Mental health outcomes among U.S. healthcare workers before, during, and after the 2019 global respiratory pandemic: A population-based study

Limited evidence exists on the persistence of anxiety and depression in the post-2019 global respiratory pandemic period among healthcare workers (HCWs). This study aims to assess anxiety and depression symptoms among HCWs during the pre-pandemic, pandemic, and post-pandemic periods-and to examine moderating effects of race and/or ethnicity, nativity, and sexual orientation. This study analyzed data from National Health Interview Survey on a nationally representative sample of adults during pre-pandemic (N = 38,109), pandemic (N = 89,693), and post-pandemic (N = 13,895) periods in 2019-2023. The sample included HCWs in the U.S., with direct patient HCW status as the primary independent variable. The primary outcomes were self-reported anxiety and depression, measured using the Washington Group on Disability Statistics Extended Set on Functioning. Weighted logistic regression models were used to assess the associations. Direct HCWs had higher odds of anxiety and depression compared to non-direct HCWs during the pandemic, but there were no significant differences between them before or after the pandemic. Non-Hispanic White (versus racial and/or ethnic minority), sexual minority (versus heterosexual), and U.S.-born (versus foreign-born) individuals had higher odds of anxiety and depression across the three pandemic phases. Nativity was the only significant moderator, with U.S.-born HCWs having higher odds of anxiety and depression compared to foreign-born HCWs during the pandemic. U.S.-born HCWs, non-Hispanic White individuals, and sexual minority remain at heightened risk for anxiety and depression, highlighting the need for targeted, long-term mental health interventions to support these vulnerable groups in the post-pandemic era.