Mental Health of Clinical Staff Working in High-Risk Epidemic and Pandemic Health Emergencies: A Rapid Review of the Evidence and Meta-Analysis

Abstract

The global pandemic of SARS-CoV-2 / COVID-19 has raised concerns about the potential mental health impact on frontline clinical staff. However, given that poor mental health is common in staff working in acute medicine, we aimed to estimate the additional burden of working directly with infected patients during epidemic and pandemic health emergencies. We completed a rapid review of the evidence and identified 74 relevant studies from outbreaks of COVID-19, Ebola, H1N1 influenza, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS). Due to varying caseness criteria, a metaanalysis of prevalence was not possible. However, it was clear that levels of self-reported depression, anxiety and posttraumatic stress disorder (PTSD) related symptoms were high, and somewhat higher in clinical staff working in high exposure roles. To assess the impact of high-versus low-exposure healthcare work more formally, we estimated the standardised mean difference (SMD) of scale means using a random effects meta-analysis. High exposure work was associated with only a small additional burden of acute mental health problems compared to low exposure work (anxiety: SMD=0.22, 95% CI 0.06 -0.38; PTSD symptoms: SMD=0.21, 95% CI 0.01 -0.4; depression: SMD=0.20, -0.07 -0.47). This effect was potentially inflated by publication bias and there was a moderate risk of bias in the studies in the meta-analysis. A narrative review of candidate risk factors identified being a nurse, seeing colleagues infected, experiencing quarantine, non-voluntary role assignment, and experiencing stigma, as associated with particularly poor mental health outcomes. Protective factors included team and institutional support, use and faith in infection prevention measures, and a sense of professional duty and altruistic acceptance of risk. Notably, formal psychological support services were valued by frontline staff, although those with the highest burden of mental health difficulties were the least likely to request or receive support.

Longitudinal changes in anxiety and psychological distress, and associated risk and protective factors during the first three months of the COVID‐19 pandemic in Germany

“…The same trend is evident regarding the daily amount of preoccupation with the topic of COVID‐19 and the subjective risk perception. This is in line with observations of psychological reactions to previous outbreaks of high‐risk infectious diseases (Bell & Wade, 2020; Bults et al., 2011; Leung et al., 2005) with a peak of symptoms of anxiety and psychological distress early during outbreaks and a subsequent decrease as time proceeds.…”

“…The study does only present cross‐sectional associations at the two points of measurement and not longitudinal associations of risk and resilience factors. With regard to findings from previous SARS outbreaks (Bell & Wade, 2020; Leung et al., 2005) and the H1N1 influenza (“swine flu”) pandemic (Bults et al., 2011), an expected pattern of the change of symptoms across time can be derived: The majority of the surveyed individuals expressed high amounts of anxiety at the initial phase of the outbreaks which subsequently decreased across the further progress of the epi‐/pandemic.…”

Men and COVID-19: the aftermath

“…It is important to also note the health and social care sector is working under enormous pressure, from those on the front line to researchers trying to find cures to those trying to coordinate stretched services. The mental health strain of the staff has been immense with already reports of staff succumbing to the stress, as was also seen during the previous pandemics [156].…”

Ängste in Zeiten von COVID-19 und anderen Gesundheitskrisen

“…Sozioökonomischer Status und berufliche Tätigkeit. Medizinisches Personal -insbesondere Pflegekräfte -zeigte in einigen Studien höhere Angst-und Belastungswerte als die Allgemeinbevölkerung, was vermutlich insbesondere auf ein größeres Infektionsrisiko durch die höhere Expositionswahrscheinlichkeit und die enorme Arbeitsbelastung im Rahmen von Krankheitsausbrüchen wie COVID-19 [15,22,24] sowie Ebola, Schweinegrippe, SARS und MERS ("middle east respiratory syndrome"; [2,8]) zurückzuführen ist. Auch von Arbeitslosigkeit oder unsicheren Arbeitsbedingungen betroffene Menschen sowie Personen mit einem niedrigen Einkommen zeigten eine besonders hohe Angstbelastung [15,25].…”