Employee Mental Health During COVID-19 Adaptation: Observations of Occupational Safety and Health/Human Resource Professionals in Ireland

Introduction

The emergence of COVID-19 has resulted in workplace adaptations or operational/environmental changes at workplace worldwide. To mitigate the transmission risk, employees had to rapidly adapt to relevant public health measures at various points during the pandemic including, working from home (WFH) or in the case of essential workers to social distancing, the use of Personal Protective Equipment (PPE), or frequent testing often without adequate psychological adjustments. Adverse psychological outcomes were observed from the beginning of the pandemic when employees, in addition to adjusting to public health measures, were challenged by mandatory quarantine, school closures, unexpected unemployment, and related uncertainties [1, 2]. Factors contributing to adverse mental health impacts on employees during COVID-19 were summarized by a review study [3] from several aspects. Specifically, heightened perception of COVID-19 contagion risk has been identified as a predictor of poor mental health. The perceived risk of being infected at work which varies depending on demographics [4] is positively associated with emotional exhaustion [5]. Also, individuals may fear for their family members’ health and safety [6]. Infodemic versus the unknown [7] contributes to pandemic fatigue as individuals are constantly exposed to an overload of rapidly changing COVID-19 information [8]. Quarantine and confinement slow the spread of infectious disease while potentially increasing risk of anxiety and depressive symptoms [1]. Lack of social interactions between colleagues can increase employee stress levels [1]. Stigma and social exclusion are frequently observed among healthcare workers leading to psychological distress and depression [9]. Additionally, individuals experiencing loss of income are reportedly more distressed and in poorer health [6].

Despite the variety of published research, there is an ongoing need for further research in this area that focuses on employees from an occupational adaptation perspective [10], since mental health impacts of COVID-19 may take weeks or months to become fully apparent with possible long-term occupational health ramifications well into the future [11]. This paper aims to explore how workplace COVID-19 adaptations contribute to employee mental health pressures and how organizations can alleviate such issues while maintaining a safe workplace environment. In general, employee welfare is in the realm of Resource (HR) management in industries in Ireland, while Occupational Safety and Health (OSH) management focuses on specific measures implementation in relation to employees’ safety, health and wellbeing. Compared to HR professionals who usually liaise with upper management and oversee allocation of resources, the role of OSH may be somewhat neglected especially in low-risk work settings. However, since some organizations were lack of OSH professionals during the COVID-19 pandemic, Human Resource (HR) professionals consequently played a similar role to be responsible for employee health and wellbeing, especially in small and medium sized enterprises. Thus, OSH/HR professional group possesses key insight into employee adaptation during COVID-19 and occupational strategies for mental wellbeing. By conducting focus groups with this cohort, this study contributes to understanding the mental health impacts arising from the workforce adaptation to the new safety measures implemented due to COVID-19.

Methods

Recruitment of Participants

To gain in-depth insight from the perspectives of OSH/HR professionals, focus group was the chosen data gathering method. In line with COVID-19 regulations, the fifteen focus groups were conducted via online ZOOM^TM meetings between April and May 2021. The participants were mainly recruited through the Centre for Health and Safety alumni network. Participants from similar sectors were designated to the same group so that peers could exchange shared experiences. For example, Focus Group (FG)3 participants were from Biopharmachem sectors; FG4 participants worked in Transportation/Logistics.

Data Collection and Instruments

The data collection stopped when 60 participants were interviewed and data saturation was reached [12]. All ZOOM^TM meetings had four sets of five-question polls built in around specific themes and the participants took part in them to supplement the qualitative data. To ensure communication efficiency, the number of participants in each group was limited to four to six per session [13]. Focus group interview protocol related to four predefined topics (Table 1): preparedness and support; actions and impact on the organization; impact on workers; and lessons to be kept moving forward. The protocol was reviewed by multi-disciplinary experts from the research team (e.g., backgrounds in OSH, medicine, psychology and public health). A 2-hour pilot test was conducted within the research team on ZOOM^TM prior to data collection to refine the protocol. All focus groups were conducted by CB to ensure consistency, with YC and MR in attendance to observe and note take as a backup in case the recording became corrupt or unusable, which also complemented the ZOOM^TM recordings (as ZOOM^TM can only record the speaking person even if there are more than one participant in the meeting.

TABLE 1. Focus group interview questions, workplace adaptation to COVID-19, Ireland, 2021.

Data Analysis

The transcript of the audio recording were generated by ZOOM^TM, which were verbatim corrected by the researchers following a playback of the original audio files downloaded. Each of the focus group transcripts contained approximately 20,000 words. To align with ethical requirements, participants were assigned pseudonyms according to their working sector after de-identification. To achieve the purpose of this study of understanding the mental health impacts caused by COVID-19 adaptation, two themes were predetermined after the researchers familiarizing themselves with the data: 1) key mental health impacts reported and 2) the related supports from the organization. Following a conventional content analysis approach [14], open coding of data was then conducted under each of themes by highlighting the exact words used by the participants to capture key thoughts or concepts. Reflexive notes were also made as the inductive coding progressed, and the codes were subsequently categorized into meaning groups based on the links between them. For example, based on the characteristics of emotions emerged during different phases of COVID-19 pandemic, the mental health related issues identified were sorted into three groups: pre-adaptation, during adaptation and post-adaptation. The codes/themes were consistently refined through critical dialogues between the researchers, and the analysis was subsequently adjusted deductively after the agreement reached on each update. Through such an iterative process, the final themes/subthemes were thus conceptualized as presented in the result section [15].

Rigor and Trustworthiness

Rigor and trustworthiness have been considered throughout the study [16]. First, credibility was ensured by data collection triangulation (focus group interviews and quantitative poll questions) and researcher triangulation when analyzing the data. For example, the coding of all qualitative data was completed by five independent coders after an intercoder reliability (ICR) assessment [17]. Specifically, the initial coding round was deductively completed by the primary coder YC, who color coded transcripts in Microsoft Word based on the four topics pre-identified in the protocol. During this process, YC took reflective notes, proposed sub-themes within each category, and chose a transcript (FG10) for ICR assessment. While coding the FG10 transcript, YC developed a primary coding frame by inductively creating an extensive set of descriptive codes under each sub-theme using Nvivo. To assess the level of agreement, coders coded the same part of the transcript independently using the primary coding frame. ICR was calculated based on Cohen’s kappa coefficient using the “coding comparison” function in NVivo. After discussing divergence and refining the themes/codes, remaining transcripts were assigned to coders for thematic analysis. Relevant findings from other research are also discussed as a triangulation. Second, thick descriptions of the theme identified were provided which enable the readers to evaluate the possibility of transferability of the study findings. Finally, the dependability was achieved as the research procedures were transparent (Figure 1) and clearly documented. Therefore, the confirmability was deemed established as the interpretations were cross-checked by the researchers who have multidisciplinary backgrounds in the team.

FIGURE 1. Data analysis flowchart relevant to employee mental health, workplace adaptation to COVID-19, Ireland, 2021.

Results

The participants’ information including overall gender distribution, type of industries represented and size of their organizations etc. are presented in Table 2. This section focuses on the mental health aspects of the findings, which frequently were discussed by the participants during the study. The results are displayed around mental health impacts on workers, the impacts on adaptive behaviors, and mitigation strategies, with simplified direct quotes from the participants. More detailed narratives are exemplified in Tables 3, 4 to provide richer descriptions and relevant poll results were also provided in Figure 2 to facilitate understanding of the narratives.

TABLE 2. Participants’ information, workplace adaptation to COVID-19, Ireland, 2021.

TABLE 3. Identified mental health impacts on employees, workplace adaptation to COVID-19, Ireland, 2021.

TABLE 4. Identified solutions to alleviate mental health issues, workplace adaptation to COVID-19, Ireland, 2021.

FIGURE 2. Poll results relevant to employee mental health, workplace adaptation to COVID-19, Ireland, 2021.

Mental Health Impacts

The mental health impacts of COVID-19 adaptation on employees are identified from three pandemic stages: pre-adaptation, during adaptation, and post-adaptation. The pre-adaptation phase refers to the period between December 2019 (first COVID-19 case was officially reported in China) to late March 2020 (public health measures to delay the spread of COVID-19 announced in Ireland). “During adaptation” is considered from April 2020 towards the end of the year until the lockdown eased (to Level 3 restrictions nationwide) for that Christmas. “Post-adaptation” is thus from the beginning of 2021 when COVID-19 vaccine was available to more people in the country, to mid-2021 when this study was conducted.

Pre-Adaptation

In the pre-adaptation phase when most organizations were in preparation for the pandemic, participants highlighted that stress, panic and frustration were evident. These negative feelings stemmed from the unprecedented nature of the pandemic, coupled with unclear information from management. The lack of preparedness for the pandemic is a basic reason, and witnessing panic behaviors of colleagues also exacerbated employees’ stress.

Construction 11: None of us knew anything about COVID and what was going to happen, so people were frustrated that they were still working on site when they didn’t feel like they were safe to be working on site. (FG12)

Local Authority 1: It was madness … there was people bringing in money and putting it in envelopes and locking it in safes and stuff like this totally fishing in the dark at the start. (FG15)

Some OSH representatives worked to provide in-time updates on COVID-19 and its transmission mechanisms, helping to alleviate anxiety and frustration by providing a sense of control. The provision of timely updates, however, requires that organizations be adequately prepared to respond to the public health emergency and faced an onslaught of health and safety queries.

Local Authority 1: we were definitely not ready…all queries seemed to come to health and safety, to see what we were doing and what we could do. (FG15)

Furthermore, even for multinational organizations with access to corporate information sources, extensive emergency scenario planning was not enough to prepare employees psychologically for the pandemic.

Biopharmachem 3: While you can plan for the scenario, it doesn’t fully psychologically prepare people for something that they don’t ever expect to happen. (FG14)

As the poll results presented (Figures 2A,B), 16.9% of the participating organization had redundant employees and 10.2% had to suspend their employees due to the COVID-19 impact. Employees’ pre-adaptation mental health issues were associated with information uncertainty and observed panic behaviors, the solutions to which are discussed in the theme of organizational mental health supports.

During Adaptation

With COVID-19 control measures implemented nationwide, most organizations had to adapt their working arrangements to follow new policies. As reported (Figures 2C,D), most participating organizations had no WFH employees or <25% employees who can WFH prior to COVID-19, while the figure was dramatically increased after the emergence of the pandemic. To align with different levels of lockdown restrictions, many employees were sent home to work or were laid off temporarily, especially those who were not essential workers (these workers were able to avail of the government’s pandemic unemployment payment). WFH brought on employee mental health challenges related to isolation/loneliness, worry, fear, internal conflict, and grief.

National Agency 5: … they’re single people, they’re living in a bad s (situation) or something like that. They haven’t even been there, working from an ironing board if (they) have a laptop. (FG5)

Other employees, unable to WFH, were apprehensive about being in close contact with co-workers. Worry was manifested among employees especially in lower-paid positions as they felt financially prohibited from taking time off work. Also, some employees felt stressful WFH when confronting IT (information technology) issues.

Manufacturing 2: we have a lot of people that would [be just] beyond [or] near minimum wage, so they’d be the type that are more inclined to come to work … because they need the money. (FG2)

Infrastructure 2: she’s a cancer survivor and she’s also an asthmatic so you know a lot of issues ... And the IT point of it was really stressful for her. (FG4)

Fear of contracting the virus and giving it to loved ones emerged as another challenge, particularly in instances of advanced age or underlying comorbidities.

Local Authority 3: you’d hear more staff talking about maybe their mother wasn’t well or the father wasn’t well or granny was living in the house, and that they were concerned about that. (FG9)

Concerns for safety were aggravated if an organization was unable to transparently communicate COVID-19 related information, including the number of confirmed cases in the workplace.

Construction 11: If there’s a positive case on a building site [and if] it’s not communicated properly, and the precautions aren’t communicated properly. People really do get nervous, and they got really scared. (FG12)

COVID-19 exemplified the contradictory needs of people between physical health and mental health. People need human contact from the mental perspective, but at the same time people are afraid of the risk of contracting COVID-19 via socialization.

Consultant 3: I saw my grandmother for the first time in the 3 months at Christmas and I went to give her a hug, and she was actually terrified that I was coming into her personal space like, you know. I thought the hug it was important, but she wanted to get out of my arm straightway. (FG8)

Finally, workers experienced grief due to loss of co-workers, friends, and family to COVID-19, which was specifically voiced by participants in healthcare.

Healthcare 7: It’s like a war zone, it’s devastating. A lot of carers who work, they’re not there for the money... I mean they’re literally like their grandparents as such. To see staff working [in] homes and they initially are losing 1, 2, 3, 4 not only residents, but sort of their friends, their sort of mentors… it’s just devastating. (FG6)

OSH professionals commented on the absence of ritual or funeral to address the emotions of experiencing loss and grief. Others noted the importance of keeping busy at work to maintain mental wellbeing despite personal loss.

Post-Adaptation

Most OSH participants indicated that being on ongoing high-alert for COVID-19 caused constant fear and fatigue for colleagues. As in sectors with high-risk exposure, healthcare workers were particularly under the consistent pressure, and always concerned about the virus transmission.

National Agency 4: …the whole issue of fear was there, you know that you’re that (the person responsible for OSH) and that’s tied into doing the right thing… we’re on high alert and it’s ongoing. (FG7)

Similarly, participants in non-healthcare occupations also described that constant fear could lead to fatigue and inadequate compliance over time with control measures.

Manufacturing 6: … a little bit of fatigue on the facemask wearing as it goes on and goes on, people are getting a little bit more tired of it. (FG6)

More than half of participants indicated that the barrage of negative COVID-19 news in the media exhausted and fatigued their colleagues and themselves. With the emergence of COVID-19 came the emergence of the term “infodemic” [18]. Employees were not able to disconnect with COVID-19 due to the extensive media coverage, especially due to the COVID-19 long-term nature.

Healthcare 1: … they’ve (people) got so many different levels of stress, but not having that time to disconnect and share and offload that piece, absolutely and utterly we’re seeing that [fatigue] (FG5)

Infrastructure 6: … the fatigue part of it, I think they’re mentally drained of the whole thing. (FG4)

Additional factors were highlighted as detrimental to the mental health of employees, such as fatigue caused by children at home during work hours due to school and childcare closures. Details on difficulties finding work-life balance will be discussed in future publications.

Organizational Mental Health Supports

In addition to sharing perceptions of the mental health impacts of COVID-19 on employees, OSH professionals shared how their organizations worked to alleviate such impacts. Organizations supported mental health of employees by providing timely and reliable information on the management of COVID-19, supports through employee assistance programs (EAPs), by having informal communication channels, allowing for hybrid work and reinforcing control measures in the workplace.

Providing Timely and Reliable Information on the Management of COVID-19

Since employees’ mental health impacts resulted from uncertainty of the everchanging situation, OSH professionals should provide in-time updates and reliable information to employees in early stages of the pandemic, including transparent communication on positive cases in the workplace.

Infrastructure 1: They were a little panicked at the start were they all going to get it out working on the side of the road or wherever they may have been, and I think the assurances we were given them, and we were explaining how the disease was being transmitted. (FG13)

Employee Assistance Programs

EAP is a free counselling service supporting employees experiencing work-related or personal problems. Usually, organizations have formal EAPs embedded in their OSH system to support the mental health and wellbeing of employees. OSH participants noted a need for upscaled EAP preparedness and resources to meet the high-volume of demand due to COVID-19.

Local Authority 1: We have a health and wellbeing unit that was initially set up just before COVID got in that was very much in its infancy. For a large organization, we are way behind the curve…we’ve rolled out resilience programs. (FG15)

Participants noted some challenges of their EAPs, including that accessing EAPs required employees to seek out the program themselves, which could limit reach. One participant observed that it was easier for male employees to seek counsel if the OSH professional was a woman.

Construction 4: Being a woman in a male dominated industry, I find men come to women’s talks. I find my office a little bit like a counselling office at sometimes you know. Man to man, you know less likely. (FG11)

Informal Communication Channels

Informal communication can complement formal EAPs in mitigating the negative impacts of COVID-19 on employee mental health. Unlike EAPs, the use of informal communication can be initiated by OSH professionals. As noted by participants, the key to informal communication is understanding employees’ emotional needs prior to providing them with support. Active listening is an effective approach to gain understanding of an employee’s situation.

Biopharmachem 1: … Try to support them, so you just you kind of had to sit there and let them [talk], just be an ear, more than anything else (FG3)

OSH participants also noted the importance of using informal communication to educate employees on long-term impacts of COVID-19 in order to minimize uncertainty; of initiating proactive communication with employees on potential concerns and stressors and providing a safe environment in which to converse; and of facilitating informal communication between employees themselves. As with EAPs, participants mentioned challenges getting male employees to disclose emotional concerns.

Biopharmachem 2: He broke down and cried. And once I got it out of him, he was fine. It was … building up until he actually broke down and [he said:] ‘I just haven’t seen my daughter! I want to see her [but I cannot] until this company gets it right!’ (FG3)

One positive result of the pandemic was a raised awareness for mental health and wellbeing instead of a workplace culture of “being tough.”

Infrastructure 6: I think it’s very different how people now feel about [it], how people feel they can maybe stand up a little bit more and talk about how they interact and who they trust to interact with. (FG4)

The positive impact of informal communication on employees’ mental health was observed by most participants, the practice of which was simple to perform. Virtual chats, such as online coffee breaks, were also reportedly an effective way.

Hybrid Work Schedules and Reinforcement of Control Measures

In addition to communication with employees, empirical measures such as hybrid working style and the reinforcement of COVID-19 control measures in the workplace can alleviate employee mental health challenges. A number of organizations realized that the hybrid work has potential benefits for employees’ mental health thanks to increased socialization in the workplace.

Construction 8: A lot of people miss the interaction in instances … a lot of people will come back to the offices when they have the opportunity to do that as well. (FG12)

Returning to work required ongoing reinforcement of COVID-19 control measures to ensure employee safety. Based on the participants’ experience, reinforcing control measures helped combat behavioral fatigue and improve employees’ awareness of COVID-19 safety compliance, as employee adherence reportedly waned over time.

Manufacturing 1: We have a lot of staff… didn’t want to come into work … we had to do a lot of convincing the lads that the site is safe, [that] we have these controls in place and you’re good to come back now. (FG2)

For employees that remained fearful of contracting COVID-19, control measures can alleviate fears by keeping the workplace a safe environment, especially in high-risk.

Discussion

This study highlighted mental health impacts and associated effects on employees’ adaptation to COVID-19 measures, and strategies used by OSH professionals to mitigate mental health concerns in their workplaces to protect their colleagues. Employees experienced stress, panic and frustration linked to uncertainty and loss of control at the onset of the pandemic, a phenomenon previously identified in the literature [19]. To support employees at this stage and to prevent trust in misleading information sources like social media [20], organizations needed to quickly obtain and communicate reliable information. OSH professionals required adequate support from their organization in order to provide timely and consistent communications to the workforce.

During the transition phase of the pandemic isolation/loneliness and worry were consequences of employee adaptation to increased and ongoing isolation [21] arising from social distancing procedures in the workplace, WFH as well as being laid off during the pandemic at a time of severe social restrictions and lockdowns. Contradictory requirements for maintaining physical and mental health were challenging. Social isolation can be detrimental to mental health but a vital component of COVID-19 safety [22]. Our finding that underlying comorbidities elevated anxiety associated with the virus was expected. An individual’s perception of having poor physical health is associated with higher stress and psychological morbidity [23], as is a history of chronic illness [24]. Some employees required to WFH faced stress stemming from lack of IT skills and/or social supports that would normally be present in their workplaces [25]. Although previous studies emphasized an increased risk for mental health disorders in females during a crisis [26–28], our study shows that male employees were less likely to seek organizational mental health supports or comfort from colleagues, especially in occupations where masculine culture prevailed [29].

Thus, there is a possibility that the manifested increased risk among females is because they are more likely to report mental health impacts and seek for assistance. Gender’s influence on mental health consultations should be considered when planning for public health emergencies, and further research conducted in male dominated industries. Planning for mental health support during a deadly crisis like COVID-19 is of particular importance since restrictions on ritual or funeral may lead to grief and greater risk of prolonged grief disorder [30]. The paid sick leave due to COVID-19 should be advocated to reduce the financial concerns especially for lower-paid employees.

When employees realized the long-term nature of COVID-19 post-adaptation, “pandemic fatigue” set in, referring to the notion of behavioral fatigue associated with adherence to COVID-19 restrictions [31]. Employees’ emotions were dramatically influenced by ongoing negative news from the media, such as daily confirmed cases and deaths reported. To alleviate this, mechanisms for effective communication on evidence-based science to the public would be valuable [18]. Organizations can play a key role in scientific communication during public health emergencies by educating staff, which require the OSH personnel in the organization to be trained for improving such skills.

The findings of this study also reflected that healthcare professionals experienced severe mental health challenges comparing to employees in other occupations. Many studies have focused on COVID-19 mental health issues arising in the healthcare sector due to long hours spent working in high-pressure environments [32]. Suggestions for improving mental health in the healthcare sector include discussions with supervisors who feel confident speaking about mental health [33]; active monitoring for anyone exposed to potentially traumatic events [34]; anonymous online self-check tools; and group discussions to help staff develop a meaningful narrative that reduces risks of harm [35]. Our findings highlight the potential value in expanding these supports to other occupational sectors.

Timely and reliable information from the management regarding COVID-19 become central to the current public health crisis as employees may mistrust information or be confused on conflicting information as a consequence of infodemic [18]. Furthermore, organizations’ mental health programs should incorporate formal and informal communication. Effective formal communication may include confidential consultancy and professional EAP services. Though most organizations provide EAP within their OSH program, we found that not all EAPs were equipped to meet the large-scale demands of a public health emergency. However, the efficacy of EAP may be limited in male dominated industries where stigma prevents employees from seeking out services [36]. Informal communication by comparison can be initiated by OSH professionals and is an effective mechanism for mitigating mental health impacts. Informal chats can be arranged after a formal online meeting by giving employees space to talk about non-work-related topics.

Finally, hybrid working arrangements can alleviate employee isolation and loneliness by increasing opportunities for social interaction and informal communication. As employees return to work, reinforced occupational control measures are vital for protection and reassurance. Meanwhile, the employer should be open to changes depending on the situation, such as acceptance of the possibility that employees need to remain WFH if COVID-19 risk becomes high. Nevertheless, occupational COVID-19 controls can have a negative impact on employees’ mental health if they see the stringency of control measures as an indicator of high risk at work [37]. It is important that management provides transparent communications to ensure that employees maintain an accurate perception of COVID-19 contagion risk at work, such as email updates with links to reliable sources.

Conclusion

This is the first qualitative study conducted with OSH/HR professionals in Ireland regarding COVID-19 adaptation, which indeed provide valuable insights to the research literature, as well as empirical experience in supporting employees with mental health impacts arising from pandemic workplace adaptation measures. As a limitation, participants’ opinions may not be sufficiently representative because of the qualitative study nature (e.g., the baseline assumption about the stress level may vary in different occupational settings). Future research focusing on specific occupation(s) especially high-risk sectors (e.g., healthcare) is needed to provide in-depth information for the development of intervention program customized to specific working setting(s). However, qualitative research design in this study allows for richer data to be gathered than a quantitative survey at a time when significant occupational and societal flux was in progress due to the changing nature of the pandemic’s early stages. To complement this, there is a need for the design of a quantitative survey instrument to investigate the COVID-19 adaptation challenges from more employees. Such a survey is under development in our project, which will enable the OSH professionals to have a better understanding of their employees’ needs during the current and future public health emergencies, and thus customize their support to specific mental health issues in their organization.

Ethics Statement

The studies involving human participants were reviewed and approved by the University College Dublin Human Research Ethics Committee. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

Author Contributions

Research design: AD, CP, CoB, and PS. Protocol development: CP, CoB, YC, ClB, and EA. Participant recruitment: CoB, AD, and YC. Data collection: CoB, YC, and MR. Data transcribing: YC, CI, and VD. Data analysis: YC, CI, and VD. Writing—original draft preparation: YC and CI. Writing—review and editing: VD, AD, ClB, EA, PS, MR, CP, and CoB. Project administration; VD and CI Supervision; CP and CoB Funding acquisition: CP and CoB.

Funding

This study was funded by Science Foundation Ireland (grant number 20/COV/8539). Open access publication funding is included in this grant.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References