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.

A Position Paper published in The Lancet Psychiatry in 2020 suggested an agenda for research about the effects of the COVID-19 pandemic on mental health, following which an interdisciplinary Lancet Psychiatry standing commission was established in 2022 to examine the emerging evidence and refine recommendations for more research. In this first Series paper from the standing commission, we focus on changes in the delivery of clinical mental health care during the COVID-19 pandemic. The second paper in the Series focuses on public mental health and policy perspectives, and the third will address neuropsychiatric consequences of infection by SARS-CoV-2. Evidence from high-quality longitudinal studies with pre-pandemic baseline data, controlled intervention trials, or systematic reviews took time to accrue. During the early months of the COVID-19 pandemic, symptoms of anxiety and depression became more prevalent, and many mental health services were compromised by pandemic-related factors; however, whether the COVID-19 pandemic accelerated pre-existing long-term trends of increasing incidence of mental health disorders, especially in children and adolescents, is unclear. Little research has been done in low-income and middle-income countries, or regarding post-COVID-19 condition (also known as long COVID), which emerged as a multisystem condition with mental health implications. Vulnerable populations, including socioeconomically disadvantaged and minoritised groups, faced disproportionate mental health impacts and limited access to care during the COVID-19 pandemic, reflecting systemic, pre-pandemic inequalities. Bold implementation of existing evidence-based mental health support for vulnerable communities, ambitious trials of novel interventions, and systematic pooling of rapidly accumulating evidence about best healh care should be priorities in future pandemics.

Background Moral injuries (MIs) may result from individuals being exposed to potentially morally injurious events (PMIEs). PMIEs have been a feature of work within much of the National Health Service (NHS) for many years, and the understanding of MI is now more commonplace, having been highlighted during the COVID-19 pandemic; however, understanding of how such events affect workers over the long term is lacking.Objective To understand the development of healthcare workers’ (HCWs) experiences of PMIEs over a period of 3 years.Design and participants We carried out follow-up semistructured qualitative interviews with 15 NHS staff who were previously interviewed on the same topic in 2021. All interviews were recorded, transcribed and analysed using reflexive thematic analysis following an inductive approach.Results Three main themes and six subthemes were identified: (1) internal context and subjective experiences, (1.i) control in a rigid system, (1.ii) psychosocial dynamics, (2) external context and the moral cost of culture, (2.i) organisational culture, (2.ii) sources of MI, (3) responses to PMIEs, (3.i) maladaptive responses, (3.ii) adaptive responses. Key issues identified included perceptions of insufficient control over their work and work environment, low psychological safety and perceived misunderstanding of the value of their work from patients and colleagues, leading to a challenging organisational culture. We found that in the 3 years between the interviews many staff reported developing ‘secondary’ feelings of betrayal as a result of perceived ongoing governmental neglect of recognition for HCWs’ sacrifices during the pandemic and a lack of acknowledgement of governmental mistakes made in the acute period.Conclusion Findings show an interplay between individual and organisational factors that HCWs faced while working in the NHS, underlining the need for wide-ranging intervention strategies. Since the HCWs’ original interviews in 2021, a secondary betrayal has developed, emphasising the need for interventions that can restore trust in the system.

Background Maintaining healthcare workers’ (HCWs) mental health is vital to reduce staff absences and turnover, ultimately improving patient care. Most research focuses on clinical staff and single timepoints, overlooking non-clinical contributions. Aims To examine mental health variations among all staff types over three years and identify those most at risk of poor mental health outcomes. Methods Our prospective cohort study followed 22,092 HCWs from 17 English NHS Trusts. Online surveys assessed common mental disorders (CMDs), depression, anxiety, alcohol misuse, PTSD, moral injury, burnout, wellbeing, resilience, and post-traumatic growth at four timepoints from April 2020 to March 2023. Data were analysed cross-sectionally and weighted to represent Trust demographics. Results Approximately 50% of participants reported probable CMDs at all timepoints. The most consistent predictor of poor mental health was having met the baseline cut-off for that outcome. No consistent differences emerged between clinical and non-clinical staff. Younger, female, lower-paid staff, those feeling unsupported by colleagues/managers, and exposed to morally injurious events were most at risk of poor mental health outcomes. Conclusions All NHS staff types face persistent mental health struggles, with no significant improvement post-pandemic restrictions. Structural inequalities must be addressed long-term, alongside targeted, flexible support for staff in the short term.

OBJECTIVES:Twenty years since the start of UK Armed Forces participation in the Iraq and Afghanistan conflicts post-2001, the extent to which these deployments continue to impact mental health outcomes and alcohol misuse in UK military personnel is unknown. This is the reporting of the fourth phase, cross-sectional study of a longitudinal cohort study that has assessed the health and well-being of UK serving and ex-serving personnel since 2004. METHODS:Participants were eligible for the most recent phase (2022-2023) if they took part previously (2014-2016) and consented to recontact. Primary outcome measures included symptoms of common mental disorders (CMD), such as depression and anxiety, probable posttraumatic stress disorder (PTSD), complex PTSD (C-PTSD) and alcohol misuse. RESULTS:In the overall sample (n=4104, response rate=54.6%), CMD were the most prevalent outcome (27.8%), followed by probable PTSD (9.4%) and alcohol misuse (8.4%). The majority of PTSD experienced met the criteria for C-PTSD (72.7%). Ex-serving Regulars compared with serving Regulars reported a higher prevalence of PTSD (10.5% vs 7.4%, adjusted OR (AOR)=1.68, 95% CI 1.12 to 2.51) and C-PTSD (6.5% vs 3.9%, AOR=1.80, 95% CI (1.07 to 3.05); a higher prevalence of both disorders was also reported in serving/ex-serving Regulars whose last deployment to Iraq/Afghanistan was in a combat role. CONCLUSION:Although the majority of those who deployed to Iraq or Afghanistan remain well, there is an enduring impact of combat deployment on PTSD. Attention should continue to be directed towards the prevention, early detection and treatment needs of this cohort.

Objectives This study aims to determine key workforce variables (demographic, health and occupational) that predicted National Health Service (NHS) staff’s absence due to illness and expressed intention to leave their current profession.Design, setting and participants Staff from 18 NHS Trusts were surveyed between April 2020 and January 2021, and again approximately 12 months later.Outcome measures Logistic and linear regression were used to explore relationships between baseline exposures and four 12-month outcomes: absence due to COVID-19, absence due to non-COVID-19 illness, actively seeking employment outside current profession and regularly thinking about leaving current profession.Results 22 555 participants (out of a possible 152 286 employees; 15%) completed the baseline questionnaire. 10 831 participants completed the short follow-up questionnaire at 12 months and 5868 also completed the long questionnaire; these participants were included in the analyses of sickness absence and intention to leave, respectively. 20% of participants took 5+ days of work absence for non-COVID-19 sickness in the 12 months between baseline and 12-month questionnaire; 14% took 5+ days of COVID-19-related sickness absence. At 12 months, 20% agreed or strongly agreed they were actively seeking employment outside their current profession; 24% thought about leaving their profession at least several times per week. Sickness absence (COVID-19 and non-COVID-19 related) and intention to leave the profession (actively seeking another role and thinking about leaving) were all more common among NHS staff who were younger, in a COVID-19 risk group, had a probable mental health disorder, and who did not feel supported by colleagues and managers.Conclusions Several factors affected both workforce retention and sickness absence. Of particular interest are the impact of colleague and manager support because they are modifiable. The NHS workforce is likely to benefit from training managers to speak with and support staff, especially those experiencing mental health difficulties. Further, staff should be given sufficient opportunities to form and foster social connections. Selection bias may have affected the presented results.

INTRODUCTION:Understanding the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and changes in demand for related healthcare services is crucial for effective healthcare policy and resource allocation. Clinicians, teachers and charities have reported increasing demand for ADHD assessments in recent years, overwhelming support systems. This review synthesises post-2020 studies of ADHD prevalence and incidence. METHODS:We conducted systematic searches in Web of Science, Embase, Medline, Global Health, and PsycInfo using terms relating to ADHD and prevalence. Additional sources included public health databases, Google, and study reference lists. Studies were included if they contained original data relating to general population rates of ADHD and we extracted data relating to methods of assessment and measures of prevalence and incidence. We followed PRISMA and synthesis without meta-analysis (SWiM) guidelines. RESULTS:Forty studies across 17 countries, with one study spanning 42 countries, were reviewed. No significant rise in ADHD prevalence was found, although incidence was found to vary during the COVID-19 pandemic. Only four of the included studies were at low risk of bias. LIMITATIONS:There are substantial limitations in the quality of the literature included in this review. Due to significant delays in reporting prevalence data, estimates from previous reviews may be inaccurate. There is a lack of healthcare data and no school-level data. CONCLUSIONS:Significant research gaps exist in determining ADHD prevalence and incidence. The highest quality findings do not suggest an increase in prevalence since 2020 but indicate some variability in incidence during the COVID-19 pandemic. Further research is urgently needed to guide clinical practice and public health policy.

PURPOSE:The relative income hypothesis theorises that one's earnings relative to others exert a greater influence on subjective wellbeing than absolute income. Understanding the relationship between relative income and mental health could contribute to employee wellbeing. This review aimed to summarise the defining features of relative income in relation to mental health and how it is measured in the literature. In addition, it aimed to explore the relationship between relative income and mental health in those currently employed in the UK. METHODS:Nine electronic databases were searched using a pre-defined search strategy: PubMed (including MEDLINE and PubMed Central), PsycINFO, Scopus, Web of Science, Global Health, JSTOR, Business Source Complete (EBSCO), ScienceDirect and Emerald. The protocol was pre-registered on PROSPERO (CRD42023408657). Quantitative and qualitative studies and grey literature, which described the defining features and measurement of relative income and its impact on mental health among UK employees, were included. RESULTS:After screening, 13 studies were included in the review. A conceptualisation of relative income revealed that an income comparison is either researcher-defined using averages or self-assessed based on a person's perception. Having a lower income than the reference group was commonly associated with diminished wellbeing, though moderating factors (gender, income inequality and composition of reference group) were identified. CONCLUSIONS:Having a lower income than the reference group is associated with poorer wellbeing. Implications for practice and policy are considered amidst the UK's 'cost of living crisis' and ongoing pay disputes in various sectors.

BackgroundThe pressures of the COVID-19 pandemic placed mental healthcare professionals at an increased risk of burnout and decreased mental wellbeing. Resilience strategies have been put in place as a protective measure, but little is known about how mental wellbeing evolved over time in this group and how resilience affects it. This study aimed to: 1) investigate long-term changes in burnout and mental well-being among mental healthcare professionals working in the National Health Service (NHS) during the COVID-19 pandemic in the United Kingdom (UK); and 2) examine whether baseline resilience levels predicted decreased burnout and increased mental well-being over the course of the pandemic.MethodsThe study used data from NHS CHECK, a longitudinal cohort study investigating NHS staff mental health and well-being since the COVID-19 pandemic. Clinical mental health staff (n = 3,289) who completed self-report measures at three time points (baseline, 6 and 12 months later). Baseline surveys were conducted during the initial pandemic peak (April 2020 - June 2020; n = 543), the initial easing of restrictions (July 2020 - September 2020; n = 1,098), and the second peak (October 2020 - January 2021, n = 1,648).ResultsMixed model analyses showed that burnout scores increased over time, with higher resilience at baseline predicting lower burnout 6 and 12 months later. However, rises in burnout were most pronounced in the high resilience group. Well-being remained relatively stable over time, with staff with higher resilience at baseline reporting higher well-being over time.ConclusionsResilience was linked with both lower burnout and higher well-being in NHS mental health staff throughout the COVID-19 pandemic. Despite showing steeper increases in burnout, staff with high initial resilience still maintained lower absolute levels of burnout compared to those with lower resilience. Healthcare organizations should consider providing interventions focusing on organizational factors in addition to individual-level resilience-focused support.

Healthcare systems across Europe face a workforce crisis characterised by staff shortages, high turnover, and psychological distress among healthcare workers (HCWs). To understand the true scope and extent of psychological distress and occupational outcomes among HCWs and key areas to target for actionable solutions to this, a comprehensive overview of the evidence is needed. In this Series paper, we have synthesised findings from existing systematic reviews and meta-analyses to assess the prevalence of psychological distress among HCWs in Europe, examine associated risk and protective factors, and evaluate the effectiveness of interventions targeting these. The Series paper shows that HCWs experience high levels of work-related psychological distress, particularly burnout. Organisational factors, such as staff shortages, high workloads, and poor leadership, are key contributors to HCWs psychological distress. Organisational-level, rather than individual-level, interventions showed greater promise in reducing psychological distress and improving occupational outcomes. Perhaps surprisingly, currently published reviews did not focus on diagnosable mental disorders, instead relying on self-report symptom-based measures, likely overestimating prevalence. Our findings show limited research available on psychological distress and occupational outcomes among non-clinical staff, HCWs from ethnic minorities, and countries outside Western Europe. We recommend long-term investment in fostering safe and supportive workplaces and implementing evidence based multi-level mental health initiatives that are co-produced with HCWs. We also advocate for high quality, longitudinal research and policies that prioritise protecting the mental health and occupational safety of HCWs in order to safeguard their wellbeing and futureproof healthcare system sustainability.

The General Health Questionnaire (GHQ), particularly the GHQ-12, is widely used in epidemiological research to detect symptoms of probable psychiatric disorders.1Goldberg DP The detection of psychiatric illness by questionnaire. Oxford University Press, London1972Google Scholar Questionnaire transcription errors can occur in multiple ways, including when converting a printed version to an online version. In March, 2023, we discovered we had made a transcription error in several waves of data we collected as part of a longitudinal study among health-care workers. The GHQ-12 has twelve items, each answered on a four-point Likert scale, with answers indicating better wellbeing on the left and worse wellbeing on the right. In creating response options for item eight of the GHQ-12 in our survey, the first response option was mistakenly labelled "not at all" when it should have been labelled "more so than usual", resulting in responses at both ends of the scale potentially indicating worse wellbeing. Several of our publications included results derived from the GHQ-12,2Lamb D Gnanapragasam S Greenberg N et al.Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic.Occup Environ Med. 2021; 78: 801-808Crossref PubMed Scopus (70) Google Scholar, 3Williamson V Lamb D Hotopf M et al.Moral injury and psychological wellbeing in UK healthcare staff.J Ment Health. 2023; 32: 890-898Crossref PubMed Scopus (8) Google Scholar including an Article in The Lancet Psychiatry.4Scott HR Stevelink SAM Gafoor R et al.Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study.Lancet Psychiatry. 2023; 10: 40-49Summary Full Text Full Text PDF PubMed Google Scholar Following this realisation, we conducted analyses to ascertain whether our results might have been affected across various data waves. We examined the data with and without the erroneous item, comparing prevalence rates with mean and median substitution for the flawed item. Neither substitution method affected the results. Removing borderline cases (ie, cases with scores of three or four following the 0–0-1–1 scoring method, with a score of four indicating caseness) also did not alter prevalence. We hypothesised that as the error featured towards the end of the questionnaire, individuals had learnt responses on the left meant better wellbeing and continued to tick responses on the basis of this logic, negating the wrong wording in item eight. To test this hypothesis definitively, we used a market research panel to establish whether item errors would make a difference in a new population. Participants (N=1504) were randomly allocated to one of three groups and provided with one of the following GHQ-12 versions: a correct version (n=500); a version with an error in item eight (n=502); or a version with a purposeful error in item one (n=502). We included an error in item one to test whether the position of the error had any effect. The results, reported in a preprint,5Croak B Bhundia R Lamb D et al.Do errors in the GHQ-12 response options matter?.OSF Preprints. 2024; (published online Feb 27.) (preprint).https://doi.org/10.31219/osf.io/34a6pGoogle Scholar were clear that there was no difference in mean GHQ-12 scores or the proportion of cases for any of the three groups. These results confirm that our transcription error made no difference to the conclusions of our Article in The Lancet Psychiatry or any others. These findings can also reassure other researchers who might have made similar mistakes. We declare no competing interests. Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional studyThe prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention. Full-Text PDF Open Access

ObjectivesWe investigated whether UK military personnel exposed to sarin during the ‘Service Volunteer Programme’ at Porton Down had increased rates of mortality or cancer incidence over a 52-year follow-up.MethodsA historical cohort study assembled from UK military records, comprising male veterans exposed to sarin during the ‘Service Volunteer Programme’ at Porton Down, UK (n=2975) and a comparison group of similar veterans who did not attend (n=2919). Mortality and cancer incidence data were obtained from national registries up to December 2019. Analysis was conducted using Cox regression adjusted for age, year of birth and service characteristics.ResultsOver a median follow-up of 52.2 years (range 2 days to 74.6 years), 1598 (53.7%) sarin-exposed veterans and 1583 (54.3%) non-exposed veterans died. Adjusted HRs for all-cause mortality were raised for any sarin exposure (HR=1.08, 95% CI 1.01 to 1.16), two or more exposures (HR=1.25, 95% CI 1.04 to 1.49) and higher doses (air >15 mg.min/m3) (HR=1.15, 95% CI 1.02 to 1.30). For cause-specific mortality, sarin exposure was associated with deaths from ‘other’ circulatory diseases (excludes ischaemic and cerebrovascular diseases) (HR=1.41, 95% CI 1.06 to 1.87) and alcohol-attributable deaths (HR=2.66, 95% CI 1.40 to 5.07). There was no association between sarin exposure and overall cancer incidence (HR=1.01, 95% CI 0.93 to 1.10), but cancer incidence was higher for alcohol-related neoplasms (HR=1.24, 95% CI 1.01 to 1.51).ConclusionsSarin exposure was associated with increased rates of mortality over a 50-year follow-up. The strongest associations were observed for deaths attributable to alcohol and ‘other’ circulatory diseases.

After disasters, many people seek compensation for physical, psychological or economic damages. However, compensation processes can be perceived as arduous and unfair and potentially create stress for both individuals and communities. This systematic review explored the psychosocial impacts of post-disaster compensation processes, including compensation sought through both litigation and government assistance programmes. We searched seven databases, hand-searched reference lists of included studies, and used thematic analysis to synthesise results of included studies. We screened 6,532 papers, ultimately including 66 in the review. While we found mixed evidence regarding the relationship between individual mental health and the compensation process, many studies suggested the process placed demands on emotional resources and could cause stress. Numerous challenges of the compensation process were described, including complicated paperwork, lengthy processes, inadequate information, confusing eligibility criteria, lack of inter-agency cooperation, poor understanding of communities’ unique needs, insufficient pay-outs, and politicisation of the process. Inequities in compensation distribution introduced additional stress to already traumatised communities, who often experienced resentment, envy and conflict. The mixed nature of the relationship between mental health and the compensation process was evident in research trends where a small number of studies reported positive findings related to relating to gratitude, helpfulness of compensation and strengthened community relationships, while a substantial number of others reported negative impacts including higher mental health problems. Positive and negative impacts were reported for both litigation and non-litigation compensation-seeking. The nuanced dynamics of these findings are described in greater detail within the paper. It is important that compensation regulators consider the potential impacts on individuals and communities and take steps to address compensation inequities. This enhanced understanding of how those affected by disasters can rebuild their lives and furthering understanding of how to support them will enable evidence-based approaches to building resilience and planning for long-term recovery. Significant compensation process improvements could be realised by ensuring clear communication and transparent decision-making. Overall, this review underscores the importance of ensuring that compensation processes are fair and straightforward so they can repair material losses without deteriorating the social norms and relationships of affected communities.

Background: The twelve item General Health Questionnaire (GHQ-12) is a widely used measure of psychological wellbeing. Because there are seven different sets of response options across the twelve items, there is scope for transcription errors to occur when researchers assemble their study materials. The impact of such errors might be more important if they occur in the first set of response options than if they occur later in the questionnaire, once participants have become aware that options to the right of the GHQ-12 response sets always indicate worse wellbeing.Aims: To test the impact of introducing errors into the first and eighth set of response options for the GHQ-12 that render those response sets partially illogical.Methods: We used a double-blind randomised controlled trial, pre-registered with Open Science Framework (osf.io/syhwf). Participants were recruited by a market research company from their existing panel of respondents in Great Britain. Participants were randomly allocated to receive one of three versions of the GHQ-12: a correct version (n=500), a version with a mistake in the first item (n=502), or a mistake in the eighth item (n=502). Mistakes replaced ‘better than usual’ (item one) or ‘more so than usual’ (item eight) with ‘not at all.’Results: We found no differences between the versions in terms of number of participants with possible poor psychological wellbeing (χ2=0.32, df=2, p=0.85) or in mean GHQ-12 scores for the three groups (F(2, 1501)=0.26, p=0.77).Conclusions: Small deviations from the standard GHQ-12 wording do not have a substantive impact on results.

The relative income hypothesis theorises that the earnings of an individual relative to others exert a greater influence on subjective wellbeing than absolute income. Understanding the relationship between relative income and mental health could contribute to employee wellbeing. This review narratively synthesised the defining features and measurement of relative income, and its impact on mental health among UK employees. Systematic searches of qualitative and quantitative research evidence identified 13 studies. A conceptualisation of relative income revealed that an income comparison is either researcher-defined using averages or self-assessed based on the perception of an individual. Having a lower income than the reference group was commonly associated with diminished wellbeing, though moderating factors (gender, income inequality and composition of reference group) are discussed. Implications for practice and policy are considered amidst the cost of living crisis in the UK and ongoing pay disputes in various sectors. ### Competing Interest Statement BC, LEG and DL have no competing interests. SW is a non-executive director at NHS-England. KK is the deputy director and part funded by the NIHR Policy Research Unit in Health and Social Care Workforce. SAMS is supported by the National Institute for Health and Care Research (NIHR), Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and the National Institute for Health and Care Research NIHR Advanced Fellowship (Dr Sharon Stevelink NIHR300592). The views expressed in this publication are those of the authors and not necessarily those of the ESRC, the NHS or the NIHR. ### Funding Statement This work is part of a PhD nested within the NHS CHECK study and funded by the ESRC (ES/P000703/1). This report is independent research supported by the National Institute for Health and Care Research ARC North Thames. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care. LEG is funded by the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Charity. Key contributors to this charity are the Headley Court Charity (principal funder), HM Treasury (LIBOR Grant), Help for Heroes, Nuffield Trust for the Forces of the Crown, Forces in Mind Trust, National Lottery Community Fund, Blesma - The Limbless Veterans and the UK Ministry of Defence. For the purposes of open access, the authors have applied a Creative Commons Attribution (CC BY) licence to any Accepted Author Manuscript version arising from this submission. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript

Objective To determine key workforce variables (demographic, health and occupational) that predicted NHS staff's 1) absence due to illness (both COVID-19 and non-COVID-19 related) and 2) expressed intention to leave their current profession. Methods Staff from 18 NHS Trusts were surveyed between April 2020 and January 2021, and again approximately 12 months later. Logistic and linear regression were used to explore relationships between baseline exposures and 12-month outcomes. Results We included 10,831 participants for analysis. At 12-months, 20% stated they agreed or strongly agreed they were actively seeking employment outside their current profession; 24% said they thought about leaving their profession at least several times per week. Twenty-percent of participants took 5+ days of work absence due to non-COVID-19 sickness in the 12-months between baseline and 12-month questionnaire; 14% took 5+ days of COVID-19 related sickness absence. Sickness absence (COVID-19 and non-COVID-19 related) and intention to leave the profession (actively seeking another role and thinking about leaving) were all more common among NHS staff who were younger, in a COVID-19 risk group, had a probable mental health disorder, and who did not feel supported by colleagues and managers. Conclusions There were several factors which affect both workforce retention and sickness absence. Of particular interest because they are modifiable, are the impact of colleague and manager support. The NHS workforce is likely to benefit from training managers to speak with and support staff, especially those experiencing mental health difficulties. Further, staff should be given sufficient opportunities to form and foster social connections. ### Competing Interest Statement NG runs a psychological health consultancy (March on Stress Ltd) which provides some mental health training for NHS organisations. No other authors report any conflicts of interest. ### Funding Statement This research was funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, NIHR ARC North Thames, and the NIHR Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between the UK Health Security Agency, King's College London and the University of East Anglia. SAM Stevelink is supported by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and funded by the National Institute for Health and Care Research, NIHR Advanced Fellowship, Dr Sharon Stevelink, NIHR300592. The NHS CHECK cohort study from which this data is taken was funded 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. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The views expressed are those of the authors and not necessarily those of NHS England, NHS Improvement, the NIHR, UKHRA or the Department of Health and Social Care. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval for the NHS CHECK study was granted by the Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust Research and Development. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data will be available to researchers who provide a justified hypothesis and structured statistical analysis plan addressing a legitimate research question that is approved by the NHS CHECK Senior Research Team and after the signing of a data sharing agreement. Only deidentified participant data will be provided.

Aims Police employees may experience high levels of stress due to the challenging nature of their work which can then lead to sickness absence. To date, there has been limited research on sickness absence in the police. This exploratory analysis investigated sickness absence in UK police employees.Methods Secondary data analyses were conducted using data from the Airwave Health Monitoring Study (2006-2015). Past year sickness absence was self-reported and categorised as none, low (1-5 days), moderate (6-19 days) and long-term sickness absence (LTSA, 20 or more days). Descriptive statistics and multinomial logistic regressions were used to examine sickness absence and exploratory associations with sociodemographic factors, occupational stressors, health risk behaviours, and mental health outcomes, controlling for rank, gender and age.Results From a sample of 40,343 police staff and police officers, forty-six per cent had no sickness absence within the previous year, 33% had a low amount, 13% a moderate amount and 8% were on LTSA. The groups that were more likely to take sick leave were women, non-uniformed police staff, divorced or separated, smokers and those with three or more general practitioner consultations in the past year, poorer mental health, low job satisfaction and high job strain.Conclusions The study highlights the groups of police employees who may be more likely to take sick leave and is unique in its use of a large cohort of police employees. The findings emphasise the importance of considering possible modifiable factors that may contribute to sickness absence in UK police forces.

Objectives This study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and physical health at the time of the study.Methods An online Inequalities Survey was conducted by the Tackling Inequalities and Discrimination Experiences in Health Services study in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments and discrimination) as well as mental health (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)), and physical health (PHQ-15) from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622).Results Regression analysis of this cross-sectional data revealed that staff from black and mixed/other ethnic groups had greater odds of experiencing workplace harassment (adjusted OR (AOR) 2.43 (95% CI 1.56 to 3.78) and 2.38 (95% CI 1.12 to 5.07), respectively) and discrimination (AOR 4.36 (95% CI 2.73 to 6.96) and 3.94 (95% CI 1.67 to 9.33), respectively) compared with white British staff. Staff from black ethnic groups also had greater odds than white British staff of reporting PPE unavailability (AOR 2.16 (95% CI 1.16 to 4.00)). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about and having the ability to inform redeployment decisions were associated with lower odds of poor physical and mental health.Conclusions Structural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required.

ObjectivesThe objectives of this study were to examine post COVID-19 syndrome (PCS) among healthcare workers (HCWs) in England and explore risk factors for the condition.MethodsData were collected by National Health Service (NHS) CHECK, a longitudinal study exploring HCWs’ mental and physical well-being during and after the COVID-19 pandemic. NHS CHECK collected data at four timepoints: the baseline survey between April 2020 and January 2021, and then three follow-up surveys at approximately 6, 12 and 32 months post baseline. PCS data were collected at 12 and 32 months, while risk factor data were from baseline. HCWs were asked what COVID-19 symptoms they experienced and for how long and were classified as having PCS if they had any symptom for ≥12 weeks. Multilevel regressions were used to examine risk factors for PCS.ResultsThis study included 5248 HCWs. While 33.6% (n=1730) reported prolonged COVID-19 symptoms consistent with PCS, only 7.4% (n=385) reported a formal diagnosis of PCS. Fatigue, difficult concentrating, insomnia and anxiety or depression were the most common PCS symptoms. Baseline risk factors for reporting PCS included screening for common mental disorders, direct contact with COVID-19 patients, pre-existing respiratory illnesses, female sex and older age.ConclusionsWhile a third of HCWs reported prolonged COVID-19 symptoms consistent with PCS, a smaller percentage reported a formal diagnosis of the condition. We replicate findings that direct contact with COVID-19 patients, older age, female sex, pre-existing respiratory illness and symptoms of common mental disorders are associated with increased risk of PCS.

Abstract Introduction Previous studies on impact of the COVID-19 pandemic on healthcare workers’ (HCWs) mental health relied on self-reported screening measures to estimate point prevalence. Screening measures, designed to be sensitive, have low positive predictive value and often overestimate prevalence. We 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) was conducted during the COVID-19 pandemic. This included two representative participant groups: i) 243 participants completed the General Health Questionnaire (GHQ-12) and the Clinical Interview Schedule – Revised (CIS-R) to assess CMDs; ii) 94 participants completed the PCL-6 and the Clinician Administered PTSD Scale (CAPS-5) for DSM-5 – to assess PTSD. Results The GHQ screening caseness for any CMD was 52·8% (95% CI 51.7 to 53.8). Using the 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 the CAPS-5 diagnostic interviews, estimated population prevalence of PTSD was estimated at 7·9% (95% CI: 4.0 to 15.1). Discussion Implications for clinical practice, policy and future research will be discussed. Conclusion Prevalence estimates of CMDs in HCWs are considerably lower when estimated using diagnostic interviews than through screening tools. Nevertheless, 1-in-7 HCWs met the threshold for a clinically diagnosable mental disorder who might benefit from intervention.