A Systematic Review and Provisional Metanalysis on Psychopathologic Burden on Health Care Workers of Coronavirus Outbreaks
Open Access
- 16 October 2020
- journal article
- review article
- Published by Frontiers Media SA in American Journal of Translational Research
- Vol. 11, 568664
- https://doi.org/10.3389/fpsyt.2020.568664
Abstract
Background: The new coronavirus (SARS-CoV-2) shows several similarities with previous outbreaks of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). Aim of this systematic review and meta-analysis is to provide evidence of the psychopathologic burden on health care workers (HCWs) of the first two deadly coronavirus outbreaks to get lessons for managing the current burden of COVID-19 outbreak. Method: According to Cochrane Collaboration guidelines and the PRISMA Statement, the study quantified the effects of frontline work on mental health of HCWs. Major databases — Pubmed, Scopus, Embase, Medline, and Web of Science — were searched for observational and case-control studies evaluating mental health indexes reported by front-line work. This study computed the percentage of sample that reported clinically significant levels of psychiatric symptoms. Cohen’s d was used for comparing mental health outcomes of health care workers directly involved in addressing pandemic emergency with a control group that was not directly exposed to such conditions. Pooled effect sizes (dw) were estimated whenever at least three independent studies yielded data. Heterogeneity of findings and bias of publication were estimated as well. Findings: Fifteen studies have been selected for a total of 7,393 HCWs. From 9.6% to 51% of HCWs reported symptoms of Post-Traumatic Stress Disorder (PTSD) and from 20% to 75% reported psychiatric symptoms, with a prevalence of anxiety and depression. From one to the three years after outbreak, from 2% to 19% reported PTSD symptoms and from 5% to 90% psychiatric symptoms. Interestingly, HWCs who were directly involved in pandemic emergency showed significantly higher depressive and anxious symptoms (dw = .66 (.46–.85); p <.001) than ones who were not directly exposed. Similarly, the direct involvement significantly affected the severity of PTSD symptoms (dw = .30 (.21–.39); p <.001). Conclusion: Health care professionals in general and most of all frontline workers showed an association with a likely risk of developing psychiatric disorders following outbreaks and for at least three years later. Mental health interventions for professionals exposed to COVID-19 need to be immediately implemented. Further studies are warranted to investigate long-term consequences carefully, and to look for mediating and buffering factors as well. The role of clinical psychologists and psychiatrists in delivering adequate interventions is critically important.Keywords
This publication has 40 references indexed in Scilit:
- Isolation of a Novel Coronavirus from a Man with Pneumonia in Saudi ArabiaNew England Journal of Medicine, 2012
- Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemicComprehensive Psychiatry, 2012
- 2009 Updated Method Guidelines for Systematic Reviews in the Cochrane Back Review GroupSpine, 2009
- The psychological effect of severe acute respiratory syndrome on emergency department staffEmergency Medicine Journal, 2007
- Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS OutbreakEmerging Infectious Diseases, 2006
- Assessing heterogeneity in meta-analysis: Q statistic or I² index?Psychological Methods, 2006
- Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospitalThe British Journal of Psychiatry, 2004
- Measuring inconsistency in meta-analysesBMJ, 2003
- An overview of clinical research: the lay of the landThe Lancet, 2002