The mental health of NHS staff during the COVID-19 pandemic: two-wave Scottish cohort study

Abstract

Background: Health and social care workers (HSCWs) are at risk of experiencing adverse mental health outcomes (e.g. higher levels of anxiety and depression) because of the COVID-19 pandemic. This can have a detrimental effect on quality of care, the national response to the pandemic and its aftermath.

Aims: A longitudinal design provided follow-up evidence on the mental health (changes in prevalence of disease over time) of NHS staff working at a remote health board in Scotland during the COVID-19 pandemic, and investigated the determinants of mental health outcomes over time.

Method: A two-wave longitudinal study was conducted from July to September 2020. Participants self-reported levels of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and mental well-being (Warwick-Edinburgh Mental Well-being Scale) at baseline and 1.5 months later.

Results: The analytic sample of 169 participants, working in community (43%) and hospital (44%) settings, reported substantial levels of depression and anxiety, and low mental well-being at baseline (depression, 30.8%; anxiety, 20.1%; well-being, 31.9%). Although mental health remained mostly constant over time, the proportion of participants meeting the threshold for anxiety increased to 27.2% at follow-up. Multivariable modelling indicated that working with, and disruption because of, COVID-19 were associated with adverse mental health changes over time.

Conclusions: HSCWs working in a remote area with low COVID-19 prevalence reported substantial levels of anxiety and depression, similar to those working in areas with high COVID-19 prevalence. Efforts to support HSCW mental health must remain a priority, and should minimise the adverse effects of working with, and disruption caused by, the COVID-19 pandemic.

Keywords: COVID-19; Mental health; National Health Service; risk factors; staff.

Fig. 1

The two measurement periods on the backdrop of infection rates in Scotland. The PHQ-9 (depression), GAD-7 (anxiety) and WEMWBS (mental well-being) was administered at time points 1 and 2. ¹N = 225, R = 0.6−0.9, COVID-19 infection growth rate increasing from −0.5 to 0; ²N = 169, R = 0.9−1.5, COVID-19 infection growth rate increasing from −2 to 7. Source: Gov.uk https://coronavirus.data.gov.uk/details/cases?areaType=overview&areaName=United%20Kingdom. GAD-7, Generalised Anxiety Disorder-7; PHQ-9, Patient Health Questionnaire-9; WEMWBS, Warwick–Edinburgh Mental Well-being Scale.

Fig. 2

Main results of WEMWBS (mental well-being), PHQ-9 (depression) and GAD-7 (anxiety), and at time points 1 and 2, presented as proportion of participants with scores in different subcategories at different time points. Mental well-being: (a) probable depression (≤40), (b) possible depression (41–44), (c) average mental well-being (45–59), (d) high mental well-being (≥60); depression: (a) normal (≤4), (b) mild depression (5–9), (c) moderate depression (10–14), (d) moderately severe depression (15–19), (e) severe depression (≥20); anxiety: (a) normal anxiety (≤4), (b) mild anxiety (6–10), (c) moderate anxiety (11–15), (d) severe anxiety (≥16). GAD-7, Generalised Anxiety Disorder-7; PHQ-9, Patient Health Questionnaire-9; WEMWBS, Warwick–Edinburgh Mental Well-being Scale.

Fig. 3

A visual representation of the changes in clinical states for mental well-being (WEMWBS score <40), depression (PHQ-9 score ≥ 10) and anxiety (GAD-7 score ≥ 10), and between time point 1 and time point 2. GAD-7, Generalised Anxiety Disorder-7; PHQ-9, Patient Health Questionnaire-9; WEMWBS, Warwick–Edinburgh Mental Well-being Scale.