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

Abstract

ObjectivesTo investigate how ethnicity and other sociodemographic, work, and physical health factors are related to mental health in UK healthcare and ancillary workers (HCWs), and how structural inequities in these factors may contribute to differences in mental health by ethnicity.DesignCross-sectional analysis of baseline data from the UK-REACH national cohort studySettingHCWs across UK healthcare settings.Participants11,695 HCWs working between December 2020-March 2021.Main outcome measuresAnxiety or depression symptoms (4-item Patient Health Questionnaire, cut-off >3), and Post-Traumatic Stress Disorder (PTSD) symptoms (3-item civilian PTSD Checklist, cut-off >5).ResultsAsian, Black, Mixed/multiple and Other ethnic groups had greater odds of PTSD than the White ethnic group. Differences in anxiety/depression were less pronounced. Younger, female HCWs, and those who were not doctors had increased odds of symptoms of both PTSD and anxiety/depression. Ethnic minority HCWs were more likely to experience the following work factors that were also associated with mental ill-health: workplace discrimination, feeling insecure in raising workplace concerns, seeing more patients with COVID-19, reporting lack of access to personal protective equipment (PPE), and working longer hours and night shifts. Ethnic minority HCWs were also more likely to live in a deprived area and have experienced bereavement due to COVID-19. After adjusting for sociodemographic and work factors, ethnic differences in PTSD were less pronounced and ethnic minority HCWs had lower odds of anxiety/depression compared to White HCWs.ConclusionsEthnic minority HCWs were more likely to experience PTSD and disproportionately experienced work and sociodemographic factors associated with PTSD, anxiety and depression. These findings could help inform future work to develop workplace strategies to safeguard HCWs’ mental health. This will only be possible with adequate investment in staff recruitment and retention, alongside concerted efforts to address inequities due to structural discrimination.Summary boxWhat is already known on this topicThe pandemic is placing healthcare workers under immense pressure, and there is currently a mental health crisis amongst NHS staffEthnic inequities in health outcomes are driven by structural discrimination, which occurs inside and outside the workplaceInvestigating ethnic inequities in the mental health of healthcare workers requires large diverse studies, of which few existWhat this study addsIn UK-REACH (N=11,695), ethnic minority staff had higher odds of Post-Traumatic Stress Disorder symptoms; we report many other factors associated with mental-ill health, including those experienced disproportionately by ethnic minority staff, such as workplace discrimination, contact with more patients with COVID-19, and bereavement due to COVID-19These findings underline the moral and practical need to care for staff mental health and wellbeing, which includes tackling structural inequities in the workplace; improving staff mental health may also reduce workforce understaffing due to absence and attrition

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

“…These findings align with other research (Martin et al, 2022 ) which identified less access to adequate PPE for ethnic minority HCWs. This situation is associated with decreased trust in employers (as evidenced in this research), which in turn may be associated with a more significant impact on the mental wellbeing of ethnic minority HCWs compared to those from white ethnic backgrounds (Melbourne et al, 2022 ). Inconsistencies in policy guidance may leave HCWs at increased risk of infection from COVID-19, and combined with a lack of trust in employer, may lead to a fundamental sense of betrayal.…”

“…In the UK, there is an emerging evidence base that demonstrates similar experiences and outcomes within the general population (Pierce et al, 2020 ) and in particular, HCWs. This emerging research suggests there is a ‘mental health crisis’ for HCWs in the UK (Melbourne et al, 2022 ). Governmental reports have also acknowledged the additional psychological burden on UK HCWs during the pandemic (PHE, 2020a ; House of Commons, 2021 ).…”

A service mapping exercise of four health and social care staff mental health and wellbeing services, Resilience Hubs, to describe health service provision and interventions

“…Not applicable. 4 Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK. 5 Greater Manchester Resilience Hub, Pennine Care NHS Foundation Trust, Trust Headquarters, 225 Old Street, Ashton-Under-Lyne, Greater Manchester, UK.…”

“…The COVID-19 pandemic impacted the mental health of health and social care workers, with staff working in frontline roles and critical care particularly affected, [1,2] especially or those redeployed into new roles [3]. Staff from Black, Asian, and other diverse ethnic communities [4], staff with existing physical or mental health conditions, and those with limited social support were also at high risk of mental health difficulties [2,[5][6][7][8]. Internationally, 49% reported insomnia, 47% anxiety, and 37% post-traumatic stress [9].…”

Impact of COVID-19 on Ethnically Minoritised Carers in UK’s Care Home Settings: a Systematic Scoping Review

“…Among included studies, three were designed as crosssectional studies [26,27,33], two cohort studies [32,34], two qualitative studies [23,29], and two studies were online surveys [28,31]. One cross-sectional study conducted a qualitative analysis of data from different sources regarding experiences of PPE [30].…”