Background Healthcare workers across the world have risen to the demands of treating COVID-19 patients, potentially at significant cost to their own health and wellbeing. There has been increasing recognition of the potential mental health impact of COVID-19 on frontline workers and calls to provide psychosocial support for them. However, little attention has so far been paid to understanding the impact of working on a pandemic from healthcare workers’ own perspectives or what their views are about support. Methods We searched key healthcare databases (Medline, PsychINFO and PubMed) from inception to September 28, 2020. We also reviewed relevant grey literature, screened pre-print servers and hand searched reference lists of key texts for all published accounts of healthcare workers’ experiences of working on the frontline and views about support during COVID-19 and previous pandemics/epidemics. We conducted a meta-synthesis of all qualitative results to synthesise findings and develop an overarching set of themes and sub-themes which captured the experiences and views of frontline healthcare workers across the studies. Results This review identified 46 qualitative studies which explored healthcare workers’ experiences and views from pandemics or epidemics including and prior to COVID-19. Meta-synthesis derived eight key themes which largely transcended temporal and geographical boundaries. Participants across all the studies were deeply concerned about their own and/or others’ physical safety. This was greatest in the early phases of pandemics and exacerbated by inadequate Personal Protective Equipment (PPE), insufficient resources, and inconsistent information. Workers struggled with high workloads and long shifts and desired adequate rest and recovery. Many experienced stigma. Healthcare workers’ relationships with families, colleagues, organisations, media and the wider public were complicated and could be experienced concomitantly as sources of support but also sources of stress. Conclusions The experiences of healthcare workers during the COVID-19 pandemic are not unprecedented; the themes that arose from previous pandemics and epidemics were remarkably resonant with what we are hearing about the impact of COVID-19 globally today. We have an opportunity to learn from the lessons of previous crises, mitigate the negative mental health impact of COVID-19 and support the longer-term wellbeing of the healthcare workforce worldwide.

Background: The empirical literature of network analysis studies of posttraumatic stress symptoms (PTSS) has grown rapidly over the last years. Objective: We aimed to assess the characteristics of these studies, and if possible, the most and least central symptoms and the strongest edges in the networks of PTSS. Method: The present systematic review, conducted in PsycInfo, Medline, and Web of Science, synthesizes findings from 20 cross-sectional PTSS network studies that were accepted for publication between January 2010 and November 2018 (PROSPERO ID: CRD42018112825). Results: Results indicated that the network studies investigated a broad range of samples and that most studies used similar analytic approaches including stability analysis. Only strength centrality was generally adequately stable. Amnesia was consistently reported to have lowest strength, while there was substantial heterogeneity regarding which nodes had highest strength centrality. The strongest edge weights were typically within each DSM-IV/DSM-5 PTSD symptom cluster. Conclusions: Hypothesis-driven studies are needed to determine whether the heterogeneity in networks resulted from differences in samples or whether they are the product of underlying methodological reasons.El enfoque de redes para el trastorno de estrés postraumático: Una revisión sistemática Antecedentes: La literatura empírica los estudios de análisis en redes de síntomas de estrés postraumático (SEPT) ha crecido rápidamente en los últimos años. Objetivos: Nuestro objetivo fue el evaluar las características de estos estudios y, de ser posible, evaluar cuáles eran aquellos síntomas más cardinales y cuáles no, y cuáles eran los enlaces más fuertes en las redes de los SEPT. Métodos: La presente revisión sistemática, realizada en PsycInfo, Medline, y Web of Science, sintetiza los hallazgos de 20 estudios transversales en redes sobre SEPT que se basaron sobre información transversal, y que fueron aceptados para publicación entre enero de 2010 y noviembre de 2018 (PROSPERO ID: CRD42018112825). Resultados: Los resultados indicaron que los estudios en redes investigaron un amplio rango de muestras, y que la mayoría de estudios emplearon enfoques analíticos similares, incluyendo el análisis de estabilidad. Solo la centralidad de la fuerza fue generalmente adecuadamente estable. Se informó consistentemente que la amnesia tenía la fuerza más baja, mientras que había una heterogeneidad sustancial con respecto a qué nodos tenían la centralidad de la fuerza más alta. Los pesos de los enlaces de red más fuertes se encontraban, por lo general, dentro de cada racimo de síntomas para trastorno de estrés postraumático contemplados en el DSM IV/DSM 5. Conclusiones: Se necesitan estudios derivados de hipótesis para determinar si la heterogeneidad de las redes resultó de las diferencias en las muestras, o si resultaron del producto de cuestiones metodológicas subyacentes.

Background: Studies have shown that working in frontline healthcare roles during epidemics and pandemics was associated with PTSD, depression, anxiety, and other mental health disorders. Objectives: The objectives of this study were to identify demographic, work-related and other predictors for clinically significant PTSD, depression, and anxiety during the COVID-19 pandemic in UK frontline health and social care workers (HSCWs), and to compare rates of distress across different groups of HCSWs working in different roles and settings. Methods: A convenience sample (n = 1194) of frontline UK HCSWs completed an online survey during the first wave of the pandemic (27 May-23 July 2020). Participants worked in UK hospitals, nursing or care homes and other community settings. PTSD was assessed using the International Trauma Questionnaire (ITQ); Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9); Anxiety was assessed using the Generalized Anxiety Disorder Scale (GAD-7). Results: Nearly 58% of respondents met the threshold for a clinically significant disorder (PTSD = 22%; anxiety = 47%; depression = 47%), and symptom levels were high across occupational groups and settings. Logistic regression analyses found that participants who were concerned about infecting others, who could not talk with their managers if there were not coping, who reported feeling stigmatized and who had not had reliable access to personal protective equipment (PPE) were more likely to meet criteria for a clinically significant mental disorder. Being redeployed during the pandemic, and having had COVID were associated with higher odds for PTSD. Higher household income was associated with reduced odds for a mental disorder. Conclusions: This study identified predictors of clinically significant distress during COVID-19 and highlights the need for reliable access to PPE and further investigation of barriers to communication between managers and staff.

Background The coronavirus disease 2019 (COVID-19) pandemic is having a well-documented impact on the mental health of front-line health and social care workers (HSCWs). However, little attention has been paid to the experiences of, and impact on, the mental health professionals who were rapidly tasked with supporting them. Aims We set out to redress this gap by qualitatively exploring UK mental health professionals’ experiences, views and needs while working to support the well-being of front-line HSCWs during the COVID-19 pandemic. Method Mental health professionals working in roles supporting front-line HSCWs were recruited purposively and interviewed remotely. Transcripts of the interviews were analysed by the research team following the principles of reflexive thematic analysis. Results We completed interviews with 28 mental health professionals from varied professional backgrounds, career stages and settings across the UK. Mental health professionals were motivated and driven to develop new clinical pathways to support HSCWs they perceived as colleagues and many experienced professional growth. However, this also came at some costs, as they took on additional responsibilities and increased workloads, were anxious and uncertain about how best to support this workforce and tended to neglect their own health and well-being. Many were professionally isolated and were affected vicariously by the traumas and moral injuries that healthcare workers talked about in sessions. Conclusions This research highlights the urgent need to consider the mental well-being, training and support of mental health professionals who are supporting front-line workers.

Research suggests that posttraumatic stress disorder (PTSD) is common, debilitating and frequently associated with comorbid health conditions, including poor functioning, and increased health care utilization. This article systematically reviewed the empirical literature on PTSD in primary care settings, focusing on prevalence, detection and correlates. Twenty-seven studies were identified for inclusion. Current PTSD prevalence in primary care patients ranged widely between 2 % to 39 %, with significant heterogeneity in estimates explained by samples with different levels of trauma exposure. Six studies found detection of PTSD by primary care physicians (PCPs) ranged from 0 % to 52 %. Studies examining associations between PTSD and sociodemographic variables yielded equivocal results. High comorbidity was reported between PTSD and other psychiatric disorders including depression and anxiety, and PTSD was associated with functional impairment or disability. Exposure to multiple types of trauma also raised the risk of PTSD. While some studies indicated that primary care patients with PTSD report higher levels of substance and alcohol abuse, somatic symptoms, pain, health complaints, and healthcare utilization, other studies did not find these associations. This review proposes that primary care settings are important for the early detection of PTSD, which can be improved through indicated screening and PCP education.

This study suggests various symptoms that could potentially be driving the development of PTSD. We discuss clinical implications such as identifying particular symptoms as targets for interventions.

Background The COVID-19 pandemic has placed a significant burden on the mental health and wellbeing of frontline health and social care workers. The need to support frontline staff has been recognised. However, there is to date little research specifically on how best to support the mental health needs of frontline workers, and none on their own experiences and views about what might be most helpful. Aims We set out to redress this research gap by qualitatively exploring UK frontline health and social care workers’ own experiences and views of psychosocial support during the pandemic. Method Frontline health and social care workers were recruited purposively through social media and by snowball sampling via healthcare colleagues. Workers who volunteered to take part in the study were interviewed remotely following a semi-structured interview guide. Transcripts of the interviews were analysed by the research team following the principles of Reflexive Thematic Analysis. Results We conducted 25 interviews with frontline workers from a variety of professional groups working in health and social care settings across the UK. Themes derived from our analysis showed that workers’ experiences and views about psychosocial support were complex. Peer support was many workers’ first line of support but could also be experienced as a burden. Workers were ambivalent about support shown by organisations, media and the public. Whilst workers valued psychological support services, there were many disparities in provision and barriers to access. Conclusions The results of this study show that frontline health and social care workers are likely to need a flexible system of support including peer, organisational and professional support. More research is needed to fully unpack the structural, systemic and individual barriers to accessing psychosocial support. Greater collaboration, consultation and co-production of support services and their evaluation is warranted.

The current study investigated posttraumatic stress disorder (PTSD) and vicarious trauma (VT) symptoms among mental health professionals (MHPs) working in communities exposed to high levels of trauma related to rocket attacks from the Gaza Strip. The study assessed direct and vicarious traumatic exposure. The study also explored the relationship between professional supports (for example, training, supervision) and sense of professional self-efficacy with MHPs' PTSD and VT symptoms. Results indicate that MHPs working in the more severely affected community of Sderot reported higher objective, subjective, and professional exposure as well as higher levels of PTSD and VT symptoms compared with MHPs working in some of the other Gaza-bordering communities. Although PTSD and VT were found to be highly correlated, there were some distinct predictors. PTSD was predicted by professional experience, subjective exposure, and professional self-efficacy. VT was further predicted by years of education and professional support. The findings indicate that MHPs exposed to concurrent primary trauma and VT are at increased risk for psychological distress and may require targeted interventions to boost their resilience. Opportunities for respite, interventions to increase professional self-efficacy, and appropriate professional supports may buffer the effects of concurrent primary trauma and VT exposure.