Acceptability and delivery of an offer of access to EMDR for depression, posttraumatic stress, and burnout in healthcare workers exposed to COVID-19: a randomized controlled trial within a cohort

Healthcare workers (HCWs) were highly exposed to COVID-19 and often experienced anxiety, depression, burnout, and posttraumatic stress disorder (PTSD). The HARD trial assessed the effect of being offered access to EMDR therapy on HCWs with COVID-19-related psychological symptoms. This cohort-embedded randomized trial enrolled 849 HCWs exposed to COVID-19.

Participants completed online assessments every 3 months for 12 months. Those scoring above predefined thresholds for PTSD, depression, or burnout were randomized (1:1) to an offer of access to EMDR or to usual care alone. Outcomes compared 6-month changes in PTSD, depression, and burnout symptoms, and EMDR compliance was evaluated.

A total of 237 eligible cohort participants were randomized in the HARD trial. Among the 118 subjects of the intervention offer, 73 (62%) consented to EMDR sessions, and of these, 38 (52%) received EMDR sessions (median 7, IQR 4 to 12 sessions). Primary analysis estimated a mean difference between groups from baseline to 6 months post-randomization of -0.61 (p = 0.77) for the PTSD score, -1.17 (p = 0.18) for the depression score, and 0.32 (p = 0.72) for the burnout subdimension.

Improvements favoring the intervention offer group were observed for depressive symptoms and PTSD avoidance at 12 months. In this pragmatic trial, uptake and adherence to an offer of EMDR among symptomatic HCWs were limited. No statistically significant between-group differences were detected in the prespecified six-month primary outcomes, although the study recruited substantially fewer participants than planned and was therefore underpowered, treatment exposure varied substantially, and the intervention was not subject to systematic fidelity monitoring.

These findings primarily provide information about real-world acceptability (a modest 62% consent rate) and delivery (only 52% of consenting participants used the intervention). Our ability to draw conclusions about potential effectiveness of EMDR, if used, however, was limited by the law rate of consent to access the intervention among those offered program access and the law rate of usage among those who did not consent. We would like to express our sincere gratitude to the research team of the CIC1415 for their invaluable contributions to the recruitment and follow-up of participants during the challenging COVID-19 period, especially Amélie Legrand and Carole Le Goas and Anne Rebion for data-management.

We also extend our thanks to Dr Marguerite d’Ussel, Dr Cédric Bornes, Pr Jean-Pierre Quenot and many other colleagues for their support, and to all participating EMDR therapists for their valuable collaboration. CHU de Tours, Centre Régional du Psychotraumatisme CVL, Tours, France Wissam El-Hage, Lyna Chami & Antoine Bray Université de Tours, INSERM, Imaging Brain & Neuropsychiatry iBraiN U1253, Tours, 37032, France CHU de Tours, INSERM, CIC1415, Domaine CIC-PSY, Tours, 37000, France Wissam El-Hage, Laurène Mansy, Valérie Gissot & Agnès Caille SPHERE U1246, Université de Tours, Université de Nantes, INSERM, Tours, France Laurène Mansy, Myriam Blanchin & Agnès Caille Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France Toulouse NeuroImaging Centre, University of Toulouse, INSERM, UPS, Toulouse, France CH Charles Perrens, Centre Régional du Psychotraumatisme, Bordeaux, France Université Angers, LPPL, SFR CONFLUENCES, Service de Psychiatrie, CHU Angers, Angers, France CHU Saint-Etienne, Pôle Universitaire de Psychiatrie, Saint-Etienne, France Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes, 44000, France Université Paris Cité, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l’Adulte, UMR S1266, Institut de Psychiatrie etNeurosciences de Paris, INSERM, Paris, France Laboratoire de Physiopathologie des maladies Psychiatriques, UMR S1266, Institut de Psychiatrie et Neurosciences de Paris, Université Paris Descartes, INSERM, Paris, France CH Charles Perrens, Centre de Référence Régional des Pathologies Anxieuses et de la Dépression, Pôle de Psychiatrie Générale et Universitaire, Bordeaux, France CHU Clermont-Ferrand, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, 63000, France Service de psychiatrie d’urgences, de liaison et de psychotraumatologie, CHRU de Strasbourg; Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France Cellule d’Urgence Médico-Psychologique, Centre Régional du Psychotraumatisme, Hôpital Edouard Herriot, Lyon, France Université de Caen Normandie, CHU Caen, Caen, France The authors declare no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.