Mental health of health care workers during and after the COVID-19 pandemic – A longitudinal cohort study

Health care workers (HCWs) faced more stressors during the COVID-19 pandemic, potentially increasing depression, anxiety and post-traumatic stress disorder (PTSD). Insight into mental health dynamics and determinants in HCWs during the pandemic could help to maintain and improve mental health and resilience in future pandemics. In this longitudinal cohort study, HCWs received five surveys from November 2020 to March 2023 assessing self-reported symptoms of depression (PHQ-9), anxiety (GAD-7), PTSD (PCL-5), stress (PSS), burn-out (UBOS-EE), insomnia (ISI), resilience (RS) and work engagement (UWES). In addition to the longitudinal analysis, mental health symptoms were assessed in relation to possible predictors, e.g. patient care roles or prior SARS-CoV-2 infection. A total of 384 HCWs (95% of HCWs given consent) completed at least one survey, 326 (81%) completed two or more. Mental health significantly declined in December 2021 compared to November 2020, with mean increases of 1.16 (95% CI 0.73 to 1.58, d = 0.48), 0.79 (95% CI 0.41 to 1.17, d = 0.37) and 1.96 (95% CI 0.95 to 2.97, d = 0.35) on the PHQ-9 (range 0-27), GAD-7 (range 0-21) and PCL-5 (range 0-80), respectively, with similar results in multivariable analysis. Symptoms returned to November 2020 levels in March 2023. No differences were found regarding patient care roles, prior SARS-CoV-2 infection, years of work experience, or hospital workdays per week. Mental health significantly declined during the COVID-19 pandemic, after which mental health symptoms returned to baseline as the burden of COVID-19 patients decreased and public measures were lifted. This demonstrates this population's ability to successfully adapt to challenging experiences and emphasizes the need for support strategies tailored to the critical phases of any future healthcare crises.