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Temporary employment (TE) arrangements have become increasingly common in Canada among both high- and low-skilled workers. In this study, we examine the prevalence and earnings effects of TE across education levels with a specific focus on highly educated workers. We also examine the earnings effects of TE across the earnings distribution. We find that higher levels of schooling are negatively associated with the probability of TE. However, the earnings discounts for temporary work are significant and increase in magnitude for individuals with higher levels of educational attainment. For highly educated workers at the top end of the earnings distribution, the discount associated with being in a temporary job is large enough to substantially reduce, although not entirely negate, the sizeable earnings premiums associated with higher levels of education.

Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews.We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD.The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1).The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention.UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.

The global coronavirus disease 2019 (COVID-19) pandemic has exposed and arguably intensified many existing inequalities. This analysis explores the relationship between recent immigrant earnings and the pandemic. Specifically, we attempt to empirically answer the question “Has the COVID-19 pandemic exacerbated (or mitigated) recent immigrant–non-immigrant employment and wage gaps?” We find that the pandemic did not change the labour force activity profile of recent or long-term immigrants. Moreover, the pandemic did not disproportionately disadvantage recent immigrants’ earnings. In fact, recent immigrant men who were employed during the COVID-19 crisis experienced a small but statistically significant earnings premium. This was insufficient, however, to overcome the overall earnings discount associated with being a recent immigrant. In addition, we find that the recent immigrant COVID-19 earnings boost is observable only at and below the median of the earnings distribution. We also use Heckman selection correction to attempt to adjust for unobserved sample selection into employment during the pandemic. The fact that COVID-19 has not worsened recent immigrant earnings gaps should not overshadow the large, recent immigrant earnings disparities that existed before the pandemic and continue to exist regardless of the COVID-19 crisis.

BackgroundHealthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated.AimsWe aimed to determine the effectiveness of the ‘Foundations’ application (app) on general (non-psychotic) psychiatric morbidity.MethodWe conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD).ResultsBetween 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 34–53). Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = −1.39, 95% CI −2.05 to −0.74), improvement in well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings were found, or adverse events reported.ConclusionsThe app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness.

BackgroundPotentially morally injurious events (PMIEs) can negatively impact mental health. The COVID-19 pandemic may have placed healthcare staff at risk of moral injury.AimTo examine the impact of PMIE on healthcare staff wellbeing.Method12,965 healthcare staff (clinical and non-clinical) were recruited from 18 NHS-England trusts into a survey of PMIE exposure and wellbeing.ResultsPMIEs were significantly associated with adverse mental health symptoms across healthcare staff. Specific work factors were significantly associated with experiences of moral injury, including being redeployed, lack of PPE, and having a colleague die of COVID-19. Nurses who reported symptoms of mental disorders were more likely to report all forms of PMIEs than those without symptoms (AOR 2.7; 95% CI 2.2, 3.3). Doctors who reported symptoms were only more likely to report betrayal events, such as breach of trust by colleagues (AOR 2.7, 95% CI 1.5, 4.9).ConclusionsA considerable proportion of NHS healthcare staff in both clinical and non-clinical roles report exposure to PMIEs during the COVID-19 pandemic. Prospective research is needed to identify the direction of causation between moral injury and mental disorder as well as continuing to monitor the longer term outcomes of exposure to PMIEs.

Background Cardiovascular disease among patients with severe mental illness in England is a major preventable contributor to premature mortality. To address this, a nurse and peer-coach delivered service (Primrose-A) was implemented in three London general practices from 2019 (implementation continued during COVID-19). This study aimed to conduct interviews with patient and staff to determine the acceptability of, and experiences with, Primrose-A. Methods Eight patients who had received Primrose-A, and 3 nurses, 1 GP, and 1 peer-coach who had delivered Primrose-A in three London-based GP surgeries. Semi-structured audio-recorded interviews were conducted. Reflexive thematic analysis was used to identify themes from the transcribed interviews. Findings Overall, Primrose-A was viewed positively by patients and staff, with participants describing success in improving patients’ mental health, isolation, motivation, and physical health. Therapeutic relationships between staff and patients, and long regular appointments were important facilitators of patient engagement and acceptance of the intervention. Several barriers to the implementation of Primrose-A were identified, including training, administrative and communication issues, burden of time and resources, and COVID-19. Conclusions Intervention acceptability could be enhanced by providing longer-term continuity of care paired with more peer-coaching sessions to build positive relationships and facilitate sustained health behaviour change. Future implementation of Primrose-A or similar interventions should consider: 1) training sufficiency (covering physical and mental health, including addiction), 2) adequate staffing to deliver the intervention, 3) facilitation of clear communication pathways between staff, and 4) supporting administrative processes.

In this article, we examine whether (and by how much) workers in Canada have been compensated for the ‘novel’ risks associated with COVID‐19. We create a unique dataset from a system that scores occupations in the US O*NET database for COVID‐19 exposure. We then combine those COVID exposure scores with Canadian occupational data contained in the Public Use Microdata File of the Labour Force Survey. This allows us to categorize Canadian occupations based on COVID‐19 exposure risk. We find a long‐tailed distribution of COVID‐19 risk scores across occupations, with most jobs at the lower end of the risk spectrum and relatively few occupations accounting for most of the high COVID‐19 exposure risk. We find that workers who are already more vulnerable in the labour market (i.e. youth, women and immigrants) are also more likely to be employed in occupations with high COVID‐19 exposure risk. When we look at the relationship between high‐COVID exposure risks in occupation and wages, we find negative compensating differentials both at the mean (negative 8%) and across the earnings distribution. However, when workers are covered by a union, they enjoy a sizeable hazard pay premium (11.7% on average) as compared to their non‐union counterparts. Furthermore, we find that the moderating effects of unionization for workers at high risk of COVID exposure to be largest at the bottom of the earnings distribution (i.e. the 10th percentile of unionized earners receives a 12.3% risk premium for high‐COVID exposure, whereas the 90th percentile receives only a 2%).

ObjectivesThis study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April–June) of the COVID-19 pandemic in the UK.MethodsPreliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale.ResultsAnalyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse.ConclusionsOur findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

The study investigates the extent to which the type of employment, specifically nonstandard work, may contribute to a better understanding of Indigenous earnings disparities. We find that Indigenous workers are overrepresented in nonstandard jobs and that such forms of work are associated with sizable earnings penalties. Although Indigenous earnings disparities are smaller in nonstandard work than in standard employment, the relatively low earnings of many nonstandard jobs are an important factor contributing to the overall economic inequalities experienced by many Indigenous Canadians. Policy responses aimed at improved human capital accumulation are likely to have limited efficacy unless additional barriers that prevent many Indigenous workers from accessing better quality employment and internal labor markets are identified and removed.

The COVID-19 pandemic has called healthcare workers globally to respond. In the UK, the predicted high demand for extra critical care beds led to the rapid construction of the NHS Nightingale Hospital, London. I volunteered to develop and deliver psychological preparedness training - coined 'Psychological PPE’ – to over 2300 frontline staff over an eight-week period. Current research has identified broad themes of the impact working on the COVID-19 frontline has on healthcare workers but is yet to capture in-depth accounts of individuals’ experiences. Using autoethnographic enquiry, this research explores my frontline experience at the NHS Nightingale, at the peak of the COVID-19 pandemic, and the personal impact this had on me. Themes identified include the interaction between recognition and sacrifice, emotional lability and fragility, and the impact of transitions. Findings inform personal recovery, as well as future research and policy development pertaining to the sustainable recovery of our NHS people.

Staff in the National Health Service (NHS) have been placed under considerable strain during the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. Moreover, the research that does exist typically includes only clinical staff, despite a large proportion of patient-facing NHS workers being in non-clinical roles. We interviewed forty-eight clinical and non-clinical healthcare workers from eighteen NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking. This could involve providing all staff with regular reminders about support options, in a variety of formats (e.g. email, posters, mentioned in meetings), and easily remembered single points of access, delivered by a mix of in-house and externally-provided services, to cater for those more and less concerned about stigma and confidentiality. In addition, managers at all levels should be trained and supported to feel confident to speak about mental health with staff, with formal peer support facilitated by building in time for this during working hours. As others have pointed out, this will require long-term strategic planning to address workforce shortages.

ObjectiveTo examine variations in impact of the COVID-19 pandemic on the mental health of all types of healthcare workers (HCWs) in England over the first 17 months of the pandemic.MethodWe undertook a prospective cohort study of 22,501 HCWs from 18 English acute and mental health NHS Trusts, collecting online survey data on common mental disorders (CMDs), depression, anxiety, alcohol use, and PTSD, from April 2020 to August 2021. We analysed these data cross-sectionally by time period (corresponding to periods the NHS was under most pressure), and longitudinally. Data were weighted to better represent Trust population demographics.ResultsThe proportion of those with probable CMDs was greater during periods when the NHS was under most pressure (measured by average monthly deaths). For example, 55% (95%CI 53%, 58%) of participants reported symptoms of CMDs in April-June 2020 versus 47% (95%CI 46%, 48%) July-October 2020. Contrary to expectation, there were no major differences between professional groups (i.e. clinical and non-clinical staff). Younger, female, lower paid staff, who felt poorly supported by colleagues/managers, and who experienced potentially morally injurious events were most at risk of negative mental health outcomes.ConclusionAmong HCWs, the prevalence of probable CMDs increased during periods of escalating pressure on the NHS, suggesting staff support should be increased at such points in the future, and staff should be better prepared for such situations via training. All staff, regardless of role, experienced poorer mental health during these periods, suggesting that support should be provided for all staff groups.Key messagesWhat is already known on this topicExisting evidence about the mental health of healthcare workers (HCWs) through the COVID-19 pandemic comes mainly from cross-sectional studies using unrepresentative convenience samples, typically focussing on clinical staff rather than all HCWs. Such studies show high prevalence of symptoms of mental disorders, but the strength of this evidence is uncertain.What this study addsUsing a defined sampling frame, with longitudinal, weighted data, we show that during periods of greater pressure on the NHS (as indicated by average monthly national COVID-19 death rates), prevalence of mental disorder symptoms increased, and, importantly, that this effect was seen in non-clinical as well as clinical staff.How this study might affect research, practice or policyThese findings indicate that provision of support for HCWs should not only focus on those providing clinical care, but also on non-clinical staff such as porters, cleaners, and administrative staff, and additional support should be provided during higher pressure periods. Better preparation of staff for such situations is also suggested.

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages.

IntroductionThere have been longstanding concerns regarding an increased risk of suicide amongst healthcare workers. The Covid-19 pandemic has placed an additional burden on staff, yet few studies have investigated the impact of the pandemic on their risk of suicide and self-harm. We aimed to investigate the cumulative incidence, prevalence, and correlates of suicidal ideation, suicide attempts, and non-suicidal self-injury amongst healthcare workers during the Covid-19 pandemic.Methods and AnalysisNHS Check is an online survey that was distributed to all staff (clinical and non-clinical), students, and volunteers in 18 NHS Trusts across England during the Covid-19 pandemic. Data collected in wave 1 (collected between April 2020 and January 2021) and wave 2 (collected 6 months after wave 1) will be analysed. The full cohort of wave 1 participants will be weighted to represent the age, sex, ethnicity, and roles profile of the workforce at each Trust, and the weighted prevalence and cumulative incidence of suicidal ideation, suicide attempts, and non-suicidal self-injury will be described. Two-level random effects logistic regression models will be used to investigate the relationship between suicidal behaviour and self-harm, and demographic characteristics (age, sex, ethnicity) and workplace factors (concerns regarding access to personal protective equipment, re-deployment status, moral injury, confidence around raising and the management of safety concerns, support by supervisors or managers, satisfaction with standard of care provided). Results will be stratified by role (clinical/non-clinical).Changes in this protocol compared with the original versionAll variables describing workplace factors will be analysed as binary variables for consistency.The responses to two questions on raising, and the management of, safety concerns will be analysed separately rather than combined to minimise loss of information.Binary suicide-related outcomes will be used in the logistic regression analyses, where the presence of an outcome represents its occurrence within the previous one (wave 2) or two months (wave 1), specifically. This was previously not specified.

Background For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams. Objectives To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units. Design Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout. Setting and participants Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England. Results Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15). Limitations In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data. Conclusions Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care). Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.

The authors examine the association between unionization and non-standard work in terms of coverage and wages. They use data from the master files of Canada’s Labour Force Survey (LFS) between 1997–98 and 2013–14 to define and measure non-standard work and to provide a continuum of vulnerability across work arrangements. The estimated probability of being employed in some form of non-permanent job increased 2.9 percentage points from 1997 to 2014. During that same period, the estimated probability of being in a non-full-time, non-permanent job—another way of capturing non-standard work—increased 2.5 percentage points. Although estimated union wage premiums declined rather precipitously for all groups, the union wage advantage remained highest among non-standard workers. Further, the authors find the union wage premium is largest for the most vulnerable of non-standard workers. In terms of estimates that look across the earnings distribution, the union wage premium among non-standard workers is larger for workers higher up the earnings profile.

Background In the UK, acute mental healthcare is provided by in-patient wards and crisis resolution teams. Readmission to acute care following discharge is common. Acute day units (ADUs) are also provided in some areas. Aims To assess predictors of readmission to acute mental healthcare following discharge in England, including availability of ADUs. Method We enrolled a national cohort of adults discharged from acute mental healthcare in the English National Health Service (NHS) between 2013 and 2015, determined the risk of readmission to either in-patient or crisis teams, and used multivariable, multilevel logistic models to evaluate predictors of readmission. Results Of a total of 231 998 eligible individuals discharged from acute mental healthcare, 49 547 (21.4%) were readmitted within 6 months, with a median time to readmission of 34 days (interquartile range 10–88 days). Most variation in readmission (98%) was attributable to individual patient-level rather than provider (trust)-level effects (2.0%). Risk of readmission was not associated with local availability of ADUs (adjusted odds ratio 0.96, 95% CI 0.80–1.15). Statistically significant elevated risks were identified for participants who were female, older, single, from Black or mixed ethnic groups, or from more deprived areas. Clinical predictors included shorter index admission, psychosis and being an in-patient at baseline. Conclusions Relapse and readmission to acute mental healthcare are common following discharge and occur early. Readmission was not influenced significantly by trust-level variables including availability of ADUs. More support for relapse prevention and symptom management may be required following discharge from acute mental healthcare.

Background For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone. Aims We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs. Method We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick–Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale). Results We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54–1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4–3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4–2.1, P = 0.004), and lower depression scores (−1.7, 95% CI −2.7 to −0.8, P < 0.001), than CRT participants. Conclusions Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research.

ObjectivesThis study reports preliminary findings on the prevalence of, and factors associated with, mental health and wellbeing outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK.MethodsPreliminary cross-sectional data were analysed from a cohort study (n=4,378). Clinical and non-clinical staff of three London-based NHS Trusts (UK), including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire (GHQ-12). Secondary outcomes are probable anxiety (GAD-7), depression (PHQ-9), Post-Traumatic Stress Disorder (PTSD) (PCL-6), suicidal ideation (CIS-R), and alcohol use (AUDIT). Moral injury is measured using the Moray Injury Event Scale (MIES).ResultsAnalyses showed substantial levels of CMDs (58.9%, 95%CI 58.1 to 60.8), and of PTSD (30.2%, 95%CI 28.1 to 32.5) with lower levels of depression (27.3%, 95%CI 25.3 to 29.4), anxiety (23.2%, 95%CI 21.3 to 25.3), and alcohol misuse (10.5%, 95%CI, 9.2 to 11.9). Women, younger staff, and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one’s moral code) was strongly associated with increased levels of CMDs, anxiety, depression, PTSD symptoms, and alcohol misuse.ConclusionsOur findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.HighlightsWhat is already known about this subject?Large-scale population studies report increased prevalence of depression, anxiety, and psychological distress during the COVID-19 pandemic.Evidence from previous epidemics indicates a high and persistent burden of adverse mental health outcomes among healthcare workers.What are the new findings?Substantial levels of probable common mental disorders and post-traumatic stress disorder were found among healthcare workers.Groups at increased risk of adverse mental health outcomes included women, nurses, and younger staff, as well as those who reported higher levels of moral injury.How might this impact on policy or clinical practice in the foreseeable future?The mental health offering to healthcare workers must consider the interplay of demographic, social, and occupational factors.Additional longitudinal research that emphasises methodological rigor, namely with use of standardised diagnostic interviews to establish mental health diagnoses, is necessary to better understand the mental health burden, identify those most at risk, and provide appropriate support without pathologizing ordinary distress responses.

Background Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs. Methods We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project. Results Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems. Conclusions Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.

BackgroundFor people in mental health crisis, Acute Day Units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to Crisis Resolution Teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly in comparison to those receiving CRT care alone.AimsTo investigate readmission rates, satisfaction, and wellbeing outcomes for ADU and CRT service users.MethodsA cohort study comparing readmission to acute mental health care during a six-month period for ADU and CRT participants. Secondary outcomes included satisfaction (CSQ), wellbeing (SWEMWBS), and depression (CES-D).ResultsWe recruited 744 participants (ADU: 431, 58%; CRT 312, 42%) across 4 NHS Trusts/health regions. There was no statistically significant overall difference in readmissions; 21% of ADU participants (versus 23% CRT) were readmitted over 6 months (adjusted HR 0.78, 95%CI 0.54, 1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire (CSQ) scores (2.5, 95% CI 1.4 to 3.5, pConclusionsService users who accessed ADUs demonstrated better outcomes for satisfaction, wellbeing, and depression, and no significant differences in risk of readmission compared to those who only used CRTs. Given the positive outcomes for service users, and the fact that ADUs are inconsistently provided across the country, their value and place in the acute care pathway needs further consideration and research.

BACKGROUND Social media is a relatively new and popular means of disseminating information. However, regarding healthcare research there are concerns over the ability of social media to reach healthcare professionals, and its ability to convey a message that is representative of the research itself. To our knowledge, a review was yet to be conducted concerning the effective use of social media in communicating healthcare research OBJECTIVE The aim of this review was to assess the effectiveness of social media as a dissemination tool regarding healthcare research to professionals in the field. METHODS A scoping review was conducted to inform the search strategy. We searched EMBASE, MEDLINE, PsycINFO, and conducted manual searches from March 2018 to August 2019, for peer-reviewed publications in English describing the effectiveness of social media in disseminating health research to healthcare professionals. No publication time restrictions were imposed. Social media was used to identify additional peer-reviewed papers. For all selected studies, an MMAT quality assessment was undertaken. RESULTS Forty-seven studies were identified for inclusion. The papers reviewed suggest that social media was a popular and effective means of disseminating health research findings. In particular, the use of Twitter was highlighted regarding its positive relationship with citations. Crucially, dissemination on social media was advantageous over purely using traditional methods. CONCLUSIONS Despite concerns over the value of using social media to encourage awareness of healthcare, overall, our review suggests a positive contribution. It provides a useful way of research to effectively reach healthcare professionals (as indicated by citation levels), whilst not misrepresenting research findings. Unfortunately, only four papers directly compared presence with absence of social media promotion. Given the apparent utility of social media for healthcare research, we would encourage more direct comparisons to be made promptly. CLINICALTRIAL PROSPERO Registration: CRD42018102083.

Drawing from investment and statistical discrimination theories, we test a model to examine the income growth trajectories of male and female youth volunteers and non-volunteers. Using growth curve modeling for four waves of longitudinal data for the reference period 2001-2007 ( n = 7,447), we find that male and female youth volunteers face an initial earnings disadvantage vis-à-vis youth non-volunteers; this penalty is smaller for females compared with males. However, over time, the income growth of volunteers is higher than that of non-volunteers. Male volunteers experience faster earnings growth than female volunteers. Furthermore, we find that, given the more rapid earnings growth of male volunteers relative to female volunteers, volunteering serves to widen, rather than narrow, the gender wage gap. The implications for future research and the relevance of the findings for career counselors, youth, and voluntary organizations are discussed.

The fact that Aboriginal peoples in Canada have experienced sizable and persistent earnings disadvantages is well documented. However, the most recent estimates of Aboriginal-non-Aboriginal wage differentials utilize data from the 2006 Census. The present analysis seeks to address this gap by providing more recent estimates of Aboriginal earnings disparities for various groups of full-time, full-year workers using data from the 2011 National Household Survey (NHS).We estimate and decompose Aboriginal/non-Aboriginal wage gaps at the mean for a number of different Aboriginal and non-Aboriginal groups living on- and off- reserve. We find that, consistent with previous literature, Aboriginal peoples continue to experience sizable earnings disparities relative to their non-Aboriginal counterparts. We find that Aboriginal Identity respondents living on-reserve experience the largest earnings disparity, followed by males who identify as First Nations and live off-reserve. Respondents who report Aboriginal ancestry, but who do not identify as Aboriginal persons, experience the smallest earnings disadvantage.Results of the decomposition analysis reveal that, unsurprisingly, educational attainment is the most salient factor contributing to the explained portion of the earnings disparity between Aboriginal and non-Aboriginal Canadians. Somewhat disconcerting, we find that where wage disparities are the largest, the explained proportion of the gap tends to be the smallest. Although previous studies can only serve as a rough comparator, relative to earlier estimates of Aboriginal/non-Aboriginal wage differentials using previous census periods, we find that earnings disparities among Aboriginal ancestry groups have remained relatively constant; wage gaps for Aboriginal identity groups have narrowed slightly; while the earnings disadvantage has widened for Aboriginal identity persons living on-reserve.Research and policy programs aimed at improving educational attainment and access to employment among Indigenous peoples are likely worthwhile initiatives. However, more research is needed on the potential role of discrimination in contributing to the persistent earnings disparities between Indigenous and non-Indigenous persons in Canada., Le fait que les peuples autochtones du Canada connaissent des écarts salariaux importants et persistants est bien documenté. Toutefois, les dernières estimations des écarts salariaux entre Autochtones et Non-Autochtones reposent sur les données du Recensement de 2006. La présente analyse vise à fournir des estimations plus récentes des écarts salariaux chez les Autochtones, et cela pour diverses catégories de travailleurs à temps plein toute l’année, à l’aide des données de l’Enquête nationale auprès des ménages (ENM) de 2011.Pour ce faire, nous estimons et décomposons la moyenne des écarts salariaux entre Autochtones et Non-Autochtones pour divers groupes autochtones et non autochtones vivant en réserve et hors réserve. Nous avons constaté que, conformément à la littérature existante, les Autochtones continuent de subir des écarts salariaux importants par rapport à leurs homologues non-autochtones. Nous constatons que les répondants qui se déclarent Autochtones vivant en réserve connaissent les plus grands écarts salariaux, suivis en cela des répondants qui se déclarent Autochtones vivant hors réserve. Les répondants qui déclarent avoir une ascendance autochtone, mais qui ne s’identifient pas comme Autochtones affichent, quant à eux, les écarts salariaux les moins prononcés.Sans surprise, les résultats de l’analyse de décomposition de la moyenne des écarts salariaux révèlent que le niveau de scolarité est de loin le facteur qui contribue le plus à la portion expliquée des écarts salariaux entre les Autochtones et Non-Autochtones du Canada. Quelque peu déconcertante, toutefois, est l’observation que, là où les écarts salariaux sont les plus importants, la portion expliquée de l’écart tend aussi à être la plus faible. Bien que les études antérieures ne puissent fournir que des comparaisons approximatives, par rapport aux estimations des écarts salariaux entre Autochtones et Non-Autochtones obtenues sur la base des périodes de recensement précédentes, nous constatons que les écarts salariaux chez les groupes d’ascendance autochtone sont demeurés relativement constants; tandis que les écarts salariaux pour les groupes d’identité autochtone ont légèrement fléchi; alors que les écarts salariaux se sont accrus pour les personnes d’identité autochtone vivant en réserve.Les programmes de recherche et de politique visant à améliorer le niveau d’instruction et l’accès à l’emploi chez les personnes autochtones constituent des initiatives valables. Cependant, il faudra davantage de recherches sur le rôle potentiel de la discrimination pour comprendre les écarts salariaux persistants entre Autochtones et Non-Autochtones au Canada., El hecho que los pueblos aborígenes en Canadá hayan experimentado desventajas salariales cuantificables y persistentes ha sido bien documentado. Sin embargo las estimaciones más recientes de los diferenciales salariales entre aborígenes y no aborígenes utilizan datos del Censo de 2006. El presente análisis enfoca dicha brecha, según diferentes grupos, proporcionando estimaciones más recientes de las disparidades de ingreso de los aborígenes que trabajan a tiempo completo, durante todo el año. Se utiliza para ello los datos de la Encuesta Nacional de Hogares (ENH) de 2011.Estimamos y descomponemos las diferencias salariales entre aborígenes y no aborígenes, que viven dentro y fuera de las reservas. Constatamos que, en concordancia con la literatura previa, los pueblos aborígenes siguen experimentando considerables disparidades de ingresos en comparación con sus contrapartes no aborígenes. Se muestra también que las personas encuestadas de identidad aborigen que viven en una reserva experimentan la más grande disparidad de ingresos, seguidos de los hombres que se identifican originarios de las Primeras Naciones y que viven fuera de la reserva. Los participantes que revelan tener ancestros aborígenes, pero que no se identifican como personas aborígenes, experimentan menos desventaja de ingresos.Los resultados de los análisis de descomposición revelan que, como era de esperar, el logro educativo es el factor más destacado que contribuye a la explicación de la disparidad de ingresos entre canadienses aborígenes y no aborígenes. De manera desconcertante, constatamos que donde las disparidades salariales son más grandes, la proporción explicada de dicha brecha tiende a ser más pequeña. Aunque los estudios previos no pueden ser utilizados para fines de comparación, encontramos que las disparidades de ingresos entre aborígenes y no aborígenes se han mantenido relativamente contantes; las brechas salariales de los grupos de identidad aborígenes se han reducido ligeramente; mientras que la desventaja de ganancias se ha ampliado para los aborígenes que viven en la reserva.Los programas de investigación y políticas destinados a mejorar el logro educativo y el acceso al empleo de los pueblos aborígenes son iniciativas que valen la pena. Sin embargo, se necesita más investigaciones sobre el rol potencial de la discriminación en la contribución a las persistentes disparidades salariales entre personas aborígenes y no aborígenes en Canadá.