Rural health workers experienced almost the same levels of psychological distress as their urban peers during the first year of the COVID-19 pandemic even without equivalent case numbers, researchers say.

While there was some spread across regional Australia in 2020, the bulk of COVID-19 infections and most serious lockdowns were concentred in major cities like Melbourne and Sydney.

But a recent study suggests that didn’t make the experience was any less emotionally demanding on health workers in smaller towns and cities.

The findings were drawn from an Australia-wide survey of 7846 doctors, nurses and other health workers conducted in late 2020, believed to be the biggest of its kind during the pandemic.

The survey confirmed that metro health workers were far more likely to be working with someone infected with COVID-19 than their rural counterparts (43% vs 22%) and were also more likely to be redeployed by their workplace.

That was where the major differences ended, however.

Anxiety rates were similar at around 60% for both groups and roughly the same number of each said they felt burnt out (57% rural vs 59% metro).

Less than 20% of either group reported no mental health issues at all – with no significant difference between rural and metro areas.

In fact, rural health workers had some unique challenges, particularly around the often limited access to support and access to specialist outside the major cities, the authors wrote in the Australian Journal of Rural Health.

“Although less than a quarter of rural participants worked with COVID-19 patients during this period, their high levels of concern about being blamed by their colleagues if they contracted the disease or concern about transmitting the virus to others in their household were still significantly associated with anxiety, depression and PTSD,” they wrote.

Workplace changes within rural health services were also extensive, the article said.

“This included increased hours (paid or unpaid), changes in income and role changes,” they wrote.

“Such factors might worsen worry, stress or anxiety irrespective of caseload.”

Potential solutions included an increase in workforce capacity in rural areas, improved training and better access to care for rural health workers in particular.

“Concerningly, despite this being a period of low COVID-19 prevalence nationally and extremely low in rural areas, approximately 82% of participants self-reported having experienced mental health concerns during this period of the COVID-19 pandemic, as well as moderate to high levels of self-reported anxiety, burnout and depression,” the authors wrote.

“Health care services throughout rural Australia need to be aware of the widespread mental health impacts of COVID-19 within their health care workforce.”

“This study supports the need for ongoing evidence-based policies and practices to ensure supportive mechanisms and adequate mental health services are in place for prevention, early detection and effective management for adverse psychological effects.”