University of Birmingham: Mental health of healthcare workers – a potential post-pandemic crisis

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Healthcare workforces around the world are facing extraordinary pressures on their physical and mental health. A report from MPs suggests that 62,000 vacancies across the NHS need to be filled, and a US survey of nurses suggested that nearly two in three were looking to leave their roles.

What is common in many of the reports about a looming crisis in healthcare staffing is the combination of physical and mental stresses that leave people burned out and looking for alternative work. We have read repeatedly about the impact that COVID-19 has had on people during the height of the pandemic, but what of its long-term effect on physical or mental health for these workers?

In our study in the journal Brain, Behavior, & Immunity – Health, we looked at the relationship between COVID-19 infection and markers of physical and mental health in workers during the first wave of the pandemic.

Between 17th of June to 30th of July 2020 (the pandemic’s first wave), we compared SARS-CoV-2 antibody prevalence to symptomatic self-reported COVID-19 infection. From there, we identify whether physical and mental health, including anxiety levels, of health care workers relate to coronavirus antibody status, a range of personal characteristics, and having symptoms of COVID-19.

The study found that nearly nine in 10 participants had COVID-19 antibodies, and more than a third had self-reported symptoms. At that point, just more than one in four members of the general public were testing positive for the same antibodies.

Our study shows that mental health of healthcare workers has been negatively affected by COVID-19 pandemic.
Dr. Anaanadeep Mandal – Associate Professor in Finance, Birmingham Business School, University of Birmingham
When we compared the data against self-reported physical and mental health surveys, the picture becomes more troubling. Individuals who were antibody positive or symptomatic had poorer self-reported physical health. Poorer physical health was found in high-risk healthcare workers, which can be related to their co-morbidities predisposing them to a greater risk of symptomatic infection with COVID-19. Physical health was better in those that were younger and without health conditions. Compared to normative data, the mental health of the HCWs was worse.

Our study shows that mental health of healthcare workers has been negatively affected by COVID-19 pandemic. Reasons may include an increased workload, greater risk of contracting COVID-19, fear of transmitting COVID-19 to friends and family, physical exhaustion, social isolation, negative impact of lockdown, understaffing due to sickness, longer working hours and anxieties related to the wearing of personal protective equipment (PPE).

When we consider the likelihood of seroprevalence – the percentage of people in a population with antibodies in their blood – in the UK, particularly among the healthcare workforce in 2022, we should have serious cause for concern.

COVID-19 has left a long shadow across the capacity of NHS and other care providers, which were already ‘running hot’ and struggling to meet the healthcare needs of the UK. Prior to the pandemic, the UK had a lower doctor-to-population ratio and lower gross domestic product (GDP) spend on healthcare compared to many other EU countries, meaning staff burnout has greater risks to healthcare provision in the UK.

The challenges related to the physical and mental health impact of COVID-19 is what the UK needs to prepare for in view of the persistence of COVID-19. Our study suggests key considerations need to be made urgently to protect the health and social care workforce from falling off a post-pandemic cliff.

There is an urgent need for wellbeing promotion to be a core consideration in the recruitment and retention policy of all healthcare providers. Placing personal responsibility for workers and line managers is not enough; institution-wide systems to ensure that employees are able to benefit from flexible and responsive patterns of work are important not only to avoid burnout, but also to support long-term physical health resilience.

The study also highlights the scope of health inequalities across the NHS workforce in relation to COVID-19. We were able to highlight where there are risks for some HCWs for persistent symptoms following COVID-19, which have been shown in other research too. This has led to pressure on at-risk HCW groups including women, younger people and Black, Indigenous, and people of colour (BIPOC).

Finally, we must be smarter about the way in which we protect healthcare workers from the excessive stresses of future healthcare challenges. As the COVID-19 public enquiry begins to consider the way that the UK Government and agencies responded to the global pandemic, we must ensure that any lessons learned include how we develop strategies so that our next health crisis isn’t one of our own making.

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