Long COVID-19 to Essential Healthcare Workers: Material Hardship and Mental Health

Background and Purpose: The COVID-19 pandemic has highlighted the fact that many lower-wage workers perform critical and essential tasks while receiving insufficient compensation, and therefore, struggle to make ends meet. During the pandemic, the U.S. federal government implemented robust cash transfer programs— the Coronavirus Aid, Relief, and Economic Security Act (March 2020), COVID-related Tax Relief (late December 2020), and the American Rescue Plan Act (ARPA, early March 2021)—to tackle public health and socioeconomic challenges. While studies indicated a reduction in material hardship and improved mental health among households following these programs (Cooney & Shaefer, 2021), there remains a gap in understanding the long-term effects, particularly among essential healthcare workers. This study aims to investigate changes in material hardship and mental health among full-time essential hospital workers from 2021 (immediately after the implementation of Tax Relief and ARPA) to 2022 (one year after the government's cash transfers).

Methods: Data came from pooled data combining Wave 4 (collected March – May 2021) and Wave 5 (February – March 2022) surveys of hospital service, clerical, and technical workers at large hospital systems in Western Pennsylvania. The analytic sample included full-time workers who worked 40 regular hours and who did not hold a second job outside the hospital (N=288). Respondents from Waves 4 and 5 were compared regarding material hardships and mental health. Material hardships were measured through self-reports on difficulties affording (1) utility bills, (2) housing, (3) medical treatment, and (4) food. Mental health symptoms were measured using self-reported scales of (1) stress, (2) depression, (3) suicidal ideation, (4) anxiety, and (5) COVID-19 related post-traumatic stress disorder (PTSD). To account for observed differences between respondents from Waves 4 and 5, inverse probability weighting was applied, adjusting for age, gender, race, educational attainment, having a child in the household, household income (in March 2023 $), public benefit receipt, hourly wage (in March 2023 $), and overtime work hours.

Results: Full-time essential hospital workers tend to experience more difficulties affording medical treatment (Odds ratio=2.21, p=0.005) in 2022 compared to workers from 2021. This finding remained consistent after controlling for perceived physical health and adjusting it in the inverse probability weight estimator. Hardships in utility bill payment, housing, and food did not differ between workers in 2021 and 2022. Regarding mental health, workers in 2022 reported higher levels of stress (B=2.05, p=0.000), as well as higher possibilities of depressive symptoms (Odds ratio=1.89, p=0.027) and anxiety (Odds ratio=2.28, p=0.004). However, there was no significant differences in suicidal ideation and PTSD symptoms between workers in 2021 and 2022.

Conclusions and Implications: The findings suggest that the positive effects of one-time cash transfer programs on the well-being of full-time essential hospital workers may not be sustained over time, particularly in certain aspects such as medical hardship, stress, depression, and anxiety. By highlighting adverse well-being outcomes among lower-wage full-time workers following the cessation of cash transfer programs, this study underscores the necessity for continuous income support for lower-wage workers, whose employment does not ensure their material well-being and mental health.