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The COVID aftermath: Do 20% of healthcare workers in the UK live with mental health conditions?
King’s College London and National Institute of Health Research Applied Research Collaboration North Thames at University College London have conducted what is the largest research study looking into mental health of people working in the National Health Service (NHS) in the UK, ranging from nurses and doctors to those who aren’t working with service users directly. Thousands of people participated in this survey and lots of interesting results have been found already as the research and data analysis continues.
In this summary, we want to take a closer look at a study by Scott and colleagues published in the January 2023 issue of The Lancet Psychiatry. The research tried to find out how many NHS staff live with Post-Traumatic Stress Disorder (PTSD), Generalised Anxiety Disorder and Depression during the time of the recent Coronavirus pandemic (more on what these are in just a moment!) A smaller group of just over 300 people from the larger NHS CHECK study, which initially included 23,000 people, were invited to take part.
What did this study look at?
Arguably the pandemic has put extraordinary strain on many people working in healthcare. Not only have they faced the risk of infection, serious health problems and death, but also overworking, understaffing and other problems could potentially have taken their toll on staff wellbeing too.
Most of us will understand what depression and anxiety look like roughly and how they can negatively impact on someone’s life. Briefly, PTSD can be triggered by experiencing or learning about a traumatic event, which can be linked to death or serious harm coming to oneself or another person. People living with this condition can often have ‘flashbacks’, intense nightmares and generally feel very anxious. This often has a serious impact because it can interrupt many important aspects of a person’s life. This current study tried to find out how often people working within the NHS during the pandemic have experienced anxiety, depression, and PTSD.
What was done?
The researchers carried out a ‘two-phase’ cross-sectional study in several different hospitals in the UK. A ‘cross-sectional study’ or ‘prevalence study’ is simply a snapshot of a group or ‘sample’ of people (in this case NHS workers) measured at one point in time. This allows us to look at rates of things (here rates of PTSD, depression, and anxiety). For more information about this check out our glossary!
One key thing about the current study is that unlike many other studies, the researchers invited staff to diagnostic interviews (‘Phase 2’) after an initial screening (‘Phase 1’) for mental health conditions. Diagnostic interviews are the ‘gold standard’ when it comes to being able to say whether or not someone has a mental health diagnosis, such as PTSD, or not using certain criteria. Most other studies use screening questionnaires completed by the person instead. This is mostly for convenience and to lower the cost since doing interviews with people can be a lengthy process that requires a lot of training, too. Screening tools such as the General Health Questionnaire and the Post-Traumatic Stress Disorder Checklist are often used. Although they can give us an idea of whether someone is experiencing some symptoms of a particular diagnosis, there is much more room for error when compared to diagnostic interviews. This can cause problems, for example that we get a false impression of how common a condition is, also known as its “prevalence”.
The current study included two samples of people:
1. One that was screened for depression and anxiety with just under 250 participants
2. Another which was screened for PTSD with just under 100 participants.
Participants in these groups were selected in a way that tried to ensure they are representative of the bigger NHS CHECK sample with regards to sharing important characteristics, such as which hospital they work in, what job they have, their age, sex, and ethnicity. The two pre-screened samples were interviewed using the Clinical Interview Schedule-Revised (CIS-R) to detect anxiety and depression and the Clinician Administered PTSD Scale for the Diagnostic Statistical Manual-5 (CAPS-5).
What did they find?
The commonly used questionnaires completed by staff overestimate the rates of ‘diagnosable’ mental health problems by quite some way, and studies using these should be interpreted with caution especially when they are used to guide what services are needed. Overestimating rates of depression, anxiety and PTSD is a significant problem. It may mean that healthcare resources are allocated where they may not be as needed compared with other areas. Also, we need to acknowledge that whilst emotional distress is a symptom of anxiety, depression, and PTSD, it also can be a normal reaction to highly challenging circumstances and non-professional support may be enough for some people to recover. As such, we need to be careful not to mis-label understandable distress as a mental health condition and ‘over medicalise’ the nature of the problem.
On the other hand, though the screening questionnaires certainly overestimated rates of mental health conditions during the pandemic, the diagnostic interviews showed many people working in the NHS have depression, PTSD, or generalised anxiety disorder. One in every five NHS staff turned out to have a depression or anxiety and they were doubly as likely to develop PTSD compared to the general public at the time this study was carried out.
These are the people providing our healthcare. So, if we can accurately identify how big the percentage of people with mental health conditions is in the workforce, we can plan more effectively and provide the help and support needed, including considering ways of preventing them in the first place. After all, we need to make sure that those caring for service users are well enough themselves to help others.
What are the most important limitations of this research?
Well, because it is a snapshot in time, we can’t say that one thing (working for the NHS during the pandemic) causes another (mental health problems). It’s also a problem that people living with mental health conditions are less likely to participate in research studies, so this could mean that the researchers in this study haven’t captured all NHS staff experiencing mental health conditions, ultimately missing a lot of people.
Also, most of the people included in the study were self-selected, which means people who were motivated to take part in the study, including clinical staff, who were white, female and earned at least £30,000 a year. There was quite a low uptake to Phase 2 diagnostic interviews. This means that more information might be needed to see if the findings apply to people from a wider variety of backgrounds. That said, the researchers made good efforts to ensure the people who took part in the study were roughly comparable to people working for the NHS nationally.
Another thing to consider is that events triggering PTSD or onset of anxiety and depression could well have happened before the pandemic. The researchers didn’t collect the information necessary to see if this was so, and whether the pandemic has ‘caused’ a change in rates of anxiety, PTSD, and depression. Also, there a 12-month delay between the screening phase and the interview phase. Arguably, a lot can change in a year… so some people who initially screened as positive or negative for a certain condition may have got better or worse over time.
The sample size was likely too small to look at differences between staff working with service users and those who are in non-clinical roles, which would have been interesting.
However, overall, this was an interesting study that shows how we still have lots to learn about the use of screening questionnaires completed by staff and need to further explore mental health support needs for our NHS workers.
YOUR LAY SUMMARY INFORMATION
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|The COVID aftermath: Do 20% of healthcare workers in the UK live with mental health conditions? Video lay summary
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|Dr Anja Harrison
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Postraumatic Stress Disorder
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Hannah R Scott, Sharon A M Stevelink, Rafael Gafoor, Danielle Lamb, Ewan Carr, Ioannis Bakolis, Rupa Bhundia, Mary Jane Docherty, Sarah Dorrington, Sam Gnanapragasam, Siobhan Hegarty, Matthew Hotopf, FMedSci Ira Madan, Sally McManus, Paul Moran, Emilia Souliou, Rosalind Raine, Reza Razavi, Danny Weston, Neil Greenberg, Simon Wessely
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No conflict of interest reported
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|Cross-sectional study / Prevalence study
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|Attribution 4.0 International (CC BY 4.0)