Long-Term Trajectory and Risk Factors of Healthcare Workers’ Mental Health during COVID-19 Pandemic: A 24 Month Longitudinal Cohort Study

Abstract

Background: Research has shown the substantial impact of the COVID-19 pandemic on healthcare workers’ (HCWs) mental health, however, it mostly relies on data collected during the early stages of COVID-19. The aim of this study is to assess the long-term trajectory of HCWs’ mental health and the associated risk factors. Methods: a longitudinal cohort study was carried out in an Italian hospital. At Time 1 (July 2020–July 2021), 990 HCWs took part in the study and completed the General Health Questionnaire (GHQ-12), the Impact of Event Scale (IES-R), and the General Anxiety Disorder (GAD-7)questionnaire. McNemar’s test measured changes in symptoms’ trajectories, and random effects models evaluated risk factors associated with scores above the cut-off. Results: 310 HCWs participated to the follow-up evaluation (Time 2; July 2021–July 2022). At Time 2, scores above cut-offs were significantly lower (p < 0.001) than at Time 1 for all scales (23% vs. 48% for GHQ-12; 11% vs. 25% for IES-R; 15% vs. 23% for GAD-7). Risk factors for psychological impairment were being a nurse (IES-R: OR 4.72, 95% CI 1.71–13.0; GAD-7: OR 2.82, 95% CI 1.44–7.17), a health assistant (IES-R: OR 6.76, 95% CI 1.30–35.1), or having had an infected family member (GHQ-12: OR 1.95, 95% CI 1.01–3.83). Compared to Time 1, gender and experience in COVID-19 units lost significance with psychological symptoms. Conclusions: data over more than 24 months from the pandemic onset showed improvement of HCWs’ mental health; our findings suggested the need to tailor and prioritize preventive actions towards healthcare workforce.

Prevalence of Moral Injury, Burnout, Anxiety, and Depression in Healthcare Workers 2 Years in to the COVID-19 Pandemic

“…Conversely, a perceived disconnect between societal view of COVID-19 ( e.g. , “postpandemic”) and the lived experience of healthcare workers who may still be caring for patients with coronavirus-related illnesses may itself contribute to moral injury (Fattori et al, 2023; Song et al, 2021). COVID-19 fatigue still exists today, and many employees lost loved ones from the pandemic.…”

“…Although society may have moved on from COVID-19, the results of our data provide utility postpandemic as a potential high-water mark against which interventions against moral injury can be measured. Conversely, a perceived disconnect between societal view of COVID-19 (e.g., "postpandemic") and the lived experience of healthcare workers who may still be caring for patients with coronavirus-related illnesses may itself contribute to moral injury (Fattori et al, 2023;Song et al, 2021). COVID-19 fatigue still exists today, and many employees lost loved ones from the pandemic.…”

Excess risk of Covid-19 infection and mental distress in healthcare workers during successive pandemic waves. Analysis of matched cohorts of healthcare workers and community referents in Alberta, Canada

“…Previous studies have shown a deterioration in mental health in HCWs early in the pandemic [13]. In Australia a study following HCWs from May 2021 to June 2022 found a deterioration in MH [17] while one from Italy for much the same period found MH improvements [18]. A systematic review that included 18 longitudinal studies of mental health in HCWs during the pandemic concluded that 12 studies suggested deterioration over time and 6 improvement, attributing the ‘remarkable variation’ to use of different instruments for measuring MH [10].…”

Cohort profile: recruitment and retention in a prospective cohort of Canadian healthcare workers during the COVID-19 pandemic

“…Early in the pandemic many short-term studies of HCWs were set up to establish risk in particular workplaces but few had the funding, resources or established protocol to follow workers through the length of the pandemic. Other cohorts of similar size and longevity as the one described here have been established either as seroprevalence studies5–7 or studies of mental health 8 9…”