Mental health of healthcare workers in England during the COVID-19 pandemic: a longitudinal cohort study

ObjectiveTo examine variations in impact of the COVID-19 pandemic on the mental health of all types of healthcare workers (HCWs) in England over the first 17 months of the pandemic. MethodWe undertook a prospective cohort study of 22,501 HCWs from 18 English acute and mental health NHS Trusts, collecting online survey data on common mental disorders (CMDs), depression, anxiety, alcohol use, and PTSD, from April 2020 to August 2021. We analysed these data cross-sectionally by time period (corresponding to periods the NHS was under most pressure), and longitudinally. Data were weighted to better represent Trust population demographics. ResultsThe proportion of those with probable CMDs was greater during periods when the NHS was under most pressure (measured by average monthly deaths). For example, 55% (95%CI 53%, 58%) of participants reported symptoms of CMDs in April-June 2020 versus 47% (95%CI 46%, 48%) July-October 2020. Contrary to expectation, there were no major differences between professional groups (i.e. clinical and non-clinical staff). Younger, female, lower paid staff, who felt poorly supported by colleagues/managers, and who experienced potentially morally injurious events were most at risk of negative mental health outcomes. ConclusionAmong HCWs, the prevalence of probable CMDs increased during periods of escalating pressure on the NHS, suggesting staff support should be increased at such points in the future, and staff should be better prepared for such situations via training. All staff, regardless of role, experienced poorer mental health during these periods, suggesting that support should be provided for all staff groups. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSExisting evidence about the mental health of healthcare workers (HCWs) through the COVID-19 pandemic comes mainly from cross-sectional studies using unrepresentative convenience samples, typically focussing on clinical staff rather than all HCWs. Such studies show high prevalence of symptoms of mental disorders, but the strength of this evidence is uncertain. What this study addsUsing a defined sampling frame, with longitudinal, weighted data, we show that during periods of greater pressure on the NHS (as indicated by average monthly national COVID-19 death rates), prevalence of mental disorder symptoms increased, and, importantly, that this effect was seen in non-clinical as well as clinical staff. How this study might affect research, practice or policyThese findings indicate that provision of support for HCWs should not only focus on those providing clinical care, but also on non-clinical staff such as porters, cleaners, and administrative staff, and additional support should be provided during higher pressure periods. Better preparation of staff for such situations is also suggested.

Characteristics of mental health stability during COVID-19: An online survey with people residing in the Liverpool City Region

Background and aimDespite the significant mental health challenges the COVID-19 pandemic and its associated government measures have presented, research have shown that the majority of people have adapted and coped well. The aim of this study was i) to determine the proportion of people with mental stability and volatility during the pandemic in a North West urban environment sample and ii) to establish group differences in psychosocial variables. Mental stability and volatility refer to the extent to which individuals reported change in levels of common mental health symptoms over the course of 12 weeks. Methoda two-wave-online survey (N = 163) was used to explore the psychological and social impact of the pandemic on relatively disadvantaged neighbourhoods within the Liverpool City Region over 12 weeks. Kruskal-Wallis with post-hoc tests were used to determine how people with mental stability and volatility differed on factors categorised within an ecological framework of resilience (individual, community, societal, and COVID-19 specific). ResultsIndividuals categorised as stable in terms of mental health symptoms (63.6%) had better mental and physical health; were more tolerant of uncertainty; reported higher levels of resilience and wellbeing compared to very volatile people (19.8%). These individuals also reported feeling less socially isolated, experienced a greater sense of belonging to their community which was more likely to fulfil their needs, and were more likely to have access to green space nearby for their recommended daily exercise. Stable individuals did not report worrying any more during the pandemic than usual and tolerated uncertainty better compared to those in the volatile group. ImplicationsThe majority of participants in this sample were mentally stable and coping well with the challenges presented by the pandemic. The resilience of these individuals was related to key place-based factors such as a strong sense of community and useable local assets. The data showcase the role of place-based social determinants in supporting resilience and thereby highlight key preventative measures for public mental health during times of international crisis.

Protocol: A two-wave cross-sectional study in England investigating suicidal behaviour and self-harm amongst healthcare workers during the Covid-19 pandemic

IntroductionThere have been longstanding concerns regarding an increased risk of suicide amongst healthcare workers. The Covid-19 pandemic has placed an additional burden on staff, yet few studies have investigated the impact of the pandemic on their risk of suicide and self-harm. We aimed to investigate the cumulative incidence, prevalence, and correlates of suicidal ideation, suicide attempts, and non-suicidal self-injury amongst healthcare workers during the Covid-19 pandemic. Methods and AnalysisNHS Check is an online survey that was distributed to all staff (clinical and non-clinical), students, and volunteers in 18 NHS Trusts across England during the Covid-19 pandemic. Data collected in wave 1 (collected between April 2020 and January 2021) and wave 2 (collected 6 months after wave 1) will be analysed. The full cohort of wave 1 participants will be weighted to represent the age, sex, ethnicity, and roles profile of the workforce at each Trust, and the weighted prevalence and cumulative incidence of suicidal ideation, suicide attempts, and non-suicidal self-injury will be described. Two-level random effects logistic regression models will be used to investigate the relationship between suicidal behaviour and self-harm, and demographic characteristics (age, sex, ethnicity) and workplace factors (concerns regarding access to personal protective equipment, re-deployment status, moral injury, confidence around raising and the management of safety concerns, support by supervisors or managers, satisfaction with standard of care provided). Results will be stratified by role (clinical/non-clinical). Changes in this protocol compared with the original versionO_LIAll variables describing workplace factors will be analysed as binary variables for consistency. C_LIO_LIThe responses to two questions on raising, and the management of, safety concerns will be analysed separately rather than combined to minimise loss of information. C_LIO_LIBinary suicide-related outcomes will be used in the logistic regression analyses, where the presence of an outcome represents its occurrence within the previous one (wave 2) or two months (wave 1), specifically. This was previously not specified. C_LI

Disordered eating and self-harm as risk factors for poorer mental health during the COVID-19 pandemic: A population-based cohort study

BackgroundYoung adults and especially those with pre-existing mental health conditions, such as disordered eating and self-harm, appear to be at greater risk of developing metal health problems during the COVID-19 pandemic. However, it is unclear whether this increased risk is affected by any changes in lockdown restrictions, and whether any lifestyle changes could moderate this increased risk. MethodsIn a longitudinal UK-based birth cohort (The Avon Longitudinal Study of Parents and Children, ALSPAC) we assessed the relationship between pre-pandemic measures of disordered eating and self-harm and mental health during the COVID-19 pandemic in 2,657 young adults. Regression models examined the relationship between self-reported disordered eating, self-harm, and both disordered eating and self-harm at age 25 years and depressive symptoms, anxiety symptoms and mental wellbeing during a period of eased restrictions in the COVID-19 pandemic (May-July 2020) when participants were aged 27-29 years. Analyses were adjusted for sex, questionnaire completion date, pre-pandemic socioeconomic disadvantage and pre-pandemic mental health and wellbeing. We also examined whether lifestyle changes (sleep, exercise, alcohol, visiting green space, eating, talking with family/friends, hobbies, relaxation) in the initial UK lockdown (April-May 2020) moderated these associations. ResultsPre-existing disordered eating, self-harm and comorbid disordered eating and self-harm were all associated with the reporting of a higher frequency of depressive symptoms and anxiety symptoms, and poorer mental wellbeing during the pandemic compared to individuals without disordered eating and self-harm. Associations remained when adjusting for pre-pandemic mental health measures. There was little evidence that interactions between disordered eating and self-harm exposures and lifestyle change moderators affected pandemic mental health and wellbeing. ConclusionsYoung adults with pre-pandemic disordered eating, self-harm and comorbid disordered eating and self-harm were at increased risk for developing symptoms of depression, anxiety and poor mental wellbeing during the COVID-19 pandemic, even when accounting for pre-pandemic mental health. Lifestyle changes during the pandemic do not appear to alter this risk. A greater focus on rapid and responsive service provision is essential to reduce the impact of the pandemic on the mental health of these already vulnerable individuals. Plain English summaryThe aim of this project was to explore the mental health of young adults with disordered eating behaviours (such as fasting, vomiting/taking laxatives, binge-eating and excessive exercise) and self-harm during the COVID-19 pandemic. We analysed data from an established study that has followed children from birth (in 1991 and 1992) up to present day, including during the pandemic when participants were 28 years old. We looked at the relationship between disordered eating and/or self-harm behaviours from before the pandemic and mental health problems (symptoms of depression and anxiety) and mental wellbeing during the pandemic. We also explored whether there were any lifestyle changes (such as changes in sleep, exercise, visiting green space) that might be linked to better mental health and wellbeing in young adults with disordered eating and self-harm. We found that young adults with prior disordered eating and/or self-harm had more symptoms of depression and anxiety, and worse mental wellbeing than individuals without prior disordered eating or self-harm. However, lifestyle changes did not appear to affect mental health and wellbeing in these young adults. Our findings suggest that people with a history of disordered eating and/or self-harm were at high risk for developing mental health problems during the pandemic, and they will need help from mental health services.

Mental health during the COVID-19 pandemic in two longitudinal UK population cohorts

BackgroundThe impact of COVID-19 on mental health is unclear. Evidence from longitudinal studies with pre pandemic data are needed to address (1) how mental health has changed from pre-pandemic levels to during the COVID-19 pandemic and (2), whether there are groups at greater risk of poorer mental health during the pandemic? MethodsWe used data from COVID-19 surveys (completed through April/May 2020), nested within two large longitudinal population cohorts with harmonised measures of mental health: two generations of the Avon Longitudinal Study of Parents and Children (ALPSAC): the index generation ALSPAC-G1 (n= 2850, mean age 28) and the parents generation ALSPAC-G0 (n= 3720, mean age = 59) and Generation Scotland: Scottish Family Health Study (GS, (n= 4233, mean age = 59), both with validated pre-pandemic measures of mental health and baseline factors. To answer question 1, we used ALSPAC-G1, which has identical mental health measures before and during the pandemic. Question 2 was addressed using both studies, using pre-pandemic and COVID-19 specific factors to explore associations with depression and anxiety in COVID-19. FindingsIn ALSPAC-G1 there was evidence that anxiety and lower wellbeing, but not depression, had increased in COVID-19 from pre-pandemic assessments. The percentage of individuals with probable anxiety disorder was almost double during COVID-19: 24% (95% CI 23%, 26%) compared to pre-pandemic levels (13%, 95% CI 12%, 14%), with clinically relevant effect sizes. In both ALSPAC and GS, depression and anxiety were greater in younger populations, women, those with pre-existing mental and physical health conditions, those living alone and in socio-economic adversity. We did not detect evidence for elevated risk in key workers or health care workers. InterpretationThese results suggest increases in anxiety and lower wellbeing that may be related to the COVID-19 pandemic and/or its management, particularly in young people. This research highlights that specific groups may be disproportionally at risk of elevated levels of depression and anxiety during COVID-19 and supports recent calls for increasing funds for mental health services. FundingThe UK Medical Research Council (MRC), the Wellcome Trust and University of Bristol.

Urethral retro-resistance pressure: association with established measures of incontinence severity and change after midurethral tape insertion.

AIMS: Our study explored the relationship between URP and established measures of incontinence severity. We also report on change in URP after insertion of midurethral tape (MUT). METHODS: All participants had incontinence secondary to urodynamic stress incontinence only. URP was measured using the Monitorr (Gynecare) device prior to and 3 months after MUT insertion. The following measures of incontinence severity were completed before and 3 months after insertion of MUT: 24-hour pad test; International Consultation on Incontinence Questionnaire for evaluating symptoms and impact of urinary incontinence; King's Health Questionnaire for evaluating disease-specific quality of life and a 3-day urinary dairy with episodes of incontinence recorded. RESULTS: Preoperative URP and measures of incontinence severity were available for 100 women. Mean URP bore no relationship to the severity of urine loss assessed by 24-hour pad loss. There was no correlation between URP and other measures of incontinence severity. Pre and postoperative URP was available in 73 women. Although 84.9% were objectively cure (24-hour pad test of <5 g) after surgery, pre and postoperative URP was not significantly different [62.7 (+/-19.4) cmH(2)O vs. 61.2 (+/-204) cmH(2)O; p = 0.57]. CONCLUSIONS: Urethral retro-resistance pressure is not a useful measure of urethral function.