Implementation of a crisis resolution team service improvement programme: a qualitative study of the critical ingredients for success.

BACKGROUND: Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place. METHODS: Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis. FINDINGS: A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a 'bigger whole' was valuable. CONCLUSION: CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.

Re: investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK REACH nationwide cohort study.

This editorial comments on the paper by Martin McBride and the UK REACH team (published in 2023) investigating financial concerns in UK healthcare workers and depressive symptoms. The research concludes that reporting future financial concerns at baseline increased the odds of depressive symptoms at follow-up around 18 months later. We discuss these findings in the context of the cost-of-living crisis and pay disputes within the NHS, important policy implications and directions for future research.

The challenges of open data sharing for qualitative researchers.

'Open Science' advocates for open access to scientific research, as well as sharing data, analysis plans and code in order to enable replication of results. However, these requirements typically fail to account for methodological differences between quantitative and qualitative research, and serious ethical problems are raised by the suggestion that full qualitative datasets can or should be published alongside qualitative research papers. Aside from important ethical concerns, the idea of sharing qualitative data in order to enable replication is conceptually at odds with the underpinnings on most qualitative methodologies, which highlight the importance of the unique interpretative function of the researcher. The question of whether secondary analysis of qualitative data is acceptable is key, and in this commentary we argue that there are good conceptual, ethical and economic reasons to consider how funders, researchers and publishers can make better use of existing data.

An integrated primary care service to reduce cardiovascular disease risk in people with severe mental illness: Primrose-A - thematic analysis of its acceptability, feasibility, and implementation.

BACKGROUND: Cardiovascular disease among patients with severe mental illness in England is a major preventable contributor to premature mortality. To address this, a nurse and peer-coach delivered service (Primrose-A) was implemented in three London general practices from 2019 (implementation continued during COVID-19). This study aimed to conduct interviews with patient and staff to determine the acceptability of, and experiences with, Primrose-A. METHODS: Semi-structured audio-recorded interviews with eight patients who had received Primrose-A, and 3 nurses, 1 GP, and 1 peer-coach who had delivered Primrose-A in three London-based GP surgeries were conducted. Reflexive thematic analysis was used to identify themes from the transcribed interviews. FINDINGS: Overall, Primrose-A was viewed positively by patients and staff, with participants describing success in improving patients' mental health, isolation, motivation, and physical health. Therapeutic relationships between staff and patients, and long regular appointments were important facilitators of patient engagement and acceptance of the intervention. Several barriers to the implementation of Primrose-A were identified, including training, administrative and communication issues, burden of time and resources, and COVID-19. CONCLUSIONS: Intervention acceptability could be enhanced by providing longer-term continuity of care paired with more peer-coaching sessions to build positive relationships and facilitate sustained health behaviour change. Future implementation of Primrose-A or similar interventions should consider: (1) training sufficiency (covering physical and mental health, including addiction), (2) adequate staffing to deliver the intervention, (3) facilitation of clear communication pathways between staff, and (4) supporting administrative processes.

Responding to the call of the NHS Nightingale, but at what cost? An auto-ethnography of a volunteer frontline mental health trainer's experiences during the COVID-19 pandemic.

Healthcare workers, globally, volunteered time and skills to the COVID-19 pandemic frontline response. In March 2020, the predicted high demand for extra critical care beds led to the rapid construction of the UK National Health Service (NHS) Nightingale field hospital, London. I volunteered to develop and deliver psychological preparedness training - coined 'Psychological PPE' - to over 2300 frontline staff over an 8-week period. Existing research has identified broad themes of the impact working on the COVID-19 frontline has on healthcare workers but does not capture in-depth accounts of individuals' experiences. Using autoethnographic enquiry, this research explores my frontline experience at the NHS Nightingale during this time, and the personal impact this had on me. Reflexive thematic analysis explored themes of recognition and sacrifice, emotional lability and fragility, and the impact of transitions. Findings inform personal recovery, as well as future research and policy development pertaining to the sustainable recovery of our NHS people.

"Fix the system the people who are in it are not the ones that are broken" A qualitative study exploring UK academic researchers' views on support at work.

Recent evidence suggests that it remains difficult for academic researchers to preserve global well-being when working in the UK higher education sector. Our study aimed to explore academic researchers' perspectives on how they feel their mental health and well-being could be better supported within the UK higher education system. Using a combination of semi-structured and narrative interviewing techniques, we gathered the perspectives of 26 researchers. Narrative and reflexive thematic analysis were then used on the data collected. Our findings highlight the need to tackle systemic issues such job insecurity and unrealistically high workloads, given the risk they can pose to researchers' mental health and well-being. Our findings also highlight the key influence of managers and supervisors in creating a supportive environment, and the importance of going beyond what support is offered. That is, it is vital to effectively promote any existing or emerging support systems, and to be proactive in offering this support. Given the diversity identified in researchers' individual situations, it is important that support is flexible and takes into consideration individual requirements and preferences. Higher education authorities and institutions need to determine how they can foster a healthy, caring environment for researchers working in this sector going forwards.

Moral Injuries in Healthcare Workers: What Causes Them and What to Do About Them?

Moral injury (MI) refers to the persisting distress which may occur following exposure to potentially morally injurious events (PMIEs). The COVID-19 pandemic has drawn attention to MI in healthcare workers, who have been found to experience more frequent PMIEs in their day-to-day work than those in other occupational groups such as the military. These events may occur on an individual, team, organizational or system level and have been associated with increased clinician burnout and distress, and poor psychological wellbeing. This paper focuses on healthcare workers' experiences of MI, including potential causes and ways to reduce them. There are myriad challenges that influence the development of MI, such as chronic understaffing and the pressure to treat high numbers of patients with limited resources. There are also multiple impacts of MI: at the individual-level, MI can lead to increased staff absences and understaffing, and prolonged patient contact with limited decision-making power. COVID-19 exacerbated such impacts, with a lack of organizational support during a time of increased patient mortality, and uncertainty and heightened pressure on the clinical frontline associated with scarce resources and understaffing. Potential methods for reduction of MI in healthcare workers include pre-exposure mitigation, such as fostering work environments which treat PMIEs in the same way as other occupational hazards and post-exposure mitigation, such as facilitating healthcare workers to process their experiences of PMIEs in peer support groups or with spiritual advisors and, if MI is associated with mental ill-health, talking therapies using trauma-focused and compassion-oriented frameworks.

Cost-effectiveness of peer-supported self-management for people discharged from a mental health crisis team: methodological challenges and recommendations.

Background: Mental health acute crisis episodes are associated with high inpatient costs. Self-management interventions may reduce readmission by enabling individuals to manage their condition. Delivery of such interventions by Peer Support Workers (PSWs) may be cost-effective. CORE, a randomized control trial of a PSW self-management intervention compared to usual care, found a significant reduction in admissions to acute mental healthcare for participants receiving the intervention. This paper aims to evaluate the cost-effectiveness of the intervention over 12 months from a mental health service perspective. Analysis methods of increasing complexity were used to account for data missingness and distribution. Methods: Participants were recruited from six crisis resolution teams in England from 12 March 2014 to 3 July 2015 (trial registration ISRCTN: 01027104). Resource use was collected from patient records at baseline and 12 months. The EQ-5D-3L was collected at baseline and 4 and 18 months, and linear interpolation was used to calculate 12-month values for quality-adjusted life-years (QALYs). The primary analysis of adjusted mean incremental costs and QALYs for complete cases are calculated separately using OLS regression. Secondly, a complete-case non-parametric two-stage bootstrap (TSB) was performed. The impacts of missing data and skewed cost data were explored using multiple imputation using chained equations and general linear models, respectively. Results: Four hundred and forty-one participants were recruited to CORE; 221 randomized to the PSW intervention and 220 to usual care plus workbook. The probability that the PSW intervention was cost-effective compared with the workbook plus usual care control at 12 months varied with the method used, and ranged from 57% to 96% at a cost-effectiveness threshold of £20,000 per QALY gained. Discussion: There was a minimum 57% chance that the intervention was cost-effective compared to the control using 12-month costs and QALYs. The probability varied by 40% when methods were employed to account for the relationship between costs and QALYs, but which restricted the sample to those who provided both complete cost and utility data. Caution should therefore be applied when selecting methods for the evaluation of healthcare interventions that aim to increase precision but may introduce bias if missing data are heavily unbalanced between costs and outcomes.

Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study.

BACKGROUND: During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021. METHODS: In this longitudinal study, we analysed online survey data completed by 22,501 HCWs from 17 NHS Trusts at baseline (Time 1) and six months (Time 2). The primary outcome measures were suicidal ideation, suicide attempts, and non-suicidal self-injury. We used logistic regression to investigate the relationship between these outcomes and demographic characteristics and occupational factors. Results were stratified by occupational role (clinical/non-clinical). RESULTS: Time 1 and Time 2 surveys were completed by 12,514 and 7,160 HCWs, respectively. At baseline, 10.8% (95% CI = 10.1%, 11.6%) of participants reported having experienced suicidal thoughts in the previous two months, whilst 2.1% (95% CI = 1.8%, 2.5%) of participants reported having attempted suicide over the same period. Among HCWs who had not experienced suicidal thoughts at baseline (and who completed the Time 2 survey), 11.3% (95%CI = 10.4%, 12.3%) reported such thoughts six months later. Six months after baseline, 3.9% (95% CI = 3.4%, 4.4%) of HCWs reported attempting suicide for the first time. Exposure to potentially morally injurious events, lack of confidence about raising safety concerns and these concerns being addressed, feeling unsupported by managers, and providing a reduced standard of care were all associated with increased suicidal ideation among HCWs during the COVID-19 pandemic. At six months, among clinicians, a lack of confidence about safety concerns being addressed, independently predicted suicidal ideation. CONCLUSION: Suicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.

Moral injury and psychological wellbeing in UK healthcare staff.

BACKGROUND: Potentially morally injurious events (PMIEs) can negatively impact mental health. The COVID-19 pandemic may have placed healthcare staff at risk of moral injury. AIM: To examine the impact of PMIE on healthcare staff wellbeing. METHODS: Twelve thousand nine hundred and sixty-five healthcare staff (clinical and non-clinical) were recruited from 18 NHS-England trusts into a survey of PMIE exposure and wellbeing. RESULTS: PMIEs were significantly associated with adverse mental health symptoms across healthcare staff. Specific work factors were significantly associated with experiences of moral injury, including being redeployed, lack of PPE, and having a colleague die of COVID-19. Nurses who reported symptoms of mental disorders were more likely to report all forms of PMIEs than those without symptoms (AOR 2.7; 95% CI 2.2, 3.3). Doctors who reported symptoms were only more likely to report betrayal events, such as breach of trust by colleagues (AOR 2.7, 95% CI 1.5, 4.9). CONCLUSION: A considerable proportion of NHS healthcare staff in both clinical and non-clinical roles report exposure to PMIEs during the COVID-19 pandemic. Prospective research is needed to identify the direction of causation between moral injury and mental disorder as well as continuing to monitor the longer term outcomes of exposure to PMIEs.

'You get looked at like you're failing': A reflexive thematic analysis of experiences of mental health and wellbeing support for NHS staff.

Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages.

Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study.

BACKGROUND: Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews. METHODS: We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD. FINDINGS: The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1). INTERPRETATION: The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention. FUNDING: UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.

Multicentre, England-wide randomised controlled trial of the 'Foundations' smartphone application in improving mental health and well-being in a healthcare worker population.

BACKGROUND: Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated. AIMS: We aimed to determine the effectiveness of the 'Foundations' application (app) on general (non-psychotic) psychiatric morbidity. METHOD: We conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD). RESULTS: Between 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 34-53). Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = -1.39, 95% CI -2.05 to -0.74), improvement in well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings were found, or adverse events reported. CONCLUSIONS: The app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness.

'It hurts your heart': frontline healthcare worker experiences of moral injury during the COVID-19 pandemic.

Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someone's moral code, values or expectations. During the COVID-19 pandemic, increased exposure to Potentially Morally Injurious Events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. Objective: We sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. Methods: We recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) [Nash et al., 2013. Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652] at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. Results: HCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. Conclusion: These results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement. HIGHLIGHTS Clinical frontline healthcare workers (HCWs) have been exposed to an accumulation of potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic, including feeling betrayed by both government and NHS leaders as well as feeling unable to provide duty of care to patients.HCWs described the significant adverse impact of this exposure on their mental health, including increased anxiety and depression symptoms and sleep disturbance.Most HCWs interviewed believed that organisational change within the NHS was necessary to prevent excess PMIE exposure and promote resolution of moral distress.

Antecedentes: El daño moral se define como las fuertes reacciones emocionales y cognitivas que siguen a los eventos que chocan con el código moral de una persona, sus valores o expectativas. Durante la pandemia de COVID-19, el aumento de la exposición a Eventos Potencialmente Dañinos para la Moral (PMIEs, por su sigla en inglés) ha puesto a los trabajadores de la salud (HCWs, por su sigla en inglés) en riesgo de daño moral. Aún se conoce poco sobre la experiencia vivida de la exposición acumulada a PMIE y cómo el personal del Servicio Nacional de Salud de Inglaterra (NHS en su sigla en inglés) responde a esto.Objetivo: Buscamos rectificar esta brecha de conocimiento a través de la exploración cualitativa de las experiencias vividas y perspectivas del personal clínico de primera línea de NHS que respondió al COVID-19.Métodos: Reclutamos una muestra diversa de 30 HCWs clínicos de primera línea de la cohorte del estudio CHECK del NHS, para entrevistas cualitativas de una sola vez. Todos los participantes aprobaron al menos un ítem de los 9 de la Escala de Eventos de Daño Moral (MIES) [Nash y cols., 2013. Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646­652] en el seguimiento a los 6 meses. Las entrevistas siguieron una guía semi-estructurada y fueron analizadas utilizando análisis temático reflexivo.Resultados: Los HCWs describieron estar expuestos de forma rutinaria a conflictos éticos, creados por exacerbación de problemas sistémicos pre-existentes que incluían falta de personal y de recursos. Encontramos que los HCWs experimentaron un rango de síntomas de salud mental primariamente relacionados a percepciones de traición institucional y al sentirse incapaces de cumplir con su deber de cuidado hacia los pacientes.Conclusión: Estos resultados sugieren que se requiere una estrategia organizacional multifacética para preparar para la exposición a PMIE fomentar oportunidades de resolución de los síntomas asociados al daño moral y prevenir la separación organizacional.

Capturing the experiences of UK healthcare workers during the COVID-19 pandemic: A structural topic modelling analysis of 7,412 free-text survey responses.

BACKGROUND: Healthcare workers (HCWs) have provided vital services during the COVID-19 pandemic, but existing research consists of quantitative surveys (lacking in depth or context) or qualitative interviews (with limited generalisability). Structural Topic Modelling (STM) of large-scale free-text survey data offers a way of capturing the perspectives of a wide range of HCWs in their own words about their experiences of the pandemic. METHODS: In an online survey distributed to all staff at 18 geographically dispersed NHS Trusts, we asked respondents, "Is there anything else you think we should know about your experiences of the COVID-19 pandemic?". We used STM on 7,412 responses to identify topics, and thematic analysis on the resultant topics and text excerpts. RESULTS: We identified 33 topics, grouped into two domains, each containing four themes. Our findings emphasise: the deleterious effect of increased workloads, lack of PPE, inconsistent advice/guidance, and lack of autonomy; differing experiences of home working as negative/positive; and the benefits of supportive leadership and peers in ameliorating challenges. Themes varied by demographics and time: discussion of home working decreasing over time, while discussion of workplace challenges increased. Discussion of mental health was lowest between September-November 2020, between the first and second waves of COVID-19 in the UK. DISCUSSION: Our findings represent the most salient experiences of HCWs through the pandemic. STM enabled statistical examination of how the qualitative themes raised differed according to participant characteristics. This relatively underutilised methodology in healthcare research can provide more nuanced, yet generalisable, evidence than that available via surveys or small interview studies, and should be used in future research.

The impact of working in academia on researchers' mental health and well-being: A systematic review and qualitative meta-synthesis.

OBJECTIVE: To understand how researchers experience working in academia and the effects these experiences have on their mental health and well-being, through synthesizing published qualitative data. METHOD: A systematic review and qualitative meta-synthesis was conducted to gain a comprehensive overview of what is currently known about academic researchers' mental health and well-being. Relevant papers were identified through searching electronic databases, Google Scholar, and citation tracking. The quality of the included studies was assessed and the data was synthesised using reflexive thematic analysis. RESULTS: 26 papers were identified and included in this review. Academic researchers' experiences were captured under seven key themes. Job insecurity coupled with the high expectations set by the academic system left researchers at risk of poor mental health and well-being. Access to peer support networks, opportunities for career progression, and mentorship can help mitigate the stress associated with the academic job role, however, under-represented groups in academia are at risk of unequal access to resources, support, and opportunities. CONCLUSION: To improve researchers' well-being at work, scientific/academic practice and the system's concept of what a successful researcher should look like, needs to change. Further high-quality qualitative research is needed to better understand how systemic change, including tackling inequality and introducing better support systems, can be brought about more immediately and effectively. Further research is also needed to better understand the experiences and support needs of post-doctoral and more senior researchers, as there is a paucity of literature in this area. TRIAL REGISTRATION: The review protocol was registered on PROSPERO (CRD42021232480).

New Canadians Working amid a New Normal: Recent Immigrant Wage Penalties in Canada during the COVID-19 Pandemic.

The global coronavirus disease 2019 (COVID-19) pandemic has exposed and arguably intensified many existing inequalities. This analysis explores the relationship between recent immigrant earnings and the pandemic. Specifically, we attempt to empirically answer the question "Has the COVID-19 pandemic exacerbated (or mitigated) recent immigrant-non-immigrant employment and wage gaps?" We find that the pandemic did not change the labour force activity profile of recent or long-term immigrants. Moreover, the pandemic did not disproportionately disadvantage recent immigrants' earnings. In fact, recent immigrant men who were employed during the COVID-19 crisis experienced a small but statistically significant earnings premium. This was insufficient, however, to overcome the overall earnings discount associated with being a recent immigrant. In addition, we find that the recent immigrant COVID-19 earnings boost is observable only at and below the median of the earnings distribution. We also use Heckman selection correction to attempt to adjust for unobserved sample selection into employment during the pandemic. The fact that COVID-19 has not worsened recent immigrant earnings gaps should not overshadow the large, recent immigrant earnings disparities that existed before the pandemic and continue to exist regardless of the COVID-19 crisis.

La pandémie mondiale de coronavirus de 2019 (COVID-19) a mis au jour et sans doute amplifié un grand nombre d'inégalités qui existaient déjà. Cette analyse explore la relation entre le salaire de personnes récemment immigrées et la pandémie. En particulier, nous essayons de répondre empiriquement à la question suivante : « La pandémie de COVID-19 a-t-elle exacerbé (ou atténué) les écarts quant à l'emploi et aux salaires entre personnes issues de l'immigration récente et personnes non immigrantes? ¼ Nos résultats montrent que la pandémie n'a pas modifié le profil de participation au marché du travail des personnes immigrantes, qu'elles soient arrivées récemment ou depuis plus longtemps. La pandémie n'a pas non plus désavantagé de manière disproportionnée les personnes arrivées récemment quant aux salaires. En fait, les hommes récemment immigrés qui occupaient un emploi pendant la pandémie ont connu une bonification salariale, petite mais statistiquement significative. Cette hausse ne suffit pas, malheureusement, à compenser le déclassement salarial généralement associé au fait d'être une personne récemment immigrée. Nous montrons également que cette bonification salariale, attribuable à la COVID-19, des personnes issues de l'immigration récente ne s'observe qu'à partir de la médiane et vers le bas dans la distribution des salaires. Nous employons la méthode de correction des biais de Heckman pour tenir compte des éléments non sélectionnés par le critère d'échantillonnage de l'emploi pendant la pandémie. Le fait que la COVID-19 n'a pas empiré les écarts de salaires pour les personnes récemment immigrées ne devrait pas occulter les écarts importants qui existaient avant la pandémie et qui continuent d'exister, avec ou sans crise sanitaire.

Unions and hazard pay for COVID-19: Evidence from the Canadian Labour Force Survey.

In this article, we examine whether (and by how much) workers in Canada have been compensated for the 'novel' risks associated with COVID-19. We create a unique dataset from a system that scores occupations in the US O*NET database for COVID-19 exposure. We then combine those COVID exposure scores with Canadian occupational data contained in the Public Use Microdata File of the Labour Force Survey. This allows us to categorize Canadian occupations based on COVID-19 exposure risk. We find a long-tailed distribution of COVID-19 risk scores across occupations, with most jobs at the lower end of the risk spectrum and relatively few occupations accounting for most of the high COVID-19 exposure risk. We find that workers who are already more vulnerable in the labour market (i.e. youth, women and immigrants) are also more likely to be employed in occupations with high COVID-19 exposure risk. When we look at the relationship between high-COVID exposure risks in occupation and wages, we find negative compensating differentials both at the mean (negative 8%) and across the earnings distribution. However, when workers are covered by a union, they enjoy a sizeable hazard pay premium (11.7% on average) as compared to their non-union counterparts. Furthermore, we find that the moderating effects of unionization for workers at high risk of COVID exposure to be largest at the bottom of the earnings distribution (i.e. the 10th percentile of unionized earners receives a 12.3% risk premium for high-COVID exposure, whereas the 90th percentile receives only a 2%).