Article Figures & Tables
Figures
- Figure 1:
Study flowchart. Note: HCP = health care professional.
- Figure 2:
Forest plot of the odds ratios (ORs) (risk) of mental health and burnout by perceived level of workplace support among health care professionals at baseline (n = 1422). Note: CI = confidence interval, Ref. = reference category. *Adjusted for age, gender, time elapsed since COVID-19 peak in subject’s region, highest level of education, relationship status, number living in household, current mental health diagnosis, current physical health diagnosis and role.
- Figure 3:
Forest plot of the odds ratio (ORs) (risk) of mental health and burnout by perceived level of workplace support among health care professionals at follow-up (n = 681). Note: CI = confidence interval, Ref. = reference category. *Adjusted for age, gender, time elapsed since COVID-19 peak in subject’s region, highest level of education, relationship status, number living in household, current mental health diagnosis, current physical health diagnosis and role.
Tables
Characteristic No. (%) of respondents p value* All baseline
n = 1574Baseline only
n = 830Baseline and follow-up
n = 744Age, yr 0.26 18–25 76 (4.8) 45 (5.4) 31 (4.2) 26–35 390 (24.8) 215 (25.9) 175 (23.5) 36–50 638 (40.5) 340 (41.0) 298 (40.1) 51–60 372 (23.6) 187 (22.5) 185 (24.9) 61–70 92 (5.8) 41 (4.9) 51 (6.9) > 70 6 (0.4) 2 (0.2) 4 (0.5) Ethnicity† < 0.001 White 1027 (65.3) 440 (53.0) 587 (78.9) Asian 359 (22.8) 266 (32.0) 93 (12.5) Black 74 (4.7) 47 (5.7) 27 (3.6) Multiple ethnicities 48 (3.1) 29 (3.5) 19 (2.6) Other 39 (2.5) 27 (3.3) 12 (1.6) Prefer not to say 27 (1.7) 21 (2.5) 6 (0.81) Gender < 0.001 Female 1105 (70.2) 543 (65.4) 562 (75.5) Male 447 (28.4) 269 (32.4) 178 (23.9) Prefer not to say 14 (0.9) 11 (1.3) 3 (0.4) Prefer to self-define 8 (0.5) 7 (0.8) 1 (0.1) Relationship status 0.95 Divorced 54 (3.4) 27 (3.3) 27 (3.6) Prefer not to say 46 (2.9) 25 (3.0) 21 (2.8) Married or living with partner or family 1048 (66.6) 552 (66.5) 496 (66.7) Other 52 (3.3) 30 (3.6) 22 (3.0) Single 374 (23.8) 196 (23.6) 178 (23.9) No. of people living in household < 0.001 1 210 (13.3) 106 (12.8) 104 (14.0) 2 487 (30.9) 235 (28.3) 252 (33.9) 3–5 799 (50.8) 432 (52.1) 367 (49.3) ≥ 6 78 (5.0) 57 (6.9) 21 (2.8) Highest level of education 0.32 GCSEs or A-levels‡ 113 (7.2) 52 (6.3) 61 (8.2) Bachelor’s or diploma 735 (46.7) 389 (46.9) 346 (46.5) Master’s or PhD 613 (39.0) 323 (38.9) 290 (39.0) Other 113 (7.2) 66 (8.0) 47 (6.3) Mental health and burnout§ Major depressive disorder 354 (24.7) 172 (23.9) 182 (25.5) 0.46 Generalized anxiety disorder 284 (19.9) 142 (19.8) 142 (19.9) 0.97 Clinical insomnia 228 (16.1) 103 (14.6) 125 (17.6) 0.13 Emotional exhaustion 580 (41.9) 298 (44.0) 282 (39.8) 0.12 Depersonalization 186 (13.4) 103 (15.2) 83 (11.7) 0.06 Low mental well-being 349 (25.1) 173 (25.3) 176 (24.8) 0.84 Professional role¶ < 0.001 Medical doctors 651 (42.4) 390 (48.7) 261 (35.5) Health care assistants (including phlebotomists, porters, cleaners) 223 (14.5) 115 (14.4) 108 (14.7) Nurses or midwives 368 (23.9) 171 (21.4) 197 (26.8) Allied health care professionals 295 (19.2) 125 (15.6) 170 (23.1) Note: GCSE = General Certificate of Secondary Education.
↵* p values from comparison of participants who completed only baseline survey with those who completed both baseline and follow-up surveys using χ2.
↵† All demographic data are self-reported. The Asian category includes those who reported South Asian, Chinese and any other Asian background.
↵‡ In the UK qualification tier system, GCSE is a general secondary certificate and A-levels are subject-based qualifications that can lead to university, further study, training or work.
↵§ The amount of missing data varied for each mental health outcome, as follows: 1434 participants (721 who completed only baseline survey and 713 who completed both baseline and follow-up) completed measure of major depressive disorder, 1429 (716 baseline only and 713 follow-up) completed measure of generalized anxiety disorder, 1418 (706 baseline only and 712 follow-up) completed measure of clinical insomnia, 1386 participants (678 baseline only and 708 follow-up) completed measures of emotional exhaustion and depersonalization, and 1393 (684 baseline only and 709 follow-up) completed measure of well-being.
↵¶ A total of 1537 health care professionals reported their role; 801 completed only the baseline survey, 736 completed baseline and follow-up surveys.
- Table 2:
Linear regressions for the association between change in perceived level of support and change in mental health, burnout and well-being scores among health care professionals from baseline to follow-up
Measure Crude Adjusted* β (95% CI) p value β (95% CI) p value* GAD-7 −0.10 (−0.21 to 0.01) 0.075 −0.13 (−0.25 to −0.01) 0.036 PHQ-9 −0.19 (−0.30 to −0.08) 0.001 −0.17 (−0.29 to −0.04) 0.008 ISI −0.07 (−0.19 to 0.05) 0.226 −0.13 (−0.26 to 0.01) 0.067 EEDP2Q −0.05 (−0.12 to 0.01) 0.112 −0.06 (−0.13 to 0.02) 0.139 SWEMWBS 0.17 (0.08 to 0.27) < 0.001 0.19 (0.10 to 0.29) < 0.001 Note: CI = confidence interval, EEDP2Q = emotional exhaustion and burnout scale, GAD-7 = 7-item Generalized Anxiety Disorder scale, ISI = Insomnia Severity Index, PHQ-9 = 9-item Patient Health Questionnaire, SWEMWBS = Short Warwick-Edinburgh Mental Wellbeing Score.
↵* Adjusted for age, gender identity, education, relationship status, number living in household, currently diagnosed mental health condition, currently diagnosed physical health condition, role (medical doctor v. health care assistants, nurses, and allied health professionals), and baseline level of support.
Theme Description Quotes Concern or understanding for welfare Genuine concern for welfare. Respondents valued managers who listened and left staff feeling understood and with consistent support.
A few respondents cited check-ins and appropriate training from original line managers as being important to their mental health when redeployed.
“Direct check in. How am I doing, and actually listen to the answer. I have been left to get on with it, with a few platitudes ‘Oh its hard.’”
“Would have wanted more recognition from management about impact and repercussions of redeployment but support from colleagues was good within the team.”
“I had no contact with my original team during my redeployment, I found this very stressful which increased my anxiety.”Flexibility and understanding. Respondents appreciated managers who were understanding and flexible of personal circumstances (e.g., amended working arrangements because of child care, school times, shielded family members, personal anxiety and stress).
“Better understanding of peoples personal situations. I am a full-time unpaid carer for partner who was told to shield for 12 weeks. Due to his condition (a traumatic brain injury and epilepsy) I was unable to leave him unsupervised for long periods of time as his seizures are fatal and in the event of one he needs medication administered to him to save his life … I requested to be able to work from home due these extenuating circumstances which was denied which caused me and my partner extreme stress … I think it needs to be looked at as a case by case basis and not as a staffing level or need as a whole.” Psychological support. One-on-one confidential counselling or access to clinical psychologist was cited as useful for respondents’ mental health.
“Well-being support with a named psychologist allocated to our team right from the start.”
“I would have wanted one-on-one therapy sessions with an external professional. We were offered these with our own psychology department free of charge though I often work closely with these individuals.”Information Communication Respondents requested regular, clear, consistent and transparent communication and updates, sent in a timely manner.
Respondents sometimes cited daily staff briefings, regular bulletins and daily huddles as being useful modes of communication.
“I found it really helpful to have daily or twice weekly staff team briefings with updates on PPE, procedures, etc., and a chance to ask questions. In the early part of the pandemic, one of the most stressful things was the sheer volume of information coming at us and constant changes to what we should be doing, what PPE we needed in which area, etc.”
“Better communication — it felt like as a nurse being redeployed that we were deliberately kept in the dark about operations surrounding COVID-19 as the trust management were more paranoid about details being leaked to the press than staff welfare.”Tangible qualities of the workplace Adequate staffing Several comments described ensuring adequate staffing in response to staff sicknesses or heightened workload.
“Not sure. Managing staff shortages was difficult and extra work needed. Now we have burnout from covering.” PPE and safety Respondents commonly reported training in how to use PPE, safety protocols (e.g., social distancing), regular testing and access to appropriate PPE.
“At the beginning of the pandemic, the PPE was rationed strictly and that caused a lot of anxiety. Those initial contacts with patient meant those staff member developed symptoms and got ill. This caused a lot of anxiety. I fortunately had annual leave for a week and when I got back to work. The PPE was fully available and in use appropriately. Scrubs were a problem especially plus sizes, not available.” Financial support Respondents described other types of financial support (e.g., free lunches, free parking so HCPs can drive and avoid public transport).
“Most helpful — being able to drive to and park at work. Food provided at work.”
“Free meals because there was no food in the shops and also I was so tired after my shift, I couldn’t cook. Not having to wash my uniform. I know my manager was doing her best to keep the unit staffed and as safe as possible.”Work-from-home support A few HCPs described support (in terms of IT equipment, software support to facilitate working from home as being important.
“Not to have to pay back hours lost trying to work from home without necessary equipment needed to enable me to work from home effectively. Necessary equipment should have been provided.” Leadership Visibility Staff felt there was a lack of senior managerial presence on the ground. As a result, patient-facing staff felt uncared for, disconnected with decision-makers and that they lacked genuine understanding of the difficulties experienced.
“Felt top senior management/directors were not visible during the peak and now — highlighting a big disconnect between the realities of working on the shop floor and those making the decisions.” Available or approachable Some respondents expressed gratitude for the approachability of their managers or supervisors.
Some respondents reported being glad that supervisors were available to help, or described the availability of well-being support services.
“Most helpful was having a manager who was always available and actively trying to improve the situation for us all, thinking of things to change before it needed changing, etc. Very grateful.” Reassurance Some respondents highlighted the importance of receiving reassurance from their managers regarding tasks and patient care, and regarding redeployment or job security.
“I work in intensive care. We were told ‘to keep patients alive and anything you do extra is a bonus.’ This was very comforting to me as I know I will always do my best and more to reach on everything but was this statement by our matron made me feel I could do my job to the best of my ability and not live with the guilt that I hadn’t reached on certain things.” Better support for managers Some participants who were managers themselves felt there was no one to manage or support them.
“I am a partner and senior manager. At the height of the crisis, there was no one to talk to about it. I and the other partners were constantly having to support the staff team. But there was no one for us to go to.” Peer support Peer support Respondents described peer support as helpful and comprising a sense of camaraderie, solidarity, unity and being open with each other.
Some participants appreciated eating lunch together with their teams and having informal discussions regarding emotional support. More formal modes of discussion included Balint groups, in a couple cases.
“We are a team of 12 working in a bubble. At the height of the pandemic, we split into 2 teams and working alternate weeks. increased workload and very stressful but we all supported each other and ensured we were all coping!”
“Meal times were really important. Meals were free and my manager ensured we all went together and ate lunch together. This seemed to brighten the day and we tried not to talk about work at lunch time. For other team members, she also requested they go back to the office before home time to have a debrief.”Note: HCP = health care professional, IT = information technology, PPE = personal protective equipment.
In this issue
Article tools
Related Articles
Cited By...
- No citing articles found.