Longitudinal comparison of depression, coping, and turnover among NHS and private sector staff caring for people with dementia

Participants, methods, and results

We measured emotional wellbeing (28 item general health questionnaire) and the use of positive coping strategies (active coping, planning, seeking social support, positive reinterpretation, and acceptance-COPE3) in the care staff of private sector residential or nursing homes and NHS continuing care facilities. All nine private facilities with over 30 residents within two catchment areas and all four NHS facilities were asked to participate. Questionnaire data were discounted from one facility in each category because of the poor return rate (<25%), although the staff turnover was calculated in all 12. We compared results using the χ² test and the Mann-Whitney U test. All data were analysed with SPSS (version 9).

A total of 225 staff completed all of the assessments (161/176 (91%) from private facilities and 64/89 (72%) from NHS facilities). There were 48 nurses (27 from NHS, 21 from private homes) and 177 care assistants or senior care assistants (37 from NHS, 140 from private homes).

Forty five (20%) respondents scored ≥5 on the general health questionnaire (the cut off point for caseness), 35 (22%) from private facilities and 10 (16%) from the NHS (χ² =1.7, df =1, P=0.30). The table gives further details. Staff scoring below 5 on the general health questionnaire were more likely to use positive coping strategies (active coping, Z=2.1, P=0.03). Nurses used active coping (Z=2.6, P=0.008) and planning (Z=2.5, P=0.011) more than the care assistants, although the differences were not significant for private staff (table).

Seventy five (38%) staff in private facilities and 19 (16%) in NHS homes had left in the 12 months before the assessment (χ²=16.4, df=1, P<0.0001). There was no relation between staff turnover and the mean general health questionnaire score (Spearman's r=0.21, P=0.52).

Comment

We found psychological distress in about 20% of professionals caring for people with dementia in private and NHS facilities. This level is low compared with reported frequencies of 50% in other healthcare workers4 and relatives caring for people with dementia.1 Levels of stress in NHS homes were lower than in private facilities (16% v 22%), although the difference was not significant. The study did not have sufficient statistical power to detect a significant difference of this magnitude. Our study confirms previous reports that positive coping strategies protect against psychological distress and indicates that nurses are more likely to use positive coping strategies than care assistants, particularly in NHS settings. This emphasises the potentially important role of nursing staff in developing such skills in care homes.

The assumption that stress is an important factor in the high turnover of professional carers seems to be unfounded. Although staff turnover was high, particularly in the private sector, it was unrelated to the level of psychological distress within individual facilities. Possible explanations for the high turnover include the poor wages and poor career structure. The lower staff turnover rates in the NHS facilities were perhaps because staff had a better sense of “community” as they were part of a larger organisation. Promotion of better links between the NHS and private sector could increase stability and allow efficient delivery of training programmes and the development of mutually supportive staff groups.