Impact of financial concerns on depression in health workers

• Context
• The study
• Key findings
• Points to consider

Context

Depression is highly prevalent in healthcare workers (HCWs). A recent meta-review including over 3.2 million HCWs determined that, since the COVID-19 pandemic, the prevalence of depression in HCWs is 14–37% globally. Depression incurs a significant personal cost to HCWs. In addition, healthcare organisations incur large financial costs as a result of mental health problems in their employees. It is well established that low household income is associated with an increased risk of mental health problems. Exploration of the association between financial concerns and depression in HCWs is paramount given the current cost-of-living crisis, ongoing strike action and recruitment/retention problems in the National Health Service.

The study

The study used longitudinal survey data from UK-REACH - a research programme established to investigate the impact of the COVID-19 pandemic on a UK-wide cohort of HCWs. The analysis used baseline data from the December 2020 to March 2021 survey wave to determine whether financial concerns were associated with depression (measured with the Public Health Questionnaire-2) at a follow-up survey stage (June to October 2022). A total of 3521 HCWs were included in the research.

The analysts used logistic regression to examine the association between financial concerns and depression, and ordinal logistic regression to establish predictors of developing financial concerns.

The study was conceived, designed and conducted by a group of academics and specialists. Various elements of the project, as well as the work of specific individuals, were sponsored and funded by a wide range of organisations, all of which are detailed in the report.

Key findings

Overall, the degree of participants’ concern about their future financial situation was strongly associated with meeting screening criteria for depression at follow-up.

• Those who were extremely concerned about finances at baseline had over seven times the odds of meeting the screening criteria for depression at follow-up compared with those who were not at all concerned at baseline.
• Financial concerns increased during the study period in 43.8% of HCWs and decreased in 9%.
• Those in nursing, midwifery and other nursing roles had over twice the odds of developing financial concerns compared with those in medical roles.
• Increasing age was associated with lower odds of meeting screening criteria for depression at follow-up.

Points to consider

• Methodological limitations: The methodology and limitations are discussed in detail in the paper. The limitations mentioned include a likely response bias – the comparison of follow-up responders and non-responders indicates that those meeting the screening criteria for depression and those with financial concerns at baseline were less likely to respond to follow-up questionnaires and this may have led to underestimates of the prevalence of depression and financial concerns. Another limitation is that the average age in the sample is higher than that of the NHS workforce which could also have led to underestimates of the prevalence of financial concerns and depression. There may also be some who are excluded from the research because they left healthcare work as a result of financial concerns, depression or for other reasons.
• Relevance: This study highlights the strong link between financial concerns and depression among UK healthcare workers, emphasizing the need for targeted mental health support that addresses financial stress.
• Generalisability/ transferability: This study is somewhat limited to healthcare workers in the UK, given the specific context of the cost-of-living crisis and the structure of the UK healthcare system. However, the findings may have broader relevance to other regions and professions where financial stress is a significant factor in mental health, particularly in similar high-pressure environments.
• Applicability: This study is applicable to healthcare organisations, policymakers, and mental health professionals. The findings can be used to develop targeted interventions.