Table 2.
Mental health impacts of COVID-19 on health professionals.
| Outcomes | Measure | References | Impact of COVID-19 on outcome | Effect size/comment | ||
|---|---|---|---|---|---|---|
| Impact classified/ | Overall impact | |||||
| compared between groups | (no comparison) | |||||
| Significant | Not significant | |||||
| Overall mental health/ psychological problems | BAI, CES-D, CPDI, DASS-21, GAD-7, GHQ-12; HADS-A, HAMA, HAMD, IES-R, ISI, ITQ, PHQ-9: PTSD-SS, PSQI, SAS, SASR, SDS, SOS, SRQ, STAI, WHO-5 | Arora et al. (23) | ✓ | 34% (95%CI: 24–44) N = 28 | ||
| NA | De Brier et al. (38) | ✓ | β: 5.347, (95%CI:3.831;8.184) N = 1. Contact with infected patients | |||
| GAD-7, GHQ, PHQ-4, PHQ-9, SCL-90, | da Silva and Neto (40) | ✓ | Meta-correlation between covid and psychiatric disorder = 0.72% (95%CI: 0.66–0.78) N = 8 | |||
| NA | Luo et al. (49) | ✓ | Range = 14 to 72%, N = 5 | |||
| NA | Shaukat et al. (58) | ✓ | 23% N = 1 | |||
| NA | Sheraton et al. (59) | ✓ | OR = 1.39 (95%CI: 0.99–1.96), Z = 1.89 N = 5. compared to non-HCW | |||
| NA | Zhao et al. (64) | ✓ | 11.6% (95% CI: 9.2–14.6) N = 3, n = 3,327 | |||
| Anxiety/ Anxiety symptoms | #GAD-7, SAS | Al Maqbali et al. (32) | ✓ | 37% (95% CI 32–41), N = 73. Nurses only | ||
| NA | De Brier et al. (38) | ✓ | AOR: range from 1.57 to 2.06, N = 2 Contact with infected patients | |||
| BAI, DASS-21, GAD-7, GAD-2, HAMA, SAS, | Cenat et al. (27) | ✓ | 16% (95%CI:12–20) N = 23, > 15% (95%CI:11–20) N = 31 | |||
| AS, DAS, GAD-7, HAMA, SAS, SCL-90, SF-36 | da Silva Neto et al. (39) | ✓ | 13%, OR = 1.62 (95%CI:1.33–1.96) N = 7, higher than non-HCW, 5% | |||
| DASS-21, GAD-7, SF-36, STAI | Danet (42) | ✓ | Range = 20–72%, N = 7 | |||
| DASS-21, GAD-7 | De Kock et al. (24) | ✓ | Range = 14.5–44.6%, N = 2 | |||
| NA | de Pablo et al. (43) | ✓ | 22.2% (95%CI: 13–36) N = 4, n = 7,716 | |||
| DASS-21, GAD-7, SAS | Dong et al. (34) | ✓ | 34.4% (95%CI: 30–39) N = 22. China | |||
| DASS-21, GAD-7, HAMA, SAS, SLC-90 | Hao et al. (45) | ✓ | 28.6% (95%CI: 22–36) N = 16 | |||
| NA | Krishnamoorthy et al. (46) | ✓ | 24% (95%CI: 16–32) N = 16 | |||
| NA | Kunz et al. (25) | ✓ | 65.2% N = 1. Only highest prevalence reported (Italy) | |||
| NA | Kunzler et al. (47) | ✓ | SMD = −0.08 (95%CI: −0.66–0.49) N = 13, n = 5,508. compared to before covid | |||
| NA | Luo et al. (49) | ✓ | 26% (95%CI: 18–34) N = 12 | |||
| # BAI, DASS-21, HAMA, HADS, GAD, SAS | Mahmud et al. (20) | ✓ | 41.42% (95% CI: 36–47) N = 75, n = 147,435 | |||
| NA | Marvaldi et al. (26) | ✓ | 30% (95 %CI, 24.2–37.05) N = 22, n = 51,942 | |||
| NA | Moitra et al. (50) | ✓ | Not quantified. N = 10 | |||
| NA | Muller et al. (51) | ✓ | 24% (95%CI: 9–90) N = 22, n = 47,630 | |||
| BAI, DASS-21, HAMA, GAD-7, SAS | Pappa et al. (29) | ✓ | 23.2% (95%CI: 18–29) N = 12 | |||
| DASS-21, GAD-7, HADS | Phiri et al. (52) | ✓ | 21.9% (95%CI: 19-25) N= 69 | |||
| DASS-21, GAD-7, SARS, SAS | Salari et al. (53) | ✓ | 25.8% (95% CI 20.5–31.9%) N = 23 | |||
| DASS-21, GAD-7, HAMA, SAS | Sanghera et al. (54) | ✓ | Range = 12.3–35.6% N = 33 | |||
| BAI, DASS-21, GAD-7, HADS, STAI-S, SAS | Santabarbara et al. (55) | ✓ | 25% (95% CI: 21–29%) N = 71 | |||
| NA | Saragih et al. (56) | ✓ | 40% (95% CI: 29–52%) N = 40 | |||
| DASS-21, GAD-2/7, HADS, HAMA, PHQ-4, SAS | Li et al. (48) | ✓ | 22.1% (95% CI, 18.2–26.3%) N = 57 | |||
| GAD-7, SAS | Shaukat et al. (58) | ✓ | Range = 23–44% N = 2 | |||
| NA | Thatrimontrichai et al. (61) | ✓ | 25.9%, N = 18, n = 6,305/24,297. Asia | |||
| NA | Varghese et al. (62) | ✓ | 32% (95%CI: 21–44%) N = 21, n = 13 641. Nurses | |||
| NA | Vindegaard and Benros (63) | ✓ | Not quantified. N = 8. | |||
| NA | Wu et al. (65) | ✓ | 29% (95%CI 23.6–34.7) N = 23, n = 50,143 Nurses/doctors; 19.9% (12.4–28.6) N = 7, n = 2,521 other professionals | |||
| NA | Zhao et al. (64) | ✓ | 23.2% (95% CI: 17–31) N = 14, n = 13,020 | |||
| Burnout | MBI | Danet (42) | ✓ | Range = 12–36% (emotional exhaustion and depersonalisation) N = 2 | ||
| NA | de Pablo et al. (43) | ✓ | 25% (95%CI: 13–43) N = 1, n = 32 | |||
| NA | Galanis et al. (44) | ✓ | emotional exhaustion 34.1%, depersonalisation 12.6%, lack of personal accomplishment 15.2%; N = 6. Nurses | |||
| NA | Kunz et al. (25) | ✓ | 45.6%, N = 1. Only highest prevalence reported (Belgium) | |||
| NA | Moitra et al. (50) | ✓ | Not quantified. N = 2 | |||
| MBI | Sanghera et al. (54) | ✓ | Range = 3.1–43.0%, N = 5 | |||
| MBI, questionnaire, Pfi | Sharifi et al. (57) | ✓ | Not quantified. N = 12 | |||
| MBI, questionnaire | Sriharan et al. (60) | ✓ | Range = 13–39%, N = 2. Nurses | |||
| Depression/ depressive symptoms | #PHQ-9, SDS | Al Maqbali et al. (32) | ✓ | 35% (95%CI: 31–39) N = 62, nurses | ||
| NA | De Brier et al. (38) | ✓ | AOR: range from 1.52 to 2.97, N = 2. Contact with infected patients. | |||
| BDI, DASS-21, HAMD, PHQ-2, PHQ-9, SDS | Cenat et al. (27) | ✓ | 14% (95%CI:11–17) N = 18, < general population 17% (95%CI:13–22) N = 28 | |||
| DS, HAMD, PHQ-4, PHQ-9, SDS | da Silva Neto et al. (39) | ✓ | 12.2%, OR = 1.3246; 95%CI 1.0930 to 1.6053) N = 7, > other professionals 9.5% | |||
| DASS-21, IPQ, PHQ-9, SDS | Danet (42) | ✓ | Range = 25–65%, N = 10 | |||
| DASS-21, PHQ-9 | De Kock et al. (24) | ✓ | Range = 8.9–50.4% N = 2 | |||
| Estimate | de Pablo et al. (43) | ✓ | 17.9% (95%CI: 7–40) N = 4, n = 7,716 | |||
| DASS-21, PHQ-9, SDS | Dong et al. (34) | ✓ | 31.1% (95 CI: 25–38) N = 18. China | |||
| DASS-21, HAMD, PHQ-2, PHQ-9, SCL-90, SDS | Hao et al. (45) | ✓ | 24.1% (95% CI: 16–32) N = 14 | |||
| NA | Krishnamoorthy et al. (46) | ✓ | 25% (95%CI:19–32) N = 16 | |||
| NA | Kunz et al. (25) | ✓ | 57.9%, N = 1. Only highest prevalence reported (Italy) | |||
| NA | Kunzler et al. (47) | ✓ | SMD =-0.16 (95%CI:−0.59–0.26) N = 7, n = 2,226. compared to before covid | |||
| #SDS, CES-D, DASS-21, HADS | Mahmud et al. (20) | ✓ | 37.12% (95% CI:32–42) N = 69, n = 144,649 | |||
| NA | Marvaldi et al. (26) | ✓ | 31% (95 %CI, 26–37) N = 25, n = 68,030 | |||
| NA | Moitra et al. (50) | ✓ | Not quantified. N = 18 | |||
| NA | Muller et al. (51) | ✓ | 28% (95%CI: 5–51) N = 19, n = 35,219 | |||
| BDI-II, DASS-21, CES-D, PHQ-2, SDS | Pappa et al. (29) | ✓ | 22.8% (95%CI: 15–32) N = 10 | |||
| DASS-21, HADS, PHQ-9 | Phiri et al. (52) | ✓ | 23.4% (95%CI: 21–26) N = 66 | |||
| DASS-21, SDS, BDI-II, HAD | Salari et al. (53) | ✓ | 24.3% (95%CI: 18–32%) N = 21 | |||
| DASS-21, PHQ-9, PHQ-4, SDS, HAMD | Sanghera et al. (54) | ✓ | Range = 13.5–44.7%, N = 32 | |||
| NA | Saragih et al. (56) | ✓ | 37% (95% CI: 29–45%) N = 30 | |||
| CES-D, DASS-21, HADS, PHQ-2, PHQ-4, PHQ-9 | Li et al. (48) | ✓ | 21.7% (95% CI:18–25) N = 55 | |||
| NA | Shaukat et al. (58) | ✓ | 50.4%, N = 1 | |||
| NA | Thatrimontrichai et al. (61) | ✓ | 27.2%, N = 14, n = 10,617/39,014. Asia | |||
| NA | Varghese et al. (62) | ✓ | 32% (95% CI: 21–44) N = 17, n = 12 294 | |||
| NA | Vindegaard and Benros (63) | ✓ | Not quantified. N = 6 | |||
| #GHQ-9, SDS, WHO-5 | Wu et al. (65) | ✓ | 31% (95%CI:25–38) N = 23, n = 41,889 Nurses/doctors; 14.1% (7.4–22.4) N = 6, n = 2,471 other professionals | |||
| NA | Zhao et al. (64) | ✓ | 23.9% (95% CI: 15–36) N = 11, n = 11,922 | |||
| Fear | NA | De Brier et al. (38) | ✓ | AOR: 1.41, (95%CI:1.03;1.93), N = 1. Contact with infected patients. | ||
| Self-questionnaire | De Kock et al. (24) | ✓ | 87%, N = 1. Dentist. Fear of infection from patient or co-worker | |||
| NA | Gohil et al. (33) | ✓ | Range = 60–96.6%, N = 12; Dental. Fear of contagion | |||
| NA | Thatrimontrichai et al. (61) | ✓ | 77.1%, N = 4, n = 2,743/3,558. Asia | |||
| Insomnia | AIS, ISI, PSQI | Cenat et al. (27) | ✓ | 37% (95%CI:33–40) N = 6, HCW, higher than general population 16% (95%CI:8–30) N = 8 | ||
| ISI | da Silva Neto et al. (39) | ✓ | Range = 34–38.4%, N = 3 | |||
| ISI | De Kock et al. (24) | ✓ | 34%, N = 1. | |||
| NA | de Pablo et al. (43) | ✓ | 44.5% (95%CI: 38–51) N = 3, n = 3,490 | |||
| ISI-7, PSQI | Hao et al. (45) | ✓ | 44.1% (95% CI:31.3–57.0%) N = 5 | |||
| NA | Krishnamoorthy et al. (46) | ✓ | 37% (95%CI:32–42) N = 4 | |||
| AIS, ISI, PSQI | Mahmud et al. (20) | ✓ | 43.76% (95% CI: 36–52) N = 21, n = 33,370 | |||
| NA | Moitra et al. (50) | ✓ | Not quantified. N = 10 | |||
| AIS, ISI | Pappa et al. (29) | ✓ | 38.9% (95%CI: 27–42) N = 5 | |||
| NA | Phiri et al. (52) | ✓ | 23.98% (95%CI: 16–32) N = 4 | |||
| AIS, ISI, PSQI | Sanghera et al. (54) | ✓ | Range = 33.8–36.1%, N = 12 | |||
| ISS, PSQI | Shaukat et al. (58) | ✓ | 34%, N = 1 | |||
| NA | Sheraton et al. (59) | ✓ | OR = 2.19 (95%CI: 1.33–3.62), Z = 3.08 N = 2. compared to non-HCW | |||
| NA | Thatrimontrichai et al. (61) | ✓ | 35%, N = 3, n = 2,072/5,919. Asia | |||
| NA | Varghese et al. (62) | ✓ | 38.3%, (95% CI = 5.8%−78.6) N = 2, n = 261 | |||
| NA | Wu et al. (65) | ✓ | 47.3% (95%CI:39–56) N = 7, n = 13,375 Nurses/doctors; 31.8 (27.2–36.5) N = 2, n = 1,380 other professionals | |||
| Obsessive compulsive symptoms | NA | Hao et al. (45) | ✓ | 16.2% (95%CI: 3.0–30) N = 4 | ||
| NA | Vindegaard and Benros (63) | ✓ | Not quantified. N = 1 | |||
| Phobia | SLC-90, SCL | Hao et al. (45) | ✓ | 35.0% (95% CI: 8.6–61) N = 4 | ||
| PTSD/ emotional stress/ distress | NA | De Brier et al. (38) | ✓ | AOR: 1.60, (95%CI:1.25;2.04), N = 1. PTSD. Contact with infected patients. | ||
| IES-R, K-6, SCL-90, SRQ-20 | Cenat et al. (27) | ✓ | 21% (95%CI:5–57) N = 4, HCW PTSD < general population 22% (95%CI:8–50) N = 9; 17% (95%CI:13–22) N = 9, HCW distress > general population 10% (95%CI:5–21) N = 10 | |||
| ASDI, IES-R; PSS | Al Maqbali et al. (32) | ✓ | 43% (95% CI: 37–49), N = 40, nurses. Emotional stress | |||
| NA | da silva and Neto (41) | ✓ | Not quantified, N = 31. HCW stress in ICU | |||
| DASS-21, DSM-5, ASAISTSS | Danet (42) | ✓ | Range = 37–78% N = 10. stress | |||
| NA | de Pablo et al. (43) | ✓ | 29.9% (95%CI: 9–65) N = 3, n = 6,789. Distress; 7.7% (95%CI: 6–11) N = 22, n = 470 PTSD | |||
| DASS-21, IES-R, IES-6, PCL-C, PTSD-SS | Dong et al. (34) | ✓ | 29.1% (95%CI: 24–34) N = 9. Stress & PTSD, China | |||
| CBI, GPS, IES-R, PCL-6, PCL-C | d'Ettorre et al. (22) | ✓ | Range = 6.6%-58.6%. N = 16, PTSD | |||
| NA | Falasi et al. (31) | ✓ | Range = 3.4% (India) to 71.5% (China) N = 5. Acute PTSD | |||
| IES-R, PTSD-SS, PCL-C, PSS-10 | Hao et al. (45) | ✓ | 25.6% (95% CI: 12–39) N = 5. PTSS | |||
| NA | Krishnamoorthy et al. (46) | ✓ | 41% (95% CI:19–65) N = 4 distress; 13% (11–16%) N = 2. PTSS | |||
| NA | Kunz et al. (25) | ✓ | 73.6% N = 1. Only highest prevalence reported (Spain). PTSD | |||
| NA | Kunzler et al. (47) | ✓ | SMD = 0.49 (95% CI:−0.60–1.57) N = 3, n = 1,570. compared to before covid. Stress | |||
| IES, DASS-21, PSS, PTSD | Mahmud et al. (20) | ✓ | 44.86% (95% CI: 36.98–52.74) N = 41, n = 82,783. Stress | |||
| NA | Marvaldi et al. (26) | ✓ | 20.2% (95 %CI:9.9–33) N = 6 PTSD; 56.5% (95 %CI:31–81), N = 3 Acute stress | |||
| NA | Muller et al. (51) | ✓ | 37% (95%CI: 7–97) N = 13, n = 20,391 | |||
| IES-R, PCL-5 | Phiri et al. (52) | ✓ | 25% (95%CI: 19–31) N = 19. PTSD | |||
| CES-D, IES-R, PSS-10, PSS | Sanghera et al. (54) | ✓ | Range = 5.2–32.9% N = 11 acute stress; 7.4–37.4% N = 13. PTSD | |||
| NA | Saragih et al. (56) | ✓ | 49% (95% CI: 22–75) N = 7 PTSD; 37% (95% CI: 25–50) N = 15 Distress | |||
| NA | Li et al. (48) | ✓ | 21.5% (95% CI, 1–35%) N = 9 | |||
| IES, PTSD-SS | Shaukat et al. (58) | ✓ | Range = 23.4–71%, N = 2. Stress disorder | |||
| NA | Varghese et al. (62) | ✓ | 18.6% PTSD (95% CI = 4.8%−38) N = 3, n = 638; 40.6% stress (95% CI = 25.4–56.8%,) N = 10, n = 4,204. Nurses | |||
| #GHQ-12, IES, K6, PSS-10 | Wu et al. (65) | ✓ | 41.2 (19.8–64.5) N = 5, n = 10,165. Distress | |||
| NA | Zhao et al. (64) | ✓ | 28% (95% CI: 9.5–59) N = 5, n = 4,327. PTSS | |||
| Somatization symptoms | NA | Hao et al. (45) | ✓ | 10.7% (95% CI: 1.9–19.6%) N = 5 | ||
| NA | Kunz et al. (25) | ✓ | Not quantified. N = 1. Reported as higher among nurses than doctors (Italy) | |||
| Substance abuse | NA | Kunz et al. (25) | ✓ | 6.2% N = 1. Only highest prevalence reported in nurses and doctors (Spain) | ||
| Suicidal thought/ self-harm | NA | Phiri et al. (52) | ✓ | 5.8% (95%CI: 5–7) N = 4 | ||
# other measures not specified; N, number of studies; n, number of participants; AOR, Adjusted Odds Ratio; ASDI, Acute Stress Disorder Inventory; BAI, Becks Anxiety Inventory; BDI, Beck Depression Inventory; CES-D, Centre for Epidemiology Scale for Depression; CPDI, COVID-19 Peritraumatic Distress Index; DASS-21, Depression, Anxiety Stress Scale; DSM-5, PTSD Symptoms Severity Scale; GAD-7, Generalised Anxiety Disorder; GHQ, General Health Questionnaire; HADS-A, Hospital Anxiety Depression Scale–Anxiety; HAMA, Hamilton Anxiety Scale; HAMD, Hamilton Depression Scale; HCW, Healthcare Workers; IES-R, Impact of Event Scale-Revised; ISI, Insomnia Severity Scale; IPQ, Illness Perception Questionnaire; ITQ, International Trauma Questionnaire; K-6, Kessler-6 Item Psychological Distress Scale; MBI, Maslach Burnout Inventory; OR, Odds Ratio; PHQ, Patient Health Questionnaire; Pfi, Stanford Professional Fulfilment Index; PTSD-SS, Post Traumatic Stress Disorder-Short Scale; PTSS, Posttraumatic Stress Symptoms; PSQI, Pittsburgh Sleep Quality Index; PCL-C, PTSD Checklist Civilian; PTSD-SS, Posttraumatic Stress SAS, Self-rating Anxiety Scale; SASR, Stanford Acute Stress Reaction; SCL, Symptoms Checklist; SDS, Self-rating Depression Scale; SF, Health Questionnaire; SMD, Standardised Mean Difference; SOS, Stress Overload Scale; STAI, State-Trait Anxiety Inventory; SRQ, Stress Response Questionnaire; SRQ-20, Self Reporting Questionnaire-20; STSS, Secondary Traumatic Stress Scale; WHO-5, World Health Organization-5.