Authors: Danielle Lamb; Sam Gnanapragasam; Neil Greenberg; Rupa Bhundia; Ewan Carr; Matthew Hotopf; Reza Razavi; Rosalind Raine; Sean Cross; Amy Dewar; Mary Docherty; Sarah Dorrington; Stephani Hatch; Charlotte Wilson-Jones; Daniel Leightley; Ira Madan; Sally Marlow; Isabel McMullen; Anne-Marie Rafferty; Martin Parsons; Catherine Polling; Danai Serfioti; Helen Gaunt; Peter Aitken; Joanna Morris-Bone; Chloe Simela; Veronica French; Rachel Harris; Sharon A M Stevelink; Simon Wessely · Research
How Has the COVID-19 Pandemic Affected the Mental Health of Healthcare Workers?
A study of over 4,000 UK healthcare workers found high rates of mental health problems during the early stages of the COVID-19 pandemic.
Source: Lamb, D., Gnanapragasam, S., Greenberg, N., Bhundia, R., Carr, E., Hotopf, M., Razavi, R., Raine, R., Cross, S., Dewar, A., Docherty, M., Dorrington, S., Hatch, S., Wilson-Jones, C., Leightley, D., Madan, I., Marlow, S., McMullen, I., Rafferty, A. M., Parsons, M., … Wessely, S. (2021). Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic. Occupational and Environmental Medicine, oemed-2020-107276. https://doi.org/10.1136/oemed-2020-107276
What you need to know
- Over half of healthcare workers surveyed reported symptoms of common mental disorders during the early stages of the COVID-19 pandemic
- Nearly one-third of participants showed signs of post-traumatic stress disorder (PTSD)
- Women, younger staff, and nurses were at higher risk of mental health problems
- Exposure to morally distressing events was strongly linked to worse mental health outcomes
Background
The COVID-19 pandemic has placed unprecedented strain on healthcare systems and workers worldwide. Healthcare workers have faced numerous challenges, including increased workloads, risk of infection, sleep deprivation, and difficult ethical decisions. There have been significant concerns about the potential psychological toll on healthcare staff.
This study aimed to assess the mental health impact of the pandemic on UK healthcare workers during the initial stages of the outbreak. The researchers surveyed staff at three London-based National Health Service (NHS) hospital trusts between April and June 2020, during the first wave of COVID-19 in the UK.
Study design and participants
The study included 4,378 clinical and non-clinical staff working in the participating NHS trusts. This represented about 12% of all eligible staff. Participants completed an online questionnaire that included several validated measures of mental health:
- General Health Questionnaire (GHQ-12) to assess common mental disorders
- Generalized Anxiety Disorder scale (GAD-7) for anxiety
- Patient Health Questionnaire (PHQ-9) for depression
- Post-Traumatic Stress Disorder Checklist (PCL-6) for PTSD symptoms
- Alcohol Use Disorders Identification Test (AUDIT) for alcohol misuse
- Moral Injury Events Scale (MIES) to measure exposure to morally distressing events
The researchers also collected demographic information and details about participants’ roles.
Key findings
High rates of mental health problems
The study found concerning levels of mental health issues among healthcare workers:
- 58.9% showed signs of common mental disorders
- 30.2% had probable PTSD
- 27.3% had probable depression
- 23.2% had probable anxiety
- 10.5% reported alcohol misuse
These rates are substantially higher than typically seen in the general population. For comparison, a large UK population study during the pandemic found 37.1% of people showed signs of common mental disorders.
Groups at higher risk
Some groups of healthcare workers appeared to be at greater risk of mental health problems:
- Women were more likely than men to have common mental disorders, anxiety, and PTSD
- Younger staff had higher rates of common mental disorders, anxiety, depression, and PTSD compared to older staff
- Nurses were at increased risk of mental health issues compared to doctors and other staff groups
Impact of moral injury
The study found that exposure to potentially morally injurious events was strongly associated with worse mental health outcomes. Moral injury refers to psychological distress caused by actions that violate one’s ethical or moral beliefs. In a healthcare context, this could involve having to make difficult decisions about patient care due to resource constraints.
Healthcare workers who reported high exposure to moral injury were:
- 2.6 times more likely to have common mental disorders
- 3.0 times more likely to have anxiety
- 2.9 times more likely to have depression
- 4.2 times more likely to have PTSD
compared to those with low exposure to moral injury.
Suicidal thoughts and self-harm
The researchers also asked about suicidal thoughts and self-harm:
- 8.5% had considered taking their own life in the past two months
- 2.0% had attempted suicide in the past two months
- 3.0% reported self-harm in the past two months
While concerning, these rates were not higher than those seen in general population studies during the pandemic. This suggests healthcare workers were not at increased risk of suicidal thoughts or behaviors compared to the wider public.
Implications
The findings highlight the substantial psychological impact of the pandemic on healthcare workers. The high rates of mental health problems, particularly PTSD symptoms, are troubling and suggest many staff may need additional support.
The study identifies some groups that may be particularly vulnerable, including women, younger staff, and nurses. Mental health services and workplace support programs should consider how to tailor their approaches to reach these higher-risk groups.
The strong link between moral injury and poor mental health is an important finding. Healthcare organizations may need to consider how to better support staff facing ethically challenging situations and decisions during crisis periods.
Limitations and future research
There are some important limitations to consider:
- The response rate was relatively low at 12%, so the sample may not be fully representative of all healthcare staff
- The study only provides a snapshot from early in the pandemic - longer-term impacts remain unclear
- Self-reported symptoms are not the same as clinical diagnoses of mental disorders
The researchers emphasize the need for further longitudinal studies to track mental health over time as the pandemic evolves. They also highlight the importance of using clinical diagnostic interviews, rather than just questionnaires, to more accurately assess rates of mental disorders.
Conclusions
- Healthcare workers experienced high rates of mental health problems during the early stages of the COVID-19 pandemic
- Women, younger staff, nurses, and those exposed to moral injury appear to be at higher risk
- While concerning, the findings do not necessarily indicate widespread mental illness - many staff may be experiencing normal distress responses to an abnormal situation
- Ongoing monitoring and targeted mental health support for healthcare workers remains vital as the pandemic continues
This study provides valuable initial data on the psychological toll of COVID-19 on healthcare staff. The findings can help inform mental health services and workplace support programs for this crucial workforce. However, further research is needed to understand the long-term impacts and identify the most effective ways to protect healthcare workers’ wellbeing during this ongoing crisis.