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Thu 24 June 2021

A groundbreaking study into the psychological impact of COVID-19 pandemic on NHS workers finds that PPE shortages were associated with severe mental health symptoms, Sian Norris reports

The largest study to date on the mental health impact of COVID-19 on NHS workers found that mental health symptoms quadrupled across the workforce during the pandemic.

Research led by Dr James Gilleen at the University of Roehampton reveals that worries about insufficient personal protective equipment (PPE) were significantly associated with NHS workers showing severe levels of mental health symptoms. 

During the first wave, many medical and social care professionals raised concerns they did not have the PPE needed to meet the demands of the pandemic. Photos of hospital staff reduced to wearing bin bags instead of aprons highlighted the urgent need for supplies. 

The Government was accused of failing to stockpile PPE in the event of a pandemic, with over 200 million items in the existing national pandemic stockpile left to expire. This included masks and respirators, as well as medical equipment such as needles and syringes. 

Writing in the British Medical Journal, David Oliver called the lack of PPE a “betrayal” of NHS staff. He said the “failure to provide adequate PPE to health and social care workers during the pandemic has highlighted the disintegration of any culture of integrity, transparency, honesty, and support for healthcare staff from the government and NHS employers.”

Health Secretary Matt Hancock has insisted that his actions prevented a national PPE shortage – a claim that flies in the face of the experiences of frontline NHS workers. Hancock’s assertion has been called “categorically untrue” by doctors. 


Lack of PPE and Mental Health

Dr Gilleen’s team surveyed 2,733 healthcare workers, of which 2,365 were women and 342 were from ethnic minority backgrounds, representing the demographics of the NHS workforce. 

Their research revealed that nearly one-third of healthcare workers reported the most severe levels of anxiety and depression, and the number reporting very high levels of symptoms was more than quadruple than before the pandemic. 

Insufficient PPE and lack of workplace preparation were associated with the most severe levels of mental ill-health. This included high-levels of post traumatic stress disorder (PTSD) linked to the pressure of having to re-use PPE, and the perception that not enough was being done to reduce the risk to workers’ health from the virus. 

Similarly, the lack of PPE and having to work without adequate PPE was associated with higher rates of depression and stress. 


PTSD and Coronavirus

One in seven of surveyed workers reported having high levels of PTSD symptoms since the pandemic began – with black and minority ethnic workers more likely to experience PTSD than their white colleagues. 

Healthcare workers from minority backgrounds were 50% more likely to have PTSD symptoms and were also significantly more worried about lack of PPE, getting ill or dying from the virus, and about contracting Covid-19 at work compared with non-ethnic minority staff.

This is reflected in how black and Asian people were disproportionately impacted by the Coronavirus, and more likely to die from the virus. At the end of the first wave in summer 2020, two-thirds of NHS workers who had died from COVID-19 were black, Asian and minority ethnic. 

Frontline workers were more likely to present with PTSD symptoms, particularly if their job involved performing resuscitation on dying patients. Having to perform the procedure came with a 125% higher risk of PTSD, as well as enhanced levels of anxiety. 

Unsurprisingly, personal loss and patients asking healthcare workers if they were going to die were also factors associated with higher levels of PTSD.


Lessons To Be Learnt

The study makes a range of recommendations to help protect healthcare workers’s mental health, including monitoring staff’s mental wellbeing and referring those displaying symptoms of psychological distress to appropriate services. Other interventions could include improving resilience through training, ensuring staff have space to share stress, and teaching “adaptive coping styles.” 

However the link between lack of PPE and PTSD, depression and stress raises questions about the Government’s responsibility to protect NHS workers’ mental health during a pandemic. 

The research found that “preventable workplace factors relating to perception of personal risk specifically increases the likelihood of having high PTSD symptoms”, including lack of PPE and the failure of workplaces to reduce risk through preparation. 

The study’s author hopes that the findings will lead to better preparedness in future waves and pandemics, ensuring staff have adequate PPE supplies to mitigate the impact on healthcare workers’ mental health.

“By learning that a lack of PPE, inadequate pandemic preparedness as well as poor training and up-to-date information on Covid-19 clinical practice are all primary factors associated with the most severe cases of mental health issues we can hopefully help both the NHS and the UK Government not only to address the urgent need for mental health support for healthcare workers but also ensure that the same issues are not repeated in future waves of COVID-19 and other pandemics,” said the study lead author Dr James Gilleen.

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