Decline in the mental health of nurses across the globe during COVID-19: A systematic review and meta-analysis

Abstract

Background Nurses represent the major proportion of frontline health care professionals delivering 24/7 services to patients with an increased vulnerability towards COVID-19 infection. Mental health issues among nurses during the COVID-19 pandemic are poorly reported across the globe. Henceforth, a systematic review and meta-analysis was performed to explore the prevalence and determinants of mental health outcomes (anxiety, stress, depression, PTSD, insomnia) among nurses across the globe due to the COVID-19. Methods A PRISMA compliant systematic review (PROSPERO-CRD 42020204120) was carried out to identify articles from multiple databases reporting the prevalence of mental health outcomes among nurses. Proportion random effect analysis, I 2 statistic, quality assessment, and sensitivity analysis were carried out. Results Pooled data on mental health outcomes were generated from 25 cross-sectional studies: 32% anxiety (95% confidence interval (CI) = 21%-44%, n (number of studies) = 21, N (sample size) = 13 641), 40.6% stress (95% CI = 25.4%-56.8%, n = 10, N = 4204), 32% depression (95% CI = 21%-44%, n = 17, N = 12 294), 18.6% PTSD (95% CI = 4.8%-38%, n = 3, N = 638), 38.3% insomnia (95% CI = 5.8%-78.6%, n = 2, N = 261) and significant risk factors for mental ailments includes; caring for COVID-19 patients, being a female, low self-efficacy, resilience, social support and having physical symptoms (sore-throat, breathlessness, cough, lethargy, myalgia, fever). Conclusion The study results highlighted a higher proportion of poor mental health outcomes namely, anxiety, stress, depression, PTSD and insomnia among nurses from different parts of the world. Poor mental health outcomes among nurses warrants the need to implement proactive psychological interventions to deter the collapse of health care systems in responding to the pandemic and in particular all possible efforts should be undertaken to mitigate the risk factors. Health care organizations should provide support to nurses with sufficient flexibility. The disaster preparedness plan envisaged by nations should have provisions to address the mental health of nurses. Greater investment in addressing the global shortage of nurses should be given priority in national health policies. Attractive salary packages should be offered to nurses to prevent their emigration from low- and middle-income countries (LMICs). Registration PROSPERO (CRD42020204120)

The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: A Systematic Review

“…Indeed, several reviews focused on other mental health outcomes among HCWs (not only ICU/ED professionals). For instance, depression, anxiety, and post-traumatic stress disorders (PTSD) result turned out to be remarkably high [47,[51][52][53], yet not reaching the half of workers as shown for burnout by many works included the present review. Interestingly, both stress and insomnia reached a prevalence comparable to burnout [47,51], further highlighting the urgent need of intervention to care for the mental health of HCWs.…”

“…For instance, depression, anxiety, and post-traumatic stress disorders (PTSD) result turned out to be remarkably high [47,[51][52][53], yet not reaching the half of workers as shown for burnout by many works included the present review. Interestingly, both stress and insomnia reached a prevalence comparable to burnout [47,51], further highlighting the urgent need of intervention to care for the mental health of HCWs. Since some studies that we have selected highlighted that burnout was more frequent or severe among ICU/ED staff compared with workers of other departments [26,30], it should be examined more in depth if other mental health outcomes could be more relevant in our target population.…”

“…Some sociodemographic variables such as age and female gender have been often found to be associated with burnout, both before the pandemic among ICU/ED workers [34] and during the pandemic among general HCWs [46]. Moreover, age and gender have been associated with many other mental conditions among general HCWs during the COVID-19 pandemic [41,42,47]. Work environment, communication, and support by supervisors have been demonstrated to play a role in burnout among ICU/ED workers before the pandemic [34,37], as well as in other mental health outcomes during the pandemic [48].…”

The Mediating Role of Resilience in the Relationship between Perceived Stress and Mental Health

“…After years of austerity with resultant low salaries [ 2 ], the current situation has left nurses overworked with little financial reward. Furthermore, nurses may experience a variety of psychological problems [ 5 , 6 , 7 ], insomnia and stress [ 8 ], as well as the fear of being infected or transmitting the disease to their families when they provide care to COVID-19 patients [ 9 ]. Recent scientific literature has generated evidence that highlights the impact of the occupational stress that nurses have been facing during the pandemic on their mental health [ 8 , 10 , 11 ].…”

Improving Mental Health through Physical Activity: A Narrative Literature Review

“…A meta-analysis comprising 189,159 subjects revealed a 16% percent prevalence of depression and a 15% prevalence of anxiety (Cenat et al, 2020). Another meta-analysis of cross-sectional studies involving healthcare workers with a cumulative sample size of 13,641 generated the following outcomes expressed as percentages of the subject pool: stress (40.6%), depression (32%), and insomnia (38%) (Varghese et al, 2021). Leisure and hospitality workers and those in customer-facing roles faced similar procedural driven depression and anxiety causing stressors as a result of COVID-19 (Fung Wong et al, 2021).…”