Mental health outcomes among U.S. healthcare workers before, during, and after the 2019 global respiratory pandemic: A population-based study

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BACKGROUND: Limited evidence exists on the persistence of anxiety and depression in the post-2019 global respiratory pandemic period among healthcare workers (HCWs). This study aims to assess anxiety and depression symptoms among HCWs during the pre-pandemic, pandemic, and post-pandemic periods-and to examine moderating effects of race and/or ethnicity, nativity, and sexual orientation. METHODS: This study analyzed data from National Health Interview Survey on a nationally representative sample of adults during pre-pandemic (N = 38,109), pandemic (N = 89,693), and post-pandemic (N = 13,895) periods in 2019-2023. The sample included HCWs in the U.S., with direct patient HCW status as the primary independent variable. The primary outcomes were self-reported anxiety and depression, measured using the Washington Group on Disability Statistics Extended Set on Functioning. Weighted logistic regression models were used to assess the associations. RESULTS: Direct HCWs had higher odds of anxiety and depression compared to non-direct HCWs during the pandemic, but there were no significant differences between them before or after the pandemic. Non-Hispanic White (versus racial and/or ethnic minority), sexual minority (versus heterosexual), and U.S.-born (versus foreign-born) individuals had higher odds of anxiety and depression across the three pandemic phases. Nativity was the only significant moderator, with U.S.-born HCWs having higher odds of anxiety and depression compared to foreign-born HCWs during the pandemic. CONCLUSIONS: U.S.-born HCWs, non-Hispanic White individuals, and sexual minority remain at heightened risk for anxiety and depression, highlighting the need for targeted, long-term mental health interventions to support these vulnerable groups in the post-pandemic era.

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