Theme: Mechanisms

Project Description

Patient-facing NHS staff face overlapping psychosocial hazards, including high workloads, limited control, staffing pressures, emotional demands and morally challenging situations. Although associated with poorer mental health, less is known about how these hazards lead to anxiety and depression over time, why outcomes differ between individuals, and which mechanisms offer opportunities for prevention.

Building on Warwick research (Creating Healthy Jobs, NIHR207666; WORK-MW, NIHR502355; JCOP evaluation, NIHR521909) and Birmingham’s longitudinal research expertise, this PhD will examine: (1) which individual and combined hazards predict worsening mental health; (2) whether psychological recovery, perceived control, moral distress and sleep mediate these relationships; and (3) how pathways vary across professional and working-pattern groups.

An evidence-informed mechanistic framework, grounded in occupational-health theory, will be refined through co-production with patient-facing NHS staff. Contributors will prioritise exposures and mechanisms, challenge assumptions, refine measures, assess participant burden and inform interpretation. This will produce a pre-specified conceptual model and analysis plan.

Approximately 250–300 staff from two NHS organisations will complete assessments at baseline, 3 and 6 months, measuring workplace hazards, candidate mechanisms and validated anxiety and depression outcomes. Longitudinal multilevel models will examine within-person change, between-person differences and potential mediation, with subgroup analyses where feasible.

A nested intensive longitudinal study (60–80 participants) will use brief smartphone assessments over 10–14 days to capture daily workplace exposures, psychological responses, sleep, recovery and next-morning symptoms. Time-lagged multilevel analyses will investigate short-term pathways linking difficult working days to subsequent mental health.

Integrating evidence, lived experience and repeated real-world measurement, the PhD will identify plausible, modifiable mechanisms explaining how, when and for whom workplace hazards become harmful, informing future prevention research. The fellow will gain interdisciplinary training in occupational mental health, co-production, longitudinal methods, PPI/E and applied health research.