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

Background
Maintaining healthcare workers’ (HCWs) mental health is vital to reduce staff absences and turnover, ultimately improving patient care. Most research focuses on clinical staff and single timepoints, overlooking non-clinical contributions.

Aims
To examine mental health variations among all staff types over three years and identify those most at risk of poor mental health outcomes.

Methods
Our prospective cohort study followed 22,092 HCWs from 17 English NHS Trusts. Online surveys assessed common mental disorders (CMDs), depression, anxiety, alcohol misuse, PTSD, moral injury, burnout, wellbeing, resilience, and post-traumatic growth at four timepoints from April 2020 to March 2023. Data were analysed cross-sectionally and weighted to represent Trust demographics.

Results
Approximately 50% of participants reported probable CMDs at all timepoints. The most consistent predictor of poor mental health was having met the baseline cut-off for that outcome. No consistent differences emerged between clinical and non-clinical staff. Younger, female, lower-paid staff, those feeling unsupported by colleagues/managers, and exposed to morally injurious events were most at risk of poor mental health outcomes.

Conclusions
All NHS staff types face persistent mental health struggles, with no significant improvement post-pandemic restrictions. Structural inequalities must be addressed long-term, alongside targeted, flexible support for staff in the short term.

Funding
NHS CHECK received funding from the Medical Research Council (MR/V034405/1), UCL/Wellcome (ISSF3/H17RCO/C3), Rosetrees (M952), Economic and Social Research Council (ES/V009931/1), and seed funding from various sources (see funding statement).