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

Danielle Lamb; Hannah Scott; Prianka Padmanathan; Sharon Stevelink; Neil Greenberg; Matthew Hotopf; Richard Morriss; Rosalind Raine; Anne Marie Rafferty; Ira Madan; Sarah Dorrington; Simon Wessely; Paul  Moran

doi:10.1371/journal.pone.0286207

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

Danielle Lamb, Hannah Scott, Prianka Padmanathan , Sharon Stevelink, Neil Greenberg, Matthew Hotopf, Richard Morriss, Rosalind Raine, Anne Marie Rafferty, Ira Madan, Sarah Dorrington, Simon Wessely, Paul Moran

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

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.

Original language	English
Article number	e0286207
Pages (from-to)	e0286207
Journal	PloS one
Volume	18
Issue number	6 June
Early online date	21 Jun 2023
DOIs	https://doi.org/10.1371/journal.pone.0286207
Publication status	Published - Jun 2023

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10.1371/journal.pone.0286207Licence: CC BY

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Lamb, D., Scott, H., Padmanathan , P., Stevelink, S., Greenberg, N., Hotopf, M., Morriss, R., Raine, R., Rafferty, A. M., Madan, I., Dorrington, S., Wessely, S., & Moran , P. (2023). Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study. PloS one, 18(6 June), e0286207. Article e0286207. https://doi.org/10.1371/journal.pone.0286207

@article{771b86f1ff56418b9c95e4e397c3784b,

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

abstract = "BackgroundDuring 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.MethodsIn 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).ResultsTime 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.ConclusionSuicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.",

author = "Danielle Lamb and Hannah Scott and Prianka Padmanathan and Sharon Stevelink and Neil Greenberg and Matthew Hotopf and Richard Morriss and Rosalind Raine and Rafferty, {Anne Marie} and Ira Madan and Sarah Dorrington and Simon Wessely and Paul Moran",

note = "Funding Information: Competinginterests:MH,RR,andSWaresenior NIHRInvestigators.SWhasreceivedspeakerfees fromSwissRefortwowebinarsonthe epidemiologicalimpactofCOVID19pandemicon mentalhealth.SWisaNonExecutiveDirectorof NHS-England.RRreportsgrantsfromDHSC/ UKRI/ESRCCOVID-19RapidResponseCall,grants fromRosetreesTrust,grantsfromKing{\textquoteright}sTogether rapidresponsecall,grantsfromUCL(Wellcome Trust)rapidresponsecall,duringtheconductof thestudy;&grantsfromNIHRoutsidethe submittedworkMHreportsgrantsfromDHSC/ UKRI/ESRCCOVID-19RapidResponseCall,grants fromRosetreesTrust,grantsfromKing{\textquoteright}sTogether rapidresponsecall,grantsfromUCLPartners rapidresponsecall,duringtheconductofthe study;grantsfromInnovativeMedicinesInitiative andEFPIA,RADAR-CNSconsortium,grantsfrom MRC,grantsfromNIHR,outsidethesubmitted work.SSreportsgrantsfromUKRI/ESRC/DHSC, grantsfromUCL,grantsfromUKRI/MRC/DHSC, grantsfromRosetreesTrust,grantsfromKing{\textquoteright}s TogetherFund,andanNIHRAdvancedFellowship [ref:NIHR300592]duringtheconductofthe study.NGreportsapotentialCOIwithNHSEI, duringtheconductofthestudy;heisthe managingdirectorofMarchonStressLtdwhich hasprovidedtrainingforanumberofNHS organisations.NGisnotawareifthecompanyhas deliveredtrainingtoanyoftheparticipatingtrusts, asheisnotinvolvedincommissioningspecific piecesofwork.DLisfundedbytheNational InstituteforHealthandCareResearchARCNorth Funding Information: 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{\textquoteright}s College London, National Institute for Health Research Health Protection Research Unit in Emergency Preparedness and Response at King{\textquoteright}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. We are especially grateful to all the participants who took part in the study. We wish to acknowledge the National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) National NHS and Social Care Workforce Group, with the following ARCs: East Midlands, East of England, South West Peninsula, South London, West, North West Coast, Yorkshire and Humber, and North East and North Cumbria. They enabled the set-up of the national network of participating hospital sites and aided the research team to recruit effectively during the COVID-19 pandemic. The NHS CHECK consortium includes the following site leads: Siobhan Coleman, Sean Cross, Amy Dewar, Chris Dickens, Frances Farnworth, Adam Gordon, Charles Goss, Jessica Harvey, Nusrat Husain, Peter Jones, Damien Longson, Paul Moran, Jesus Perez, Mark Pietroni, Ian Smith, Tayyeb Tahir, Peter Trigwell, Jeremy Turner, Julian Walker, Scott Weich, Ashley Wilkie. The NHS CHECK consortium includes the following co-investigators and collaborators: Peter Aitken, Ewan Carr, Anthony David, Mary Jane Doherty, Sarah Dorrington, Rosie Duncan, Sam Gnanapragasam, Cerisse Gunasinghe, Stephani Hatch, Danielle Lamb, Daniel Leightley, Ira Madan, Richard Morriss, Isabel McMullen, Dominic Murphy, Martin Parsons, Catherine Polling, Alexandra Pollitt, Anne-Marie Rafferty, Rebecca Rhead, Danai Serfioti, Chloe Simela, Charlotte Wilson Jones. Publisher Copyright: {\textcopyright} 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.",

year = "2023",

month = jun,

doi = "10.1371/journal.pone.0286207",

language = "English",

volume = "18",

pages = "e0286207",

journal = "PloS one",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "6 June",

}

Lamb, D, Scott, H, Padmanathan , P, Stevelink, S , Greenberg, N , Hotopf, M, Morriss, R, Raine, R, Rafferty, AM, Madan, I, Dorrington, S , Wessely, S & Moran , P 2023, 'Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study', PloS one, vol. 18, no. 6 June, e0286207, pp. e0286207. https://doi.org/10.1371/journal.pone.0286207

TY - JOUR

T1 - Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic

T2 - A longitudinal study

AU - Lamb, Danielle

AU - Scott, Hannah

AU - Padmanathan , Prianka

AU - Stevelink, Sharon

AU - Greenberg, Neil

AU - Hotopf, Matthew

AU - Morriss, Richard

AU - Raine, Rosalind

AU - Rafferty, Anne Marie

AU - Madan, Ira

AU - Dorrington, Sarah

AU - Wessely, Simon

AU - Moran , Paul

N1 - Funding Information: Competinginterests:MH,RR,andSWaresenior NIHRInvestigators.SWhasreceivedspeakerfees fromSwissRefortwowebinarsonthe epidemiologicalimpactofCOVID19pandemicon mentalhealth.SWisaNonExecutiveDirectorof NHS-England.RRreportsgrantsfromDHSC/ UKRI/ESRCCOVID-19RapidResponseCall,grants fromRosetreesTrust,grantsfromKing’sTogether rapidresponsecall,grantsfromUCL(Wellcome Trust)rapidresponsecall,duringtheconductof thestudy;&grantsfromNIHRoutsidethe submittedworkMHreportsgrantsfromDHSC/ UKRI/ESRCCOVID-19RapidResponseCall,grants fromRosetreesTrust,grantsfromKing’sTogether rapidresponsecall,grantsfromUCLPartners rapidresponsecall,duringtheconductofthe study;grantsfromInnovativeMedicinesInitiative andEFPIA,RADAR-CNSconsortium,grantsfrom MRC,grantsfromNIHR,outsidethesubmitted work.SSreportsgrantsfromUKRI/ESRC/DHSC, grantsfromUCL,grantsfromUKRI/MRC/DHSC, grantsfromRosetreesTrust,grantsfromKing’s TogetherFund,andanNIHRAdvancedFellowship [ref:NIHR300592]duringtheconductofthe study.NGreportsapotentialCOIwithNHSEI, duringtheconductofthestudy;heisthe managingdirectorofMarchonStressLtdwhich hasprovidedtrainingforanumberofNHS organisations.NGisnotawareifthecompanyhas deliveredtrainingtoanyoftheparticipatingtrusts, asheisnotinvolvedincommissioningspecific piecesofwork.DLisfundedbytheNational InstituteforHealthandCareResearchARCNorth Funding Information: 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. We are especially grateful to all the participants who took part in the study. We wish to acknowledge the National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) National NHS and Social Care Workforce Group, with the following ARCs: East Midlands, East of England, South West Peninsula, South London, West, North West Coast, Yorkshire and Humber, and North East and North Cumbria. They enabled the set-up of the national network of participating hospital sites and aided the research team to recruit effectively during the COVID-19 pandemic. The NHS CHECK consortium includes the following site leads: Siobhan Coleman, Sean Cross, Amy Dewar, Chris Dickens, Frances Farnworth, Adam Gordon, Charles Goss, Jessica Harvey, Nusrat Husain, Peter Jones, Damien Longson, Paul Moran, Jesus Perez, Mark Pietroni, Ian Smith, Tayyeb Tahir, Peter Trigwell, Jeremy Turner, Julian Walker, Scott Weich, Ashley Wilkie. The NHS CHECK consortium includes the following co-investigators and collaborators: Peter Aitken, Ewan Carr, Anthony David, Mary Jane Doherty, Sarah Dorrington, Rosie Duncan, Sam Gnanapragasam, Cerisse Gunasinghe, Stephani Hatch, Danielle Lamb, Daniel Leightley, Ira Madan, Richard Morriss, Isabel McMullen, Dominic Murphy, Martin Parsons, Catherine Polling, Alexandra Pollitt, Anne-Marie Rafferty, Rebecca Rhead, Danai Serfioti, Chloe Simela, Charlotte Wilson Jones. Publisher Copyright: © 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.

PY - 2023/6

Y1 - 2023/6

N2 - BackgroundDuring 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.MethodsIn 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).ResultsTime 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.ConclusionSuicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.

AB - BackgroundDuring 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.MethodsIn 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).ResultsTime 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.ConclusionSuicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.

UR - http://www.scopus.com/inward/record.url?scp=85163075338&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0286207

DO - 10.1371/journal.pone.0286207

M3 - Article

SN - 1932-6203

VL - 18

SP - e0286207

JO - PloS one

JF - PloS one

IS - 6 June

M1 - e0286207

ER -

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

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