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We investigated the longitudinal associations between alcohol use and wider stressors with symptoms of CMD among HCWs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data were obtained from the UK-REACH prospective cohort study of HCWs, collected between Dec 2020 and Feb 2021 (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200912,821), and 6\u00a0months (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20095164, 40% response rate) and 10\u00a0months later (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20095454, 43% response rate). Symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), changes in frequency of alcohol use, COVID-19 stressors, occupational stressors, and discrimination were self-reported at each time point. Multilevel models analysed changes in symptoms of CMD over time and explored the associations with changes in alcohol use and wider stressors, for those who completed two or more surveys (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u20096973).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean symptoms of depression declined from baseline (1.07\u2009\u00b1\u20090.02) to 6-month (0.96\u2009\u00b1\u20090.02) and 10-month follow up (0.97\u2009\u00b1\u20090.02), as did mean symptoms of anxiety (baseline, 1.45\u2009\u00b1\u20090.02; 6-month, 1.35\u2009\u00b1\u20090.02; 10-month, 1.39\u2009\u00b1\u20090.02). Symptoms of PTSD only declined from baseline (3.36\u2009\u00b1\u20090.02) to 10-month follow-up (3.31\u2009\u00b1\u20090.02). More frequent alcohol use over time was associated with increased symptoms of depression (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.31; 95% CI, 0.19 to 0.44), anxiety (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.32; 95% CI, 0.18 to 0.45), and PTSD (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.32; 95% CI, 0.18 to 0.46), as was bereavement due to COVID-19, and discrimination from patients and other staff. Occupational stressors were positively associated with symptoms of CMD, though this association was not as pronounced for those who drank less often (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009= \u2212\u20090.08; 95% CI,\u2009\u2212\u20090.14 to\u2009\u2212\u20090.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified several mechanisms which contributed to worsened CMD, demonstrating that organisational changes are required to support HCWs to reduce their alcohol use, tackle discrimination, and to create a work environment where staff feel secure raising concerns.<\/jats:p>\n                  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