Health cAre woRkers exposeD to COVID-19

Health care workers working in hospital or nursing home for elderly people involved in the
coronavirus epidemic are facing several challenges such as direct exposure and involvement in
the resolution of major public health emergencies, exposure to potentially fatal
contamination, physical exhaustion, unadjusted work organizations, the unusual number of
deaths among patients, colleagues and close relatives, and significant ethical challenges in
decision-making. Preliminary data from China suggests that frontline and lay professionals
suffer from different types of psychological distress. A study of the mental health of 230
frontline medical staff in the COVID-19 outbreak found a high prevalence of anxiety and
stress disorder (up to 25%).

These data highlight the importance of screening for psychological distress in response to
the scale of the pandemic and the provision of targeted psychological interventions, such as
EMDR (desensitization and neuro-emotional integration by eye movements), to improve the
psychological well-being of healthcare workers exposed to COVID-19. EMDR is a therapy which
for nearly 30 years has demonstrated, through well-conducted international experimental
studies with a high level of evidence including a recent meta-analysis from 2019, its
effectiveness in the treatment of post-traumatic stress disorder and depression. Its use is
recommended by the French National Authority for Health and the World Health Organization. In
France, more than 1,700 therapists practice it. While the evidence for the effectiveness of
EMDR is strong and its feasibility adapted to a crisis such as the COVID-19 pandemic, its use
has not been evaluated at the population level in the context of an exceptional health
crisis.

This project is both a cohort study with the proposal of a randomized trial to evaluate an
intervention adapted to the exceptional circumstances of the crisis. As such, it is designed
as Trial(s) Within Cohort design (TWIC).

In addition, this project is also built to allow health professionals involved in the fight
against COVID-19 to have regular access to self-administered screening with immediate
feedback concerning the most frequent psychological symptoms, this method of screening and
monitoring psychological distress in the context of a pandemic is not currently implemented
in France.

The objectives of the study are as follows:

1. / Create a cohort of French hospital health-care workers and French health professionals
working in nursing home for elderly people involved in the care of COVID-19 patients in
which we will:

- offer a self-administered mass screening test for common psychiatric disorders
likely to occur in this context, and estimate the frequency of occurrence of common
psychological symptoms in the short and long term (depression, burnout,
post-traumatic stress);

- estimate the evolution over a year of the aforementioned symptoms and try to
explain these trajectories.

2. / To evaluate, in a randomized controlled trial, the effectiveness of 12 sessions of a
specific therapeutic intervention combining "EMDR + usual care" compared to "usual care"
alone in eligible participants (those screened positive for psychological symptoms) .