Psychosocial Workloads and Resilience of Heads of Municipal Public Health Authorities in Germany During the COVID-19 Pandemic: Perceptions of Operational Organization, Communication, and Measures

Healthcare professionals are particularly vulnerable to mental health issues during epidemics, as evidenced by the COVID-19 crisis. German public health authorities, crucial for disease prevention, faced significant strain from chronic understaffing and resource limitations exacerbated by the pandemic. The study was designed as a cross-sectional, observational online survey. This study conducted an online needs assessment survey among heads of municipal public health authorities in Thuringia, Saxony, North Rhine-Westphalia, Bavaria, and Berlin between June and November 2023. Of the 191 contacted authorities, 74 responses (38.7%) were analyzed, focusing on professional demands, recognition, stress resilience, general life satisfaction, operational organization, and communication during the pandemic. Validated scales such as ERI, RS-13, L-1, and the COVID-19 add-on module of the COPSOQ were utilized. Statistical tests included descriptive statistics, correlation coefficients, Chi-Square tests, linear regression, T-tests, and ANOVA with a significance level set at p < 0.05. Respondents were mainly from North Rhine-Westphalia (43.3%) and Bavaria (24.3%), predominantly female (54.1%), and had a mean age of 52.7 years. The majority were medical specialists (71.9%). The RS-13 mean score was 72.66 ( SD = 12.42), with 58.9% demonstrating high stress resilience. Public health degree holders showed the highest resilience. The ER-ratio indicated high effort versus reward for 96.7% of heads. Larger districts showed lower ER-ratios, suggesting resilient organizational structures. The study highlights high psychosocial workload and resilience among German public health authority heads during COVID-19, suggesting the need for optimized crisis management and scalable staffing for future pandemics and crises.