Factors influencing the mental health of an ethnically diverse healthcare workforce during COVID-19: a qualitative study in the United Kingdom

Abstract

Background: Healthcare workers (HCWs) have been reported to be experiencing a deterioration in their mental health due to COVID-19. In addition, ethnic minority populations in the United Kingdom are disproportionately affected by COVID-19. It is imperative that HCWs are appropriately supported and protected from mental harm during the pandemic. Our research aims to add to the evidence base by providing greater insight into the lived experience of HCWs from diverse ethnic backgrounds during the pandemic that had an impact on their mental health. Methods: We undertook a qualitative work package as part of the United Kingdom Research study into Ethnicity And COVID-19 outcomes among Healthcare workers (UK-REACH). As part of the qualitative research, we carried out 16 focus groups with a total of 61 HCWs between December 2020 and July 2021. The aim of the study was to explore topics such as their experiences, fears and concerns, while working during the pandemic. The purposive sample included ancillary healthcare workers, doctors, nurses, midwives and allied health professionals from diverse ethnic backgrounds to ensure inclusion of underrepresented and disproportionately impacted individuals. We conducted discussions using Microsoft Teams. Recordings were transcribed and thematically analysed. Results: Several factors were identified which impacted on the mental health of HCWs during this period including anxiety (due to inconsistent protocols and policy); fear (of infection); trauma (due to increased exposure to severe illness and death); guilt (of potentially infecting loved ones); and stress (due to longer working hours and increased workload). Conclusion: COVID-19 has affected the mental health of HCWs. We identified a number of factors which may be contributing to a deterioration in mental health for participants from diverse ethnic backgrounds. Healthcare organisations should consider developing strategies to counter the negative impact of these factors, including recommendations made by HCWs themselves.

Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study

“…Comparative data revealed strong social inequalities and discrimination against migrant HCWs and racialised groups in the HCWF. This was especially documented for BAME doctors in the UK (53, 54, 56, 57, 58, 59, 60) and ethnic minorities in Brazil (17, 62, 63). Black HCWs faced the strongest discrimination in most countries included in the analysis, as shown for the UK (53, 56, 57, 61), Brazil (17, 62), USA (64) and Canada (65).…”

“…Disadvantages and discrimination were reported for all countries and both topics, except for one study in the UK that specifically investigated the persistence of vaccine hesitancy and did not identify significant differences related to an ethnic group (55). Other disadvantages for migrant HCWs were reported for personal protective equipment (PPE) (54, 65), mental health (58), and more generally higher levels of experienced inequalities (17, 61, 67).…”

“…To begin with, ‘systemic racism’ was reported from a survey in the US (64). Qualitative studies carried out in the UK added further evidence that ‘institutional and structural racism’ created inequalities and discrimination in the HCWF (58, 59, 60). A multi-country nursing report brought the importance of new health labour market policy and welfare state arrangements into the debate, which were enhanced by the ‘redistribution of power relations’ during the pandemic (67).…”

“…In healthcare, professional and organisational settings are interconnected and inequalities created in one area may be reinforced in another. This was described, next to Brazil (17, 63) for Canada (65), Germany (45, 51, 52) and the UK (53, 54, 58, 61). For instance, disadvantages caused by lower PPE protection were strongest for lower status groups, e.g., hospital support worker (63), community healthcare workers (17), and HCWs working in residency care/long-term care (65).…”

“…Records with marginal information on our topic, as well as study protocols and mere opinion papers and editorials without substantive empirical data were also excluded. Finally, 19 articles were selected for the thematic analysis (17, 45, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67).…”