The psychosocial impact of the COVID-19 pandemic on 4,378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic
Authors: Lamb Danielle , Gnanapragasam Sam , Greenberg Neil , Bhundia Rupa , Carr Ewan , Hotopf Matthew , Razavi Reza , Raine Rosalind , Cross Sean , Dewar Amy , Docherty Mary , Dorrington Sarah , Hatch Stephani L , Wilson-Jones Charlotte , Leightley Daniel , Madan Ira , Marlow Sally , McMullen Isabel , Rafferty Anne Marie , Parsons Martin , Polling Catherine , Serfioti Danai , Aitken Peter , French Veronica , Gaunt Helen , Morris-Bone Joanna , Harris Rachel , Simela Chloe , Stevelink Sharon A M , Wessely Simon 
Published: January 2021

Objectives

This study reports preliminary findings on the prevalence of, and factors associated with, mental health and wellbeing outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK.

Methods

Preliminary cross-sectional data were analysed from a cohort study (n=4,378). Clinical and non-clinical staff of three London-based NHS Trusts (UK), including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire (GHQ-12). Secondary outcomes are probable anxiety (GAD-7), depression (PHQ-9), Post-Traumatic Stress Disorder (PTSD) (PCL-6), suicidal ideation (CIS-R), and alcohol use (AUDIT). Moral injury is measured using the Moray Injury Event Scale (MIES).

Results

Analyses showed substantial levels of CMDs (58.9%, 95%CI 58.1 to 60.8), and of PTSD (30.2%, 95%CI 28.1 to 32.5) with lower levels of depression (27.3%, 95%CI 25.3 to 29.4), anxiety (23.2%, 95%CI 21.3 to 25.3), and alcohol misuse (10.5%, 95%CI, 9.2 to 11.9). Women, younger staff, and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of CMDs, anxiety, depression, PTSD symptoms, and alcohol misuse.

Conclusions

Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

Highlights

What is already known about this subject?

Large-scale population studies report increased prevalence of depression, anxiety, and psychological distress during the COVID-19 pandemic.

Evidence from previous epidemics indicates a high and persistent burden of adverse mental health outcomes among healthcare workers.

What are the new findings?

Substantial levels of probable common mental disorders and post-traumatic stress disorder were found among healthcare workers.

Groups at increased risk of adverse mental health outcomes included women, nurses, and younger staff, as well as those who reported higher levels of moral injury.

How might this impact on policy or clinical practice in the foreseeable future?

The mental health offering to healthcare workers must consider the interplay of demographic, social, and occupational factors.

Additional longitudinal research that emphasises methodological rigor, namely with use of standardised diagnostic interviews to establish mental health diagnoses, is necessary to better understand the mental health burden, identify those most at risk, and provide appropriate support without pathologizing ordinary distress responses.