Mental health impacts of COVID-19 on healthcare workers (multiple reviews)
What is this? The COVID-19 pandemic is placing a strain on the mental health of healthcare workers. Findings from several relevant systematic reviews are summarised here. More details, including citations and links to the full reviews, are available lower down this page.
What was found: A variety of mental health symptoms have been reported by healthcare workers involved in illness outbreaks or pandemics; stress, anxiety, psychological distress, depressive symptoms, insomnia and “moral injury”. Such symptoms may evolve into long-term mental health conditions, including anxiety, depression, PTSD or suicidal ideation. Several reviews have recommended access to mental health and psychological support services for healthcare workers involved in providing patient care during the COVID-19 pandemic, including regular screening for stress, anxiety and depression.
Kisely et al. noted that healthcare workers in contact with affected patients during novel virus outbreaks had increased levels of acute or post-traumatic stress and psychological distress; Pan et al. reported marked increases in anxiety in healthcare workers in China during the COVID-19 pandemic and Berger et al. reported that rescue workers, including emergency department and ambulance staff, have a higher prevalence of PTSD.
The Kisely et al. rapid review showed that healthcare workers who were younger, more junior or the parents of dependent children were more at risk of psychological distress during novel virus outbreaks. Other factors identified which might influence the mental health of healthcare workers include gender, marital status, social support, self-efficacy, occupation specialization and type of COVID-19 related work.
The Spoorthy et al. rapid review noted factors specific to COVID-19 that may contribute to stress for healthcare workers. It highlighted three main issues for healthcare workers: concerns for their personal safety, families and patients. It also reported that coping measures for healthcare workers might include strict protective measures, knowledge of infection prevention and transmission, social isolation measures, positive self-attitude and social support.
The Kisely et al. rapid review found that clear communication, access to adequate personal protection, adequate rest, and practical and psychological support were associated with lower psychological distress in healthcare workers during novel virus outbreaks.
Brooks et al. recommended specialized training to equip healthcare workers with the skills, knowledge, and confidence to operate under challenging conditions. They highlighted considerations for managers: ensuring an approachable and supportive environment, regular adequate communication with staff, preparing employees for the potential impact of negative experiences such as isolation or discrimination, and ensuring support measures for those who may face these experiences. They also noted that web-based support or discussion groups may help provide support to healthcare workers during a crisis, thus potentially reducing feelings of social isolation.
Kunzler et al. found very low certainty evidence that healthcare students who receive resilience training may report higher levels of resilience, and lower levels of anxiety, stress, and stress perception compared to controls, immediately after training intervention. However, medium and long-term impacts are uncertain and there is little or no evidence that resilience training affects depression, well-being or quality of life of healthcare students.
What are the reviews:
Citation: Berger W, Coutinho ES, Figueira I, et al. Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social psychiatry and psychiatric epidemiology. 2012 Jun 1;47(6):1001-11.
In this systematic review, the authors searched for studies that of PTSD in rescue workers, including hospital emergency and ambulance personnel. They did not restrict their searches by date, type or language of publication and did the search in September 2008. They included 28 articles.
Citation: Bohlken J, Schömig F, Lemke MR, et al. COVID-19 Pandemic: Stress Experience of Healthcare Workers-A Short Current Review. Psychiatrische Praxis. 2020 Apr 27;47(4):190-7.
In this rapid review, the authors searched for quantitative studies of the psychological stress caused by the COVID-19 pandemic among healthcare workers. They restricted their searches to articles published between January and March 2020 and did their most recent search on 12 April 2020. They included 14 studies.
Citation: Brooks SK, Dunn R, Amlôt R, et al. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. Journal of Occupational and Environmental Medicine 2018; 60(3): 248-57.
In this systematic review, the authors searched for studies of social and occupational factors associated with mental health outcomes for healthcare employees during an infectious disease outbreak. They restricted their search to articles published in English and did their search in 2015. They included 22 studies and listed considerations for protecting the mental health of healthcare workers during emerging infections.
Citation: Kisely S, Warren N, McMahon L, et al. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ. 2020 May 5;369:m1642.
In this rapid review, the authors searched for studies of the psychological impact on healthcare staff working with patients during an outbreak of an emerging virus. They did not restrict their searches by language of publication and did the search in late March 2020. They included 59 studies, covering SARS (37 studies), MERS (7), Ebola virus disease (3), COVID-19 (8) and H1N1 influenza (3) and H7N9 influenza (1).
Citation: Kunzler AM, Helmreich I, König J, et al. Psychological interventions to foster resilience in healthcare students. Cochrane Database of Systematic Reviews 2020;(7):CD013684.
In this Cochrane review, the authors searched for randomized trials of interventions to foster resilience in healthcare students. They did not restrict by language of publication and did the search in June 2019. They included 30 randomized trials (total: 2680 participants) from high-income countries (24 studies) and middle-income countries (6); and identified an additional 38 studies awaiting classification and 3 ongoing studies.
Citation: Pan R, Zhang L, Pan J. The Anxiety Status of Chinese Medical Workers During the Epidemic of COVID-19: A Meta-Analysis. Psychiatry Investigation. 2020 May;17(5):475.
In this rapid review, the authors searched for studies assessing anxiety in Chinese healthcare workers during the COVID-19 epidemic. They restricted their search to articles published between 2019 and 11 March 2020. They included 7 studies.
Citation: Spolverato G, Capelli G, Restivo A, Bao QR, Pucciarelli S, Pawlik TM, Gronchi A. The management of surgical patients during the COVID-19 pandemic. Surgery. 2020;168(1):4-10.
In this rapid review, the authors searched for research or opinion papers on the epidemiology and diagnosis of COVID-19, the management of cancer and surgical patients, and the safety of healthcare workers during the pandemic. They did not restrict by type or language of publication and searched for articles published between January 1998 and 2 April 2020. They included 28 studies.
Citation: Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian Journal of Psychiatry. 2020;51:102119.
In this rapid review, the authors searched for studies on mental health issues faced by healthcare workers during the COVID-19 pandemic. They did not restrict by type of study and searched for articles published between January and April 2020. They included 5 observational studies from China and a qualitative analysis from India.
Other reviews of this topic:
Citation: Kuhn CM, Flanagan EM. Self-care as a professional imperative: physician burnout, depression, and suicide. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2017 Feb 1;64(2):158-68.
Citation: Pappa S, Ntella V, Giannakas T, et al. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, behavior, and immunity. 2020;88:901-7.
Citation: Salazar de Pablo G, Serrano JV, Catalan A, et al. Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis. Journal of affective disorders. 2020 Jun;275:48-57.
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