Pre-pandemic Mental Health and Well-being of Healthcare Workers

Even before the COVID-19 pandemic, healthcare workers faced substantial work-related stress. Most research on the mental health and well-being of healthcare workers has focused on physicians and nurses, with less attention paid to other healthcare occupations. Recent research from the National Institute for Occupational Safety and Health (NIOSH) evaluated the pre-pandemic mental health and well-being of a broad range of healthcare workers, including lower-wage healthcare support workers with patient care responsibilities and ancillary healthcare workers, such as janitors and housekeepers.[1]

Assessing Mental Health and Wellbeing

Researchers evaluated data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2017 to 2019. They compared self-reported mental health and wellbeing among 37,685 respondents who worked in healthcare industries (dental, home health, ambulatory care, hospital, nursing care) and 219,871 workers from other industries. Healthcare workers were grouped by occupation, and then by industry, to examine prevalences of six health conditions collected by the BRFSS:

• poor self-rated health (poor or fair self-rated overall health)
• frequent physical distress (physical health reported as not good at least 14 of the past 30 days)
• frequent mental distress (mental health reported as not good at least 14 of the past 30 days)
• activity limitations
• depression diagnosed by a healthcare provider
• insufficient sleep (<7 hours of sleep per 24 hours).

Findings

Across the healthcare workforce, insufficient sleep (41%) and diagnosed depression (19%) were the conditions most frequently reported and were more common among healthcare workers than among non-healthcare workers.

Healthcare workers who diagnose and treat patients were less likely than non-healthcare workers to say their health was poor or that they experienced frequent physical or mental distress. Within healthcare, prevalences of many conditions were lowest in diagnosing and treating practitioners and highest among patient care support and ancillary healthcare workers.

However, poor mental health and well-being were common among some groups of healthcare workers:

• Healthcare support workers with patient care responsibilities reported high prevalences of poor self-rated health, frequent physical distress, and frequent mental distress.
  • Nursing, psychiatric, and home care aides, along with personal care aides working in healthcare industries, reported high levels of poor self-rated health, frequent mental distress, activity limitations, diagnosed depression, and insufficient sleep.
• Counselors had the highest prevalence of depression of all healthcare occupation groups.  Health technologists and technicians and healthcare support workers also had high prevalences of depression.
• Ancillary support workers (food preparation and serving workers, janitors, maids, and housekeepers) were 5 times as likely as workers who diagnose patients to say they had poor health.
• Food prep and serving workers and trades workers were more likely than non-healthcare workers to say they often felt physical distress and had insufficient sleep.
• In analyses by healthcare industry, home health workers were most likely to say they had poor health, often felt physical distress, had activity limitations, and had diagnosed depression.
• Home health and nursing care industry workers were most likely to report mental distress.

Conclusion: Healthcare Workers Need More Support

Before the COVID-19 pandemic, insufficient sleep was common across the healthcare workforce and  low-wage healthcare workers had elevated prevalences of a broad range of mental health-related concerns. More recent work has documented the effects of both occupational and personal stressors associated with COVID-19 on a range of healthcare workers.[2] [3] [4] [5] The current emotional support needs of the healthcare workforce are likely greater than those indicated by this study. However, mental health treatment resources have been heavily strained during the pandemic and are not available to all who would benefit from them. Moreover, many lower-income healthcare workers may not have access to affordable mental health treatment.

In November 2021, NIOSH launched the Health Worker Mental Health Initiative to help improve the mental health of the vital healthcare workforce. A concerted effort to develop, implement, and evaluate occupation- and industry-specific, culturally competent prevention, intervention, and mitigation strategies addressing both organizational and personal conditions that lead to mental health issues is critical to ensuring a robust healthcare workforce.

Sharon Silver, MS, is a Lead Research Epidemiologist in the Health Informatics Branch of the Division of Field Studies and Evaluation of NIOSH.

Jia Li, MS, is a Statistician in the Health Informatics Branch of the Division of Field Studies and Evaluation of NIOSH.

Suzanne Marsh, MPA, is a Lead Research Statistician in the Surveillance and Field Investigations Branch in the Division of Safety Research of NIOSH.

Eric Carbone, PhD, is the Branch Chief of the Surveillance and Field Investigations Branch in the Division of Safety Research of NIOSH.

References

[1] Silver, Sharon R. MS1; Li, Jia MS1; Marsh, Suzanne MPA2; Carbone, Eric PhD2. Pre-pandemic Mental Health and Well-being: Differences within the Healthcare Workforce and the Need for Targeted Resources. Journal of Occupational and Environmental Medicine: July 7, 2022 – Volume – Issue – 10.1097/JOM.0000000000002630 doi: 10.1097/JOM.0000000000002630

[2] Sinsky CA, Brown RL, Stillman MJ, Linzer M. COVID-related stress and work intentions in a sample of US health care workers. Mayo Clin Proc Innov Qual Outcomes. 2021;5:1165–1173.

[3] Prasad K, McLoughlin C, Stillman M, et al. Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: a national cross-sectional survey study. EClinicalMedicine. 2021;35:100879.

[4] Li Y, Scherer N, Felix L, Kuper H. Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: a systematic review and meta-analysis. PLoS One. 2021;16:e0246454.

[5] Vizheh M, Qorbani M, Arzaghi SM, Muhidin S, Javanmard Z, Esmaeili M. The mental health of healthcare workers in the COVID-19 pandemic: a systematic review. J Diabetes Metab Disord. 2020;19:1–12.