Prevalence of depression, anxiety, and stress among first responders for medical emergencies during COVID-19 pandemic: A meta-analysis

Abstract

Background The COVID-19 pandemic has been shown to cause enormous psychological burden among health care workers, including first responders. However, psychological well-being of first responders, essential in the fight against COVID-19 pandemic, has often been ignored. We performed the first meta-analysis to explore the prevalence of 1) depression, 2) anxiety, and 3) stress among first responders for medical emergencies during the COVID-19 pandemic. Methods A comprehensive search was conducted in Embase, CINAHL, Web of Science, PsychInfo, PubMed, and the WHO COVID-19 database from 2020. The Freeman-Tukey double-arcsine transformation model in R-software determined the pooled prevalence and Comprehensive Meta-Analysis for associated factors of depression, anxiety, and stress with corresponding 95% confidence intervals (CI). The Cochrane Q, τ 2 , and I 2 statistics were used to examine heterogeneity. Sub-group analysis was conducted to identify moderator variables. Results We identified 765 records, from which 17 studies were included with 8096 first responders. The pooled prevalence was 31% (95% CI = 21%-41%) for depression; 67% (95% CI = 64%-70%) for mild depression, 24% (95% CI = 17%-31%) for moderate depression, and 16% (95% CI = 4%-34%) for severe depression. The pooled prevalence for anxiety was 32% (95% CI = 20%-44%); 60% (95% CI = 46%-73%) for mild anxiety, 27% (95% CI = 14%–42%) for moderate anxiety, and 14% (95% CI = 7%-22%) for severe anxiety. The pooled prevalence for stress was 17% (95% CI = 4%-34%); 58% (95% CI = 38%-77%) for mild stress, 22% (95% CI = 5%-44%) for moderate stress, and 19% (95% CI = 5%-37%) for severe stress. The prevalence of depression was 37% (95% CI = 25%-52%) for paramedics, 28% (95% CI = 12%-54%) for EMS personnel and 22% (95% CI = 13%-33%) for police. Similarly, the prevalence of anxiety was 38% (95% CI = 20%-60%) for paramedics, 28% (95% CI = 11%-53%) for EMS personnel, and 19% (95% CI = 10%-32%) for police. Married responders were likely at risk for depression (1.50, 95% CI = 1.26-1.78) and anxiety (1.94, 95% CI = 1.62-2.33), while unmarried responders were less likely at risk for depression (0.67, 95% CI = 0.56-0.79) and anxiety (0.50, 95% CI = 0.43-0.63). Conclusions High prevalence of depression, anxiety, and stress during the COVID-19 pandemic among first responders for medical emergencies emphasizes the need for monitoring their psychological well-being. Early assessment and management of mild depression, anxiety, and stress among first responders are crucial in preventing progression into moderate and severe types.

Anxiety Levels and Coping Strategies to Deal with COVID-19: A Cross-Cultural Study among the Spanish and Latin American Healthcare Populations

“…[ 2 , 5 , 6 , 7 , 9 , 11 , 22 , 23 , 26 , 58 , 60 ] contradict our findings, as they showed that the main sources of anxiety among health professionals were due to patient care, concern about becoming infected or infecting family members, work-related concerns, burnout, and fear of the unknown. Our results are inconsistent with [ 2 , 5 , 6 , 11 , 16 , 19 , 20 , 22 , 23 , 26 , 36 ], that reflected that the COVID-19 pandemic has generated higher levels of anxiety among health workers, regarding factors such as having been in contact with the virus or fear at work. Moreover, our results are contrary to the studies by [ 18 , 60 ], as they showed that health professionals have had to develop their profession in a precarious environment, putting both their individual and collective health at risk, considerably increasing their patients’ death anxiety; the predictor variables of this anxiety are the absence of personal protective equipment and high levels of burnout, emotional exhaustion, and depersonalization.…”

“…Health professionals perceived that their psychological health worsened during the COVID-19 pandemic, and higher levels of anxiety were associated with increased avoidance coping strategies [ 7 , 14 , 17 , 41 , 45 , 50 , 57 ]. Thus, people with high levels of anxiety symptoms were prone to a maladaptive response to uncertain new situations [ 1 , 9 , 16 , 17 , 35 , 39 , 40 , 64 ].…”

“…Additionally, health professionals have been directly involved with their COVID-19 patients at different stages—diagnosis, treatment, care, and in the process of death—as family members were unable to accompany COVID-19 patients, who ended up dying alone. Because of this, they are more vulnerable to psychological disorders, such as anxiety [ 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

“…Moreover, the psychological impact produced by the COVID-19 pandemic can manifest itself as serious problems involving a deterioration in the health and operation of the healthcare population, resulting in anxiety, sleep disorders, stress, depression, burnout, acute stress, and post-traumatic stress disorder [ 1 , 2 , 4 , 5 , 6 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 16 , 17 , 19 , 20 , 23 , 24 , 26 , 29 , 35 , 39 , 40 , 41 , 42 , 45 , 48 , 52 , 60 , 64 , 66 , 67 , 68 ].Various studies have shown that the presence of anxiety is associated with symptoms of stress, nervousness, fear, fatigue, viral symptoms, job disappointment, perception of discrimination, and negative actions related to COVID-19 [ 1 , 5 , 6 , 7 , 9 , 10 , 11 , 19 , 20 , 22 , 23 , 24 , 36 , 59 , 62 , 63 …”

Postpandemic Stress Disorder among Health Care Personnel: A Cross-Sectional Study (Silesia, Poland)

“…The COVID-19 pandemic's scarce protective resources and increased workload may have also had an impact on them. Therefore, providing work resources (such as protective gear) to ensure and enhance first responders' safety may eventually result in higher psychological well-being and prehospital medical service delivery [ 51 ].…”