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      Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study

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          Abstract

          Background

          During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021.

          Methods

          In this longitudinal study, we analysed online survey data completed by 22,501 HCWs from 17 NHS Trusts at baseline (Time 1) and six months (Time 2). The primary outcome measures were suicidal ideation, suicide attempts, and non-suicidal self-injury. We used logistic regression to investigate the relationship between these outcomes and demographic characteristics and occupational factors. Results were stratified by occupational role (clinical/non-clinical).

          Results

          Time 1 and Time 2 surveys were completed by 12,514 and 7,160 HCWs, respectively. At baseline, 10.8% (95% CI = 10.1%, 11.6%) of participants reported having experienced suicidal thoughts in the previous two months, whilst 2.1% (95% CI = 1.8%, 2.5%) of participants reported having attempted suicide over the same period. Among HCWs who had not experienced suicidal thoughts at baseline (and who completed the Time 2 survey), 11.3% (95%CI = 10.4%, 12.3%) reported such thoughts six months later. Six months after baseline, 3.9% (95% CI = 3.4%, 4.4%) of HCWs reported attempting suicide for the first time. Exposure to potentially morally injurious events, lack of confidence about raising safety concerns and these concerns being addressed, feeling unsupported by managers, and providing a reduced standard of care were all associated with increased suicidal ideation among HCWs during the COVID-19 pandemic. At six months, among clinicians, a lack of confidence about safety concerns being addressed, independently predicted suicidal ideation.

          Conclusion

          Suicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.

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          Most cited references56

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          Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study

          Background The effects of coronavirus disease 2019 (COVID-19) on the population's mental health and well-being are likely to be profound and long lasting. Aims To investigate the trajectory of mental health and well-being during the first 6 weeks of lockdown in adults in the UK. Method A quota survey design and a sampling frame that permitted recruitment of a national sample was employed. Findings for waves 1 (31 March to 9 April 2020), 2 (10 April to 27 April 2020) and 3 (28 April to 11 May 2020) are reported here. A range of mental health factors was assessed: pre-existing mental health problems, suicide attempts and self-harm, suicidal ideation, depression, anxiety, defeat, entrapment, mental well-being and loneliness. Results A total of 3077 adults in the UK completed the survey at wave 1. Suicidal ideation increased over time. Symptoms of anxiety, and levels of defeat and entrapment decreased across waves whereas levels of depressive symptoms did not change significantly. Positive well-being also increased. Levels of loneliness did not change significantly over waves. Subgroup analyses showed that women, young people (18–29 years), those from more socially disadvantaged backgrounds and those with pre-existing mental health problems have worse mental health outcomes during the pandemic across most factors. Conclusions The mental health and well-being of the UK adult population appears to have been affected in the initial phase of the COVID-19 pandemic. The increasing rates of suicidal thoughts across waves, especially among young adults, are concerning.
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            The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: a rapid systematic review

            Highlights • Healthcare workers’ mental health problems correlate with organizational factors such as workload and exposure to covid-19 patients • Healthcare workers are more interested in occupational protection, rest, and social support than in professional psychological help • Interventions focus more on addressing individual psychopathology, which points towards a mismatch between what workers want and need, and the services available to them
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              A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being

              Background Health and social care workers (HSCWs) have carried a heavy burden during the COVID-19 crisis and, in the challenge to control the virus, have directly faced its consequences. Supporting their psychological wellbeing continues, therefore, to be a priority. This rapid review was carried out to establish whether there are any identifiable risk factors for adverse mental health outcomes amongst HSCWs during the COVID-19 crisis. Methods We undertook a rapid review of the literature following guidelines by the WHO and the Cochrane Collaboration’s recommendations. We searched across 14 databases, executing the search at two different time points. We included published, observational and experimental studies that reported the psychological effects on HSCWs during the COVID-19 pandemic. Results The 24 studies included in this review reported data predominantly from China (18 out of 24 included studies) and most sampled urban hospital staff. Our study indicates that COVID-19 has a considerable impact on the psychological wellbeing of front-line hospital staff. Results suggest that nurses may be at higher risk of adverse mental health outcomes during this pandemic, but no studies compare this group with the primary care workforce. Furthermore, no studies investigated the psychological impact of the COVID-19 pandemic on social care staff. Other risk factors identified were underlying organic illness, gender (female), concern about family, fear of infection, lack of personal protective equipment (PPE) and close contact with COVID-19. Systemic support, adequate knowledge and resilience were identified as factors protecting against adverse mental health outcomes. Conclusions The evidence to date suggests that female nurses with close contact with COVID-19 patients may have the most to gain from efforts aimed at supporting psychological well-being. However, inconsistencies in findings and a lack of data collected outside of hospital settings, suggest that we should not exclude any groups when addressing psychological well-being in health and social care workers. Whilst psychological interventions aimed at enhancing resilience in the individual may be of benefit, it is evident that to build a resilient workforce, occupational and environmental factors must be addressed. Further research including social care workers and analysis of wider societal structural factors is recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10070-3.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Writing – original draft
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 June 2023
                2023
                21 June 2023
                : 18
                : 6
                : e0286207
                Affiliations
                [1 ] Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
                [2 ] Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, United Kingdom
                [3 ] Department of Applied Health Research, University College London, London, United Kingdom
                [4 ] Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
                [5 ] The Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
                The University of Manchester Division of Psychology and Mental Health, UNITED KINGDOM
                Author notes

                Competing Interests: MH, RR, and SW are senior NIHR Investigators. SW has received speaker fees from Swiss Re for two webinars on the epidemiological impact of COVID 19 pandemic on mental health. SW is a Non Executive Director of NHS-England. RR reports grants from DHSC/UKRI/ESRC COVID-19 Rapid Response Call, grants from Rosetrees Trust, grants from King’s Together rapid response call, grants from UCL (Wellcome Trust) rapid response call, during the conduct of the study; & grants from NIHR outside the submitted work MH reports grants from DHSC/UKRI/ESRC COVID-19 Rapid Response Call, grants from Rosetrees Trust, grants from King’s Together rapid response call, grants from UCL Partners rapid response call, during the conduct of the study; grants from Innovative Medicines Initiative and EFPIA, RADAR-CNS consortium, grants from MRC, grants from NIHR, outside the submitted work. SS reports grants from UKRI/ESRC/DHSC, grants from UCL, grants from UKRI/MRC/DHSC, grants from Rosetrees Trust, grants from King’s Together Fund, and an NIHR Advanced Fellowship [ref: NIHR 300592] during the conduct of the study. NG reports a potential COI with NHSEI, during the conduct of the study; he is the managing director of March on Stress Ltd which has provided training for a number of NHS organisations. NG is not aware if the company has delivered training to any of the participating trusts, as he is not involved in commissioning specific pieces of work. DL is funded by the National Institute for Health and Care Research ARC North Thames. PM reports grants from NIHR and the Cassell Hospital Charitable Trust outside the submitted work. PM is part-funded by the NIHR ARC West. PP and PM report a grant from Bristol and Weston Hospitals Charity outside the submitted work. PP was funded by the Medical Research Council Addiction Research Clinical Training programme (MR/N00616X/1). Other authors report no competing interests. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0003-1292-6575
                https://orcid.org/0000-0003-4550-2971
                Article
                PONE-D-22-25700
                10.1371/journal.pone.0286207
                10284388
                37343030
                9c0c8713-a7b8-4638-ba1f-de4358db1651
                © 2023 Padmanathan et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 September 2022
                : 10 May 2023
                Page count
                Figures: 1, Tables: 5, Pages: 17
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: MR/V034405/1
                Funded by: funder-id http://dx.doi.org/10.13039/100010269, Wellcome Trust;
                Award ID: ISSF3/ H17RCO/C3
                Funded by: funder-id http://dx.doi.org/10.13039/501100000833, Rosetrees Trust;
                Award ID: M952
                Funded by: Economic and Social Research Council
                Award ID: ES/V009931/1
                Funded by: funder-id http://dx.doi.org/10.13039/100019418, NIHR Maudsley Biomedical Research Centre;
                Funded by: National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London
                Funding for main NHS CHECK cohort study (co-chief investigators SW, SAMS, RR, MH, NG) was received from the following sources: Medical Research Council (MR/V034405/1); UCL/Wellcome (ISSF3/ H17RCO/C3); Rosetrees (M952); Economic and Social Research Council (ES/V009931/1); NHS England and NHS Improvement; as well as seed funding from National Institute for Health Research Maudsley Biomedical Research Centre, King's College London, National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London. P.M. is supported by the NIHR Applied Research Collaboration (ARC West) and the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Suicide
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                Medicine and Health Sciences
                Epidemiology
                Pandemics
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Self Harm
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Engineering and Technology
                Equipment
                Safety Equipment
                Medicine and Health Sciences
                Public and Occupational Health
                Safety
                Safety Equipment
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Custom metadata
                Due to Research Ethics Committee restrictions, the data set is not publicly available. Requests to access to the de-identified data set can be made to the NHS CHECK team at nhscheck@ 123456kcl.ac.uk .
                COVID-19

                Uncategorized
                Uncategorized

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