Mental Healthcare Utilization Among US Healthcare Workers During the COVID-19 Pandemic: Evidence from the 2020-2021 National Health Interview Survey.

Abstract

Goal: Despite the well-documented mental health impact of the COVID-19 pandemic on healthcare workers (HCWs), the literature holds limited research on their use of mental healthcare. This study assessed the prevalence and correlates of mental healthcare utilization among US HCWs, which can be used as baseline measurements to guide the evaluation of interventions and guide the development of those interventions.

Methods: We used the 2020-2021 US National Health Interview Survey and restricted our analytic sample to respondents who worked in healthcare settings and reported daily, weekly, or monthly mental health symptoms (unweighted n = 1,412). Our outcome variables were: (1) receiving anxiolytic or antidepressant prescriptions, (2) receiving psychotherapy, and (3) not utilizing either treatment. We conducted multivariable logistic regression models to identify factors associated with each outcome. Based on Andersen's behavioral model, we included predisposing factors (e.g., gender, healthcare role), enabling factors (e.g., social support, telehealth use), need factors (e.g., frequency of depressive or anxiety symptoms), and year.

Principal findings: We found that 32.1% of HCWs received prescriptions, 22.3% received psychotherapy, and 59.0% were not currently using mental healthcare. Overall, some predisposing, enabling, and need factors were associated with all three outcome variables for mental healthcare utilization among HCWs. For instance, when examining the odds of not reporting current use of mental healthcare services, odds were higher among HCWs who were non-Hispanic Black/African American (odds ratio [OR] = 1.90, 95% confidence interval [CI] [1.16-3.12]), or Hispanic (OR = 2.68, 95% CI [1.63-4.39]) compared to those who were non-Hispanic White. Higher odds were also observed among HCWs who reported rarely or never received adequate social support (OR = 1.94, 95% CI [1.04-3.62]) as compared to those who reported always receiving adequate social support, those who were male (OR = 1.47, 95% CI [1.00-2.16]), and those without a usual source of care (OR = 2.08, 95% CI [1.12-3.88]). Inversely, lower odds were observed among HCWs who reported themselves as not heterosexual (OR = 0.58, 95% CI [0.34-0.99]) and those who had used telehealth appointments (OR = 0.32, 95% CI [0.24-0.44]). Lower odds were also observed among HCWs with more frequent anxiety symptoms: monthly (OR = 0.42, 95% CI [0.20-0.88]), weekly (OR = 0.36, 95% CI [0.18-0.73]), or daily frequency (OR = 0.27, 95% CI [0.14-0.55]), compared to never or few times a year. A similar pattern was observed among HCWs with more frequent depressive symptoms: monthly (OR = 0.33, 95% CI [0.22-0.49]), weekly (OR = 0.15, 95% CI [0.09-0.24]), or daily (OR = 0.11, 95% CI [0.05-0.21]), compared to never or few times a year. No differences in any outcome variable by type of HCW (diagnosing vs. nondiagnosing roles) were observed.

Practical applications: Our findings reveal a potential pattern of underutilization of mental health services among HCWs with mental health symptoms. To inform intervention design and delivery, additional research is needed to identify barriers to mental healthcare and preferences for their modalities that are specific to HCWs.