Will we ever be the same again? The mental health impact of the COVID-19 pandemic on health care staff and institutions.

As a group, health care workers (HCWs) were vulnerable to poor mental health (MH) prior to the COVID-19 pandemic. The added burdens of COVID-19 have put extra stressors on the health system and its most precious resource-its workers. This pandemic has exacerbated already poor MH in HCWs, leading to a workforce that is burnt out and struggling to cope with growing demands. Throughout the COVID-19 pandemic, risk factors for poor HCW mental health have been identified. The changes in practices brought about by the COVID-19 pandemic and identified as risk factors for poor MH that were experienced in other areas of health care and medical establishments were also witnessed by HCWs working in cytology. Indeed, all health care staff have been affected by this pandemic, and we now know that MH problems in HCWs are negatively impacting the public health response to the COVID-19 pandemic and its aftermath as they adversely influence quality of care. The question is then rightfully asked: Will we, as health care staff working in medical establishments, ever be the same again, or has COVID-19 forever changed our working lives? Fortunately, protective factors and multi-level interventions associated with adaptive MH outcomes during the COVID-19 pandemic have also been identified. In this article, we conclude that whilst working life is unlikely to return to pre-pandemic practices, the health care system now has an opportunity to promote individual and systemic growth by adhering to the principles that protect HCWs' MH and mitigate burnout during these challenging times.

The mental health of healthcare workers during the COVID-19 pandemic: a narrative review.

PURPOSE OF REVIEW: Mental health (MH) problems among healthcare workers (HCWs) have the potential to impact negatively on the capacity of health systems to respond effectively to COVID-19. A thorough understanding of the factors that degrade or promote the MH of HCWs is needed to design and implement suitable intervention strategies to support the wellbeing of this population. RECENT FINDINGS: MH problems among HCWs were elevated prior to the COVID-19 pandemic. Accumulating evidence indicates that this public health crisis has had a disproportionately negative impact on the MH of specialised populations, including HCWs. Literature from prior health pandemics suggests that the adverse effects of the COVID-19 pandemic on the MH of HCWs are likely to persist in the aftermath of the public health crisis. Primary and secondary risk factors for adverse MH outcomes have been identified and should be considered when implementing interventions to protect the MH of HCWs. SUMMARY: The MH of HCWs has been negatively impacted by the COVID-19 pandemic, which is having a detrimental influence on the public health response to COVID-19. Protecting the MH of HCWs both during and beyond this public health crisis should remain a top priority, with particular emphasis on multifaceted interventions that aim to balance the psychological needs of individual HCWs with organisational-level strategies that could be targeted to promote their wellbeing.

Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial.

BACKGROUND: Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time. OBJECTIVE: This study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic. METHODS: NHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6). RESULTS: Retention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI -0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI -0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI -0.11 to 0.46), and mental well-being (vs MPS: Cohen d=-0.04, 95% CI -0.62 to -0.08; vs NHSWBP: Cohen d=-0.15, 95% CI -0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group. CONCLUSIONS: Our analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments. TRIAL REGISTRATION: ISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122.

The mental health of NHS staff during the COVID-19 pandemic: two-wave Scottish cohort study.

BACKGROUND: Health and social care workers (HSCWs) are at risk of experiencing adverse mental health outcomes (e.g. higher levels of anxiety and depression) because of the COVID-19 pandemic. This can have a detrimental effect on quality of care, the national response to the pandemic and its aftermath. AIMS: A longitudinal design provided follow-up evidence on the mental health (changes in prevalence of disease over time) of NHS staff working at a remote health board in Scotland during the COVID-19 pandemic, and investigated the determinants of mental health outcomes over time. METHOD: A two-wave longitudinal study was conducted from July to September 2020. Participants self-reported levels of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and mental well-being (Warwick-Edinburgh Mental Well-being Scale) at baseline and 1.5 months later. RESULTS: The analytic sample of 169 participants, working in community (43%) and hospital (44%) settings, reported substantial levels of depression and anxiety, and low mental well-being at baseline (depression, 30.8%; anxiety, 20.1%; well-being, 31.9%). Although mental health remained mostly constant over time, the proportion of participants meeting the threshold for anxiety increased to 27.2% at follow-up. Multivariable modelling indicated that working with, and disruption because of, COVID-19 were associated with adverse mental health changes over time. CONCLUSIONS: HSCWs working in a remote area with low COVID-19 prevalence reported substantial levels of anxiety and depression, similar to those working in areas with high COVID-19 prevalence. Efforts to support HSCW mental health must remain a priority, and should minimise the adverse effects of working with, and disruption caused by, the COVID-19 pandemic.

A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being.

BACKGROUND: Health and social care workers (HSCWs) have carried a heavy burden during the COVID-19 crisis and, in the challenge to control the virus, have directly faced its consequences. Supporting their psychological wellbeing continues, therefore, to be a priority. This rapid review was carried out to establish whether there are any identifiable risk factors for adverse mental health outcomes amongst HSCWs during the COVID-19 crisis. METHODS: We undertook a rapid review of the literature following guidelines by the WHO and the Cochrane Collaboration's recommendations. We searched across 14 databases, executing the search at two different time points. We included published, observational and experimental studies that reported the psychological effects on HSCWs during the COVID-19 pandemic. RESULTS: The 24 studies included in this review reported data predominantly from China (18 out of 24 included studies) and most sampled urban hospital staff. Our study indicates that COVID-19 has a considerable impact on the psychological wellbeing of front-line hospital staff. Results suggest that nurses may be at higher risk of adverse mental health outcomes during this pandemic, but no studies compare this group with the primary care workforce. Furthermore, no studies investigated the psychological impact of the COVID-19 pandemic on social care staff. Other risk factors identified were underlying organic illness, gender (female), concern about family, fear of infection, lack of personal protective equipment (PPE) and close contact with COVID-19. Systemic support, adequate knowledge and resilience were identified as factors protecting against adverse mental health outcomes. CONCLUSIONS: The evidence to date suggests that female nurses with close contact with COVID-19 patients may have the most to gain from efforts aimed at supporting psychological well-being. However, inconsistencies in findings and a lack of data collected outside of hospital settings, suggest that we should not exclude any groups when addressing psychological well-being in health and social care workers. Whilst psychological interventions aimed at enhancing resilience in the individual may be of benefit, it is evident that to build a resilient workforce, occupational and environmental factors must be addressed. Further research including social care workers and analysis of wider societal structural factors is recommended.