Table 2.

Specific characteristics.

Author, year	Reported conditions	Measurement tool	Reported manifestations	Reported impact
Altinbilek et al. (2021) [31]	Anxiety	Beck Anxiety Inventory	Concerned about being unable to find enough adequate PPE in the future	Higher anxiety and stress scores among physicians and nurses compared to other ED personnel, including security, staff working in patient transport, cleaning staff and patient data entry staff
	Stress	Perceived Stress Scale	Anxious about getting support from management and salary payments
An et al. (2020) [23]	Depression	Patient Health Questionnaire	Of the 481 ED nurses with reported depression, 305 (27.7%) reported mild, 95 (8.6%) reported moderate, 58 (5.3%) experienced moderate-to-severe, and 23 (2.1%) reported severe depression.	Nurses with depression had lower quality of life compared to their colleagues who were not depressed.
	Quality of life	World Health Organization
		Quality of Life Questionnaire-Brief Version
Araç and Dönmezdil (2020) [28]	Anxiety and depression	Hospital Anxiety Depression Scale (HADS)	Presence of severe anxiety and depression, and perceived stress levels and PSQI subscale scores were significantly higher among ED staff than those working in other departments.	Anxiety and depression scores were higher in the first encounters with COVID-19 patients than succeeding encounters. Anxiety was due to fear of infecting family members that could be prevented through precautions such as isolation. However, it should be remembered that loneliness and feelings of missing family members, consequent to isolation could increase the risk of depression.
	Sleep quality	Pittsburgh Sleep Quality Index (PSQI)
Baumann et al. (2021) [21]	COVID-19 patient exposure, availability of COVID-19 testing, levels of home and workplace anxiety/stress, changes in behaviours, and performance on a primary care posttraumatic stress disorder screen (PC-PTSD-5)	Researcher–developed instrument with 5 items validated from the PC-PTSD-5 scale	Median (IQR) work and home stress levels decreased over time from the initial survey 5 (4–6) versus 4 (4–5) at follow-up. Most concerns that were reassessed were less highly rated at this follow-up study.	While exposure to suspected COVID-19 patients was nearly universal, stress levels in emergency physicians decreased with time.
Caliskan and Dost (2020) [29]	Depression and anxiety	Hospital Anxiety Depression Scale (HADS)	Depression was detected in 180 participants (62%) while anxiety was detected in 103 participants (35.5%), with the median depression and anxiety scores found to be 8 (0–21) and 7 (0–21), respectively	Psychological trauma manifested by reported depression and anxiety of emergency physicians was caused by providing care during the COVID-19 pandemic
Cui et al. (2020) [24]	AnxietyStress	Self-Rating Anxiety Scale (SAS)	Among the participants, 281 (62.03%) reported no anxiety symptoms, 154 (34.00%) reported mild, 16 (3.53%) reported moderate, and two (0.44%) reported severe anxiety. There were 146 (32.23%) participants with scores greater than 25 in the PSS, suggesting excessive stress; 229 (50.55%) participants were more likely to respond positively to stress, while 224 (49.45%) were more likely to respond negatively.Participants who had the following characteristics had more mental health problems: female gender, fear of infection among family members, regretting being a nurse, less rest time, more night shifts, having children, lack of confidence in fighting transmission, not having emergency protection training, and negative professional attitude.	Participants reported presence of anxiety, stress, and stress coping tendency primarily due to fear of infecting their family members.
	Coping tendency	Perceived Stress Scale (PSS)
		Simplified Coping Style Questionnaire (SCSQ)
de Wit et al. (2020) [39]	Burnout	Emotional exhaustion and depersonalisation items, from the Maslach Burnout Inventory	The study did not find a time trend in burnout levels (P = 0.632 for emotional exhaustion and P = 0.155 for depersonalisation).	The impact of COVID-19 on the work environment and personal perceptions and fears about the impact on lifestyle affected physician well-being. Personal safety, academic and educational work, personal protective equipment, the workforce, patient volumes, work patterns, and work environment had an impact on physician well-being. A new financial reality and contrasting negative and positive experiences affected participants’ psychological health.
			Emergency physician burnout levels remained stable during the initial 10 weeks of this pandemic
Elhadi et al. (2021) [34]	Depression and anxiety	Hospital Anxiety and Depression Scale (HADS)	With respect to the prevalence of anxiety and depression, the data based on the HADS indicated that ∼ 65.6% of subjects (n = 101) were experiencing anxiety (those who received a score ≥ 11), and about 73.4% of subjects (n = 113) were experiencing depressive symptoms (those who received a score ≥ 11). Findings demonstrated that 67.5% (n = 104) of subjects suffered from emotional exhaustion, while 48.1% (n = 74) experienced depersonalisation (both derived from scores of ≥ 10 out of 18 on the aMBI). However, for low personal accomplishment (PA), only 21.4% (n = 33) scored < 10 (indicating burnout for this category). About 46.1% (n = 71) of respondents had encountered at least one episode of verbal abuse, while 12.3% (n = 19) had experienced physical abuse.	The study demonstrated higher than expected levels of anxiety, depression, and burnout among 154 emergency doctors from Libya who worked during the COVID-19 pandemic.
	Burnout	Abbreviated Maslach Burnout Inventory (aMBI) scale
Fitzpatrick et al. (2020) [19]	Wellness	Wellness survey with 10 primary questions and 2 supplemental questions	Physicians felt less in control, felt decreased happiness while at work, had more trouble falling asleep, had an increased sense of dread when thinking of work needing to be done, felt more stress on days not at work, and were more concerned about their own health.	This study showed a statistically significant decrease in EP wellness during the COVID-19 pandemic when compared to the pre-pandemic period.
Havlioğlu and Demir (2020) [30]	Anxiety	Beck Anxiety Inventory	Among the participants, 53.7% had mild, 28.4% had moderate and 17.9% had severe anxiety levels.	Anxiety levels of emergency healthcare employees who are were at in the front lines, were increasing. Among the participants, 82.1% stated that they encountered COVID-19-positive patients, 44.2% said they experienced suspected COVID-19%, and 96.8% stated they were afraid of carrying the COVID-19 virus home.
Ilczak et al. (2021) [35]	Stress	Researcher-developed questionnaire with 18 questions	One aspect of professional life that, according to research, was felt particularly severely was occupational stress, as illustrated by Polish emergency medical personnel.	During the COVID-19 pandemic, stress among emergency medical personnel had increased considerably due to new factors that did not previously exist.
Jose et al. (2020) [37]	Burnout	Maslach Burnout Inventory	The nurses in the emergency during pandemic experienced moderate-to-severe levels of burnout in emotional exhaustion (29.13 ± 10.30) and depersonalisation (12.90 ± 4.67) but mild-to-moderate level of burnout in reduced personal accomplishment (37.68 ± 5.17) and showed moderate to high levels of resilience (77.77 ± 12.41).	The fear of infection to self and family resulted in the frontline staff being more susceptible to anxiety and stress during the pandemic. Increased patient physical workloads led to severe burnout in the form of emotional exhaustion, depersonalisation, and reduced personal accomplishment. In general, the outbreak of an emerging disease contributed to a general atmosphere of fear that needed to be psychologically studied through comprehensive research activity to understand its possible negative impacts on individuals’ mental health and productivity, to mitigate such impacts on the HCWs, in particular, who are in the frontline of counteracting the disease.
	Resilience	Connor-Davidson Resilience Scale
Kelker et al. (2020) [20]	Wellness	Well Being Index	Frontline EM physicians and APPs advanced practice providers during the initial surge of the COVID-19 pandemic in Indiana found significant levels of stress, anxiety, fear, concerns about safety, and relationship strain, all of which improved but endured. Additionally, while providers were a resilient group, feelings of isolation and burnout persisted, but did not significantly worsen.	Despite being considered a resilient group, the majority experienced stress, anxiety, fear, and concerns about personal safety due to COVID19, with many at risk for burnout.
	Burnout	Physician Work Life Study item
	Resilience	Brief Resilience Scale
Li et al. (2020) [25]	PTSD symptoms	Impact of Event Scale Revised (IES-R)	During their stay in Wuhan, the medics experienced high levels of depression (46.7%), anxiety (35.6%) and stress symptoms (16.0%). Upon returning home, the overall prevalence of clinically concerned PTSD symptoms was as high as 31.6%.	The reserve medics reported a high prevalence of depression, anxiety and stress as well as clinically concerned PTSD symptoms.
	Anxiety and stress (Mental health status)	Depression Anxiety Stress Scales-21 (DASS-21)
Munawar and Choudhry (2021) [38]	Psychological impact of COVID-19 on emergency HCWs	Semi-structured interviews	It was found that during the pandemic, media was mentioned to be a major source of exacerbating anxiety and stress levels of masses as authenticity of updates or news shared could not be ascertained.	The findings of thematic analysis revealed that participants practised and recommended various coping strategies to deal with stress and anxiety emerging from the COVID-19 pandemic.
Nie et al. (2020) [26]	Psychological distress	General Health Questionnaire (GHQ-12)	A majority of nurses experienced psychological distress because of the COVID-19 outbreak. Most reported variable degrees of concern about their families or themselves being infected with COVID-19.	Nurses who were working in the ED were concerned for their families being infected with COVID-19, being treated differently, having been affected by COVID-19 and having negative coping style made them at high risk of being psychologically distressed.
	Coping style	Simplified Coping Style Questionnaire (SCSQ)
	Intrusive thoughts related to COVID-19 and consequent avoidance behaviour	Revised version of the Impact of Event Scale (IES-R)
	Social support	Perceived Social Support Scale (PSSS)
Rodriguez et al. (2020) [22]	Stress, perceptions and key elements in the following domains: numbers of suspected COVID-19 patients, availability of diagnostic testing, levels of home and workplace anxiety, severity of work burnout, identification of stressors, changes in home behaviours, and measures to decrease provider anxiety.	Researcher-developed tool	On the 1–7 scale, the median reported effect of the COVID-19 pandemic on work stress levels was 5 (IQR = 4–6) and on home stress levels was 5 (IQR = 4–6).	COVID-19 exposure during work had a major impact on home lives of physicians.The most commonly reported changes by friends and family were expressions of concern about the EM physician participants’ health, expressions of concern about their exposure to COVID-19 because of contact with the EM physician, and a reluctance of family members to be in close contact with the EM physician.
			Reported levels of emotional exhaustion/burnout increased from a pre-pandemic median of 3 to since the pandemic started a median of 4 after the pandemic had started, with a difference in medians of 1.8.
			Most physicians (90.8%) reported changing their behaviour toward family and friends, especially by decreasing signs of affection (76.8%).
			Worries included: adequacy of personal protective equipment (PPE), ability to accurately diagnose COVID-19 cases quickly, well-being of co-workers who had been diagnosed with COVID-19, and that patients with unclear diagnoses were exposing others in the community
Song et al. (2020) [27]	PTSD	PTSD Checklist for DSM-5 (PCL-5)	The prevalence rates of depressive symptoms and post-traumatic stress disorder (PTSD) were 25.2% and 9.1%, respectively.	A considerable number of medical staff in the emergency department suffered from depressive symptoms and PTSD.
	Depressive symptoms	Centre for Epidemiologic Studies Depression Scale (CES-D)
	Social support	Perceived Social Support Scale (PSSS)
Vagni et al. (2020) [33]	Psychological stress	Emergency Stress Questionnaire	Volunteers who had worked even a few hours a week to carry out emergency interventions seemed to have developed similar reactions of stress and secondary trauma, probably because they were exposed to a sense of helplessness and gravity, given the high number of patients and deaths from this pandemic in Italy.	High stress reactions, associated with manifestations of arousal, avoidance, and intrusion of secondary trauma, therefore, appear to be linked to the characteristics of the pandemic and not to possible factors of inexperience.
	Secondary trauma	Secondary Traumatic Stress Scale—Italian Version
	Hardiness	Dispositional Resilience Scale-15—Italian Version
	Coping style	Coping Self-Efficacy Scale—Short Form
Vagni et al. (2020) [32]	Psychological stress	Emergency Stress Questionnaire	The results of this study highlighted how emergency workers who worked with COVID-19 patients experienced high stress levels and burnout.	Lack of suitable and needed instructions to be able to intervene in a timely manner had a significant impact on stress levels. Correspondingly, stress levels had high positive associations with depersonalisation and emotional exhaustion components of burnout. Nonetheless, the study revealed that hardiness played a protective role in relation to experiencing high stress levels and the risk of developing burnout.
	Burnout	Maslach Burnout Inventory–Human Services Survey, Italian version
	Hardiness	Dispositional Resilience Scale-15—Italian Version
	Stress factors	Original questionnaire or checklist on stressful factors
Zakaria et al. (2021) [36]	Burnout	Burnout Questionnaire with 28 questions on behaviour, attitude, and job-related questions that evaluated burnout levels	51.3% of respondents had burnout, consisting of 61.2% of nurses, 35.1% of doctors, and 29.6% of assistant medical officers.	Factors leading to burnout were frequent exposure to angry members of the public, job overload, lack of clear guidelines, and perceptions of being underpaid.
			Emergency HCWs had a high rate of burnout, especially nurses and senior staff in comparison to juniors. They reported commonly exhibited fatigue, feeling tired, and suffered from frequent illness as part of their burnout symptoms.