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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.
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IntroductionThe COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear. This longitudinal cohort study aims to recruit a cohort of NHS healthcare workers, conducting surveys at regular intervals to provide evidence about the prevalence of symptoms of mental disorders, investigate associated factors such as occupational contexts and support interventions available. Methods and AnalysisAll staff, students, and volunteers working in each of the 18 participating NHS Trusts in England will be sent emails inviting them to complete a survey at baseline, with email invitations for the follow up surveys being sent 6 and 12 months later. Opening in late April 2020, the baseline survey collects data on demographics, occupational and organisational factors, experiences of COVID-19, a number of validated measures of symptoms of poor mental health (e.g. depression, anxiety, post-traumatic stress disorder; PTSD), and measures of constructs such as resilience and moral injury. These regular surveys will be complemented by in-depth psychiatric interviews with a select sample of healthcare workers. Qualitative interviews will also be conducted, to gain deeper understanding of the support programmes used or desired by staff, and facilitators and barriers to accessing such programmes. Ethics and DisseminationEthical approval for the study was granted by the Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust Research and Development approval. Cohort data are being collected via Qualtrics online survey software, are pseudonymised and held on secure University servers. Participants are aware that they can withdraw from the study at any time, and there is signposting to support services for any participant who feels they need it. Only those consenting to be contacted about further research will be invited to participate in the psychiatric and qualitative interview components of the study. Findings will be rapidly shared with NHS Trusts to enable better support of staff during the pandemic, and via academic publications in due course. Strengths and limitations of this studyO_LIThe longitudinal cohort design addresses the lack of long-term data on this population, and the current predominance of cross-sectional evidence available. C_LIO_LIThe availability of Trust HR data means we will be able to calculate response rates, and weight the data appropriately. C_LIO_LIThe diagnostic interview component of the study will allow us to establish the true prevalence of mental disorders, which can be inflated by the measures used in most mental health and wellbeing cohort studies. C_LIO_LIThe qualitative interviews will give deeper insight into the support programmes that HCWs find most helpful, and provide ideas for Trusts to improve their offer to staff. C_LIO_LIThe three components of the study give breadth and depth lacking in much of the mental health and wellbeing research currently available, but there is a risk of over-burdening already stretched HCWs. C_LI
