Nursing home staff mental health during the COVID-19 pandemic in the Republic of Ireland

Abstract

This thesis comprises three main studies. The aim of this project was to characterise nursing home staff mental health during the COVID-19 pandemic in the Republic of Ireland.

Study 1: Cross-sectional survey of nursing home staff working in the Republic of Ireland during the third wave of the COVID-19 pandemic (November 2020-January 2021) The objective was to conduct a national, cross-sectional survey of nursing home staff in the Republic of Ireland during the third wave of the COVID-19 pandemic. I hypothesised that there may be significant differences in these outcomes between jobs or professions. 390 responses were collected. Moderate-severe post-traumatic stress disorder (PTSD) symptoms were found in 45.1% (95% CI 40.2-50.1%) of all staff. A World Health Organisation-5 (WHO-5) wellbeing index score ?32, indicating low mood, was reported by 38.7% (33.9-43.5%) of staff; significantly more nurses reported low mood. Suicidal ideation and suicide planning were reported respectively by 13.8% (10.4-17.3%) and 9.2% (6.4-12.1%) of participants with no differences between groups. HCAs reported significantly higher moral injury than nonclinical staff. Nurses were more likely to use approach coping styles than nonclinical staff.

Study 2: Cross-sectional, anonymous online survey one year after the original study of nursing home staff mental health in the Republic of Ireland (November 2021-January 2022) The objective was to conduct a follow-up, anonymous online survey one year after the original study to further characterise nursing home staff mental health and to assess if there have been changes in these outcomes over time. I hypothesised the rollout of vaccination, and the easing of pandemic-related restrictions would improve mental health outcomes. 229 responses were collected. More staff reported moderate-severe post-traumatic stress symptoms (Survey 1 (S1) 45%; S2 65%; p<0.01), depression (S1: 39%; S2 57%; p<0.01), suicidal ideation (S1: 14%; S2 18%; p<0.01) and suicidal planning (S1: 9%; S2 15%; p=0.04) later in the pandemic. There was a higher degree of moral injury in Survey 2 (S2) (S1: 20.8 standard deviation (SD) 9.1; S2: 25.7 SD (11.3), p<0.01) and use of avoidant (maladaptive) coping styles at S2 (S1: 20.8 (6.3); S2 23.0 (6.3); p<0.01) with no significant differences found in the use of approach (adaptive) coping styles. Staff reported significantly more concerns at S2 regarding contracting Covid-19 (p<0.01), social stigma (p=0.01), job stress (p<0.01), doubts about personal protective equipment (p<0.01) and systems and processes (p<0.01). This study shows that mental health outcomes have significantly worsened over time in this cohort. My hypothesis has not been supported.

Study 3: Multiple linear regression analyses of correlates of depression, post-traumatic stress, and moral injury in nursing home staff in the Republic of Ireland during the COVID-19 pandemic. The objective was to perform analyses of the data collected in both surveys to ascertain if demographic and employment characteristics, COVID-19 exposure, perceptions regarding the pandemic, and coping styles correlate with depressive symptoms, post-traumatic stress symptoms and moral injury. Based upon previous related research, I hypothesised that significant correlates of these measures would exist. Maladaptive coping was found to moderately correlate with worse outcomes in every measure in both Survey 1 and Survey 2. This may provide a target for mitigating poor outcomes in this cohort in future.