Mental health of clinical staff working in high-risk epidemic and pandemic health emergencies a rapid review of the evidence and living meta-analysis

Abstract

Purpose The SARS-CoV-2 / COVID-19 pandemic has raised concerns about the potential mental health impact on frontline clinical staff. However, given that poor mental health is common in acute medical staff, we aimed to estimate the additional burden of work involving high exposure to infected patients. Methods We report a rapid review, meta-analysis, and living meta-analysis of studies using validated measures from outbreaks of COVID-19, Ebola, H1N1 influenza, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS). Results A random effects meta-analysis found that high-exposure work is not associated with an increased prevalence of above cut-off scoring (anxiety: RR = 1.30, 95% CI 0.87–1.93, Total N = 12,473; PTSD symptoms: RR = 1.16, 95% CI 0.75–1.78, Total N = 6604; depression: RR = 1.50, 95% CI 0.57–3.95, Total N = 12,224). For continuous scoring, high-exposure work was associated with only a small additional burden of acute mental health problems compared to low-exposure work (anxiety: SMD = 0.16, 95% CI 0.02–0.31, Total N = 6493; PTSD symptoms: SMD = 0.20, 95% CI 0.01–0.40, Total N = 5122; depression: SMD = 0.13, 95% CI -0.04–0.31, Total N = 4022). There was no evidence of publication bias. Conclusion Although epidemic and pandemic response work may add only a small additional burden, improving mental health through service management and provision of mental health services should be a priority given that baseline rates of poor mental health are already very high. As new studies emerge, they are being added to a living meta-analysis where all analysis code and data have been made freely available: https://osf.io/zs7ne/.

Testing the Multi-Theory Model (MTM) to Predict the Use of New Technology for Social Connectedness in the COVID-19 Pandemic

“…While the sample size was limited, a total of 47.1% of the respondents reported having high levels of social isolation (score above 6.0 units on a scale of 0–12). These findings were consistent with reports from Rosenberg and colleagues (2020) that the prevalence of loneliness was 54% during the COVID-19 pandemic in April 2020 [ 14 ]. Our study was conducted in March 2021 when restrictions were relatively relaxed, resulting in slightly lower rates of social isolation.…”

“…Studies have suggested that COVID-19 preventive behaviors may result in greater odds of reporting loneliness and social isolation [ 11 , 12 , 13 ]. For instance, a population-based study in the United States (U.S.) examining the impact of COVID-19 social distancing and preventive behaviors found that 54% of participants reported loneliness [ 14 ]. Loneliness was associated with more significant depressive symptoms among people with fewer social interactions than those who had more frequent in-person social interactions or connections [ 14 ].…”

Experiences of NHS Mental Healthcare Workers During the Covid-19 Pandemic: Qualitative Study

“…The pandemic has created a range of extraordinary strains on healthcare workers: as well as exposure to a potentially deadly infection that could affect them directly or be transmitted to their families, staff may be routinely faced with traumatising situations, the deaths of patients they have cared for the need to take highly consequential decisions under severe pressure. (7) The need to attend to the mental health of healthcare workers was raised early in the pandemic. (8,9) Much of the focus of attention and research on the impacts of the pandemic to date has been on those working in acute medical settings, including, for example, intensive care units.…”

“…(8,9) Much of the focus of attention and research on the impacts of the pandemic to date has been on those working in acute medical settings, including, for example, intensive care units. (7) (10) The di culties confronted by those working in mental healthcare settings, both in-patient and in the community, have been less well scrutinised and understood, but are no less important; working practices have changed dramatically (11)(12)(13) while population need and referrals to care are likely to continue to increase. In this article, we respond to this void in the literature, reporting an interview-based qualitative study that seeks to characterise the challenges faced by those working in NHS mental health settings during the rst wave of the Covid-19 pandemic in 2020.…”

Regulatory Flexibility of Sustaining Daily Routines and Mental Health in Adaptation to Financial Strain: A Vignette Approach

“…Although context sensitivity was inversely associated with positive affect at higher levels of perceived financial strain, in general, context sensitivity and responsiveness to feedback were linked with lower anxiety and depressive symptoms. Cultivating regular daily routines in everyday life may be a simple and effective intervention in reducing psychological distress [ 78 , 79 , 80 , 81 ], especially for persons with less socioeconomic resources (e.g., low savings, no home ownership) in times with multiple large-scale stressors such as civil unrest and pandemic [ 82 ].…”