Worldwide, the health care system has been stretched to its limit with the increasing number of people presenting with Coronavirus disease 2019 (COVID-19. While the world’s attention is focused on the physical wellbeing of the general population, the mental wellbeing of the health care workers (HCW) has received less attention. Its rapid transmission has created a sense of urgency as the world continues to grapple with the reality of how highly infectious and fatal the disease can be. Unfortunately, mental health has taken a back seat for the most part compared to the attention the physical impact of the disease has received during the pandemic (Xiang et al., 2020). A recent editorial by Tandon (2020) tried to address the question of the relevance of COVID-19 and Psychiatry with each other (Tandon, 2020). One should not be surprised that the initial responses of colleagues about the relevance of COVID-19 and psychiatry were in the negative. However, their views changed in the affirmative after the author explained the mental health effects of COVID-19 on the general population and also among healthcare professionals (Tandon, 2020).
We reviewed the literature of the various mental health symptoms among HCW during the COVID-19 pandemic to better understand why mental health is relevant during COVID-19 especially among HCW. Our search included common databases like PUBMED and EMBASE using keywords from the thrust of our paper with search terms such as mental health, anxiety, depression, acute stress disorder, fear, stress, panic disorder, loneliness, COVID-19, severe acute respiratory syndrome coronavirus 2, and SARS COV-2. Articles were reviewed from December 2019 to April 2020. Seven cross-sectional studies were available as of May 1st addressing mental health problems among HCW during the COVID-19 pandemic (see Table 1 ).
Table 1.
Studies on mental health symptoms of health care workers during COVID-19 pandemic.
| Author | Study site | Study question | Age mean | Gender | Sample size | Category of health care workers | Instrument used | Study Outcome |
|---|---|---|---|---|---|---|---|---|
| Ahmed et al. (2020) | 30 countries 2020 | Assess the anxiety and fear of getting infected with COVID-19 | n/a | M = 160 (25 %) F = 490 (75 %) | 650/669 | Dentists | Structured questionnaire | Two third were anxious and scared of the devastating effect of the virus |
| Bohlken et al. (2020) | Germany 2020 | Experience of the impact of pandemic on anxiety and sleep problems | n/a | 396/2072 | Physicians (Neurologists and psychiatrist) | Likert type questionnaire | 18 % reported that the pandemic has triggered anxiety while 9% reported sleep problems | |
| Xiao et al. (2020) | China 2020 | Effects of social support on sleep quality and function of medical staff | 40.58 ± 4.88 years | M 51 (28.3 %) F129 (71.7 %) |
180/220 | Doctors, Nurses | Self-Rating Anxiety Scale (SAS) General Self-Efficacy Scale (GSES), Stanford Acute Stress Reaction (SASR) questionnaire, Pittsburgh Sleep Quality Index (PSQI), Social Support Rate Scale (SSRS), |
Anxiety Stress Self-Efficacy were dependent on sleep quality and social support |
| Lai et al. (2020) | China 2020 |
Degree of symptoms of depression, anxiety, insomnia, and distress | n/a | M = 293 (23.3 %) F = 964 (76.7 %) |
1257/1830 | Physicians Nurses |
9 item Patient Health Questionnaire 7-item Generalized Anxiety Disorder scale 7-item Insomnia Severity Index, and 22-item Impact of Event Scale–Revised, |
HCW particularly women, nurses and frontline HCW have a higher risk of developing unfavorable mental health outcomes. |
| Lin et al. (2020) | China 2020 |
Evaluate measures of depression, anxiety, insomnia, and distress | n/a | n/a | 1431/2316 | Physicians Nurses |
9 item Patient Health Questionnaire 7-item Generalized Anxiety Disorder scale 7-item Insomnia Severity Index, and 22-item Impact of Event Scale–Revised, |
Frontline HCW were more likely to have depression, anxiety, insomnia, and stress than non-frontline HCW |
| Moghadasi (2020) | Iran 2020 |
Evaluation of level of anxiety among medical staff | 32.31 ± 4.44 years | M = 7 (50 %) F = 7 (50 %) |
14/14 | Physicians | Beck Anxiety Inventory | Mild level of anxiety found in only 2 physicians (mean level of anxiety 5.24 ± 3.79) |
| Shacham et al. (2020) | Israel 2020 |
Evaluate the association of COVID-19 factors and psychological factors with psychological distress | 56.39 ± 11.18 years | M = 140 (41.4 %) F = 198 (58.6 %) |
338 | Dental Staff (Dentist and Dental hygienist) | Demands Scale—Short Version General Self-Efficacy Scale Kessler’s K6 |
Elevated psychological distress was found among those who have background illness, fear of COVID-19 and higher overload |
The study conducted in China by Lai et al. found that nurses, women and frontline HCW were at higher risk of developing unfavorable mental health outcomes compared to their counterpart (Lai et al., 2020). A similar study conducted in China by Lin et al. reported that frontline HCW were more likely to have depression, anxiety, insomnia, and stress than non-frontline HCW (Lin et al., 2020). Lai et al. also found that being a woman and an intermediate cadre medical staff was associated with severe symptoms of depression, anxiety and distress (Lai et al., 2020). Xiao et al. (2020) identified various symptoms of mental health including anxiety, self-efficacy, stress, sleep quality and social support and analyzed them using a structural equation model (SEM) (Xiao et al., 2020).
These studies and other available papers on COVID-19 highlight some of the risk factors that may have influenced the severity of mental health symptoms among HCW. Some of the factors discussed were the increasing number of new cases, overwhelming workload, lack of personal protection equipment (PPE), lack of drug treatment/vaccines, lack of social support, lack of communication, lack of training in certain aspects, maladaptive measure, and media sensation about the pandemic.
Another mental health issue that can escalate among health care workers is anxiety. In Italy, one of the epicenters for COVID-19 in Europe, it was reported that some of the physicians developed insomnia and anxiety facing exceptional work and mental demand during this pandemic sometimes leading to unfavorable outcomes such as resigning from their jobs (Fagiolini et al., 2020). The study by Ahmed et al. among dental staff reported that their anxiety and fears increased due to a high risk of contracting the virus with exposure to droplets and aerosol (Ahmed et al., 2020). Health workers also fear the worse when they are at high risk of spreading the disease to families and friends (Tiong and Koh, 2013).
Limitation of these cross-sectional studies is the loss of temporal association Also, preexisting psychiatric conditions in study participants prior to study participation were not evaluated. The overlap of HCW being a member of the same community during the pandemic makes one wonder if the mental health symptoms are because of being an HCW working in the hospital or a member of the community in quarantine. However, more needs to be done for health personnel to prevent long term adverse health outcomes. Strategies important to get our world back to normal post COVID-19 are enshrined in making mental health assessment, support services, and ultimately making treatment options available to every HCW (Xiang et al., 2020). This will help the health systems better improve on mental health programs specially designed to prevent unfavorable mental health outcomes among HCW.
Therefore, we reaffirm that COVID-19 is relevant to psychiatry and Psychiatry is relevant to COVID-19.
Author’s contribution
AO and OO both contributed to the conception, design of the manuscript, literature search, writing of the manuscript and final approval of manuscript.
Funding sources declaration
No funding or research grant was received during study research or assemble of the above manuscript.
Declaration of Competing Interest
None.
Acknowledgement
None.
References
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