The Impact of Informal Caregiving on the Mental Health of Health Care Workers During the COVID-19 Pandemic -Cross-Sectional and Longitudinal Results from the Voice Study

Gloria-Beatrice Wintermann^1*Anne Bornhorn¹Susann Schmiedgen¹Christian Albus²Andreas Michael Baranowski³Petra Beschoner⁴Yesim Erim⁵Franziska Geiser³Lucia Jerg-Bretzke⁴Eva Morawa⁵Sabine Mogwitz¹Kerstin Weidner¹

• ¹Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
• ²Department of Psychosomatics and Psychotherapy, University Hospital of Cologne, Cologne, Germany, Cologne, North Rhine-Westphalia, Germany
• ³Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Bonn, University Bonn, Bonn, Germany
• ⁴Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
• ⁵Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Germany

Background: The COVID-19 pandemic increased psychological distress among health care workers (HCWs). Those with informal caregiving responsibilities (ICs) may be especially vulnerable, but data remain limited. Methods: In a multicenter online survey conducted across four time points (T1–T4: 2020–2022) within the German healthcare system, HCWs with ICs were compared to those without (comparison group, CG). Psychological distress was assessed using validated measures of anxiety (Generalized Anxiety Disorder/ GAD-2) and depression (Patient Health Questionnaire/ PHQ-2). Group differences were analyzed using non-parametric Mann–Whitney U and chi-square tests.. Longitudinal logistic regression analyses examined the impact of IC on psychological distress, controlling for sociodemographic, occupational, and psychological factors. A moderation analysis tested whether fear of infecting relatives influenced the salutogenic effect of optimism. All analyses were performed with multiply imputed data and a retrospective sample size justification was conducted. Results: ICs were more likely to be female, older, work in occupations other than medicine, work part-time, have children, and have more than six years of work experience. While ICs showed significantly higher PHQ-4 anxiety and depression than CG at T1 and T2, no significant differences could be shown for the other time points. IC emerged as a significant risk factor for increased psychological distress longitudinally, even after controlling for confounders. The protective effect of optimism was moderated by fear of infecting relatives at T1. Conclusion: HCWs with informal caregiving duties represent a vulnerable subgroup with increased psychological distress, especially during the early pandemic. This group may benefit from targeted support (e.g., flexible schedules, protective equipment, psychological interventions). Limitations include lack of pre-pandemic data and reliance on self-report. Findings underscore the importance of acknowledging and addressing overlapping care burdens in future health crises.