Healthcare workers in England experience PTSD at twice the rate of the general public

New research part-funded by NIHR Maudsley BRC, and led by the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London in collaboration with the NIHR ARC North Thames at University College London and NHS Trusts across England, has found that healthcare workers experience post-traumatic stress disorder (PTSD) at twice the rate of the general public.

The research, published in The Lancet Psychiatry, was conducted as part of a study to establish a more accurate prevalence of mental disorders within the NHS workforce. The study also found that one in five healthcare workers met the threshold for diagnosable illnesses like depression and anxiety.

Researchers recruited participants from the NHS CHECK study, the UK's largest survey of the mental health and wellbeing of all NHS staff during COVID-19. Over 23,000 participants completed commonly used self-report measures which look for symptoms of common mental disorders like depression and anxiety as well as PTSD. This particular study reported on diagnostic interviews with two smaller groups of healthcare workers, which were broadly representative of NHS staff overall in terms of ethnicity, age, sex and clinical role. 243 participants were surveyed to establish the prevalence of common mental disorders, while a further 94 helped to establish PTSD prevalence.

High prevalence of mental health disorders when diagnosed by professionals

While there have been many studies of the mental health of healthcare workers, especially since the pandemic, the vast majority of these have relied on self-reported screening tools that often over-estimate prevalence of mental disorder. Most of these studies have reported highly elevated, and highly varied, rates of common mental disorders and PTSD. In this study, trained professionals carried out interviews and assessed participants against diagnostic criteria which are considered the gold standard for accurately diagnosing mental disorders.

Researchers found that self-reporting screening measures showed very high prevalences of common mental disorders and PTSD (52.8% and 25.4% respectively), the diagnostic interview showed the prevalences to be considerably lower - 21.5% for common mental disorders and 7.9% for PTSD. While it is a significant drop, researchers say that these lower and more accurate figures still show that more than one in five healthcare workers have a diagnosable mental disorder with rates of PTSD being around double those found amongst the general public.

Dr Sharon Stevelink, the study’s joint first author and a Senior Lecturer in Epidemiology at King’s IoPPN, said,

"Our study has established a more accurate prevalence of PTSD and common mental disorders among all healthcare workers, not only frontline staff, by using gold standard diagnostic interviews. While it is good news that fewer healthcare workers have a diagnosable mental disorder than the screening measures have previously suggested, our findings more definitively indicate that many could benefit from a clinical intervention.”

The research suggests that this more accurate picture of prevalence means that resources and therapies can be directed to those most in need.

Targeted support to those most in need

Professor Simon Wessely joint senior author, and Regius Professor of Psychiatry from King’s IoPPN said,

“We are not suggesting that those participants who did not meet the criteria for a diagnosable disorder were not in need of any care. However, peer- and team-based interventions can be preferable for effectively helping to manage distress. This then frees up capacity to provided more targeted support for those in greater need.”

Professor Neil Greenberg, joint senior author, and a Professor of Defence Mental Health at King’s IoPPN said,

“These results thankfully show that the often scary rates of common mental disorders and PTSD, reported in less well constructed studies, are inaccurate. It is important to distinguish between the large numbers of NHS staff who may be experiencing distress, and the smaller, but still very important numbers, who are likely to benefit from professional care. The NHS should not ignore these results, which show that a sizeable proportion of NHS staff have diagnosable mental health conditions, and are likely be functionally impaired, increasing the likelihood of poor care delivery, accidents, and other undesirable outcomes for patients, themselves, and colleagues”.

The NHS CHECK team is currently preparing to follow-up the healthcare workers who took part in NHS CHECK, to determine changes in our cohort’s mental health, and assess the impact of the ongoing pressures of the COVID-19 pandemic alongside a push to deal with the backlog of patients.

This study was possible thanks to funding from the Medical Research Council, Rosetrees Trust, NHS England and Improvement, Economic and Social Research Council, UCL/Wellcome, National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King’s College London, and the NIHR Protection Research Unit in Emergency Preparedness and Response at King’s College London. This study was supported by the NIHR Applied Research Collaborative (ARC) North Thames, with input from the ARCs East Midlands, East of England, South West Peninsula, South London, West, North West Coast, Yorkshire and Humber, and North East and North Cumbria.

Prevalence of post-traumatic stress disorder and common mental disorders in healthcare workers in England during the COVID-19 pandemic: a two-phase cross-sectional study (DOI 10.1016/S2215-0366(22)00375-3) was published in the Lancet Psychiatry.