Economic management and depression in healthcare workers during the COVID-19 pandemic in Czechia

BACKGROUND: Inequalities in the regional management of healthcare systems can have impact on mental health of healthcare workers. We examined the relationship between regional economic management and depression among healthcare workers during the COVID-19 pandemic in Czechia. METHODS: We conducted cross-sectional analyses of 3 waves (2020 n = 1,282; 2021 n = 1,510 & 2022 n = 956) from the Czech COVID-19 HEalth caRe wOrkErS (HEROES) Study. The cost-to-income ratio for 2019 was used to capture regional healthcare economic management prior to the pandemic. Based on this indicator, regions were grouped into 3 categories (poor, adequate=capital region, good). Depression was defined as ≥ 10 points on the Patient Health Questionnaire. We estimated odds ratio (OR) with 95% confidence interval (CI) for the association of regional healthcare economic management with depression using logistic regression, adjusting for age, sex, and occupation in Model 1 and for self-reported COVID-19 exposure and regional COVID-19 incidence rates in Model 2. RESULTS: In 2020, there was a statistically non-significant trend towards a graded relationship between the regional healthcare economic management and depression with OR 1.8 (95%CI:0.8-4.2) for poor management and OR of 1.3 (95%CI:0.6-2.5) for adequate management, when compared to regions with good management. No substantial differences were apparent (OR for poor=0.9; 95%CI:0.6-1.3 & OR for adequate=0.9; 95%CI:0.6-1.3) in 2021. In 2022 showing an increased chance for depression with adequate management (OR = 1.4; 95%CI:0.6-3.2) but a lower chance of depression for regions with poor management (OR = 0.7; 95%CI:0.4-1.5). CONCLUSIONS: We did not find strong evidence for the impact of regional healthcare economic management on depression of healthcare workers. There was an indication that in regions with poorer management, healthcare workers showed an increased chance of depression in the early phase of the pandemic. KEY MESSAGES: • Poorer regional economic healthcare management may play a role for depression of healthcare workers, especially in early phases pandemic or other crisis situations. • We did not find strong evidence for the impact of regional healthcare economic management on depression of healthcare workers.