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In America’s demanding work culture, it can be difficult to avoid bringing work home. But when bringing work home equates to potentially infecting your family or friends with a deadly virus, there’s a whole new level of concern for health care workers.

Seventy-six percent of health care workers with children reported being worried about exposing them to COVID-19, according to a 2020 Mental Health America (MHA) survey. MHA data also reveals a majority of health care workers experience stress, anxiety, frustration, exhaustion, and burnout. A recent study from the University of Utah reports that more than half are at risk for mental health problems.

More than ever, that’s why Anthony Zannas and Jose Rodríguez-Romaguera believe in the need for the Carolina Stress Initiative at the University of North Carolina at Chapel Hill. What began in 2019 as an effort to study how stress and anxiety disorders affect our brains, has transformed into an assessment of COVID-19 on the mental health of health care workers. In June 2020, they received a Foundation of Hope for Research and Treatment of Mental Illness award to pursue this project.

Zannas, an assistant professor in the departments of Psychiatry and Genetics and a practicing physician with UNC Hospitals, studies how stress and trauma affect epigenetics — the body’s chemical response to the outside environment. Rodríguez-Romaguera, also an assistant professor in the Department of Psychiatry, researches how stress and anxiety affect the brain.

To study social stress and anxiety in this demographic, Zannas and Rodríguez-Romaguera recruited Guillermo Rodríguez-Romaguera, a documentary filmmaker and teaching assistant professor in the Department of English and Comparative Literature, and hired an actress to recreate a narrative of a COVID-19 nurse featured in Time magazine earlier this year. The video was filmed and edited to allow them to reliably measure the stress responses of study participants through eye-tracking and heart rate monitoring.

Zannas will collect blood samples to use as biomarkers for the changes happening in participants’ bodies. The epigenome fine-tunes gene and cell function in response to life experiences, and Zannas wants to know how stress shapes health and disease states.

“By knowing these epigenetic changes that occur in response to stress, we think we will be able to predict how these behaviors develop over time,” Zannas says.

Using the biomarkers from the human study, Rodríguez-Romaguera can look for similar patterns in mice to predict when irregular behavior will occur and pinpoint the precise neurocircuits involved in those responses. More specifically, he’s interested in arousal — a response to a stimulus that then leads to anxiety.

“One of the things we’ve seen in videos on the news is this emotional fatigue that occurs because of the stress of going to work every day,” Rodríguez-Romaguera says. “That it becomes more intense as time goes by — which I think is something that could turn pathological.”

As a practicing psychiatrist, Zannas has experienced these effects first-hand.

“I provide tele-psychiatry and in-person care, and I can see how much mental health has been impacted by COVID-19,” Zannas says. “It’s so much harder interacting with people. Everyone is stressed and less social supported — including my patients.”

Zannas hopes that combining his clinical experiences with Rodríguez-Romaguera’s studies in the lab will bridge the gap between basic science and human interventions. They will spend the next two years collecting data in order to do exactly that, working to ultimately impact the next generation of therapeutics for treating stress and anxiety.

“For many years, [the field of psychiatry] has focused a lot on PTSD and anxiety disorders in soldiers,” Rodríguez-Romaguera says. “Now, with the pandemic, our health care workers are our soldiers. And the same way you think about a soldier going to war, they’re going into a hospital.”


Anthony Zannas is an assistant professor in the departments of Psychiatry and Genetics within the UNC School of Medicine and co-director of the Carolina Stress Initiative.

Jose Rodríguez-Romaguera is an assistant professor in the Department of Psychiatry within the UNC School of Medicine. He is also a member of the UNC Neuroscience Center and the Carolina Institute for Developmental Disabilities.

For health care workers interested in participating in this study, email or visit for more information

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