Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review

Abstract

Background Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout. The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health. Methods We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 17, 2020. Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers. Results From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review. Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries. Psychological symptoms of anxiety (14.3–92.3%), stress (11.9–93.7%), depression (17–80.5%), post-traumatic stress disorder (13.2–75.2%) and burnout (14.7–76%) were commonly reported among physicians, regardless of infectious disease outbreak or country. Younger, female (vs. male), single (vs. married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms. Interpretation Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist. Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19.

The effect of the outbreak of COVID-19 on respiratory physicians and healthcare in Japan: Serial nationwide surveys by the Japanese Respiratory Society

“…Work overload increases the likelihood of mental health problems [ 5 ]. In addition, physicians tend to avoid psychiatric support due to the stigma and negative influence on their careers [ 6 ].…”

Associations between the working experiences at frontline of COVID-19 pandemic and mental health of Korean public health doctors

“…Second, working environment factors of increased workload [ 19 , 20 ], longer contact and higher exposure to patients [ 15 , 21 ], insufficient supplies of protective equipment [ 22 ], risks of COVID-19 infection during medical practice [ 23 ], active duty at intensive care unit [ 24 ], lack of self-control over one’s daily routine [ 25 ], and needs of readjustment for upcoming situational changes [ 25 ] are related to the worse mental health of medical professionals. Of note, working in high-risk settings of closed wards treating COVID-19 patients, collecting respiratory specimen at screening center, or serving duty at emergency room during pandemic are associated with higher risk of poor mental health [ 10 , 15 , 17 ]. Third, for the psychosocial aspects, fear of the unknown and perceived threat of becoming infected [ 15 , 18 ], perceived stigma and rejection from family members and neighborhood as a possible medium of propagating infection [ 8 , 15 , 18 , 26 ], personal experience of quarantine after exposure to the COVID-positive patient [ 15 ], feelings of vulnerability and helplessness [ 15 , 25 ] contribute to the perceived distress, feelings of isolation [ 18 ], and emotional reluctance to work [ 27 ].…”

“…Moreover, associations between working experience of PHDs at frontline versus mental health of PHDs were explored using the multivariate logistic regression analyses. We hypothesized that factors of working environments (such as workload [ 19 , 20 ], working hours [ 15 , 21 ], supplies of protective equipment [ 22 ], frequency of medical practice with more risks of infection [ 23 ], working location of dispatch [ 24 ], and capability of participating in the decision making [ 25 ]) and psychosocial aspects (such as perceived threat of becoming infected [ 15 , 18 ], perceived stigma and rejection from others [ 8 , 15 , 18 , 26 ], and feelings of vulnerability and helplessness [ 15 , 25 ]) comprising the working experiences at frontline might be associated with mental health for PHD in Korea, who are younger-aged physicians in their earlier stage of career and serve direct care for the infected patients [ 10 , 15 , 17 , 18 ].…”

“…In other words, reports of mental suffers among medical professionals at the COVID-19 frontline including perceived stress [7], anxiety [8][9][10], insomnia [11,12], depressive mood [13], reduced self-efficiency in medical practice [14], traumatic or stress-related disorders [15], or suicidal ideation [16] have been increasing. First, in terms of the demographic features, younger-aged medical professionals in their earlier stage of career (with fewer years of work experience) and who provide direct care for the infected patients could be more vulnerable for the poor mental health outcome [10,15,17,18]. Second, working environment factors of increased workload [19,20], longer contact and higher exposure to patients [15,21], insufficient supplies of protective equipment [22], risks of COVID-19 infection during medical practice [23], active duty at intensive care unit [24], lack of self-control over one's daily routine [25], and needs of readjustment for upcoming situational changes [25] are related to the worse mental health of medical professionals.…”

Impact of COVID-19 Pandemic on Patients With Neurodegenerative Diseases

“…(Verkhratsky et al, 2020). Psychological stress is frequently noticed in COVID-19 patients, medical staffs and general population (Fiest et al, 2021;Osimo et al, 2021;Saita et al, 2021). The global impact of the COVID-19 pandemic is unprecedented, with the entire population vulnerable possibly until COVID-19 vaccines are developed and widely available.…”