Financial concerns lead to symptoms of depression in healthcare workers

Financial concerns among healthcare workers are a driving factor for declining mental health.

The findings are the result of the largest study of its kind, led by the University of Leicester in collaboration with University College London (UCL) and other higher education institutions, which found that money worries were associated with an increased risk of depression, particularly in nursing staff. 

Data from the UK-REACH study confirmed that out of 3,521 healthcare workers who took part, money worries increased the likelihood of having symptoms of depression such as low mood. 

Healthcare workers answered questions related to finance and mental health in a baseline survey between December 2020 and March 2021 and follow up survey between June and October 2022.

The proportion of staff who had concerns about finances went up by a third, from 56 per cent of staff at the start of the study to 78 per cent in 2022. During that period, the proportion who reported having no financial concerns at all dropped by half, from 44 per cent at baseline to 22 per cent in 2022, whereas the proportion who were extremely concerned about finances more than doubled from 1.9 per cent to 4.4 per cent. 

Those who were extremely concerned about finances at baseline had approximately three times the odds of meeting the screening criteria for depression at follow-up compared to those who were not at all concerned at baseline.

The study, which has now been published in the British Journal of Psychiatry Open, also showed that those in nursing, midwifery and other roles allied to nursing were more likely to have symptoms of depression and had approximately twice the odds of developing financial concerns at follow up compared to those in medical roles.

Professor Manish Pareek from the University’s Department of Respiratory Sciences and Chair in Infectious Diseases at the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, and chief investigator for the UK-REACH study, said: 

“Our findings are stark and highlight that staff working in healthcare are increasingly concerned about their financial positions. These heightened financial concerns predict the later development of depressive symptoms with those in nursing, midwifery and other allied nursing roles disproportionately impacted.

“Our results are concerning given the potential effects of depression on sickness absence and intentions to leave the workforce. Healthcare policymakers should consider acting to alleviate financial concerns to reduce the impact this may have on an already stretched, under-pressure workforce plagued by understaffing.”

The UK-REACH study is a public health study jointly funded by the National Institute for Health Research (NIHR) and UK Research and Innovation (UKRI).

A Government workforce plan for the NHS regarding recruitment, retention, and training of NHS staff, including nurses was published on 30 June 2023. The plan recommends that NHS organisations develop benefits packages for staff including local financial wellbeing support initiatives, and that NHS organisations invest in occupational health and wellbeing services for staff, overseen by a dedicated wellbeing guardian.

NHS England statistics reported by the House of Commons Library in May 2023 indicate that the average annual basic pay of full-time equivalent nurses was £36,600 in December 2022. This represents a real terms reduction of 6% since December 2021 and 12.2% since December 2010.

Professor Katherine Woolf, Professor of Medical Education Research at UCL and co-author of the study, said that despite it being the only study of its kind covering the UK, the proportion of those with financial concerns or depression may still be underestimated because those with money worries at baseline may have been less likely to respond to the follow up questionnaire.

She added: “Depression incurs a significant personal cost to healthcare workers and poses a risk to good patient care. In addition, healthcare organisations incur large financial costs as a result of mental health problems in their employees. The sickness absence rate of nurses, midwives and ambulance staff is roughly three to four times the national average for the labour force and 20-30% of sick days in the NHS are due to mental health problems. 

“These findings suggest that increasing financial concerns could lead to an increase in poor mental health among NHS staff, potentially leading to increased sickness absence and people leaving healthcare altogether. 

“Further research should examine whether the relationship between financial concerns and subsequent depression symptoms observed in this study contribute to more staff leaving the workforce.”