Occupational and Environmental Medicine ( is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.


Arnetz JE, Goetz CM, Sudan S, et al. Personal protective equipment and mental health symptoms among nurses during the COVID-19 pandemic. J Occup Environ Med. 2020;62(11):892-897.