Anxiety (GAD-7)
Insomnia (ISI)
Health Related Quality of Life HrQoL (SF-12)
Abbreviations: Appendix B .
A summary of the cohort studies included in this review.
Study (Year)/Country | Disease Outbreak | Participants (Setting), Period of Assessment | Mental Health Outcome Measures (Instrument) | Main Findings |
---|---|---|---|---|
Lee et al. (2018) [ ] Korea | MERS-CoV Epidemic | N= 359 HCWs (Hospital) 6 Weeks | Distress (IES-R) | First survey: 64.1% PTSD-like symptoms, 51.5% PTSD Second survey (N = 77 from the high-risk group): 54.5% PTSD-like symptoms, 40.3% PTSD PTSD symptoms were higher in HCWs who performed MERS related tasks. |
Lung et al. (2009) [ ] Taiwan | SARS Epidemic | N = 127 HCWs (hospital) 8 months | Psychiatric morbidity (CHQ), Personality (EPQ) at the first stage and the CHQ again a year later | Initial assessment (shortly after the SARS epidemic was under control): 17.3% had psychiatric symptoms (CHQ > 3) At follow up (after 1 year): 15.4% had psychiatric symptoms (CHQ > 3) Stress was from job, families, and daily life events. A higher percentage of physicians (35%), compared to nurses (25%), developed psychiatric symptoms |
Lancee et al. (2008) [ ] Canada | SARS Epidemic | N = 139 103 nurses 15 clerical staff (hospital) One year | Distress (IES) Distress (K-10) Burnout (MBI) (SCID) (CAPS) | 30% Lifetime prevalence of psychiatric diagnosis 4% New episode major depression Incidence 2% New-onset PTSD incidence 5% New onset psychiatric disorder incidence New episodes associated with history of psychiatric disorder before the outbreak and less years of healthcare experience. New episodes inversely related to perceived adequacy of training |
McAlonan et al. (2007) [ ] Hong Kong | SARS Epidemic | Doctors, nurses, and healthcare assistants First sample 106 High risk vs. 70 low risk Follow up. 71 High Risk 113 Low Risk (Hospital) One year | First sample Stress (PSS-10) Follow up sample Depression, Anxiety and Stress (DASS-21) Post-traumatic stress (IES) (PSS-10) | 2003 peak of SARS outbreak PSS -10 scores for both groups were elevated but not significantly different from each other. High Risk (17.0) Low risk (15.9) 2004 Follow up. High Risk group remained highly stressed. High risk (18.56) Low risk (14.81) High-Risk group also had higher levels of depression, anxiety, and post-traumatic stress. |
Su et al. (2007) [ ] Taiwan | SARS Epidemic | N = 102 Nurses 70 SARS 32 Non-SARS (hospital) 7 Weeks | Depression (BDI) Anxiety (STAI) Post-traumatic Stress (DTS-C) Insomnia (PSQI) | Depression symptom ratings decreased as the SARS epidemic decreased regardless of which group (SARS vs. non-SARS unit nurses) was assessed. Anxiety symptoms decreased as a function of time. Fifty percent decrease in PTSD symptom scores at the end of the study for each group. After 7 weeks: Depression, insomnia, and stress was higher in SARS unit nurses vs. non-SARS unit nurses. Depression (38.5% vs. 3.1%) Insomnia (37% vs. 9.7%) Post-traumatic stress symptoms (33% vs. 18.7%) No differences in anxiety |
Abbreviations in table of results: Appendix B .
A more detailed assessment is available in Table 3 and Table 4 . All eligible studies were included in the review, regardless of their quality assessment results. Of the 71 cross-sectional studies, 42 papers (59%) were of very good quality, five papers (7%) were of good quality, 15 papers (21%) were of average quality, and nine papers (13%) were of poor quality. Of the five cohort studies, one paper was of very good quality, two papers were of good quality, one paper had average quality, and one was of poor quality.
Critical appraisal of cross-sectional studies.
Study | Johanna Briggs Institute Score | Were the Criteria for Inclusion in the Sample Clearly Defined? | Were the Study Subjects and the Setting Described in Detail? | Exposure Measured in a Valid and Reliable Way? | Objective, Standard Criteria Used for Measurement of the Condition? | Confounding Factors Identified? | Strategies to Deal with Confounding Factors Stated? | Outcomes Measured in a Valid and Reliable Way? | Appropriate Statistical Analysis Used? |
---|---|---|---|---|---|---|---|---|---|
Amerio et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Cai et al. (2020) | 5 | Y | Y | Y | Y | N | N | N | Y |
Chew et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Du et al. (2020) | 5 | N | Y | Y | Y | N | N | Y | Y |
Hacimusalar et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Hu et al. (2020) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Kang et al. (2020) | 7 | N | Y | Y | Y | Y | Y | Y | Y |
Lai et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Li et al. (2020) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Liang et al. (2020) | 5 | N | Y | Y | Y | N | N | Y | Y |
Liu et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Lu et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Mo et al. (2020) | 5 | Y | Y | Y | Y | Y | Y | Y | Y |
Qi et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Que et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Shechter et al. (2020) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Sun et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Tan et al. (2020) | 7 | N | Y | Y | Y | Y | Y | Y | Y |
Temsah et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Wang et al. (2020) | 7 | N | Y | Y | Y | Y | Y | Y | Y |
Wu et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Wu and Wei (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Xiao et al. (2020) | 7 | N | Y | Y | Y | Y | Y | Y | Y |
Xiaoming (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Xing et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Zhang et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Zhang et al. (2020) | 5 | N | Y | Y | Y | N | N | Y | Y |
Zhu et al. (2020) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Alsubaie et al. (2019) | 6 | N | Y | Y | N | Y | Y | Y | Y |
Park et al. (2018) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Oh, et al. (2017) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Tang et al. (2017) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Ji et al. (2017) | 6 | N | Y | Y | Y | N | N | Y | Y |
Bukhari et al. (2016) | 6 | N | Y | Y | Y | Y | N | Y | Y |
Khalid et al. (2016) | 5 | Y | Y | Y | Y | N | N | Y | N |
Kim et al. (2016) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Lehmann et al. (2016) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Li et al. (2015) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Mohammed (2015) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Liu et al. (2012) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Matsuishi et al. (2012) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Goulia et al. (2010) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Wu et al. (2009) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Styra et al. (2008) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Wu et al. (2008) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Chen (2007) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Lin et al. (2007) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Marjanovic et al. (2007) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Chen et al. (2006) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Fiksenbaum et al. (2006) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Maunder et al. (2006) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Chan et al. (2005) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Cheng et al. (2005) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Grace et al. (2005) | 5 | Y | Y | Y | N | N | N | Y | Y |
Ho et al. (2005) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Koh et al. (2005) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Lee et al. (2005) | 5 | N | Y | Y | Y | N | N | Y | Y |
Phua et al. (2005) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Tham et al. (2005) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Wong et al. (2005) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Bai et al. (2004) | 6 | N | Y | Y | Y | Y | Y | N | Y |
Chan et al. (2004) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Chong et al. (2004) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Chua et al. (2004) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Nickell et al. (2004) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Poon et al. (2004) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Sim et al. (2004) | 7 | N | Y | Y | Y | Y | Y | Y | Y |
Sin.S.S. and Huak C.Y (2004) | 6 | Y | Y | Y | Y | N | N | Y | Y |
Tam et al. (2004) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Verma et al. (2004) | 8 | Y | Y | Y | Y | Y | Y | Y | Y |
Wong et al. (2004) | 5 | Y | Y | Y | Y | N | N | N | Y |
Critical appraisal of cohort studies.
Study | Johanna Briggs Institute Score | Were the Criteria for Inclusion in the Sample Clearly Defined? | Were the Study Subjects and the Setting Described in Detail? | Exposure Measured in a Valid and Reliable Way? | Objective, Standard Criteria Used for Measurement of the Condition? | Confounding Factors Identified? | Strategies to Deal with Confounding Factors Stated? | Outcomes Measured in a Valid and Reliable Way? | Appropriate Statistical Analysis Used? | Was the Follow Up Time Reported and Sufficient to Be Long Enough for Outcomes to Occur? | Was Follow Up Complete, and If Not, Were the Reasons to Loss to Follow Up Described and Explored? | Were Strategies to Address Incomplete Follow-Up Utilized? |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Lee et al. (2018) | 7 | Y | Y | Y | Y | N | N | Y | Y | Y | N | N |
Lung et al. (2009) | 8 | N | N | Y | Y | Y | Y | Y | Y | Y | Y | N/A |
Lancee et al. (2008) | 9 | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | N |
McAlonan et al. (2007) | 9 | Y | Y | Y | Y | Y | Y | Y | Y | Y | N | N |
Su T.P. (2007) | 10 | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | N/A |
The Impact of Events Scale (IES) and the Perceived Stress Scale (PSS) were the most common instruments used to measure stress. The Generalized Anxiety Disorder (GAD) and the Zung Self-Rating Anxiety Scale (SAS) were frequently used instruments to measure anxiety. Commonly used instruments to measure depression were the Patient Health Questionnaire (PHQ) and the Zung Self-Rating Depression Scale. Insomnia was often measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). Most studies which measured burnout used the Maslach’s Burnout Inventory.
3.5.1. stress.
Stress was the most commonly measured mental health symptom. Any one of acute stress, distress, or post-traumatic stress symptoms was examined in forty-two studies [ 4 , 24 , 25 , 26 , 29 , 30 , 35 , 38 , 40 , 44 , 45 , 49 , 52 , 53 , 54 , 56 , 57 , 58 , 60 , 62 , 63 , 64 , 73 , 74 , 75 , 76 , 78 , 80 , 81 , 82 , 83 , 84 , 86 , 87 , 89 , 90 , 91 , 92 , 95 , 96 , 97 ]. The prevalence of stress varied, and it ranged from 5% to 80%. Ten studies identified that nurses experienced more distress compared to doctors [ 30 , 38 , 54 , 63 , 64 , 80 , 81 , 82 , 87 , 91 ]. HCWs providing direct care to confirmed cases of SARS and COVID 19 were more likely to be distressed compared to those who did not provide direct care [ 30 , 45 , 53 , 58 , 63 , 76 , 78 , 91 , 92 ]. Moving from a low risk ward to work in a high risk ward [ 75 ], more working time per week [ 35 ], frequent changes in infection control measures and protocols [ 79 ], seeing a colleague getting sick, being intubated or dying increased stress [ 57 ] while those who received adequate social support were least likely to have PTSD [ 90 ]. Having been in quarantine during the outbreak was associated with high levels of PTSD [ 4 , 62 , 83 ]. Availability of adequate PPE significantly reduced stress [ 38 , 49 , 90 ].
Anxiety and fear symptoms were examined in 29 studies [ 23 , 25 , 26 , 27 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 36 , 37 , 40 , 41 , 42 , 44 , 45 , 46 , 48 , 50 , 51 , 59 , 64 , 68 , 88 , 93 , 96 , 97 ]. The prevalence of anxiety varied and ranged from 7% to 78% across all virus exposures. Nine studies found that HCWs who had contact with confirmed cases had more anxiety compared to HCWs who had had no contact with confirmed cases [ 27 , 30 , 33 , 34 , 37 , 44 , 88 , 97 ]. A common cause of anxiety was worrying about transmitting infection to family members [ 41 , 51 , 88 ]. Nurses had higher anxiety scores compared to doctors [ 27 , 30 , 35 , 37 , 38 , 50 , 88 ]. Female healthcare workers were more likely to have anxiety compared to males [ 26 , 27 , 30 , 45 , 46 , 48 , 56 , 88 ]. Three studies from China compared anxiety levels of HCWs in Wuhan to those of HCWs in the outreach or other regions and found that HCWs in Wuhan, which was the epicenter of COVID-19 at that time, had significantly higher anxiety compared to HCWs in other regions of China [ 26 , 30 , 33 ]. Similar results were found in Canada were HCWs in Toronto who had more contact with SARS patients had higher levels of burnout and distress compared to HCWs in Hamilton where they had fewer confirmed cases [ 73 ]. Fear and anxiety were significantly increased when a colleague became infected or died. Anxiety and fear of infection were inversely related to availability of hospital resources, HCWs’ resilience and support from family and friends [ 26 , 28 ]. The increase in working hours during a disease outbreak was directly related to anxiety levels [ 27 , 35 ]. Lack of knowledge of the virus was also associated with an increase in anxiety [ 59 ].
Symptoms of depression were examined in 25 studies [ 23 , 25 , 26 , 28 , 29 , 30 , 32 , 34 , 36 , 37 , 38 , 40 , 42 , 44 , 45 , 46 , 48 , 49 , 50 , 59 , 62 , 67 , 71 , 96 , 97 ]. The prevalence of depression ranged from 8.9% and 74.2%. Five studies showed that depression was higher in females compared to males [ 30 , 45 , 46 , 49 , 50 ]. The frontline medical staff working in the respiratory, emergency, ICU, and infectious disease departments were twice more likely to suffer from depression than the non-clinical staff [ 30 , 34 , 44 ]. Nurses working in SARS units were more depressed than nurses in non-SARS units [ 97 ]. The HCWs in Wuhan, which was the epicenter of the COVID-19 pandemic, had higher levels of depression compared to HCWs outside Hubei province [ 26 , 30 ]. Increased working hours were associated with elevated depression and hopelessness [ 27 , 35 ]. Having a past exposure to traumatic events or pre-existing psychiatric disorder before the epidemic was associated with high levels of depressive symptoms [ 62 , 95 ]. Those HCWs with a marital status of being single were more likely than married HCWs to have high levels of depressive symptoms [ 46 , 62 ]. A history of being quarantined was associated with higher levels of depression [ 62 ]. Support from family and friends [ 26 , 28 , 34 ], psychological preparedness, altruistic acceptance, and perceived efficacy of dealing with the pandemic was associated with lower levels of depression [ 46 , 62 ].
Insomnia and sleep quality was assessed in 11 studies [ 23 , 29 , 30 , 36 , 37 , 38 , 42 , 44 , 48 , 71 , 97 ]. All 11 studies reported substantial sleep problems, ranging from 26% to 45%. Insomnia was independently associated with depression and anxiety [ 23 , 42 ]. In three studies, insomnia symptoms were higher in frontline HCWs compared to second line workers [ 30 , 36 , 37 , 42 ]. Nurses reported more sleep problems compared to other HCWs [ 30 , 37 , 38 ], and nurses working in SARS units were more likely to have insomnia compared to nurses working in non-SARS units [ 97 ]. HCWs in Wuhan reported more insomnia symptoms compared to healthcare workers in other areas out of Hubei province [ 30 ].
Burnout (emotional exhaustion) was assessed in eight studies, and they all confirmed high levels of burnout in HCWs [ 28 , 43 , 58 , 70 , 72 , 73 , 88 , 96 ]. HCWs who worked in the frontline or had contact with confirmed cases were more likely to be emotionally exhausted compared to HCWs who were not in the frontline and who had no direct contact with confirmed cases [ 70 , 72 , 73 , 88 ], while one study reported different results in that front-line HCWs had lower levels of burnout compared to other HCWs. The possible explanation given by the researchers for this unexpected trend was front-line HCWs had received timely and accurate information hence they had a higher sense of control of their situation [ 43 ]. Two studies showed that HCWs who had spent more time in quarantine had higher levels of burnout [ 70 ]. Lower levels of organizational support, job stress and poor hospital resources, were directly related to emotional exhaustion [ 58 , 70 , 72 ]. Burnout was negatively correlated to self-efficacy, resilience and family support [ 28 ]. High anxiety scores predicted high levels of burnout [ 88 ].
Five studies examined stigma and in all studies, HCWs had been stigmatized either by their family or by the community or both [ 52 , 76 , 78 , 83 , 92 ]. The prevalence of stigma in HCWs ranged from 20% to 49%. HCWs who were working in direct contact with confirmed cases and those who had been quarantined experienced higher levels of stigma [ 76 , 92 ]. One study which compared psychological morbidity of stigma between general practitioners and Chinese traditional practitioners found that general practitioners had more exposure to SARS patients and suffered more stigma than the Chinese traditional practitioners [ 92 ]
This review showed that epidemics and pandemics have a negative impact on the psychological wellbeing of HCWs by the wide range of mental health symptoms, in particular stress, depression, anxiety, insomnia, fear, stigma, and emotional exhaustion.
This review identified common factors that increased the risk of mental health symptoms. Frontline HCWs working in high risk environments where they had direct contact with suspected and confirmed cases of SARS and COVID 19 reported more psychological symptoms compared to non-frontline HCWs working in low risk environments [ 30 , 31 , 34 , 36 , 37 , 43 , 44 , 45 , 48 , 53 , 58 , 63 , 65 , 66 , 69 , 73 , 75 , 76 , 85 , 91 , 92 , 96 ]. Working in direct contact with infectious patients was associated with higher levels of symptoms of anxiety, stress, insomnia, and depression due to the increased fear of contracting infection, greater concern of infecting family members, stigmatization, and isolation [ 34 , 54 , 72 , 88 ]. This might explain why nurses were found to be more stressed, anxious, depressed, and had poorer sleep quality compared to doctors. Most studies explained this to be due to the higher workload that nurses have and the more time they spend in direct contact with patients whilst nursing them [ 27 , 30 , 37 , 38 , 41 , 50 , 54 , 63 , 72 , 76 , 80 , 81 , 82 , 87 , 88 , 91 ]. HCWs in the epicenter of a pandemic experienced more psychological distress compared to HCWs in other regions due to the higher exposure to infectious patients [ 26 , 30 , 33 , 73 ]. Another occupational risk factor identified was the extent of healthcare experience that a HCW had. HCWs with less work experience were more likely to be stressed compared to HCWs with more years of work experience. Less experienced HCWs have less knowledge, skills, and are less able to self-regulate, thus they get stressed more easily compared to more experienced HCWs who have more knowledge and skills, and are thus more able to adapt [ 53 , 54 , 96 ].
Inadequate hospital equipment and the limited supply of personal protective equipment (PPE) were also associated with higher levels of psychological symptoms [ 23 , 34 , 38 , 58 ]. Being of female gender was also identified as a risk factor [ 27 , 29 , 30 , 38 , 39 , 45 , 48 , 49 , 50 , 54 , 56 , 62 , 81 , 85 , 91 ]. A history of exposure to other traumatic events before an t outbreak increased the risk of re-occurrence of a psychiatric disorder [ 62 , 95 ]. Having a high perceived risk of infection and low self-efficacy were also identified as risk factors associated with mental health symptoms [ 49 , 56 , 62 , 74 , 87 ]. HCWs who were unconfident about beating the outbreak [ 49 , 56 , 62 , 74 , 87 ] were more depressed and had a poor mental state compared to HCWs who were more confident and resilient [ 28 , 77 ]. Lack of knowledge of the virus and lack of outbreak management training was associated with low perceived self-efficacy. Constantly changing infection control measures and documentation processes also reduced self-efficacy and caused an increase in stress levels [ 45 ]. Having been quarantined was identified as a risk factor of depressive and post-traumatic stress symptoms. This was attributed to the increased fear of dying from the disease. Quarantining was associated with increased levels of fear and stress in HCWs due to the emotional isolation and loneliness experienced during quarantine [ 39 , 62 , 65 , 67 , 70 , 77 , 83 ].
Despite the limited number of cohort studies compared to cross sectional studies, the cohort studies conducted during the SARS epidemic confirmed the persistence of mental health symptoms up to a year after the pandemic has ended.
Protective factors identified in this systematic review include adequate information, clear guidelines, training and organizational support [ 24 , 43 , 70 , 71 , 72 , 78 , 79 , 95 ], altruistic acceptance of risk, [ 62 , 65 ], availability of specialized equipment for treating patients, adequate personal protective equipment [ 49 , 57 , 74 , 78 , 90 ], having more years of healthcare experience [ 95 ], adequate time off work [ 68 ], and support from family and friends [ 71 , 90 ].
The strengths of this review are, first, that it identified a large number of studies conducted during and after the epidemics and pandemics that have occurred in the past twenty years, including the current COVID-19 pandemic. Second, results are generalizable as the included studies were from Asia, Europe, Africa, Middle East, and America. Third, most papers included in this review used standardized and previously validated instruments for measuring mental health symptoms. However, a potential limitation is that we only included published articles and excluded gray literature, which might have caused some publication bias. Another limitation is that there were only five cohort studies, 94% of the studies included were cross-sectional which implies that no causal inferences can be drawn. Furthermore, meta-analyses were not undertaken because of the methodological heterogeneity of the studies.
It is important to conduct more cohort studies to obtain a detailed picture of mental health symptoms at the different points of a disease outbreak, and to understand the long-term mental health impact of a pandemic or epidemic among HCWs.
The possible role of occupation and exposure on mental health needs to be examined further in future studies. While many studies have reported higher levels of mental health problems among female HCWs, it is still unclear whether gender is a sole influencing factor, or if gender is being confounded by other factors. For instance, most of the female HCWs were nurses, and nurses experience higher mental health problems due to their increased exposure and nature of work. Besides, previous studies have shown that nurses and doctors working in the emergency department and intensive care units are at a higher risk of burnout, depression, and job stress compared to their colleagues working in other hospital departments [ 98 , 99 , 100 ]. Therefore, future studies need to rule out these aspects, while determining the effects of a pandemic or epidemic on mental health.
Increasing age, and prior chronic medical conditions make a person more susceptible to the effects of a pandemic. Therefore, in future studies, it is important to address the association between these factors and mental health outcome.
Many studies used online platforms for data collection, and this method is known to increase the risk of sampling and response bias [ 101 ]. However, we consider this method as appropriate for the current studies as face-to-face data collection was not possible due to social distancing guidelines.
As this review identified many protective factors including adequate information about the pandemic, clear guidelines and training, social support, availability of specialized equipment for treating patients, adequate personal protective equipment, adequate time off work, may be provided to the HCWs for reducing adverse mental health outcome.
This systematic review provides a comprehensive narrative synthesis of the underlying negative impacts of epidemics and pandemics on the mental health of HCWs which include acute stress, post-traumatic stress disorders, severe depression, anxiety, burnout, insomnia, and stigmatization. It is apparent from this review that the current healthcare systems and many governments across the globe need to prioritize mobilizing resources to provide sufficient and necessary psychological support to HCWs during and after epidemics and pandemics.
The search was performed from May 2020 to end-June 2020. An English language limit was applied. No restrictions were placed on the publication date and location of study. The search terms were grouped into three categories:
Category 1: Population (“healthcare professional”, “healthcare workers”, physician, doctor, nurse)
Category 2: Exposure (epidemic, pandemic)
Category 3: Outcomes (“mental health”, “mental disorder”, psychological, depression, anxiety, stress, burden, insomnia, “sleep disturbance”, burnout, fear, stigma, discrimination).
Mesh terms and synonyms of the keywords were identified and used in the search.
PubMed Search.
Search | Query | Items Found |
---|---|---|
#1 | (“health personnel” OR “ healthcare provider*” OR “healthcare worker*” OR “healthcare personnel” OR “ healthcare professional*” OR “healthcare staff” OR doctor OR physician OR “physician assistant*” OR nurse OR “healthcare assistant*” OR “allied health*” OR clinician OR “hospital worker*” OR “hospital staff” OR “hospital employee*”) | 1,923,975 |
#2 | (epidemic* OR pandemic* OR SARS OR “severe acute respiratory syndrome” OR coronavirus OR MERS OR “middle east respiratory syndrome” OR MERS-CoV OR Ebola OR EVD OR H1N1 OR “influenza type A virus” OR H7N9 OR covid-19 OR 2019-nCoV OR SARS-COV-2 OR “2019 novel coronavirus”) | 220,091 |
#3 | mental* OR psychiatric* OR psychological* OR resilience OR depression OR emotio* OR anxiety* OR nervous* OR stress* OR PTSD OR “post-traumatic stress disorder” OR insomnia OR “sleep disorder” OR DIMS OR “ disorder of initiating and maintaining sleep” OR burnout OR exhaustion OR fear OR panic OR stigma* OR discrimination OR “mental health” | 3,376,683 |
#4 | #1 AND #2 AND #3 | 3311 |
PsycArticles Search.
Search | Query | Items Found |
---|---|---|
#1 | (“health personnel” OR “ healthcare provider*” OR “healthcare worker*” OR “healthcare personnel” OR “ healthcare professional*” OR “healthcare staff” OR doctor OR physician OR “physician assistant*” OR nurse OR “healthcare assistant*” OR “allied health*” OR clinician OR “hospital worker*” OR “hospital staff” OR “hospital employee*”) | 17,759 |
#2 | (epidemic* OR pandemic* OR SARS OR “severe acute respiratory syndrome” OR coronavirus OR MERS OR “middle east respiratory syndrome” OR MERS-CoV OR Ebola OR EVD OR H1N1 OR “influenza type A virus” OR H7N9 OR covid-19 OR 2019-nCoV OR SARS-COV-2 OR “2019 novel coronavirus”) | 932 |
#3 | mental* OR psychiatric* OR psychological* OR resilience OR depression OR emotio* OR anxiety* OR nervous* OR stress* OR PTSD OR “post-traumatic stress disorder” OR insomnia OR “sleep disorder” OR DIMS OR “ disorder of initiating and maintaining sleep” OR burnout OR exhaustion OR fear OR panic OR stigma* OR discrimination OR “mental health” | 158,189 |
#4 | #1 AND #2 AND #3 | 117 |
PsycInfo Search.
#1 | (“health personnel” OR “ healthcare provider*” OR “healthcare worker*” OR “healthcare personnel” OR “ healthcare professional*” OR “healthcare staff” OR doctor OR physician OR “physician assistant*” OR nurse OR “healthcare assistant*” OR “allied health*” OR clinician OR “hospital worker*” OR “hospital staff” OR “hospital employee*”) | 344,711 |
#2 | epidemic* OR pandemic* OR SARS OR “severe acute respiratory syndrome” OR coronavirus OR MERS OR “middle east respiratory syndrome” OR MERS-CoV OR Ebola OR EVD OR H1N1 OR “influenza type A virus” OR H7N9 OR covid-19 OR 2019-nCoV OR SARS-COV-2 OR “2019 novel coronavirus” | 41,531 |
#3 | mental* OR psychiatric* OR psychological* OR resilience OR depression OR emotio* OR anxiety* OR nervous* OR stress* OR PTSD OR “post-traumatic stress disorder” OR insomnia OR “sleep disorder” OR DIMS OR “ disorder of initiating and maintaining sleep” OR burnout OR exhaustion OR fear OR panic OR stigma* OR discrimination OR “mental health” | 2,335,979 |
#4 | #1 AND #2 AND #3 | 2288 |
AIS Athens Insomnia Scale, BAI Beck Anxiety Inventory, BDI-II Beck Depression Inventory II, BHS Beck Hopelessness Scale, CAPS Clinician-Administered PTSD Scale, CES-D Centre for Epidemiologic Studies Depression Scale, CHQ Chinese health Questionnaire, CHQ-12 Chinese Health Questionnaire-12, COPE Coping Orientation to Problems Experienced, DASS-21 Depression, Anxiety and Stress Scale-21, DRS-15 Dispositional Resilience Scale-15, DTS-C Davidson Trauma Scale-Chinese version, ECR-R Experiences in Close Relationships-Revised, EPQ Eysenck Personality Questionnaire, FS-HPs Fear Scale for Healthcare Professionals, GAD-7 Generalized Anxiety Disorder-7, GHQ-28 General health Questionnaire -28, HAM-A Hamilton Anxiety Score, HAMD Hamilton Depression Scale, HADS Hospital Anxiety and Depression Scale, IES-R Impact Events Scale Revised, ISI -7 Insomnia severity index-7, K-10 Kessler Psychological Distress Scale-10, K-6 Kessler Psychological Distress Scale-6, MBI Maslach Burnout Inventory, MOS SF-36 Medical Outcome Study Short-Form 36 Survey, NHSDA National Household Survey on Drug Abuse, NRS Numeric Rating Scale, OLBI Oldenburg Burnout Inventory, OSSS Oslo Social Support Scale, PCL-C PTSD Checklist-Civilian Version, PC-PTSD Primary Care PTSD screen, PHQ-12 Patient Health Questionnaire-12, PHQ-9 Patient Health Questionnaire-9, PSDI Positive Symptom Distress Index, PSQI Pittsburgh Sleep Quality Index, PSS Perceived Stress Scale, PSS-10 perceived stress scale-10, SARS NSQ SARS Nurses’ Survey Questionnaire, SAS Self-Rating Anxiety Scale, SCID Structured Clinical Interview for DSM-IV, SCL-90 The 90-item symptom checklist, SCSQ Simplified coping style questionnaire, SDS Self-Rating Depression Scale, SES Self-Efficacy Scale, SF-12 Short Form Health Survey-12, SF-36 Short Form Health Survey-36, SFS SARS Fear Scale, SRSR SARS-Related Stress Reactions questionnaire, SSI Suicidal and self-harm ideation, SOS Stress Overload Scale, SPOS Survey of Perceived Organizational Support, SRQ-20 WHO Self-Reporting Questionnaire, STAI The State-Trait Anxiety Inventory, STAXI State-Trait Anger Expression Inventory, TCSQ Trait Coping Style Questionnaire, VAS Visual Analogue Scale, WCQ Ways of Coping Questionnaire, HCW Health Care Worker, HR High Risk, LR Low Risk SL Sierra Leonne, FMW Frontline Medical Workers, GP General Practitioner, TCM Traditional Chinese medicine, SARS Severe Acute Respiratory Syndrome, MERS-CoV Middle East Respiratory Syndrome Coronavirus, COVID Coronavirus Disease A/H1N1 Influenza A Subtype H1N1, EBV Ebolavirus Disease, HCA Healthcare Assistant, FL Frontline, UW Usual wards, PPE Personal protective equipment, PTSD Post-Traumatic Stress Disorder.
Conceptualization, O.C.C., A.S., Z.K. and E.A. Database search, O.C.C. Screening abstracts for relevance, O.C.C. Checked the relevant studies for eligibility and extracted data from the eligible studies onto a standard Microsoft Excel data extraction form, O.C.C. Independently verified the eligibility of the included studies, A.S. Discrepancies were resolved by discussion, O.C.C., A.S. and Z.K. Critical Appraisal of studies O.C.C., A.S. Data analysis and synthesis O.C.C. Writing—original draft preparation, O.C.C.; writing—review and editing, O.C.C., A.S., Z.K. and E.A.; Visualization, O.C.C., A.S., Z.K. and E.A.; Supervision, A.S., Z.K. and E.A. All authors have read and agreed to the published version of the manuscript.
This research received no external funding.
Not applicable.
Data availability statement, conflicts of interest.
The authors declare no conflict of interest.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Title: | Effect of yogic practice core strength training and combined training on selected muscular performance mental skill measure and hematological variables among university female students |
Researcher: | Archana mani malathi, S |
Guide(s): | |
Keywords: | Clinical Pre Clinical and Health Physical Education Sport Sciences |
University: | Alagappa University |
Completed Date: | 2019 |
Abstract: | newline |
Pagination: | |
URI: | |
Appears in Departments: | |
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Shodhganga. The Shodhganga@INFLIBNET Centre provides a platform for research students to deposit their Ph.D. theses and make it available to the entire scholarly community in open access. Shodhganga@INFLIBNET. International Institute for Population Sciences IIPS. Department of Public Health and Mortality Studies.
Shodhganga: a reservoir of Indian theses @ INFLIBNET ... Mental Health Battery by A. K. Singh and Alpana Sen Gupta (2000), WHO s Quality of Life scale - BREF (WHOQOL - BREF) and the Adolescent Coping Scale by Frydenberg and Lewis (1993) were used to gather the research data. The variables were assessed on phases of adolescence, gender, mothers ...
Shodhganga: a reservoir of Indian theses @ INFLIBNET The Shodhganga@INFLIBNET Centre provides a platform for research students to deposit their Ph.D. theses and make it available to the entire scholarly community in open access. ... Mental health status and counselling of children in conflict with the law: Kalpana Purushothaman: Tripathi, S.K.
VDOM DHTML PE html>. Shodhganga : a reservoir of Indian theses @ INFLIBNET.
Shodhganga is a digital repository of Indian Electronic Theses and Dissertations. Shodhganga stands for the reservoir of Indian intellectual output stored in a repository set-up and maintained by the INFLIBNET Centre. Click on the link to access Shodhganga: ... Mental health and well-being ; IPR Guidelines; CURAJ Documentary; CURAJ Alumni Network;
The major goal is to determine the relationship between smartphone addiction and mental health problems (poor sleep, loneliness, stress, depression, anxiety) among adolescents in systematic manner ...
Bibliography p.348- 359, Appendix p.360- 401. Shodhganga: a reservoir of Indian theses @ INFLIBNET The Shodhganga@INFLIBNET Centre provides a platform for research students to deposit their Ph.D. theses and make it available to the entire scholarly community in open access.
The aim of this research is to identify any existing correlations between the COVID-19. pandemic and negative mental health outcomes in younger populations. This paper examines the. impact of the COVID-19 pandemic on the mental health of those younger than 25 years of age, specifically focusing on students.
Common mental health symptoms identified by this review were acute stress disorder, depression, anxiety, insomnia, burnout, and post-traumatic stress disorder. The associated risk factors were working in high-risk environments (frontline), being female, being a nurse, lack of adequate personal protective equipment, longer shifts, lack of ...
The ICMR-Department of Health Research (DHR) in association with the ... Medical Shodhganga, a thesis topics repository of Indian Medical Postgraduate theses to help prospective postgraduates in case of difficulties encountered while selecting thesis topics. The thesis topics included in the repository were solicited from the selected ...
Shodhganga : a reservoir of Indian theses @ INFLIBNET; SWAYAM PRABHA, Free DTH Channel for Education, MHRD, GoI; Open Source Digital Library; National Digital Library; Education for Health - Journal; MUHS Health Sciences Review; Podcast on Preventive Cardiology by MUHS Chair of preventive cardiology powered by Madhavbaug Institute of Preventive ...
Mental Health Thesis Shodhganga These kinds of 'my essay writing' require a strong stance to be taken upon and establish arguments that would be in favor of the position taken. Also, these arguments must be backed up and our writers know exactly how such writing can be efficiently pulled off.
Shodhganga: a reservoir of Indian theses @ INFLIBNET ... Effectiveness of comprehensive health literacy and relaxing music CHARM intervention on perinatal mental health and birth outcomes among low risk primigravid women and neonatal dyads in a tertiary referral hospital Udupi district Karnataka A randomized controlled trial:
RESOURCES — PINELLAS COUNTY. Information and Resource. National Alliance on Mental Illness—NAMI Pinellas. Help Line 727-791-3434 (this is not a crisis line) Tampa Bay Cares. 2-1-1. To access up-to-date information about all community resources, call 2-1-1. Suicide/Emergency Hotline-Pinellas County. 727-791-3131.
Thank you to our community supporters. NAMI Pinellas County specifically wants to thank Central Florida Behavioral Health Network, the Florida Department of Children and Families, System of Care (SOC), NAMI and NAMI Florida for their generous and ongoing support.. Investing in mental health benefits us all. We could not accomplish our goals without the support, involvement and enthusiasm of ...
The Shodhganga@INFLIBNET Centre provides a platform for research students to deposit their Ph.D. theses and make it available to the entire scholarly community in open access. Shodhganga@INFLIBNET. Pt. Ravishankar Shukla University.
Diagnosis and treatment modalities include: looking for biological causes of mental health symptoms such as nutritional deficiencies and environmental influences via laboratory testing ...
Shodhganga: a reservoir of Indian theses @ INFLIBNET The Shodhganga@INFLIBNET Centre provides a platform for research students to deposit their Ph.D. theses and make it available to the entire scholarly community in open access. ... Relationship of self esteem self confidence ego strength mental toughness hope and shyness with academic and ...
Brian F Lann. Counselor, LPC, LPC/S, LAC. An ideal client in my perspective is someone presenting to therapy who endorses a reasonable level of self-awareness and openness to explore ineffective ...
Shodhganga : a reservoir of Indian theses @ INFLIBNET. Shodhganga. The Shodhganga@INFLIBNET Centre provides a platform for research students to deposit their Ph.D. theses and make it available to the entire scholarly community in open access. Shodhganga@INFLIBNET.
Shodhganga: a reservoir of Indian theses @ INFLIBNET The Shodhganga@INFLIBNET Centre provides a platform for research students to deposit their Ph.D. theses and make it available to the entire scholarly community in open access. ... New Approaches in Data Driven Structural Health Monitoring: Researcher: Agrawal, Anand Kumar: Guide(s ...
Shodhganga: a reservoir of Indian theses @ INFLIBNET ... Health as A Human Right in International Law: Researcher: Kumar, Avanish: Guide(s): Verma, D P: Keywords: Health Human rights Law Law--International Social Sciences Social Sciences General: University: Banaras Hindu University:
Shodhganga: a reservoir of Indian theses ... Effect of yogic practice core strength training and combined training on selected muscular performance mental skill measure and hematological variables among university female students ... Archana mani malathi, S: Guide(s): Sundar, M: Keywords: Clinical Pre Clinical and Health Physical Education ...