Mental health of nursing home staff declined further despite COVID-19 pandemic restrictions easing, finds study

Follow-on findings from an initial study showed that nursing home staff working after Ireland's pandemic restrictions had been lifted reported substantially higher levels of post-traumatic stress, moral injury, low mood and suicidal thinking than during the pandemic.

Findings from phase two of a research study from St Patrick's Mental Health Services; Trinity; the Royal College of Surgeons Ireland; and Nursing Homes Ireland, which explored nursing home staff's mental health during the COVID-19 pandemic, revealed a further decline in the mental health of staff working in nursing homes across Ireland, which coincided with the easing of public health restrictions.

Phase two findings, which were gathered through a national anonymous survey of nursing home staff at the beginning of 2022, follows a previous national anonymous survey carried out at the beginning of 2021, during the height of the pandemic. Phase two research commenced at the beginning of 2022 when hospitalization rates were declining, most staff were vaccinated, and restrictions were being eased.

The COWORKER Nursing Home Study, led by Prof Declan McLoughlin, Research Professor of Psychiatry at Trinity College, Dublin and Consultant Psychiatrist at St Patrick's Mental Health Services, was developed to investigate the mental health impact of the pandemic on nursing home staff; identifying mental health needs of both clinical and non-clinical nursing home staff, and helping to inform appropriate responses.

The follow-on findings from the peer-reviewed study showed that nursing home staff working after Ireland's pandemic restrictions had been lifted reported substantially higher levels of post-traumatic stress, moral injury, low mood and suicidal thinking than during the pandemic.

Research from the follow-on study showed:

• 65% of respondents reported moderate or severe symptoms of post-traumatic stress (PTSD).
• 57% of nursing home staff reported low mood in the second phase of the research.

Researchers also found levels of suicidal thinking increased. At the time of the first survey, 1 in 7 staff reported thinking of ending their life over the past week; this had increased to 1 in 6 by the time of the second survey. Earlier in the pandemic, 1 in 11 staff reported planning to end their life; during phase two of the study in 2022, 1 in 7 staff reported planning to end their lives in the past week.

Staff also reported more concerns about the stigma associated with working in their jobs, more stress and concerns about infection control processes.

Declan McLoughlin, Research Professor of Psychiatry at Trinity and Consultant Psychiatrist at St Patrick's Mental Health Services, explains, "Despite the easing of public health restrictions and the widespread roll-out of vaccinations among staff and residents of nursing homes, findings from phase two of the COWORKER study show that the mental health effects of COVID-19 are ongoing and require continued monitoring to inform appropriate responses.

"Through the publication of these findings, it is hoped that key areas of concern for nursing home staff's mental health can be highlighted and addressed as required, and we would encourage any nursing home staff who are experiencing mental health difficulties following the pandemic to seek support as needed."

With the research highlighting high levels of low mood (57%), suicidal ideation (18%) and suicidal planning (15%), lead author of the study, Dr. Conan Brady, has emphasized the importance of providing support to those working in the nursing home sector. He said, "Findings from the COWORKER study emphasize the scale of the mental health impacts of COVID-19 on nursing home staff and identify some key areas where staff may require support, such as for PTSD and moral injury.

"The nursing home sector is one that will become more and more critical as our population ages. Like many areas of the health care sector, it is vital that we ensure that the mental health of staff working in nursing homes is supported."

The results of phase two of the study were published in PLOS ONE in late September.