Background: The Coronavirus disease (COVID-19) has emphasised the critical need to investigate the mental well-being of healthcare professionals working during the pandemic. It has been highlighted that healthcare professionals display a higher prevalence of mental distress and research has largely focused on frontline professions. Social restrictions were enforced during the pandemic that caused rapid changes to the working environment (both clinically and remotely). The present study aims to examine the mental health of a variety of healthcare professionals, comparing overall mental wellbeing in both frontline and non-frontline professionals and the effect of the working environment on mental health outcomes.

Method: A cross-sectional mixed methods design, conducted through an online questionnaire. Demographic information was optional but participants were required to complete: (a) Patient Health Questionnaire, (b) Generalised Anxiety Disorder, (c) Perceived Stress Scale, and (d) Copenhagen Burnout Inventory. The questionnaire included one open-ended question regarding challenges experienced working during the pandemic.

Procedure:
Upon ethical approval the online questionnaire was advertised for six weeks from 1st May 2021 to 12th June 2021 to maximise the total number of respondents able to partake. The survey was hosted on the survey platform “Online Surveys”. It was not possible to determine a response rate because identifying how many people had received the link was unattainable information. The advert for the study was placed on social media platforms (WhatsApp, Instagram, Facebook and Twitter) and shared through emails.

Participants were recruited through the researchers’ existing professional networks and they shared the advertisement and link to questionnaire with colleagues. The information page explained the purpose of the study, eligibility criteria, procedure, costs and benefits of partaking and data storage. Participants were made aware on the information page that completing and submitting the questionnaire indicated their informed consent. It was not possible to submit complete questionnaires unless blank responses were optional demographic data. Participants were informed that completed questionnaires could not be withdrawn due to anonymity.

The questionnaire consisted of four sections: demographic data, mental health information and the four psychometric tools, PHQ-9, GAD-7, PSS-10 and CBI. Due to the sensitive nature of this research, only the psychometric measures required an answer for each question, thus all demographic information was optional to encourage participant contentment. Once participants had completed the questionnaire and submitted, they were automatically taken to a debrief page. This revealed the hypothesis of the questionnaire and rationalised why it was necessary to conceal this prior to completion. Participants were signposted to mental health charities and a self-referral form for psychological support. Participants could contact the researcher via email to express an interest in the results. It was explained that findings would be analysed using descriptive statistics to investigate any correlations or patterns in the responses. Data collected was stored electronically, on a password protected laptop. It will be kept for three years and then destroyed.

Instruments: PHQ-9, GAD-7, PSS-10 and CBI.

Other questions included:

Thank you for considering taking part in the questionnaire! Please remember by completing and submitting the questionnaire you are giving your informed consent to participate in this study.

Demographic:

Gender: please select one of the following:

Male Female Non-binary Prefer not to answer

Age: what is your age?

Open question: Prefer not to answer

What is your current region in the UK?

South West, East of England, South East, East Midlands, Yorkshire and the Humber, North West, West Midlands, North East, London, Scotland, Wales, Northern Ireland Prefer not to answer

Ethnicity: please select one of the following:

White English, Welsh, Scottish, Northern Irish or British Irish Gypsy or Irish Traveller Any other White background Mixed or Multiple ethnic groups White and Black Caribbean White and Black African White and Asian Any other Mixed or Multiple ethnic background Asian or Asian British Indian Pakistani Bangladeshi Chinese Any other Asian background Black, African, Caribbean or Black British African Caribbean Any other Black, African or Caribbean background Other ethnic group Arab Option for other please specify Prefer not to answer

Employment/environment:

What was your employment status in 2020 prior to COVID-19 pandemic?

Please select the option that best applies. Employed Self-employed Unpaid work (homemaker/carer) Out of work and looking for work Out of work but not currently looking for work Student Volunteer Retired Unable to work Prefer not to answer Option for other please specify

What is your current employment status?

Please tick the option that best applies. Employed Self-employed Unpaid work (homemaker/carer) Out of work and looking for work Out of work but not currently looking for work Student Volunteer Retired Unable to work Prefer not to answer Option for other please specify

What is your healthcare profession/helping profession?

Please state your job title. Open question

How often did you work from home before the COVID-19 pandemic?

Not at all, rarely, some, most, everyday Option for N/A

How often did you work from home during the first UK national lockdown for COVID-19?

Not at all, rarely, some, most, everyday Option for N/A

How often did you work from home during the second UK national lockdown during COVID-19?

Not at all, rarely, some, most, everyday Option for N/A

How often have you worked from home during the third UK national lockdown during COVID-19?

Not at all, rarely, some, most, everyday Option for N/A

How often are you currently working from home during the COVID-19 pandemic?

Not at all, rarely, some, most, everyday Option for N/A

Mental health:

How would you describe your mental health leading up to the COVID-19 pandemic?

Excellent, Very good, Good, Fair, Poor

How would you describe your mental health during the COVID-19 pandemic?

Excellent, Very good, Good, Fair, Poor

What have been the main challenges working as a healthcare professional/helping profession during COVID-19 pandemic? Open question

Data analysis: Firstly, any missing data was checked by the researcher and noted in the results section. The data was then analysed using a statistical software package called Statistical Package for the Social Sciences version 28 (SPSS-28). Descriptive statistics were collected to organise and summarise the data, and a correlation coefficient describes the strength and direction of the relationship between two variables. Inferential statistics were used to determine whether the effects were statistically significant. Responses to the open-ended question were coded and examined for key themes and patterns utilising the Braun and Clarke (2006) thematic analysis approach.

Ethical considerations: The study was approved by the Health Science, Engineering and Technology Ethical Committee with Delegated Authority at the University of Hertfordshire.

The potential benefits and risks of partaking in the research were contemplated and presented on the information page to promote informed consent. Precautions to prevent harm to participants included eligibility criteria, excluding those under eighteen years older or experiencing mental health distress. As the questionnaire was based around employment and the working environment, another exclusion involved experiencing a recent job change which caused upset.

An anonymous questionnaire and optional input of demographic data fostered the participants’ right to autonomy, privacy and respect. Specific employment and organisation or company information were not collected to protect confidentiality. Although participants were initially deceived regarding the hypotheses, they were provided with accurate information about the purpose of the study. Deceit was appropriate to collect unbiased information and participants were subsequently informed of the hypotheses on the debrief page.