Comparing the mental health trajectories of four different types of keyworkers with non-keyworkers: 12-month follow-up observational study of 21 874 adults in England during the COVID-19 pandemic

Abstract

Background: There are concerns that keyworkers may be at a greater risk for psychological distress than non-keyworkers during the COVID-19 pandemic. However, little research has included keyworkers outside of the healthcare sector or has disaggregated keyworkers into different subgroups.

Aims: To examine longitudinal changes in mental health over 12 months during the COVID-19 pandemic comparing four different groups of keyworkers with non-keyworkers.

Method: Longitudinal data were from 21 874 adults living in England (21 March 2020 to 22 February 2021). Latent growth modelling was utilised to compare growth trajectories of depressive and anxiety symptoms in non-keyworkers and four types of keyworkers: (a) health and social care workers, (b) teachers and child care workers, (c) public service workers, and (d) essential services keyworkers (such as food chain or utility workers).

Results: When accounting for both time-invariant and time-varying covariates, keyworkers in the essential services category had consistently higher levels of depressive and anxiety symptoms than non-keyworkers across the whole of the study period. There was little difference in the mental health trajectories between health/social care, teachers/child care and public service worker categories and non-keyworkers.

Conclusions: Our findings suggest that the risk for poorer mental health during the COVID-19 pandemic varies within the broad category of keyworkers generally, and that those working in utility, food chain and transport roles are especially at risk. Future research should focus on identifying which aspects of working conditions may be contributing to occupational stress in these groups.

Keywords: COVID-19; anxiety; depression; keyworker; pandemic.

Fig. 1. Descriptive statistics of the time-varying variables across time points by keyworker status. (a) Depressive symptoms; (b) anxiety symptoms; (c) going out for work; and (d) vaccinated.

Depressive symptoms were measured with the Patient Health Questionnaire-9 and range from 0 to 27, and anxiety symptoms were measured with the Generalized Anxiety Disorder-7 and range from 0 to 21.

Fig. 2. Predicted growth trajectories of depressive and anxiety symptoms by keyworker status from latent growth models. Model I controlled for time-invariant covariates: (a) depressive symptoms and (c) anxiety symptoms; Model II controlled for both time-invariant and varying covariates: (b) depressive symptoms and (d) anxiety symptoms.

Depressive symptoms were measured with the Patient Health Questionnaire (PHQ-9) and range from 0 to 27, and anxiety symptoms were measured with the Generalized Anxiety Disorder-7 rand range from 0 to 21.