Mental Health Symptoms in a Cohort of Hospital Healthcare Workers Following the Peak of the COVID-19 Pandemic in the United Kingdom

ABSTRACTBackgroundNo studies have reported comparisons of mental health symptoms prior to and during COVID-19 in vulnerable populations. Objectives were to compare anxiety and depression symptoms among people with a pre-existing medical condition, the autoimmune disease systemic sclerosis (SSc; scleroderma), including continuous change scores, proportion with change ≥ 1 minimal clinically important difference (MCID), and factors associated with changes, including country.MethodsPre-COVID-19 Scleroderma Patient-centered Intervention Network Cohort data were linked to COVID-19 data collected April 9 to April 27, 2020. Anxiety symptoms were assessed with the PROMIS Anxiety 4a v1.0 scale (MCID = 4 points) and depression symptoms with the Patient Health Questionnaire-8 (MCID = 3 points). Multiple linear and logistic regression were used to assess factors associated with continuous change and change ≥ 1 MCID.FindingsAmong 435 participants (Canada = 98; France = 159; United Kingdom = 50; United States = 128), mean anxiety symptoms increased 4.9 points (95% confidence interval [CI] 4.0 to 5.7). Depression symptom change was negligible (0.3 points; 95% CI −0.7 to 0.2). Compared to France, adjusted scores from the United States and United Kingdom were 3.8 points (95% CI 1.7 to 5.9) and 2.9 points higher (95% CI 0.0 to 5.7); scores for Canada were not significantly different. Odds of increasing by ≥ 1 MCID were twice as high for the United Kingdom (2.0, 95% CI 1.0 to 4.2) and United States (1.9, 95% CI 1.1 to 3.2). Participants who used mental health services pre-COVID had adjusted increases 3.7 points (95% CI 1.7 to 5.7) less than other participants.InterpretationAnxiety symptoms, but not depression symptoms, increased dramatically during COVID-19 among people with a pre-existing medical condition. Increase was larger in the United Kingdom and United States than in Canada and France but substantially less for people with pre-COVID-19 mental health treatment.RESEARCH IN CONTEXTEvidence before this studyWe referred to a living systematic review that is evaluating mental health changes from pre-COVID-19 to COVID-19 by searching 7 databases, including 2 Chinese language databases, plus preprint servers, with daily updates (https://www.depressd.ca/covid-19-mental-health). As of June 13, 2020, only 5 studies had compared mental health symptoms prior to and during COVID-19. In 4 studies of university students, there were small increases in depression or general mental health symptoms but minimal or no increases in anxiety symptoms. A general population study from the United Kingdom reported a small increase in general mental health symptoms but did not differentiate between types of symptoms. No studies have reported changes from pre-COVID-19 among people vulnerable due to pre-existing medical conditions. No studies have compared mental health changes between countries, despite major differences in pandemic responses.Added value of this studyWe evaluated changes in anxiety and depression symptoms among 435 participants with the autoimmune condition systemic sclerosis and compared results from Canada, France, the United Kingdom, and the United States. To our knowledge, this is the first study to compare mental health symptoms prior to and during COVID-19 in any vulnerable population. These are the first data to document the substantial degree to which anxiety symptoms have increased and the minimal changes in depression symptoms among vulnerable individuals. It is also the first study to examine the association of symptom changes with country of residence and to identify that people receiving pre-COVID-19 mental health services may be more resilient and experience less substantial symptom increases than others.Implications of all the available evidenceAlthough this was an observational study, it provided evidence that vulnerable people with a pre-existing medical condition have experienced substantially increased anxiety symptoms and that these increases appear to be associated with where people live and, possibly, different experiences of the COVID-19 pandemic across countries. By comparing with evidence from university samples, which found that depression symptoms were more prominent, these data underline the need for accessible interventions tailored to specific needs of different populations. They also suggest that mental health treatments may help people to develop skills or create resilience, which may reduce vulnerability to major stressors such as COVID-19.

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Mental Health During COVID-19: A Qualitative Study with Ethnically Diverse Healthcare Workers in the United Kingdom

10.1101/2021.12.13.21267718 ◽

2021 ◽

Author(s):

Irtiza Qureshi ◽

Mayuri Gogoi ◽

Amani Al-Oraibi ◽

Fatimah Wobi ◽

Jonathan Chaloner ◽

...

Keyword(s):

Mental Health ◽

United Kingdom ◽

Ethnic Minority ◽

Healthcare Workers ◽

Negative Impact ◽

Ethnically Diverse ◽

Working Hours ◽

Severe Illness ◽

List Type ◽

The United Kingdom

ABSTRACTIntroductionHealthcare workers are experiencing deterioration in their mental health due to COVID-19. Ethnic minority populations in the United Kingdom are disproportionately affected by COVID-19, with a higher death rate and poorer physical and mental health outcomes. It is important that healthcare organisations consider the specific context and mental, as well as physical, health needs of an ethnically diverse healthcare workforce in order to better support them during, and after, the COVID-19 pandemic.MethodsWe undertook a qualitative work package as part of the United Kingdom Research study into Ethnicity and COVID-19 outcomes among healthcare workers (UK-REACH). As part of the qualitative research, we conducted focus group discussions with healthcare workers between December 2020 and July 2021, and covered topics such as their experiences, fears and concerns, and perceptions about safety and protection, while working during the pandemic. The purposive sample included ancillary health workers, doctors, nurses, midwives and allied health professionals from diverse ethnic backgrounds. We conducted discussions using Microsoft Teams. Recordings were transcribed and thematically analysed.FindingsWe carried out 16 focus groups with a total of 61 participants. Several factors were identified which contributed to, and potentially exacerbated, the poor mental health of ethnic minority healthcare workers during this period including anxiety (due to inconsistent protocols and policy); fear (of infection); trauma (due to increased exposure to severe illness and death); guilt (of potentially infecting loved ones); and stress (due to longer working hours and increased workload).ConclusionCOVID-19 has affected the mental health of healthcare workers. We identified a number of factors which may be contributing to a deterioration in mental health across diverse ethnic groups. Healthcare organisations should consider developing strategies to counter the negative impact of these factors. This paper will help employers of healthcare workers and other relevant policy makers better understand the wider implications and potential risks of COVID-19 and assist in developing strategies to safeguard the mental health of these healthcare workers going forward, and reduce ethnic disparities.Key messagesWhat is already known about this subjectHealthcare Workers (HCWs) are experiencing deterioration of their mental health due to COVID-19Ethnic minority populations and HCWs are disproportionately affected by COVID-19More research is needed on the specific factors influencing the mental health of ethnically diverse healthcare workforcesWhat are the new findingsProminent factors influencing the mental health and emotional wellbeing of this population include:anxiety (due to inconsistent protocols and policy)fear (of infection)trauma (due to increased exposure to severe illness and death)guilt (of potentially infecting loved ones)stress (due to longer working hours and increased workload)How might this impact on policy or clinical practice in the foreseeable futureHealthcare organisations should consider the specific circumstances of these staff and develop strategies to counter the negative impact of these factors and help safeguard the mental health of their staff

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Mental Health, Deprivation, and the Neighborhood Social Environment: A Network Analysis

Clinical Psychological Science ◽

10.1177/2167702619830640 ◽

2019 ◽

Vol 7 (4) ◽

pp. 719-734 ◽

Cited By ~ 5

Author(s):

Eoin McElroy ◽

Jason C. McIntyre ◽

Richard P. Bentall ◽

Tim Wilson ◽

Keith Holt ◽

...

Keyword(s):

Mental Health ◽

Network Analysis ◽

Social Environment ◽

Social Cohesion ◽

Statistical Approach ◽

Mental Health Symptoms ◽

Health Symptoms ◽

The United Kingdom ◽

Economically Deprived ◽

Network Comparisons

Different aspects of the neighborhood social environment have been linked with mental ill health; however, the mechanisms underlying these associations remain poorly understood because of the number and complexity of the components involved. We used a novel statistical approach, network analysis, to explore the complex associations between neighborhood social cohesion, social disorder, and mental-health symptoms in a sample of 3,670 adults from an economically deprived region of the United Kingdom (mean age = 49.34 years, SD = 18.87; 57% female). Elasso regularized networks were estimated, and network comparisons were conducted by level of deprivation. Mental-health symptoms and neighborhood components formed relatively distinct clusters of items. These domains were linked primarily by paranoia, although only in the most deprived group. Drunken/rowdy behavior was particularly influential within the neighborhood cluster; therefore, policies aimed at reducing such disruptive behavior could have positive knock-on effects for social cohesion and mental health.

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Prevalence of mental health symptoms in residential healthcare workers in Michigan during the covid-19 pandemic

Psychiatry Research ◽

10.1016/j.psychres.2020.113266 ◽

2020 ◽

Vol 291 ◽

pp. 113266 ◽

Cited By ~ 1

Author(s):

Ana M. Daugherty ◽

Eamonn P. Arble

Keyword(s):

Mental Health ◽

Healthcare Workers ◽

Mental Health Symptoms ◽

Health Symptoms

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High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross-sectional survey

General Psychiatry ◽

10.1136/gpsych-2021-100577 ◽

2021 ◽

Vol 34 (5) ◽

pp. e100577

Author(s):

Natasha Smallwood ◽

Leila Karimi ◽

Marie Bismark ◽

Mark Putland ◽

Douglas Johnson ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Healthcare Workers ◽

Allied Health ◽

Well Being ◽

Health Staff ◽

Mental Health Symptoms ◽

Psychological Well Being ◽

Health Symptoms ◽

Frontline Healthcare Workers

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.AimsThe Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues, as well as the social, workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.MethodsA nationwide, voluntary, anonymous, single timepoint, online survey was conducted between 27 August and 23 October 2020. Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts and national media. Demographics, home and work situation, health and psychological well-being data were collected.ResultsA total of 9518 survey responses were received; of the 9518 participants, 7846 (82.4%) participants reported complete data. With regard to age, 4110 (52.4%) participants were younger than 40 years; 6344 (80.9%) participants were women. Participants were nurses (n=3088, 39.4%), doctors (n=2436, 31.1%), allied health staff (n=1314, 16.7%) or in other roles (n=523, 6.7%). In addition, 1250 (15.9%) participants worked in primary care. Objectively measured mental health symptoms were common: mild to severe anxiety (n=4694, 59.8%), moderate to severe burnout (n=5458, 70.9%) and mild to severe depression (n=4495, 57.3%). Participants were highly resilient (mean (SD)=3.2 (0.66)). Predictors for worse outcomes on all scales included female gender; younger age; pre-existing psychiatric condition; experiencing relationship problems; nursing, allied health or other roles; frontline area; being worried about being blamed by colleagues and working with patients with COVID-19.ConclusionsThe COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers. Crisis preparedness together with policies and practices addressing psychological well-being are needed.

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The new frontline: exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic

BMC Psychiatry ◽

10.1186/s12888-021-03637-w ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Edward G. Spilg ◽

Cynda Hylton Rushton ◽

Jennifer L. Phillips ◽

Tetyana Kendzerska ◽

Mysa Saad ◽

...

Keyword(s):

Mental Health ◽

Healthcare Workers ◽

Online Survey ◽

Moral Distress ◽

Protective Measure ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Moral Resilience

Abstract Background Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs. Methods A total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed. Findings Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5, p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1, p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p < .001); compared to those with higher moral resilience, the subgroup with the lowest moral resilience had a steeper cross-sectional worsening in moral distress as the frequency of potentially morally distressing events increased. Moral resilience also correlated with lower stress, anxiety, and depression symptoms (r > .27, p < .001). Factors independently associated with stronger moral resilience included: being male, older age, no mental disorder diagnosis, sleeping more, and higher support from employers and colleagues (B [0.02, |-0.26|]. Interpretation Elevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.

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Mental health symptoms in a cohort of hospital healthcare workers following the first peak of the COVID-19 pandemic in the UK

BJPsych Open ◽

10.1192/bjo.2020.150 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Kasun Wanigasooriya ◽

Priyanka Palimar ◽

David N. Naumann ◽

Khalida Ismail ◽

Jodie L. Fellows ◽

...

Keyword(s):

Mental Health ◽

Healthcare Workers ◽

Well Being ◽

Moral Dilemmas ◽

Ptsd Symptoms ◽

Mental Health Symptoms ◽

Health Symptoms ◽

History Of ◽

Clinically Significant ◽

The Uk

Background The coronavirus disease 2019 (COVID-19) pandemic is likely to lead to a significant increase in mental health disorders among healthcare workers (HCW). Aims We evaluated the rates of anxiety, depressive and post-traumatic stress disorder (PTSD) symptoms in a population of HCW in the UK. Method An electronic survey was conducted between the 5 June 2020 and 31 July 2020 of all hospital HCW in the West Midlands, UK using clinically validated questionnaires: the 4-item Patient Health Questionnaire(PHQ-4) and the Impact of Event Scale-Revised (IES-R). Univariate analyses and adjusted logistic regression analyses were performed to estimate the strengths in associations between 24 independent variables and anxiety, depressive or PTSD symptoms. Results There were 2638 eligible participants who completed the survey (female: 79.5%, median age: 42 years, interquartile range: 32–51). The rates of clinically significant symptoms of anxiety, depression and PTSD were 34.3%, 31.2% and 24.5%, respectively. In adjusted analysis a history of mental health conditions was associated with clinically significant symptoms of anxiety (odds ratio (OR) = 2.3, 95% CI 1.9–2.7, P < 0.001), depression (OR = 2.5, 95% CI 2.1–3.0, P < 0.001) and PTSD (OR = 2.1, 95% CI 1.7–2.5, P < 0.001). The availability of adequate personal protective equipment (PPE), well-being support and lower exposure to moral dilemmas at work demonstrated significant negative associations with these symptoms (P ≤ 0.001). Conclusions We report higher rates of clinically significant mental health symptoms among hospital HCW following the initial COVID-19 pandemic peak in the UK. Those with a history of mental health conditions were most at risk. Adequate PPE availability, access to well-being support and reduced exposure to moral dilemmas may protect hospital HCW from mental health symptoms.

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The Impact of Epidemics and Pandemics on the Mental Health of Healthcare Workers: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136695 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6695

Author(s):

Ottilia Cassandra Chigwedere ◽

Anvar Sadath ◽

Zubair Kabir ◽

Ella Arensman

Keyword(s):

Mental Health ◽

Systematic Review ◽

Healthcare Workers ◽

Stress Disorder ◽

Acute Stress ◽

Hospital Setting ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Wide Range ◽

The Impact

Background: There is increasing evidence that healthcare workers (HCWs) experience significant psychological distress during an epidemic or pandemic. Considering the increase in emerging infectious diseases and the ongoing COVID-19 pandemic, it is timely to review and synthesize the available evidence on the psychological impact of disease outbreaks on HCWs. Thus, we conducted a systematic review to examine the impact of epidemics and pandemics on the mental health of HCWs. Method: PubMed, PsycInfo, and PsycArticles databases were systematically searched from inception to June-end 2020 for studies reporting the impact of a pandemic/epidemic on the mental health of HCWs. Results: Seventy-six studies were included in this review. Of these, 34 (45%) focused on SARS, 28 (37%) on COVID-19, seven (9%) on MERS, four (5%) on Ebola, two (3%) on H1N1, and one (1%) on H7N9. Most studies were cross-sectional (93%) and were conducted in a hospital setting (95%). Common mental health symptoms identified by this review were acute stress disorder, depression, anxiety, insomnia, burnout, and post-traumatic stress disorder. The associated risk factors were working in high-risk environments (frontline), being female, being a nurse, lack of adequate personal protective equipment, longer shifts, lack of knowledge of the virus, inadequate training, less years of experience in healthcare, lack of social support, and a history of quarantine. Conclusion: HCWs working in the frontline during epidemics and pandemics experience a wide range of mental health symptoms. It is imperative that adequate psychological support be provided to HCWs during and after these extraordinary distressful events.

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Meta-analytical evidence on mental disorder symptoms during the COVID-19 pandemic in Latin America

10.1101/2021.06.21.21259299 ◽

2021 ◽

Author(s):

Stephen X. Zhang ◽

Kavita Batra ◽

Tao Liu ◽

Rebecca Kechen Dong ◽

Wen Xu ◽

...

Keyword(s):

Mental Health ◽

Latin America ◽

General Population ◽

Mental Disorder ◽

Healthcare Workers ◽

Mental Health Symptoms ◽

Eligibility Criteria ◽

Health Symptoms ◽

Pooled Prevalence ◽

Frontline Healthcare Workers

Objective. There is a lack of evidence related to the prevalence of mental disorder symptoms as well as their heterogeneities during the COVID-19 pandemic in Latin America, a continent across the equators. The current study aims to provide meta-analytical evidence on mental disorder symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population, and university students in Latin America. Methods. Bibliographical databases, such as PubMed, Embase, Web of Sciences, PsycINFO, and medRxiv, were systematically searched to identify pertinent studies up to Februry 6, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimize data entry errors. Results. A total of 33 studies with 101,772 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress, and insomnia was 32%, 27%, 32%, and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (33% vs. 27%, p <0.001). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers, and students in Latin America was 33%, 31%, 37%, and 36%, respectively. Conclusion. The high yet heterogenous level of prevalence of mental disorder symptoms emphasizes the need for appropriate identification of psychological interventions in Latin America.

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Mental health symptoms in a cohort of hospital healthcare workers following the first peak of the Covid-19 pandemic in the United Kingdom

10.1101/2020.10.02.20205674 ◽

2020 ◽

Author(s):

Kasun Wanigasooriya ◽

Priyanka Palimar ◽

David Naumann ◽

Khalida Ismail ◽

Jodie L. Fellows ◽

...

Keyword(s):

Mental Health ◽

At Risk ◽

United Kingdom ◽

Healthcare Workers ◽

Moral Dilemmas ◽

Health Conditions ◽

The United Kingdom ◽

History Of ◽

Clinically Significant ◽

Anxiety Depression

AbstractBackgroundThe Covid-19 pandemic is likely to lead to a significant increase in mental health disorders amongst healthcare workers (HCW).AimsWe evaluated the prevalence of anxiety, depressive and post-traumatic stress disorder (PTSD) symptoms in a HCW population in the United Kingdom (UK), to identify subgroups most at risk.MethodsAn electronic survey was conducted between the 05/06/2020 and 31/07/2020 of all hospital HCW in the West Midlands, UK using clinically validated questionnaires: Patient Health Questionnaire-4 (PHQ-4) and the Impact of Event Scale-Revised (IES-R). Univariate analyses and adjusted logistic regression analyses were performed to estimate the strengths in associations.ResultsThere were 2638 eligible participants who completed the survey (female: 79.5%, median age: 42 [IQR: 32-51] years). The prevalence rates of clinically significant symptoms of anxiety, depression and PTSD were 34.3%, 31.2% and 24.5% respectively. In adjusted analysis a history of mental health conditions was associated with clinically significant symptoms of anxiety (odds ratio 2.3 [95% CI 1.9–2.7]; p<0.001), depression (2.5 [2.1–3.0]; p<0.001) and PTSD (2.1 [1.7–2.5]; p<0.001). The availability of adequate personal protective equipment (PPE), wellbeing support and lower exposure to moral dilemmas at work demonstrated significant negative associations with former symptoms (p≤0.001).ConclusionsWe report a high prevalence of clinically significant symptoms of anxiety, depression and PTSD in hospital HCW following the initial Covid-19 pandemic peak in the UK. Those with a history of mental health conditions were most at risk. Adequate PPE availability, access to wellbeing support and reduced exposure to moral dilemmas may protect hospital HCW from mental health symptoms.

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