Health care workers in the US were more likely than non–health care workers to report diagnosed anxiety and depression from 2021 to 2024, and those with either condition were also less likely to report receiving treatment for either condition, according to a retrospective cross-sectional study.
Researchers analyzed National Health Interview Survey data from 76,800 adults aged 18 to 64 years, including 7,626 health care workers. Investigators described the study as among the first national analyses to compare mental health diagnoses and treatment patterns between health care workers and non–health care workers during and after the COVID-19 pandemic.
Health care worker status was based on self-report of providing direct medical care to patients, including work as a physician, nurse, dentist, therapist, home health care worker, or emergency responder.
The primary outcomes were self-reported anxiety and depression, defined as ever having received a diagnosis. Untreated anxiety and depression were defined as reporting the condition but not receiving counseling or therapy from a mental health professional and not taking prescription medication.
Self-reported anxiety was more common among health care workers than non–health care workers, at 23% vs 19%. Depression was also more common, at 22% vs 19%. Among adults with anxiety or depression, health care workers were more likely to report untreated anxiety and untreated depression. Overall, nearly 87% of health care workers with anxiety or depression reported receiving neither medication nor counseling.
After adjustment for age, sex, household income, region, education, employment, and insurance status, health care workers had higher odds of self-reported anxiety, depression, untreated anxiety, and untreated depression compared with non–health care workers.
Anxiety and depression increased among health care workers from 2021 to 2024, but untreated anxiety and untreated depression did not change statistically significantly during that period. Among non–health care workers, however, untreated anxiety increased statistically significantly over the same interval, providing additional context for the broader rise in mental health burden nationally.
The researchers also evaluated health diagnosing and treating practitioners, a subgroup that included physicians, dentists, nurse practitioners, physician associates, and other specialized health care professionals. In adjusted analyses, evaluated health diagnosing and treating practitioners (HDTPs) had similar odds of anxiety, depression, untreated anxiety, and untreated depression compared with other health care workers. However, unadjusted analyses linked HDTP status with untreated anxiety and depression, findings the researchers said were consistent with prior literature suggesting elevated barriers to mental health treatment among physicians and other diagnosing clinicians.
In subgroup analyses among health care workers, male workers had lower odds of self-reported anxiety and depression than female workers. Black, Hispanic, and Asian workers also had lower odds of self-reported anxiety and depression than non-Hispanic White workers.
Researchers noted that those findings appeared paradoxical given prior evidence linking discrimination with increased risk for anxiety and depression. They suggested that the lower reported prevalence may reflect underdiagnosis, cultural differences in symptom expression, mental health stigma affecting disclosure or care-seeking, provider bias in recognizing psychiatric conditions in minority populations, or survey response patterns rather than true lower disease burden.
Lower household income was associated with higher odds of self-reported anxiety and depression. Health care workers with household income below 100% of the federal poverty level had higher odds of anxiety compared with those with income at or above 400% of the federal poverty level.
The researchers emphasized that the findings should be interpreted cautiously. The study relied on self-reported diagnoses rather than symptom screening, meaning the estimates may reflect access to diagnosis, willingness to disclose mental health conditions, and stigma in addition to underlying disease burden. The cross-sectional design also prevented conclusions about whether health care work caused anxiety, depression, or lower treatment rates.
Additional limitations included potential nonresponse bias, with NHIS response rates ranging from 47% to 51% during the study years, as well as limited generalizability outside the US or outside the 2021 to 2024 period.
Although treatment rates remained relatively stable despite rising prevalence of anxiety and depression, the researchers noted that this pattern could reflect greater responsiveness of the health care system to mental health needs among health care workers or greater willingness among workers to seek treatment.
Researchers suggested that structural interventions such as peer support programs, protected time for care, and embedded counseling services may help address barriers to mental health treatment among health care workers. They also called for efforts to reduce stigma and improve access to care within the workforce.
The researchers reported no funding and no competing interests.
Source: J Gen Intern Med
