Mental health impact of COVID-19 among Spanish health care workers: A 3-year longitudinal study (MINDCOVID)

AIMS: We assessed the trajectory of adverse mental health outcomes of Spanish healthcare workers (HCWs) during three years after the COVID-19 pandemic initiation, and their association with distal and proximal risk factors. METHODS: A prospective cohort of HCWs from 18 Spanish institutions was assessed seven times between May 2020 and June 2023 through institutional web-based surveys. Outcomes included: (1) any probable mental disorder (MDx)-depression (PHQ-8 ≥10), anxiety (GAD-7 ≥10), panic attack, post-traumatic stress disorder (PCL-5 ≥7), or substance use disorder (CAGE-AID ≥2); and (2) any suicidal thoughts or behaviors (STB, CSSRS). Risk factors comprised 11 distal (sociodemographic, professional, health-related) and 13 proximal (COVID-19 infection, work, health, financial, and family stressors) variables. Latent class growth analysis identified trajectories. RESULTS: Four thousand eight hundred nine were followed. Most were women (77.3%), hospital workers (57.6%), and nurses/nurse assistants (44.4%). Prevalence of any MDx declined from 45.5% (May-September 2020) to 31.2% (April-June 2023), while STB increased slightly from 8.4% to 9.4% (not significant). Common risk factors for MDx and STB were previous mental disorders, female gender, nurse assistant role, foreign-born status, primary care work, and physical comorbidities. Four trajectory classes were identified for both MDx and STB: persistent high (19.4%, 5.0%), decreasing from high prevalence (28.5%, 5.2%), increasing from low (5.9%, 4.2%), and persistent low (46.2%, 85.5%). Persistent high classes were associated with interpersonal stress, loved ones' health, lack of preparedness/protective equipment, and ethically challenging care decisions. CONCLUSIONS: Adverse mental health outcomes remained substantial among Spanish HCWs during three years of follow-up, about one in five showing persistently high burden. Continued monitoring and support are warranted.