Longitudinal comparisons of mental health, burnout and well-being in patient-facing, non-patient-facing healthcare professionals and non-healthcare professionals during the COVID-19 pandemic: findings from the CoPE-HCP study

Abstract

Background: The COVID-19 pandemic may disproportionately affect the mental health of healthcare professionals (HCPs), especially patient-facing HCPs.

Aims: To longitudinally examine mental health in HCPs versus non-HCPs, and patient-facing HCPs versus non-patient-facing HCPs.

Method: Online surveys were distributed to a cohort at three phases (baseline, July to September 2020; phase 2, 6 weeks post-baseline; phase 3, 4 months post-baseline). Each survey contained validated assessments for depression, anxiety, insomnia, burnout and well-being. For each outcome, we conducted mixed-effects logistic regression models (adjusted for a priori confounders) comparing the risk in different groups at each phase.

Results: A total of 1574 HCPs and 147 non-HCPs completed the baseline survey. Although there were generally higher rates of various probable mental health issues among HCPs versus non-HCPs at each phase, there was no significant difference, except that HCPs had 2.5-fold increased risk of burnout at phase 2 (emotional exhaustion: odds ratio 2.50, 95% CI 1.15-5.46, P = 0.021), which increased at phase 3 (emotional exhaustion: odds ratio 3.32, 95% CI 1.40-7.87, P = 0.006; depersonalisation: odds ratio 3.29, 95% CI 1.12-9.71, P = 0.031). At baseline, patient-facing HCPs (versus non-patient-facing HCPs) had a five-fold increased risk of depersonalisation (odds ratio 5.02, 95% CI 1.65-15.26, P = 0.004), with no significant difference in the risk for other outcomes. The difference in depersonalisation reduced over time, but patient-facing HCPs still had a 2.7-fold increased risk of emotional exhaustion (odds ratio 2.74, 95% CI 1.28-5.85, P = 0.009) by phase 3.

Conclusions: The COVID-19 pandemic had a huge impact on the mental health and well-being of both HCPs and non-HCPs, but there is disproportionately higher burnout among HCPs, particularly patient-facing HCPs.

Keywords: Burnout; COVID-19; Epidemiology; Healthcare professionals; Mental health.

Fig. 1

Flow diagram for participant numbers. Total numbers of participants at baseline, phase 2 and phase 3 was 1721, 957 and 830, respectively. These numbers are higher than those included in the figure because not all HCPs could be accurately categorised as patient-facing or non-patient-facing HCPs (e.g. the total number of participants at baseline where patient-facing status and HCP status could be identified is 1713). HCP, healthcare professional; IQR, interquartile range.

Fig. 2

Rates of probable mental health conditions and burnout domains as assessed by validated screening tools in healthcare professionals and non-healthcare professionals at baseline, phase 2 and phase 3.

Fig. 3

Rates of probable mental health conditions and burnout domains as assessed by validated screening tools in patient-facing healthcare professionals and non-patient-facing healthcare professional at baseline, phase 2 and phase 3.

Fig. 4

Separate mixed-effects logistic regression models calculating the odds for each outcome in HCPs compared with non-HCPs at baseline, phase 2 and phase 3. Blue plots denote risk (odds) with 95% confidence intervals for HCPs to meet criteria for outcomes, relative to non-HCPs (red line). The number of participants included in each regression model varied slightly for each outcome and for each phase (see Supplementary Table 6 for participant numbers with valid data for each outcome at each phase). HCP, healthcare professional; SWEMWBS, Short Warwick–Edinburgh Mental Wellbeing Scale.

Fig. 5

Separate mixed-effects logistic regression models calculating the odds for each outcome in patient-facing HCPs compared with non-patient-facing HCPs at baseline, phase 2 and phase 3. Blue plots denote risk (odds) with 95% confidence intervals for patient-facing HCPs to meet criteria for outcomes, relative to non-patient-facing HCPs (red line). The number of participants included in each regression model varied slightly for each outcome and for each phase (see Supplementary Table 7 for participant numbers with valid data for each outcome at each phase). HCP, healthcare professional; SWEMWBS, Short Warwick–Edinburgh Mental Wellbeing Scale.