Mental health in a diverse sample of healthcare workers during the COVID-19 pandemic: cross-sectional analysis of the UK-REACH study
Authors: Melbourne Carl A , Guyatt Anna L , Nellums Laura , Papineni Padmasayee , Gupta Amit , Qureshi Irtiza , Martin Christopher A , Bryant Luke , John Catherine , Gogoi Mayuri , Wobi Fatimah , Al-Oraibi Amani , Chaloner Jonathan , Aujayeb Avinash , Gregary Bindu , Lagrata Susie , Reza Rubina , Simpson Sandra , Zingwe Stephen , Tobin Martin , Carr Sue , Khunti Kamlesh , Gray Laura J , McManus I Chris , Woolf Katherine , Pareek Manish 
Published: February 2022

Objectives

To investigate how ethnicity and other sociodemographic, work, and physical health factors are related to mental health in UK healthcare and ancillary workers (HCWs), and how structural inequities in these factors may contribute to differences in mental health by ethnicity.

Design

Cross-sectional analysis of baseline data from the UK-REACH national cohort study

Setting

HCWs across UK healthcare settings.

Participants

11,695 HCWs working between December 2020-March 2021.

Main outcome measures

Anxiety or depression symptoms (4-item Patient Health Questionnaire, cut-off >3), and Post-Traumatic Stress Disorder (PTSD) symptoms (3-item civilian PTSD Checklist, cut-off >5).

Results

Asian, Black, Mixed/multiple and Other ethnic groups had greater odds of PTSD than the White ethnic group. Differences in anxiety/depression were less pronounced. Younger, female HCWs, and those who were not doctors had increased odds of symptoms of both PTSD and anxiety/depression. Ethnic minority HCWs were more likely to experience the following work factors that were also associated with mental ill-health: workplace discrimination, feeling insecure in raising workplace concerns, seeing more patients with COVID-19, reporting lack of access to personal protective equipment (PPE), and working longer hours and night shifts. Ethnic minority HCWs were also more likely to live in a deprived area and have experienced bereavement due to COVID-19. After adjusting for sociodemographic and work factors, ethnic differences in PTSD were less pronounced and ethnic minority HCWs had lower odds of anxiety/depression compared to White HCWs.

Conclusions

Ethnic minority HCWs were more likely to experience PTSD and disproportionately experienced work and sociodemographic factors associated with PTSD, anxiety and depression. These findings could help inform future work to develop workplace strategies to safeguard HCWs’ mental health. This will only be possible with adequate investment in staff recruitment and retention, alongside concerted efforts to address inequities due to structural discrimination.

Summary box

What is already known on this topic

The pandemic is placing healthcare workers under immense pressure, and there is currently a mental health crisis amongst NHS staff

Ethnic inequities in health outcomes are driven by structural discrimination, which occurs inside and outside the workplace

Investigating ethnic inequities in the mental health of healthcare workers requires large diverse studies, of which few exist

What this study adds

In UK-REACH (N=11,695), ethnic minority staff had higher odds of Post-Traumatic Stress Disorder symptoms; we report many other factors associated with mental-ill health, including those experienced disproportionately by ethnic minority staff, such as workplace discrimination, contact with more patients with COVID-19, and bereavement due to COVID-19

These findings underline the moral and practical need to care for staff mental health and wellbeing, which includes tackling structural inequities in the workplace; improving staff mental health may also reduce workforce understaffing due to absence and attrition