Mental health of healthcare workers in England during the first three years of the COVID-19 pandemic: the NHS CHECK study cohort

Background Maintaining the mental health of healthcare workers is vital to reduce staff absences and high turnover, which in turn should improve patient care. Most research in this area focusses on clinical staff, despite the important contributions non-clinical staff make to the health system, and uses data from one time point. Our objectives were to examine mental health status variations for all types of healthcare workers (HCWs) in England over a three-year period, and to examine which workers were at increased risk of poorer mental health outcomes. Method We undertook a prospective cohort study of 22,092 HCWs from 17 English acute and mental health NHS Trusts, collecting online survey data on common mental disorders (CMDs), depression, anxiety, alcohol misuse, PTSD, moral injury, burnout, wellbeing, resilience, and post-traumatic growth at four time points from April 2020 to March 2023. We analysed these data cross-sectionally over time by data collection point. Data were weighted to better represent individual Trust population demographics. Results Around 50% of participants reported probable CMDs across all time points. The most consistent predictor of any poor mental health outcome was having met cut-off on that outcome at baseline. There were no consistent differences between clinical and non-clinical staff. Younger, female, lower paid staff, those who felt poorly supported by colleagues/managers, and who experienced potentially morally injurious events were most at risk of poor mental health outcomes. Conclusion Our evidence suggests that all types of NHS staff are struggling, and that mental health has not improved since the end of pandemic restrictions. Longer term work to address structural inequalities that underlie some of these findings is needed, as well as targeted, flexible support for staff in the short term.