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.
The Kisely review (search done in March 2020) 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; the Pan review (search done on 11 March 2020) reported marked increases in anxiety in healthcare workers in China during the COVID-19 pandemic and the Berger review (search done in September 2008) reported that rescue workers, including emergency department and ambulance staff, had a higher prevalence of PTSD.
The Spoorthy review (search up to April 2020) noted 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 review (search done in March 2020) found that healthcare workers who were younger, more junior or the parents of dependent children were more at risk of psychological distress, and that clear communication, access to adequate personal protection, adequate rest, and practical and psychological support were associated with lower psychological distress.
The authors of the Brooks review (search done in 2015) 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 healthcare workers during a crisis, potentially reducing feelings of social isolation.
The Pollock review (search done up to 28 May 2020) found only very low certainty evidence for interventions to improve the mental health of frontline workers. This included whether training frontline healthcare workers to deliver psychological first aid influenced burnout. Primary barriers to intervention implementation were frontline workers themselves or the organization they work in and lack of equipment, staff time or skills needed for intervention. Facilitators to intervention implementation were adapting interventions to local needs, implementing effective communication, and building a positive, safe, and supportive learning environment for frontline workers.
The Kunzler review (search done in June 2019) found very low certainty evidence that healthcare students who receive resilience training report higher levels of resilience, and lower levels of anxiety, stress, and stress perception compared to controls, immediately after training intervention.
The De Brier review (search up to 28 May 2020) found that clear communication and support from employers, social support, and a personal sense of control may be protective.
The Fernandez review (search done before 15 April 2020) found that nurses often expressed that they had been put through an ethical and moral dilemma in which they would have to choose between their patient and family responsibilities, leading to the social isolation of nurses through separation from their family and friends. Nurses were also more likely to experience fear, vulnerability and psychological distress in the face of a pandemic or epidemic; and often expressed feeling overwhelmed and a sense of powerlessness.
The Rohr review (search done on 30 March 2020) found that healthcare workers were more likely to experience negative psychosocial impacts of quarantine measures, particularly stigmatization.
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;47(6):1001-11.
In this systematic review, the authors searched for studies 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;47(4):190-7. Language: German
In this rapid review, the authors searched for quantitative studies of the psychological stress caused by the COVID-19 pandemic on 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 searches to articles published in English and did the search in 2015. They included 22 studies and listed considerations for protecting the mental health of healthcare workers during emerging infections.
Citation: De Brier N, Stroobants S, Vandekerckhove P, et al. Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS & COVID-19): A rapid systematic review. PloS ONE. 2020;15(12):e0244052.
In this rapid review, the authors searched for studies on risk factors and protective factors for psychological outcomes in healthcare workers during coronavirus epidemics. They restricted their searches to articles published in English and did the search up to 28 May 2020. They included 33 observational studies, done during the SARS outbreak (23 studies), current COVID-19 pandemic (7) and the MERS outbreak (3).
Citation: Fernandez R, Lord H, Halcomb E, et al. Implications for COVID-19: a systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic. International Journal of Nursing Studies. 2020;111:103637.
In this systematic review, the authors searched for qualitative research on the experiences of nurses working in acute hospital settings during a pandemic or epidemic. They restricted their searches to articles published in English but did not restrict their search by date or type of publication. They do not report the date of the search but the manuscript was submitted to the journal on 15 April 2020. They included 13 qualitative studies (348 nurses).
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;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), 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 their searches by language of publication and did the search in June 2019. They included 30 trials (2680 participants) from high-income countries (24 trials) and middle-income countries (6). They 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;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 searches to articles published between 2019 and 11 March 2020. They included 7 studies.
Citation: Pollock A, Campbell P, Cheyne J, et al. Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review. Cochrane Database of Systematic Reviews. 2020;(11):CD013799
In this Cochrane rapid review, the authors searched for studies of interventions aimed at supporting the resilience and mental health of frontline health and social care professionals. They restricted their searches to articles published between 2002 and 28 May 2020 but did not restrict their searches by language of publication. They included 16 studies related to professionals who had worked during outbreaks of SARS (2 studies), Ebola (9), MERS (1) and COVID-19 (4).
Citation: Röhr S, Müller F, Jung F, et al. Psychosocial Impact of Quarantine Measures During Serious Coronavirus Outbreaks: A Rapid Review. Psychiatrische Praxis. 2020;47(4):179-89. Language: English (Abstract), German
In this rapid review, the authors searched for studies of the psychosocial effects of quarantine and isolation related to the SARS and MERS outbreaks. The restricted their searches to articles published in English and German and did the search on 30 March 2020. They included 13 studies.
Citation: Spolverato G, Capelli G, Restivo A, et al. 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 their searches 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 their searches 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: Krishnamoorthy Y, Nagaraian R, Sava G, et al. Prevalence of psychological morbidities among general population, healthcare workers and COVID-19 patients amidst the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Research. 2020;293:113382
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;64(2):158-68.
Citation: Lasheras I, Gracia-García P, Lipnicki DM, et al. Prevalence of anxiety in medical students during the covid-19 pandemic: A rapid systematic review with meta-analysis. International journal of environmental research and public health. 2020;17(18):6603.
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: Paybast S, Baghalha F, Emami A, et al. The Anxiety Disorder Among the Healthcare Providers During The COVID-19 Infection Pandemic: A Systematic Review. International Clinical Neuroscience Journal. 2020;7(3):115-21.
Citation: Salazar de Pablo G, Serrano JV, 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;275:48-57.
Citation: Shaukat N, Ali DM, Razzak J. Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review. International Journal of Emergency Medicine. 2020;13:40.
Citation: Thapa B, Gita S, Chatterjee K, et al. Impact of COVID-19 on the mental health of the society & HCW (healthcare workers): a systematic review. International Journal of Science & Healthcare Research. 2020;5(2):234-40.
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