Thoughts of suicide or self-harm among healthcare workers during the COVID-19 pandemic: qualitative analysis of open-ended survey responses

BACKGROUND: Healthcare workers are at higher risk of suicide than other occupations, and suicidal thoughts appear to have increased during the COVID-19 pandemic. AIMS: To understand the experiences of healthcare workers with frequent thoughts of suicide or self-harm during the pandemic, including factors that contributed to their distress, and the supports that they found helpful. METHOD: We used content analysis to analyse free-text responses to the Australian COVID-19 Frontline Healthcare Workers Study, from healthcare workers who reported frequent thoughts that they would be better off dead or of hurting themselves, on the Patient Health Questionnaire-9. RESULTS: A total of 262 out of 7795 healthcare workers (3.4%) reported frequent thoughts of suicide or self-harm in the preceding 2 weeks. They described how the pandemic exacerbated pre-existing challenges in their lives, such as living with a mental illness, working in an unsupportive environment and facing personal stressors like relationship violence or unwell family members. Further deterioration in their mental health was triggered by heavier obligations at home and work, amid painful feelings of loneliness. They reported that workplace demands rose without additional resources, social and emotional isolation increased and many healthful activities became inaccessible. Tokenistic offers of support fell flat in the face of multiple barriers to taking leave or accessing professional help. Validation of distress, improved access to healthcare and a stronger sense of belonging were identified as helpful supports. CONCLUSIONS: These findings highlight the need for better recognition of predisposing, precipitating, perpetuating and protective factors for thoughts of suicide and self-harm among healthcare workers.