The Lancet Psychiatry: During the pandemic, 1 in 5 healthcare workers in the UK had mental health problems

At the end of 2019, the novel coronavirus swept the world in the
hustle and bustle of the year-end and New Year holidays.

For three years, each of us has been tenaciously fighting
against it.
Recently, with the National Health Commission's renaming of "new crown pneumonia" and the revision of the prevention and control level, "new crown infection" has officially entered the stage of history instead of "new crown pneumonia"
.

When all this seems to go with the wind, we can't help but salute with gratitude to the shining medical staff who have been working on the front line of ambulance for more than 1,000 days and nights, and say: "Hard work!" ”
。

During the novel coronavirus pandemic, health care systems around the world have come under tremendous pressure
.
Healthcare workers face unprecedented long-term pressures due to the nature of their profession, including overwork, potential risk of infection, risk of social isolation, increased patient mortality, staffing difficulties, inadequate personal protective equipment, and potential moral blame
.

This undoubtedly has a certain negative impact
on the mental health of medical staff.
Previous studies have shown that the prevalence of anxiety and depression among healthcare workers during the pandemic ranged from 9 to 90 percent and 5 to 65 percent, respectively, and the prevalence of post-traumatic stress disorder (PTSD) ranged from 7 to 37 percent [1].

It is not difficult to find that estimates of the prevalence of these mental illnesses in previous studies vary widely, because screening for illnesses relies entirely on participants' self-reports, which reduces the accuracy of
the estimates.

To address this problem, researchers from King's College in the United Kingdom used a two-stage epidemiological study design [2] to investigate 11,967 healthcare workers during the pandemic with related mental illnesses to more accurately explore the mental health status
of healthcare workers during the pandemic.

After comparison, the researchers found that previous data generally overestimated the prevalence of
mental illness among healthcare workers.
However, the results of the two-phase study design still suggest that the pandemic has had a potentially adverse impact
on the mental health of more than one-fifth of healthcare workers.
Specifically, the prevalence of anxiety was 14.
3%, depression was 13.
7%, and PTSD was 7.
9%.

The findings were published in The Lancet Psychiatry
.

Screenshot of the paper

The sample population is from the National Health Service (NHS) CHECK cohort study[3], which investigated the physical health
of healthcare workers during the coronavirus pandemic in England and Wales.

In the study presented, the researchers used a two-stage cross-sectional survey – first extracting data from healthcare workers in the NHS study who had complete reports of mental health conditions between 24 April 2020 and 15 January 2021, and then conducting detailed consultations with 50% of them, with the aim of
improving diagnostic accuracy.

In the first phase, subjects self-filled out a reported GHQ-12 questionnaire to diagnose depression and anxiety symptoms, based on the PCL-6 questionnaire to determine if they had PTSD
.
In the second phase, participants were interviewed for mental disorders and PTSD using CIS-R [4] and CAPS-5 [5] scales
, respectively.

In the end, 250 participants participated in the CIS-R interview assessment and 94 participants participated in the CAPS-5 interview assessment
.
In the statistical methodology, investigators estimated the prevalence of self-reported and interview-confirmed psychiatric symptoms, weighted the age, sex, race, and occupation (clinical or non-clinical)
of participants.

Study populations were included in the flowchart

The results showed that the prevalence of mental disorders estimated by traditional self-reported screening methods was: 52.
8% for depression and/or anxiety; PTSD was 25.
4%.

In contrast, the prevalence of diagnosis confirmed by consultation was significantly reduced: depression and/or anxiety was 21.
5%; PTSD is 7.
9%.

Weighted adjusted prevalence of mental disorders

In discussing the results, the researchers argue that overestimating the prevalence of psychiatric symptoms can lead to over-medical problems, which in turn can put healthcare workers under stress and suffering
caused by unnecessary treatment.

Therefore, in specific health practice, different interventions or medical decisions
should be given to patients with mental illness who are self-reported for screening and those who are diagnosed by consultation.
Because there may be a large number of false-positive "patients," some non-special, team-based interventions and supports may be better suited to the management and assistance
of self-reported screened patients with mental illness.
However, for those medical staff who have been diagnosed by consultation, timely and effective psychological counseling and health care
should be carried out by professional psychologists.

The main advantage of the study was the two-phase study design and weighting of participants
' population characteristics.
At the same time, the NHS cohort included a wider range of survey participants, including clinical and non-clinical healthcare practitioners in addition to people of all age groups, genders and ethnicities in the UK and Wales, so that the estimates could be extrapolated to all workers in health
care-related occupations.

In conclusion, the findings suggest that it is necessary to conduct more accurate interviews with healthcare workers before conducting mental health interventions to avoid excessive medical care and waste of resources
.
In addition, future longitudinal cohort studies are needed to further explore the causal association
between the novel coronavirus epidemic and the high prevalence of mental illness in healthcare workers.