Challenges facing essential workers: a cross-sectional survey of the subjective mental health and well-being of New Zealand healthcare and 'other' essential workers during the COVID-19 lockdown

Caroline Bell, Jonathan Williman, Ben Beaglehole, James Stanley, Matthew Jenkins, Philip Gendall, Charlene Rapsey, Susanna Every-Palmer, Caroline Bell, Jonathan Williman, Ben Beaglehole, James Stanley, Matthew Jenkins, Philip Gendall, Charlene Rapsey, Susanna Every-Palmer

Abstract

Objectives: To compare psychological outcomes, experiences and sources of stress over the COVID-19 lockdown in New Zealand in essential workers (healthcare and 'other' essential workers) with that of workers in nonessential work roles.

Design: Online cross-sectional survey.

Setting: Conducted in New Zealand over level 4 lockdown in April/May 2020.

Participants: Findings from employed participants (2495) are included in this report; 381 healthcare workers, 649 'other' essential workers and 1465 nonessential workers.

Primary and secondary outcome measures: Measures included psychological distress (Kessler Psychological Distress Scale (K10)), anxiety (Generalised Anxiety Disorder (GAD-7)), well-being (WHO-5), alcohol use, subjective experiences and sources of stress. Differences between work categories were quantified as risk ratios or χ2 tests.

Results: After controlling for confounders that differed between groups of essential and nonessential workers, those in healthcare and those in 'other' essential work were at 71% (95% CI 1.29 to 2.27) and 59% (95% CI 1.25 to 2.02) greater risk respectively, of moderate levels of anxiety (GAD-7 ≥10), than those in nonessential work. Those in healthcare were at 19% (95% CI 1.02 to 1.39) greater risk of poor well-being (WHO-5 <13). There was no evidence of differences across work roles in risk for psychological distress (K10 ≥12) or increased alcohol use. Healthcare and 'other' essential workers reported increased workload (p<0.001) and less uncertainty about finances and employment than those in nonessential work (p<0.001). Healthcare and nonessential workers reported decreased social contact. No difference by work category in health concerns was reported; 15% had concerns about participants' own health and 33% about other people's health.

Conclusions: During the pandemic lockdown, essential workers (those in healthcare and those providing 'other' essential work) were at increased risk of anxiety compared with those in nonessential work, with those in healthcare also being at increased risk of poor well-being. This highlights the need to recognise the challenges this vital workforce face in pandemics.

Keywords: COVID-19; epidemiology; mental health; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Adhanom Ghebreyesus T. Addressing mental health needs: an integral part of COVID ‐19 response. World Psychiatry 2020;19:129–30. 10.1002/wps.20768
    1. Holmes EA, O'Connor RC, Perry VH, et al. . Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020;7:547–60. 10.1016/S2215-0366(20)30168-1
    1. Xiong J, Lipsitz O, Nasri F, et al. . Impact of COVID-19 pandemic on mental health in the general population: a systematic review. J Affect Disord 2020;277:55–64. 10.1016/j.jad.2020.08.001
    1. da Silva ML, Rocha RSB, Buheji M, et al. . A systematic review of the prevalence of anxiety symptoms during coronavirus epidemics. J Health Psychol 2021;26:115–25. 10.1177/1359105320951620
    1. Krishnamoorthy Y, Nagarajan R, Saya GK, et al. . Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: a systematic review and meta-analysis. Psychiatry Res 2020;293:113382. 10.1016/j.psychres.2020.113382
    1. Chew NWS, Lee GKH, Tan BYQ, et al. . A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun 2020;88:559–65. 10.1016/j.bbi.2020.04.049
    1. Zhang W-R, Wang K, Yin L, et al. . Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom 2020;89:242–50. 10.1159/000507639
    1. Lai J, Ma S, Wang Y, et al. . Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976. 10.1001/jamanetworkopen.2020.3976
    1. Wu P, Fang Y, Guan Z, et al. . The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry 2009;54:302–11. 10.1177/070674370905400504
    1. Kang L, Li Y, Hu S, et al. . The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7:e14. 10.1016/S2215-0366(20)30047-X
    1. Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA 2020;323:2133–4. 10.1001/jama.2020.5893
    1. Mazza M, Attanasio M, Pino MC, et al. . Moral decision-making, stress, and social cognition in frontline workers vs. population groups during the COVID-19 pandemic: an explorative study. Front Psychol 2020;11:588159. 10.3389/fpsyg.2020.588159
    1. Robillard R, Saad M, Edwards J, et al. . Social, financial and psychological stress during an emerging pandemic: observations from a population survey in the acute phase of COVID-19. BMJ Open 2020;10:e043805. 10.1136/bmjopen-2020-043805
    1. Fang X, Zhang J, Teng C, et al. . Depressive symptoms in the front-line non-medical workers during the COVID-19 outbreak in Wuhan. J Affect Disord 2020;276:441–5. 10.1016/j.jad.2020.06.078
    1. Karlsson U, Fraenkel CJ. Covid-19: risks to healthcare workers and their families.. BMJ 2020;371:m3944.
    1. Government NZ . National Crisis Management Centre National Action Plan. In: National Crisis Management Centre. Wellington, New Zealand: New Zealand Government, 2020.
    1. Hale TW S, Anna P, Phillips T, et al. . Oxford COVID-19 government response Tracker. Blavatnik School of Government OU, editor, 2020.
    1. Cousins S. New Zealand eliminates COVID-19. Lancet 2020;395:1474. 10.1016/S0140-6736(20)31097-7
    1. Covid-19 coronavirus: Top intensive care doctor admits he is scared . New Zealand Herald, 2020. [Accessed 24 Mar 2020].
    1. Every-Palmer S, Jenkins M, Gendall P, et al. . Psychological distress, anxiety, family violence, suicidality, and wellbeing in New Zealand during the COVID-19 lockdown: a cross-sectional study. PLoS One 2020;15:e0241658. 10.1371/journal.pone.0241658
    1. Jenkins M, Hoek J, Jenkin G, et al. . Silver linings of the COVID-19 lockdown in New Zealand. PLoS One 2021;16:e0249678. 10.1371/journal.pone.0249678
    1. NZ Ministry of Health . Methodology report 2019/20: new Zealand health survey. Wellington, New Zealand: New Zealand Ministry of Health, 2020.
    1. NZ Ministry of Justice . New Zealand crimes and victims survey; methodology report. Wellington, New Zealand: New Zealand Ministry of Justice, 2018.
    1. Kessler RC, Barker PR, Colpe LJ, et al. . Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003;60:184–9. 10.1001/archpsyc.60.2.184
    1. Spitzer RL, Kroenke K, Williams JBW, et al. . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092–7. 10.1001/archinte.166.10.1092
    1. Topp CW, Østergaard SD, Søndergaard S, et al. . The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom 2015;84:167–76. 10.1159/000376585
    1. Bradburn NW, Brain; Sudman S. Asking questions : the definitive guide to questionnaire design—for market research, political polls, and social and health questionnaires. San Francisco, USA: Jossey-Bass, 2004.
    1. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004;159:702–6. 10.1093/aje/kwh090
    1. Oakley Browne MA, Wells JE, Scott KM, et al. . The Kessler psychological distress scale in te Rau Hinengaro: the New Zealand mental health survey. Aust N Z J Psychiatry 2010;44:314–22. 10.3109/00048670903279820
    1. Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, et al. . Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis. J Affect Disord 2020;275:48–57. 10.1016/j.jad.2020.06.022
    1. Skoda E-M, Teufel M, Stang A, et al. . Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the International context. J Public Health 2020;42:688–95. 10.1093/pubmed/fdaa124
    1. Chew NWS, Ngiam JN, Tan BY-Q, et al. . Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic. BJPsych Open 2020;6:e116. 10.1192/bjo.2020.98
    1. Maciaszek J, Ciulkowicz M, Misiak B, et al. . Mental health of medical and non-medical professionals during the peak of the COVID-19 pandemic: a cross-sectional nationwide study. J Clin Med 2020;9. 10.3390/jcm9082527. [Epub ahead of print: 05 08 2020].
    1. Kim M-S, Kim T, Lee D, et al. . Mental disorders among workers in the healthcare industry: 2014 National health insurance data. Ann Occup Environ Med 2018;30:31. 10.1186/s40557-018-0244-x
    1. Ahola K, Honkonen T, Isometsä E, et al. . The relationship between job-related burnout and depressive disorders--results from the Finnish Health 2000 Study. J Affect Disord 2005;88:55–62. 10.1016/j.jad.2005.06.004
    1. Wall TD, Bolden RI, Borrill CS, et al. . Minor psychiatric disorder in NHS trust staff: occupational and gender differences. Br J Psychiatry 1997;171:519–23. 10.1192/bjp.171.6.519
    1. Cipolotti L, Chan E, Murphy P. Factors contributing to the distress, concerns, and needs of UK neuroscience health care workers during the COVID-19 pandemic. Psychology and Psychotherapy: Theory, Research and Practice:e12298.
    1. Mutambudzi M, Niedwiedz C, Macdonald EB, et al. . Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants. Occup Environ Med 2020. 10.1136/oemed-2020-106731. [Epub ahead of print: 09 Dec 2020].
    1. H D. Coronavirus: Healthcare workers make up 1 in 10 of New Zealand’s COVID-19 cases. Stuff, New Zealand [Accessed 30 April 2020].
    1. Serrano-Ripoll MJ, Meneses-Echavez JF, Ricci-Cabello I, et al. . Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis. J Affect Disord 2020;277:347–57. 10.1016/j.jad.2020.08.034
    1. Hobfoll SE, Stevens NR, Zalta AK. Expanding the science of resilience: conserving resources in the aid of adaptation. Psychol Inq 2015;26:174–80. 10.1080/1047840X.2015.1002377
    1. Chen DT-H, Wang Y-J. Inequality-Related health and social factors and their impact on well-being during the COVID-19 pandemic: findings from a national survey in the UK. Int J Environ Res Public Health 2021;18. 10.3390/ijerph18031014. [Epub ahead of print: 24 01 2021].
    1. Brooks SK, Dunn R, Amlôt R, et al. . A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occup Environ Med 2018;60:248–57. 10.1097/JOM.0000000000001235
    1. Baker MG, Wilson N, Anglemyer A. Successful elimination of Covid-19 transmission in New Zealand. N Engl J Med 2020;383:e56. 10.1056/NEJMc2025203
    1. Levis B, Yan XW, He C, et al. . Comparison of depression prevalence estimates in meta-analyses based on screening tools and rating scales versus diagnostic interviews: a meta-research review. BMC Med 2019;17:65. 10.1186/s12916-019-1297-6
    1. Ruiz-Frutos C, Ortega-Moreno M, Allande-Cussó R, et al. . Sense of coherence, engagement, and work environment as precursors of psychological distress among non-health workers during the COVID-19 pandemic in Spain. Saf Sci 2021;133:105033. 10.1016/j.ssci.2020.105033
    1. Pierce M, McManus S, Jessop C, et al. . Says who? the significance of sampling in mental health surveys during COVID-19. Lancet Psychiatry 2020;7:567–8. 10.1016/S2215-0366(20)30237-6

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner