Psychological Trauma: Theory, Research, Practice, and Policy; Dana Rose Garfin, Lindita Djokovic, Roxane Cohen Silver and E. Alison Holman; Published May 2022;


Health care and non-health care essential workers working in face-to-face interactions during the coronavirus disease 2019 (COVID-19) pandemic may be vulnerable to psychosocial distress. Limited empirical research on COVID-19-related psychosocial outcomes has utilized probability-based samples including both health care and non-health care essential workers.


We surveyed a sample of 1,821 United States self-identified essential workers, collected using probability-based methods, working in face-to-face interactions during the early phase of the COVID-19 outbreak (March 18, 2020 through April 18, 2020), in three consecutive 10-day cohorts. We assessed acute stress, health-related worries, and functional impairment. Demographics, secondary stressors (lack of childcare or health care, lost wages), and pre-COVID-19 mental and physical health were examined as predictors of psychological outcomes.


Acute stress (β = .08, p = .001), health-related worries (β = .09, p = .001), and functional impairment (β = .05, p = .034) increased over time in the early weeks of the outbreak. Health care essential workers reported lower functional impairment (β = −.06, p = .009) and acute stress (β = −.06, p = .015) compared with non-health care essential workers. Across the sample, prior mental and physical health ailments, inability to obtain health care, lost wages, younger age, female gender, and Hispanic ethnicity were associated with acute stress (βs = −.14 to .15, ps ≤ .001), health-related worries (βs = −.09 to .14, ps ≤ .001), and functional impairment (βs = −.08 to .16, ps ≤ .006). Lack of childcare (β = .09, p < .001) was positively associated with acute stress.


Non-health care essential workers may be vulnerable to negative psychosocial outcomes. Targeted training and support may help facilitate coping with the effects of working in-person during the ongoing COVID-19 pandemic. Findings may help inform intervention efforts, critical as COVID-19 becomes endemic and society must learn to live with its evolving variants.

Clinical Impact Statement

Prior literature has documented health care essential workers’ adverse psychological responses during viral outbreaks including coronavirus disease 2019 (COVID-19); non-health care essential workers have been understudied. Between March 18, 2020 and April 18, 2020, we surveyed 1,821 United States residents (a subsample of a nationally representative sample of 6,514) still working in-person during the COVID-19 pandemic. Demographics, secondary stressors, non-health care occupation, and mental/physical health history were positively associated with acute stress, health-related worries, and functional impairment. As society adapts to COVID-19 and its evolving variants, essential workers may continue to be vulnerable. Adequate protection, targeted psychosocial services, and appropriate preparation for future outbreaks is crucial.