Approximately 31% of healthcare workers experienced persistently high symptoms of probable common mental disorders throughout the COVID-19 pandemic, while 69% experienced persistently low symptoms, with female sex, younger age, being single, working as a nurse, and pre-existing mental health diagnosis increasing odds of belonging to a high symptom class.
Key Findings
Results
Two distinct latent classes of mental health trajectories were identified for each outcome, with approximately 31% of healthcare workers experiencing persistently high symptoms of probable common mental disorders and 69% experiencing persistently low symptoms.
Growth mixture models were used to identify latent classes characterized by distinct trajectories of probable common mental disorders.
The analytical sample included 22,764 participants from 18 NHS Trusts in England.
Data were collected longitudinally from April 2020 to April 2023.
For secondary outcomes (anxiety, depression, alcohol misuse, and post-traumatic stress symptoms), similar two-class patterns were observed.
Small subgroups within the secondary outcomes demonstrated worsening symptoms followed by improvement.
Results
Being female, younger, single, working as a nurse, or having a pre-existing mental health diagnosis increased the odds of belonging to a high symptom class.
Logistic regression examined associations between baseline personal and employment characteristics and class membership.
These demographic and occupational factors were identified as risk factors for persistent high mental health symptom burden.
Nursing as an occupational role was specifically identified as a risk factor compared to other healthcare worker roles.
Pre-existing mental health diagnosis at baseline was associated with increased odds of high symptom class membership.
These associations were consistent across the study period from April 2020 to April 2023.
Results
Perceived support from colleagues and managers was identified as a protective factor against belonging to the high symptom class.
Perceived support from both colleagues and managers was examined as a baseline employment characteristic.
This protective association was identified through logistic regression analyses.
The finding suggests that workplace social support may buffer against persistent mental health difficulties in healthcare workers.
This was examined alongside personal factors such as sex, age, marital status, occupational role, and pre-existing mental health diagnosis.
Methods
The study drew longitudinal data from the NHS CHECK cohort, including both clinical and non-clinical staff across 18 NHS Trusts in England over a three-year period.
Data collection spanned April 2020 to April 2023, covering the full course of the COVID-19 pandemic period studied.
The analytical sample included 22,764 participants.
Both clinical and non-clinical staff were included, broadening the representativeness of findings.
Growth curve and growth mixture models were used to identify latent trajectory classes.
Secondary outcomes included anxiety, depression, alcohol misuse, and post-traumatic stress symptoms in addition to the primary outcome of probable common mental disorders.
Conclusions
The authors conclude that mental health support for vulnerable healthcare worker groups should be embedded within routine NHS practice rather than limited to crisis periods.
Almost a third of healthcare workers belonged to a latent class characterized by persistently high symptoms across all time points.
The persistently high symptom burden was not confined to acute pandemic phases, suggesting chronic rather than crisis-driven need.
Specific vulnerable groups were identified: female workers, younger workers, single workers, nurses, and those with pre-existing mental health diagnoses.
The findings underscore the need for sustained, routine mental health infrastructure within NHS settings.
What This Means
This research suggests that the mental health impact of the COVID-19 pandemic on healthcare workers in England was not uniform — roughly one in three healthcare workers experienced persistently high levels of mental health symptoms throughout the entire study period (April 2020 to April 2023), while about two in three maintained consistently low symptom levels. These patterns held across multiple mental health outcomes including anxiety, depression, alcohol misuse, and post-traumatic stress. The study followed over 22,000 NHS staff across 18 hospital trusts, making it one of the larger and longer studies of its kind.
The research identified specific groups of healthcare workers who were more likely to experience persistent mental health difficulties: women, younger workers, those who were single, nurses specifically (compared to other roles), and those who already had a mental health diagnosis before the pandemic. On the other hand, feeling supported by colleagues and managers appeared to reduce the likelihood of belonging to the high-symptom group, suggesting that workplace relationships and management practices may play an important protective role.
This research suggests that mental health problems in healthcare workers were not simply a temporary crisis response that faded as the pandemic eased — for a substantial minority, symptoms remained high throughout the three-year study period. This points to the importance of providing ongoing, routine mental health support within healthcare systems, rather than only deploying resources during acute emergencies. Targeting support toward the identified higher-risk groups — including nurses, younger staff, and those with prior mental health histories — could be a practical approach for health services looking to protect their workforce.
Penfold C, Almeida-Meza P, Redaniel T, Scott L, Moran P, Raine R, et al.. (2026). The longitudinal trajectories of mental health outcomes in healthcare workers in England during the COVID-19 pandemic.. Psychological medicine. https://doi.org/10.1017/S0033291726104280