Mental Health During COVID-19: A Qualitative Study with Ethnically Diverse Healthcare Workers in the United Kingdom

Abstract

IntroductionHealthcare workers are experiencing deterioration in their mental health due to COVID-19. Ethnic minority populations in the United Kingdom are disproportionately affected by COVID-19, with a higher death rate and poorer physical and mental health outcomes. It is important that healthcare organisations consider the specific context and mental, as well as physical, health needs of an ethnically diverse healthcare workforce in order to better support them during, and after, the COVID-19 pandemic.MethodsWe 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 conducted focus group discussions with healthcare workers between December 2020 and July 2021, and covered topics such as their experiences, fears and concerns, and perceptions about safety and protection, while working during the pandemic. The purposive sample included ancillary health workers, doctors, nurses, midwives and allied health professionals from diverse ethnic backgrounds. We conducted discussions using Microsoft Teams. Recordings were transcribed and thematically analysed.FindingsWe carried out 16 focus groups with a total of 61 participants. Several factors were identified which contributed to, and potentially exacerbated, the poor mental health of ethnic minority healthcare workers 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).ConclusionCOVID-19 has affected the mental health of healthcare workers. We identified a number of factors which may be contributing to a deterioration in mental health across diverse ethnic groups. Healthcare organisations should consider developing strategies to counter the negative impact of these factors. This paper will help employers of healthcare workers and other relevant policy makers better understand the wider implications and potential risks of COVID-19 and assist in developing strategies to safeguard the mental health of these healthcare workers going forward, and reduce ethnic disparities.Key messagesWhat is already known about this subjectHealthcare Workers (HCWs) are experiencing deterioration of their mental health due to COVID-19Ethnic minority populations and HCWs are disproportionately affected by COVID-19More research is needed on the specific factors influencing the mental health of ethnically diverse healthcare workforcesWhat are the new findingsProminent factors influencing the mental health and emotional wellbeing of this population include: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)stress (due to longer working hours and increased workload)How might this impact on policy or clinical practice in the foreseeable futureHealthcare organisations should consider the specific circumstances of these staff and develop strategies to counter the negative impact of these factors and help safeguard the mental health of their staff

Mental health in a diverse sample of healthcare workers during the COVID-19 pandemic: cross-sectional analysis of the UK-REACH study

“…The ethnic categorisations used and quantitative associations presented cannot fully capture the nuance of participants' lived experiences; however, complementary qualitative work in UK-REACH contextualises HCWs' individual experiences, and also highlights the role of bereavement due to COVID-19, increased clinical workloads (including the traumatic and exhausting nature of treating high volumes of sick patients), and fear of contracting or transmitting infection (including PPE access) in contributing to mental ill-health in HCWs. 21 Our finding that anxiety/depression symptoms were only weakly associated with ethnicity is similar to another study of HCW mental health during the pandemic; 5 that study also found no strong associations between ethnicity and PTSD, which may reflect its smaller sample size and lower proportion of ethnic minority participants. However, our findings are similar to the results of the NHS Staff survey 2019, 42 in which lower levels of pre-pandemic stress were generally reported by participants from Asian, Black, Chinese, and Mixed ethnic groups.…”

“…The ethnic categorisations used and quantitative associations presented cannot fully capture the nuance of participants’ lived experiences; however, complementary qualitative work in UK-REACH contextualises HCWs’ individual experiences, and also highlights the role of bereavement due to COVID-19, increased clinical workloads (including the traumatic and exhausting nature of treating high volumes of sick patients), and fear of contracting or transmitting infection (including PPE access) in contributing to mental ill-health in HCWs. 21…”

“…both quantitative (workload) and qualitative (roles at work, trust in employer), are less studied, but are described as work predictors for common mental health problems, alongside external factors. 20 21 We therefore hypothesised that ethnic inequities in stressful conditions at work and factors outside of work could contribute to differences in mental health between ethnic groups.…”

The Mental Health of Medical Frontliners during the COVID 19 Pandemic

“…In a study entitled COVID-19 anxiety among frontline nurses: predictive role of organizational support, personal resilience and social support (Qureshi et al, 2021). Anxiety-related to the COVID-19 pandemic is prevalent in the nursing workforce, potentially affecting nurses' well-being and work performance.…”