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The COVID-19 pandemic raised concerns about the mental health of an already burdened healthcare workforce. This study examined mental health trajectories among healthcare workers (HCWs) across the pandemic and identified personal and employment factors associated with different symptom patterns.
Methods
Longitudinal data were drawn from the NHS CHECK cohort, including clinical and non-clinical staff from 18 NHS Trusts in England (April 2020–April 2023). Growth curve and growth mixture models identified latent classes of HCWs characterized by distinct trajectories of probable common mental disorders. Secondary outcomes included anxiety, depression, alcohol misuse, and post-traumatic stress symptoms. Logistic regression examined associations between baseline personal and employment characteristics and class membership.
Results
The analytical sample included 22,764 participants. For each outcome, growth mixture models identified two latent classes. Approximately 31% of HCWs experienced persistently high symptoms of probable common mental disorders, while 69% experienced persistently low symptoms. Similar patterns were observed for secondary outcomes, with small subgroups demonstrating worsening symptoms followed by improvement. Logistic regression analyses showed that being female, younger, single, working as a nurse, or having a pre-existing mental health diagnosis increased the odds of belonging to a high symptom class. Perceived support from colleagues and managers was protective.
Conclusions
While many HCWs reported consistently low mental health symptom levels, almost a third belonged to a latent class characterized by persistently high symptoms across all time points. These findings underscore the need for mental health support for vulnerable HCW groups, embedded within routine NHS practice rather than limited to crisis periods.
Objectives/Goals: To tailor support for behavioral and social science research (BSSR), it is helpful to understand this broad category. As a first step to characterizing BSSR at University of Michigan (UM), our goal is to use a large language model (LLM) to identify health-related BSSR from a database of funded studies. Methods/Study Population: We are using a private, secure version of Open AI ChatGPT-4.1 LLM to evaluate whether studies are health-related BSSR or not based on the study team’s (1) abstract, (2) objectives, and (3) key words entered into UM’s internal research proposal system for all studies funded over the last 10 years (i.e., 2014 – 2024). The model included a prompt with the National Institutes of Health (NIH) definition of BSSR and was instructed to categorize the research as being BSSR, not BSSR, or possibly BSSR. Results from the LLM were compared for consistency with assessments made by human-made decision rules. Results/Anticipated Results: Preliminary results from a pilot sample of 150 studies funded in 2024 (~5%) reviewed by ChatGPT for BSSR status revealed: 6 false positives, 128 true negatives, 14 true positives, and 2 false negatives. Accuracy = 95%, precision = 70%, recall (sensitivity) = 88%, specificity = 96%, and F1 Score = 0.78. ChatGPT and human-based decisions differed primarily on cognition and vehicle technology studies and studies for which information was sparse. Further refinements to the prompt are being made and applied to the remaining studies funded in 2024 before expanding to the entire sample of studies from the last 10 years. Discussion/Significance of Impact: It is time and cost prohibitive for a human to review and classify all funded studies at UM as BSSR or not. Using LLMs offers the potential to make this classification work feasible with limited resources, which is a necessary step toward understanding the state of BSSR.
Chapter eight analyses the relevance of the theory of multi-level governance (MLG) to explain the role of the European Union (EU) in Northern Ireland and contends that the EU successfully engages Northern Ireland as a region of a member state without threatening that state’s sovereignty or power. The EU has increasingly become successful because of its accommodation with the British state, and the British state allows the EU as a mechanism to reconcile communities in Northern Ireland. MLG emphasises the multi-level nature of EU politics and attaches significance to the role played by subnational units and supranational institutions in the policy process. The model also proposes new forms of governance which offers a specific conception of EU politics based on an altered relationship between state and non-state actors, where the latter have become increasingly influential. The MLG model may not fully capture some of the internal constraints, complexities, and divisions which are characteristic of Northern Ireland’s recent political experience and which are reflected in its evolving relationship with the EU.
This unique book breaks new ground in engaging the study of Northern Ireland politics directly with broader debates about European integration and European governance. The text offers the most comprehensive coverage to date of the institutional development of Northern Ireland following the UK government’s devolution programme and Northern Ireland’s development as an autonomous policy actor in Europe. This study marshals evidence from Northern Ireland’s relationship with the European Union (EU) during the contemporary era of devolved power. Uniquely, it does not treat Northern Ireland as a sui generis case-study, but as a region facing the same challenges as many other parts of Europe. This distinctive approach is a key strength of the book. It is a fresh and novel means of studying the EU and produces new and compelling conclusions with broad appeal and application. The text argues that in Northern Ireland, a series of national and regional constraints, complexities and divisions limit the application of the multi-level governance (MLG) model. The distinction between state and civil society in Northern Ireland has become less, rather than more blurred, and has shifted in the direction of the former. The author questions the synergy between devolution and the EU and queries the existence of new forms of ‘governance’. This is a contribution of both immense substance and considerable importance and will appeal to scholars from a diverse range of social science disciplines. It is essential reading for students and scholars of contemporary Northern Ireland politics, EU governance, European regions and conflict studies.
The chapter introduces readers to Northern Ireland by discussing key features and characteristics of the region’s society, economy and politics. A brief overview of the Northern Ireland conflict is presented and its impact on the evolution of Northern Ireland’s political system and landscape is charted. The chapter also contains a review of the multi-level governance literature which forms the basis for disentangling aspects of Northern Ireland’s relationship with the EU since the devolution of powers in 1999.
This chapter explores the different ways in which the EU has been associated with Northern Ireland politics in the broadest sense – i.e. how it has contributed to addressing the conflict and also its impact on political parties, interest groups and notions of identity. It notes that the EU’s impact on resolving the Northern Ireland conflict has been largely benign. For Northern Ireland political parties, the EU has typically been an issue of low political salience. Interest groups traditionally played an important role in terms of delivering services and engaging with the EU, but the introduction of devolution has undermined their role and vitality. On issues of identity, the EU has not had a neutralising impact on national identity. The question of governance. In terms of political dynamics, the EU has not produced a more governance-driven approach in Northern Ireland.
The introduction of devolution fundamentally changed the nature of the policy-making and policy-implementing process in Northern Ireland. It also required that local political actors in Northern Ireland refocus their attentions away from the constitutional question and consider broader policy questions. This chapter details the growing pervasiveness of EU policies and outlines the extent to which the increasing policy competence of the Union impacts on the policy remit of the Northern Ireland devolved unit. The region’s response to this new policy environment is identified via an examination of a series of official policy documents produced by the Northern Ireland Executive, Northern Ireland Assembly and the European Commission since 1999. The chapter notes that the development of a vision for Northern Ireland’s engagement with the EU has tentatively emerged. Pronouncements in relation to managing and directing the EU agenda suggest the emergence of a more advanced and sophisticated engagement with the EU. Importantly, these dynamics and developments were aided by direct engagement between Belfast and Brussels – a situation which was permitted by the UK government. Progress in the EU policy domain has been dependent on the domestic national political arena and is not solely attributable to new and novel forms of governance.
This chapter charts the evolution of relations between Northern Ireland and actors outside the region, including other parts of the UK, the Republic of Ireland and Brussels. An overview of key institutional developments is provided. This includes an examination of the Office of the Northern Ireland Executive in Brussels (ONIEB), North-South Ministerial Council (NSMC), Special EU Programmes Body (SEUPB) and the British-Irish Council. These new institutions facilitate and manage the region’s external relationships. Many had difficult early experiences. However, they have settled into a pattern of existence which is less politically controversial and focused on strategically pursuing Northern Ireland’s functional interests. To some extent, the EU has provided these institutions with the means to do so, by providing a legitimate and neutral testing ground for operationalizing new and innovative forms of cross-border, cross-national and multi-level governance.
The stability and peace which Northern Ireland now enjoys has transformed life there and it has transformed politics too. Differences and division persist, but they are now better managed and controlled. The process of agreeing policy is not without its flaws, and it may not always produce optimal outputs, but it does allow for the gradual achievement of progress and a steady (if incomplete) normalisation of the political progress. The EU has played a supporting role. This, however, does not mean that the MLG model captures the full complexity and nuance of the dynamics and relationships which characterise the new Northern Ireland and its relationship with the EU. The model is certainly a useful tool with which to interrogate the experiences of a European region. However, not all MLG claims and pronouncements mesh fully with the empirical findings revealed in this study. Neither the EU nor devolution have occasioned a movement away from government and towards governance. The traditional mechanisms associated with the state may now have a different form, but their intensity and dominance survive. The influence of the EU at the regional level is mediated by the nature of state arrangements and the characteristics of the region itself.
Chapter two is heavily contextual and focused on the nature of issues around how Northern Ireland structured relations with the world beyond its borders. The chapter examines Northern Ireland’s historical experience of devolution from 1921-1972 and recounts the factors which brought this early experiment in devolved power to a halt. The direct rule period which followed coincided with the accession of the UK to the EU. The chapter looks at how the prospect of EU membership was greeted in Northern Ireland and how Northern Ireland-EU relations were managed during the direct rule period. The return of devolution after the signing of the Belfast Agreement is noted and details of its key features and dynamics are discussed.
This chapter traces the ways in which Northern Ireland’s devolved administration has adapted at the domestic level to new responsibilities vis-à-vis the EU. An overview of key administrative developments provides a basis for determining the ways in which the introduction of devolution has changed how Northern Ireland is governed. This includes an examination of the framework for relations between the Northern Ireland administration and UK central government. Consideration is also given to the role of the Northern Ireland Executive, the Office of the First Minister and Deputy First Minister and the Northern Ireland Assembly. The changes to the Northern Ireland institutional landscape are judged to have been important for the manner and impact of Northern Ireland’s engagement with the EU. The developments may not be categorised as an explicit example of multi-level governance in action, but nevertheless, progress in advancing Northern Ireland’s EU agenda is evident.
This chapter identifies and discusses the peculiarities of the Northern Ireland economy and the broad economic challenges facing the region. It details the economic nature of the Northern Ireland-EU relationship with a focus on the single European market; EU structural funds; EU peace funding; the Common Agricultural Policy (CAP); and North-South economic relations. The chapter suggests that EU financial programmes and the governance structures they spawn at the regional level do not undermine the dominance of the central state. In the context of its economic and financial impact, the EU has permeated Northern Ireland in interesting and innovative ways, but not to the point where it has prompted a definitive move from government to governance or facilitated advanced multi-level interactions.