Almost 60% of UK frontline health and social care workers (HSCWs) experienced a mental health disorder during the first COVID-19 lockdown, with many of those surveyed suffering "very high rates of distress", suggests a new study led by researchers at UCL and the University of Haifa, Israel.
Given the significantly high levels of mental health disorders across all HSCWs, the researchers believe the sector could be on "the verge of a mental health crisis", and are now calling for long-term planning to meet the needs of the staff, such as specialist trauma services, similar to the NHS psychological trauma provisions for military veterans.
The 'Frontline-COVID study', published today in the peer-reviewed European Journal of Psychotraumatology, surveyed 1,194 HSCWs, who worked in UK hospitals, nursing or care homes and other community settings, to identify and compare the rates of mental health disorder across different job roles and places of work.
The research, carried out just after the UK's first wave of COVID between 27 May and 23 July, 2020, found that:
- 58% of HSCWs met the threshold for any mental health disorder
- 22% met criteria for post-traumatic stress disorder (PTSD)
- 47% had clinically significant anxiety
- 47% had depression.
Importantly, the findings show it was not just doctors and nurses who were experiencing clinically significant distress - symptom levels were high across all job roles and settings in health and social care; such as allied health professionals, ambulance workers, hospital porters, pharmacists, and care home staff.
Furthermore, the research also identified some specific mental health risk factors, principally: concern about infecting others with COVID; being unable to talk with managers about how they were coping; feeling stigmatised (about their role); and not having had reliable access to personal protective equipment (PPE).
Key predictors for PTSD included staff being redeployed to other teams and having had COVID themselves.
Conducted by the 'COVID Trauma Response Working Group' (formed by UCL psychiatrists and psychologists), the research is the first UK study to assess mental health disorders across all health and social care settings during COVID-19.
Lead author, Dr Talya Greene (UCL Psychiatry and University of Haifa), said: "Our study shows that more than half of health and social care staff surveyed met criteria for a mental disorder following the first wave of COVID-19 in the UK.
"Let's be clear: we may be on the verge of a mental health crisis across the health and social care sector. So, we need to make sure that specialist help is offered and accessible across all the different roles and settings.
"It is important that this support (for those that need it) is planned for the long-term. These findings clearly highlight the urgency for immediate long-term funding for specialist mental health services for all health and social care workers."
She added: "Specifically, for some frontline HSCWs, their distress and other symptoms will be severe and have the potential to become chronic.
"These cases need to be detected early and treated promptly in order to protect the individuals and the overall functioning of the entire health and social care system during the pandemic.
"The findings that distress levels were relatively high across the different occupational groups and work settings emphasizes the need to ensure services reach out to all these groups."
The survey, carried out online, also demonstrates that over 30% of participants felt they could not tell their manager about how they were coping, and this was associated with the highest odds of distress across most models.
However, those with higher household incomes were shown to be associated with reduced odds for a mental disorder.
Co-author Dr Jo Billings (UCL Psychiatry) states: "In particular, this study highlights the need for reliable access to PPE for all staff working in health and social care roles, to reduce their feelings that they are at risk of catching COVID, and crucially, the perception that they are a risk to others.
"Additionally, we find it is important to examine the role that managers can play in reducing staff distress, especially for redeployed staff. Differentiating between those with temporary distress, and those who are on a trajectory for longer term mental health problems, is a priority.
"Therefore, there is also a need for further investigation to understand the barriers to communication between managers and staff."
Co-author, Dr Michael Bloomfield (UCL Psychiatry), concludes: "Our colleagues in the health and social care system are doing fantastic work under very difficult circumstances. At the same time, we know that many mental health clinicians are doing great work in supporting frontline colleagues in need.
"Whilst our study is based on self-report, and so needs to be interpreted with caution, our findings nonetheless add to a growing body of research on the toll of the pandemic on health and social care workers.
"Importantly, our study has identified risk factors that might help in better supporting staff. It's important that staff across the health and social care sector are offered this support."
Limitations of the research include that the majority of those surveyed were female (92.4%) and white (90.8%). The authors recommend further studies examine COVID-19 distress in HSCWs, especially with non-clinical staff working in health and social care settings, who have been typically neglected in research to date.