High levels of PTSD among nursing home staff during Covid, study finds

Nursing home staff have suffered severe post-traumatic stress disorder, depression and in a small number of cases contemplated suicide during the Covid-19 pandemic, a new study has found.

Researchers found nearly half of nursing home staff, one of the sectors hit hardest by Covid-19, had symptoms of moderate to severe post-traumatic stress disorder (PTSD).

The study by Trinity College Dublin, St Patrick's Mental Health Services and Royal College of Surgeons in Ireland surveyed 390 staff across 64 nursing homes during the third wave of the virus.

The research found “concerning” levels of suicidal ideation and suicide planning among staff in the sector.

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During the first three waves of Covid-19, nursing home residents accounted for about half of all deaths from the virus, with several homes ravaged with large outbreaks that pushed facilities near breaking point.

Some 14 per cent of nursing home staff surveyed reported that they had thought about suicide in the past week, while 9 per cent reported some level of planning to end their lives, the research said. Ten staff told researchers they had had thoughts about suicide “quite a bit” in the past week.

Overall the study found a fifth of staff were believed to be likely to be suffering from depression, with 39 per cent of workers reporting low moods.

Moral injury

Some 45 per cent of staff reported symptoms of moderate to severe PTSD, which was “significantly higher” than hospital staff during Covid-19.

The study found high rates of “moral injury” among health care assistants, a phenomenon traditionally seen in the military, where someone has to witness or take part in something that goes against their moral and ethical beliefs.

Researchers said it seemed the “severe difficulties in providing optimal care” to residents during the pandemic had triggered similar reactions in nursing home staff.

The vast majority of staff were female, and about 40 per cent had more than 10 years’ experience working in the sector, the study found.

Some 17 per cent of staff said they had personally attended to between one and 10 Covid-19 positive residents, while 9 per cent had cared for 11-20 cases. Five nursing home staff said they had personally cared for more than 40 Covid-19-positive residents.

A fifth of the staff had contracted the virus, while a little less than a third said they had had to quarantine at one point, either with symptoms or as a close contact.

The study found that, given the high numbers of deaths, staff who often formed close bonds with residents “may have been forced to regularly witness their deaths first hand”.

Selection bias

Academics said that although they believed the survey sample to be representative, they noted a low response rate. As a result, selection bias in who decided to take the survey could be a factor in the high levels of mental health conditions seen.

The researchers plan to carry out a second survey, to compare the findings with the current mental health of staff, given that widespread vaccination rates in nursing homes have since prevented significant outbreaks and deaths.

Dr Conan Brady, lead author of the study, said it laid bare "the significant mental health impacts of the pandemic for those working in nursing homes".

On top of restrictions faced by the general population, Dr Brady said nursing home staff were working in stressful conditions with “high levels of Covid-19”.

Prof Declan McLoughlin, consultant psychiatrist at St Patrick's Mental Health Services, said it was clear the pandemic presented "immense challenges for nursing homes". The findings of the study highlighted "potential areas of concern for nursing home staff", which should be addressed with supports, he said.