Mental health of healthcare workers during the COVID-19 outbreak: A rapid scoping review to inform provincial guidelines in South Africa

Abstract

COVID-19, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly transmissible, with a high mortality in vulnerable individuals and no known disease-specific treatment or vaccine. [1] On 11 March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak to be a pandemic, making global recommendations to reduce transmission, prepare and be ready. [2] As anticipated, it continued to spread and is now prevalent in South Africa (SA) and other African countries, [1] putting healthcare systems under severe pressure.Healthcare workers (HCWs) are the most important resource in both the COVID-19 response and in maintaining essential services. [3] HCW motivation and empathy are critical to effective and compassionate healthcare. Mental health conditions may compromise work performance and increase risk of burnout, absenteeism and resignations. [4,5] Fatigue, emotional exhaustion or poor concentration are likely to increase clinical error, including breaches in infection control, impacting on patient care and staff infections. Protecting the mental health and wellbeing of HCWs is therefore of paramount importance during an infectious disease outbreak.Such outbreaks cause high levels of psychosocial stress, [6] related to uncertainty regarding risk of infection and prognosis, loss of loved ones, and the social impact of measures instituted to contain the spread of disease. Being at the frontline in disease detection and management, HCWs are vulnerable, exposed to infection, high workloads and difficult working conditions. Resource constraints, including shortages of personal protective equipment (PPE), limit individual capacity to provide appropriate patient care and heighten the mental health risk. Being quarantined appears to convey particular stress. [7] The Gauteng Province Department of Health's research and evaluation workstream therefore requested evidence-based recommendations regarding the potential impact of the COVID-19 pandemic on the mental health of HCWs and their protection. This article describes the process behind, and builds upon, a presentation made to the senior leadership of the Gauteng Department of Health's COVID-19 response team in April 2020, for which we sought to answer two questions: (i) what may be expected regarding the psychological impact of the COVID-19 outbreak on HCWs; and (ii) what interventions could be considered in order to protect and support the mental health and wellbeing of HCWs during the crisis. MethodsWe conducted a rapid scoping review of published literature on mental health of HCWs exposed to infectious disease outbreaks. Literature search and study selectionTo gain an understanding of the topic, we conducted a preliminary search and screen of the PubMed and Cochrane databases on 7 and 8 April 2020, respectively, using terms (healthcare workers OR medical doctors OR nurses OR community health workers) AND This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

The Association between Future Anxiety, Health Literacy and the Perception of the COVID-19 Pandemic: A Cross-Sectional Study

“…Increased anxiety, apart from fear, symptoms of depression, and lower quality of sleep, was the most frequently reported mental consequence of the COVID-19 pandemic in the general population [75][76][77]. Similar findings were confirmed for health care professionals [78] and patients who had suffered from the symptoms of COVID-19 infection [79]. A better understanding of the determinants of anxiety during COVID-19 pandemic is of the utmost importance as symptoms of anxiety and depression may result in people being less likely to adhere to the recommended preventative measures [80].…”

Data Synthesis: COVID-19 Vaccine Perceptions in Africa: Social and Behavioural Science Data, March 2020-March 2021

“…One model projects a 45% increase in under-five childhood deaths and a 39% increase in maternal death per month if coverage of basic life-saving interventions are extensively disrupted. 56 COVID-19 has meant that vaccination programmes have had to adapt to challenges with access; providers' and community concerns; sanitation, IPC and distancing requirements; and, alternative delivery mechanisms such as reassigning vaccinations sites e.g., to a local football stadium. 59 Numerous studies also showed that COVID-19 restrictions and community perceptions of contagion have had a negative impact on routine immunisation access.…”

Cross-Cultural Comparison of Mental Health Between German and South African Employees: Shame, Self-Compassion, Work Engagement, and Work Motivation

“…In Germany, although the general population demonstrated improved overall mental health scores (Ahrens et al, 2021), large proportions of employees reported increased stress (43.2%), worries about their future (53.9%) and their family well-being (73.5%) (Kramer et al, 2021). In South African organizations, heightened levels of depression, anxiety, stress and other mental health symptoms were reported (Robertson et al, 2020). These have been further exacerbated by the unstable employment: 2.5 million South African adults have lost their jobs between February and April 2020 (Posel et al, 2021).…”