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Most Accurate Prevalence of PTSD and Common Mental Disorders in Healthcare Workers in England: A Two-Phase Epidemiological Survey
18 Pages Posted: 2 Jun 2022
More...Abstract
Background: Previous studies on the impact of the COVID-19 pandemic on healthcare workers’ (HCWs) mental health have relied on self-reported screening measures to estimate point prevalence. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We now present a more accurate prevalence of common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) among HCWs in England using diagnostic interviews.
Methods: A two-stage, cross-sectional study comprising diagnostic interviews (n=337) within a larger multi-site longitudinal cohort of HCWs (n=23,462) conducted during the COVID-19 pandemic. This study included two representative participant groups: i) 243 participants were screened with the General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule – Revised (CIS-R) for CMDs; ii) 94 participants were screened with the PCL-6 and assessed with the Clinician Administered PTSD Scale (CAPS-5) for DSM-5 for PTSD.
Findings: The GHQ screening caseness for any CMD was 52.8% (95% CI 51.7 to 53.8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14.3% (95% CI 10.4 to 19.2) and for depression 13.7% (95% CI 10.1 to 18.3). The PCL-6 screening caseness for PTSD was 25.4% (95% CI 24.3 to 26.5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7.9% (95% CI 4.0 to 15.1).
Conclusion: The prevalence estimates of CMD and PTSD in HCWs are considerably lower when assessed through diagnostic interviews than when estimated using screening tools. Nevertheless, 1-in-5 HCWs met the threshold for a diagnosable mental disorder which might benefit from clinical intervention.
Funding Information: This study was supported by the Medical Research Council (MR/V034405/1); UCL/Wellcome (ISSF3/ H17RCO/C3); Rosetrees (M952); NHS England and Improvement; Economic and Social Research Council (ES/V009931/1); National Institute of Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.
Declaration of Interests: MH and SW are senior NIHR Investigators. NG sits on the NHSEI expert reference group and also runs March on Stress which is a psychological health consultancy that provides mental health training to some NHS Trusts. All other authors declare no competing interests.
Ethics Approval Statement: Ethical approval for the study was granted by the Health Research Authority (reference: 20/HRA/2107, IRAS: 282686) and local Trust Research and Development approval. The study was approved as having Urgent Public Health Status by the NIHR in August 2020.
Keywords: common mental disorders, epidemiology, healthcare workers, mental health, prevalence, post-traumatic stress disorder
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