Mental Health Impact of COVID-19 among Spanish Healthcare Workers. A 3-year follow-up study

Purpose We assessed mental health trajectories of Spanish healthcare workers (HCWs) during three years following the first COVID-19 wave, focusing on distal and proximal risk factors. Methods A prospective cohort of HCWs from 18 Spanish institutions was assessed seven times between May 2020 and June 2023 through institutional web-based surveys. Outcomes included: (1) any probable mental disorder (MDx)—depression (PHQ-8 ≥ 10), anxiety (GAD-7 ≥ 10), panic attack, post-traumatic stress disorder (PCL-5 ≥ 7), or substance use disorder (CAGE-AID ≥ 2); and (2) any suicidal thoughts or behaviors (STB, CSSRS). Risk factors comprised 11 distal (sociodemographic, professional, health-related) and 13 proximal (COVID-19 infection, work, health, financial, and family stressors) variables. Latent Class Growth Analysis identified trajectories. Results 4,809 were followed. Most were women (77.3%), hospital workers (57.6%), and nurses/nurse assistants (44.4%). Prevalence of any MDx declined from 45.5% (May–Sept 2020) to 31.2% (Apr–Jun 2023), while STB increased slightly from 8.4% to 9.4% (not significant). Common risk factors for MDx and STB were previous mental disorders, female gender, nurse assistant role, foreign-born status, primary care work, and physical comorbidities. Four trajectory classes were identified for both MDx and STB: persistent high (19.4%, 5.0%), decreasing from high prevalence (28.5%, 5.2%), increasing from low (5.9%, 4.2%), and persistent low (46.2%, 85.5%). Persistent high classes were associated with interpersonal stress, loved ones’ health, lack of preparedness/protective equipment, and ethically challenging care decisions. Conclusions Mental health problems remained substantial among Spanish HCWs during three years of follow-up, about one in five showing persistently high burden. Continued monitoring and support are warranted.