IES Distress Scale Scores
A large portion of participants had symptoms of distress (210 [60.2%]), with 32.7% of all participants in the mild range, 20.9% in the moderate range, and 6.6% in the severe range. Females reported experiencing higher symptoms of distress compared to males (p=0.001,Table 2A ). Compared with those working in states with less than 20,000 positive cases, participants working in states with greater than 20,000 positive cases were significantly more likely to experience symptoms of distress on the IES (p=0.027). Compared to those working in states with less than 1,000 deaths reported, participants working in states with greater than 1,000 reported deaths were also significantly more likely to experience symptoms of distress on the IES (p=0.013) (Table 2B ).
The median (IQR) score on the IES for distress was 13.0 (3.0-27.0). The median (IQR) scores for the two sub-scores that comprise the distress score were 6.0 (2.0-13.0) for intrusive symptoms and 6.0 (1.0-14.0) for avoidance symptoms. Similar to findings in severity of symptoms, female participants had higher scores compared to males (19.0 [8.0-31.0] for females vs. 10.0 [2.0-22.2] for males; p<0.0005;Table 3A ). Those who worked in a state with greater than 20,000 cumulative positive cases had significantly increased scores of distress compared to those who worked in a state with fewer than 20,000 positive cases (17.0 [5.0-29.0] vs. 10.0 [3.0-27.0]; p=0.021), and this was also reflected in the two distress sub-scores (intrusive and avoidance). Working in a state with greater than 1,000 deaths had significantly increased scores of distress compared to working in a state with fewer than 1,000 deaths (17.0 [5.0-29.0] vs. 10.0 [2.0-27.0]; p=0.014), and this was also reflected in the two distress sub-scores. Lastly, geographic region was associated with significant differences in the intrusive sub-score of distress (Midwest 5.0 [1.0-13.0], Northwest 8.0 [3.0-15.0], South 3.0 [1.0-11.0], West 6.0 [1.0-13.0]; p=0.021) (Table 3B ).
Multivariable logistic regression analysis also showed that females and physicians working in a state with greater than 20,000 positive cases were associated with increased presence of symptoms of distress (Table 4 ). Compared to males, females were more likely to report symptoms of distress (OR 2.68, CI [1.64-4.37]; p<0.0005). Compared to physicians working in a state where the number of positive COVID-19 cases was less than 20,000, those working in a state where the positive case number exceeded 20,000 were more likely to have symptoms of distress (OR 2.01, CI [1.22-3.31]; p=0.006).