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

  1. Carl A Melbourne
  2. Anna L Guyatt
  3. Laura Nellums
  4. Padmasayee Papineni
  5. Amit Gupta
  6. Irtiza Qureshi
  7. Christopher A Martin
  8. Luke Bryant
  9. Catherine John
  10. Mayuri Gogoi
  11. Fatimah Wobi
  12. Amani Al-Oraibi
  13. Jonathan Chaloner
  14. Avinash Aujayeb
  15. Bindu Gregary
  16. Susie Lagrata
  17. Rubina Reza
  18. Sandra Simpson
  19. Stephen Zingwe
  20. Martin Tobin
  21. Sue Carr
  22. Kamlesh Khunti
  23. Laura J Gray
  24. I Chris McManus
  25. Katherine Woolf
  26. Manish Pareek

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Abstract

Objectives

To 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.

Design

Cross-sectional analysis of baseline data from the UK-REACH national cohort study

Setting

HCWs across UK healthcare settings.

Participants

11,695 HCWs working between December 2020-March 2021.

Main outcome measures

Anxiety 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).

Results

Asian, 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.

Conclusions

Ethnic 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 box

What is already known on this topic

  • The pandemic is placing healthcare workers under immense pressure, and there is currently a mental health crisis amongst NHS staff

  • Ethnic inequities in health outcomes are driven by structural discrimination, which occurs inside and outside the workplace

  • Investigating ethnic inequities in the mental health of healthcare workers requires large diverse studies, of which few exist

What this study adds

  • In 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-19

  • These 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

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2022.02.03.22270306: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Participants who gave their informed consent to join the study were invited to complete the baseline questionnaire online (data collected between 4th December 2020 - 8th March 2021).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations: in all cross-sectional studies, associations may be bidirectional, or due to reverse causation, e.g. smoking and mental health,33 religiosity and PTSD34. Moreover, although the breadth of UK-REACH data permitted adjustment for hypothesised confounders, residual confounding (due to missing data or measurement error) is possible in all observational studies. Selection bias may also have affected our conclusions. Eligible individuals with worse mental health may be less likely to join a study35 and despite being similar to the NHS workforce in terms of age and sex,36 the current sample includes more clinical healthcare professionals,36 fewer ancillary workers, fewer participants from White and Black ethnic groups, and more from Asian and Mixed/multiple ethnic groups.37 Estimating prevalence of anxiety/depression and PTSD is difficult when using a screening tool and cut-offs to define caseness. Epidemiological studies may provide overoptimistic estimates if participants generally underreport symptoms, and biased associations may result from systematic variation in disclosure of symptom severity by levels or categories of a risk factor38. For example, under-reporting of symptoms by men has been hypothesised as a reason for why women may appear more susceptible to mental ill-health.39 Two studies of diverse participants reported that the PHQ-9 scale (from which the PHQ-2 is derived) performed similarly across ethnicities, suggesting that inequalities in s...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.02.03.22270306 on medRxiv