The longitudinal trajectories of mental health outcomes in healthcare workers in England during the COVID-19 pandemic

Christopher Penfold; Pamela Almeida; Theresa Redaniel; Lauren J. Scott; Paul Moran; Rosalind Raine; Rupa Bhundia; Neil Greenberg; Simon Wessely; Bethany Croak; Richard Morriss; Ira Madan; Peter  Aitken; Anne Marie Rafferty; Sarah Dorrington; Dominic Murphy; Sharon Stevelink; Danielle Lamb

doi:10.1017/S0033291726104280

The longitudinal trajectories of mental health outcomes in healthcare workers in England during the COVID-19 pandemic

Christopher Penfold
, Pamela Almeida
, Theresa Redaniel
, Lauren J. Scott
, Paul Moran
, Rosalind Raine
, Rupa Bhundia
, Neil Greenberg
, Simon Wessely
, Bethany Croak
, Richard Morriss
, Ira Madan
, Peter Aitken
, Anne Marie Rafferty
, Sarah Dorrington
, Dominic Murphy
, Sharon Stevelink
, Danielle Lamb

University Hospital Bristol NHS Foundation Trust
Bristol Medical School
University of Bristol
UCL University College London
King's College London
University of Nottingham
NIHR Applied Research Centre East Midlands
London
GSTT Guy's and St Thomas' NHS Foundation Trust
St Thomas' Hospital
Devon Partnership NHS Trust
Sussex Partnership NHS Foundation Trust
University of Exeter

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

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Abstract

Background
The COVID-19 pandemic raised concerns about the mental health of an already burdened healthcare workforce. This study examined mental health trajectories among healthcare workers (HCWs) across the pandemic and identified personal and employment factors associated with different symptom patterns.

Methods
Longitudinal data were drawn from the NHS CHECK cohort, including clinical and non-clinical staff from 18 NHS Trusts in England (April 2020–April 2023). Growth curve and growth mixture models identified latent classes of HCWs characterized by distinct trajectories of probable common mental disorders. Secondary outcomes included anxiety, depression, alcohol misuse, and post-traumatic stress symptoms. Logistic regression examined associations between baseline personal and employment characteristics and class membership.

Results
The analytical sample included 22,764 participants. For each outcome, growth mixture models identified two latent classes. Approximately 31% of HCWs experienced persistently high symptoms of probable common mental disorders, while 69% experienced persistently low symptoms. Similar patterns were observed for secondary outcomes, with small subgroups demonstrating worsening symptoms followed by improvement. Logistic regression analyses showed that 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. Perceived support from colleagues and managers was protective.

Conclusions
While many HCWs reported consistently low mental health symptom levels, almost a third belonged to a latent class characterized by persistently high symptoms across all time points. These findings underscore the need for mental health support for vulnerable HCW groups, embedded within routine NHS practice rather than limited to crisis periods.

Original language	English
Article number	e148
Journal	Psychological Medicine
Volume	56
Early online date	14 May 2026
DOIs	https://doi.org/10.1017/S0033291726104280
Publication status	Published - 14 May 2026

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The longitudinal trajectories of mental health_VoRFinal published version, 1.27 MBLicence: CC BY

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Penfold, C., Almeida, P., Redaniel, T., Scott, L. J., Moran, P., Raine, R., Bhundia, R., Greenberg, N., Wessely, S., Croak, B., Morriss, R., Madan, I., Aitken, P., Rafferty, A. M., Dorrington, S., Murphy, D., Stevelink, S., & Lamb, D. (2026). The longitudinal trajectories of mental health outcomes in healthcare workers in England during the COVID-19 pandemic. Psychological Medicine, 56, Article e148. https://doi.org/10.1017/S0033291726104280

@article{73b27431bb73479ca85c4159cdf4bfa8,

title = "The longitudinal trajectories of mental health outcomes in healthcare workers in England during the COVID-19 pandemic",

abstract = "Background The COVID-19 pandemic raised concerns about the mental health of an already burdened healthcare workforce. This study examined mental health trajectories among healthcare workers (HCWs) across the pandemic and identified personal and employment factors associated with different symptom patterns. Methods Longitudinal data were drawn from the NHS CHECK cohort, including clinical and non-clinical staff from 18 NHS Trusts in England (April 2020–April 2023). Growth curve and growth mixture models identified latent classes of HCWs characterized by distinct trajectories of probable common mental disorders. Secondary outcomes included anxiety, depression, alcohol misuse, and post-traumatic stress symptoms. Logistic regression examined associations between baseline personal and employment characteristics and class membership. Results The analytical sample included 22,764 participants. For each outcome, growth mixture models identified two latent classes. Approximately 31\% of HCWs experienced persistently high symptoms of probable common mental disorders, while 69\% experienced persistently low symptoms. Similar patterns were observed for secondary outcomes, with small subgroups demonstrating worsening symptoms followed by improvement. Logistic regression analyses showed that 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. Perceived support from colleagues and managers was protective. Conclusions While many HCWs reported consistently low mental health symptom levels, almost a third belonged to a latent class characterized by persistently high symptoms across all time points. These findings underscore the need for mental health support for vulnerable HCW groups, embedded within routine NHS practice rather than limited to crisis periods.",

author = "Christopher Penfold and Pamela Almeida and Theresa Redaniel and Scott, \{Lauren J.\} and Paul Moran and Rosalind Raine and Rupa Bhundia and Neil Greenberg and Simon Wessely and Bethany Croak and Richard Morriss and Ira Madan and Peter Aitken and Rafferty, \{Anne Marie\} and Sarah Dorrington and Dominic Murphy and Sharon Stevelink and Danielle Lamb",

note = "Publisher Copyright: {\textcopyright} The Author(s), 2026. Published by Cambridge University Press.",

year = "2026",

month = may,

day = "14",

doi = "10.1017/S0033291726104280",

language = "English",

volume = "56",

journal = "Psychological Medicine",

issn = "0033-2917",

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Penfold, C, Almeida, P, Redaniel, T, Scott, LJ, Moran, P, Raine, R, Bhundia, R, Greenberg, N, Wessely, S , Croak, B, Morriss, R, Madan, I, Aitken, P, Rafferty, AM , Dorrington, S , Murphy, D , Stevelink, S & Lamb, D 2026, 'The longitudinal trajectories of mental health outcomes in healthcare workers in England during the COVID-19 pandemic', Psychological Medicine, vol. 56, e148. https://doi.org/10.1017/S0033291726104280

TY - JOUR

T1 - The longitudinal trajectories of mental health outcomes in healthcare workers in England during the COVID-19 pandemic

AU - Penfold, Christopher

AU - Almeida, Pamela

AU - Redaniel, Theresa

AU - Scott, Lauren J.

AU - Moran, Paul

AU - Raine, Rosalind

AU - Bhundia, Rupa

AU - Greenberg, Neil

AU - Wessely, Simon

AU - Croak, Bethany

AU - Morriss, Richard

AU - Madan, Ira

AU - Aitken, Peter

AU - Rafferty, Anne Marie

AU - Dorrington, Sarah

AU - Murphy, Dominic

AU - Stevelink, Sharon

AU - Lamb, Danielle

PY - 2026/5/14

Y1 - 2026/5/14

N2 - Background The COVID-19 pandemic raised concerns about the mental health of an already burdened healthcare workforce. This study examined mental health trajectories among healthcare workers (HCWs) across the pandemic and identified personal and employment factors associated with different symptom patterns. Methods Longitudinal data were drawn from the NHS CHECK cohort, including clinical and non-clinical staff from 18 NHS Trusts in England (April 2020–April 2023). Growth curve and growth mixture models identified latent classes of HCWs characterized by distinct trajectories of probable common mental disorders. Secondary outcomes included anxiety, depression, alcohol misuse, and post-traumatic stress symptoms. Logistic regression examined associations between baseline personal and employment characteristics and class membership. Results The analytical sample included 22,764 participants. For each outcome, growth mixture models identified two latent classes. Approximately 31% of HCWs experienced persistently high symptoms of probable common mental disorders, while 69% experienced persistently low symptoms. Similar patterns were observed for secondary outcomes, with small subgroups demonstrating worsening symptoms followed by improvement. Logistic regression analyses showed that 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. Perceived support from colleagues and managers was protective. Conclusions While many HCWs reported consistently low mental health symptom levels, almost a third belonged to a latent class characterized by persistently high symptoms across all time points. These findings underscore the need for mental health support for vulnerable HCW groups, embedded within routine NHS practice rather than limited to crisis periods.

AB - Background The COVID-19 pandemic raised concerns about the mental health of an already burdened healthcare workforce. This study examined mental health trajectories among healthcare workers (HCWs) across the pandemic and identified personal and employment factors associated with different symptom patterns. Methods Longitudinal data were drawn from the NHS CHECK cohort, including clinical and non-clinical staff from 18 NHS Trusts in England (April 2020–April 2023). Growth curve and growth mixture models identified latent classes of HCWs characterized by distinct trajectories of probable common mental disorders. Secondary outcomes included anxiety, depression, alcohol misuse, and post-traumatic stress symptoms. Logistic regression examined associations between baseline personal and employment characteristics and class membership. Results The analytical sample included 22,764 participants. For each outcome, growth mixture models identified two latent classes. Approximately 31% of HCWs experienced persistently high symptoms of probable common mental disorders, while 69% experienced persistently low symptoms. Similar patterns were observed for secondary outcomes, with small subgroups demonstrating worsening symptoms followed by improvement. Logistic regression analyses showed that 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. Perceived support from colleagues and managers was protective. Conclusions While many HCWs reported consistently low mental health symptom levels, almost a third belonged to a latent class characterized by persistently high symptoms across all time points. These findings underscore the need for mental health support for vulnerable HCW groups, embedded within routine NHS practice rather than limited to crisis periods.

UR - https://www.scopus.com/pages/publications/105038884289

U2 - 10.1017/S0033291726104280

DO - 10.1017/S0033291726104280

M3 - Article

SN - 0033-2917

VL - 56

JO - Psychological Medicine

JF - Psychological Medicine

M1 - e148

ER -

The longitudinal trajectories of mental health outcomes in healthcare workers in England during the COVID-19 pandemic

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