Background
Why is this review needed?
Methods
Search strategy and selection criteria
Results
Primary Studies | ||||||||
First author (year) | Country (disease outbreak) | Timepoint (design) | Sample | Mental health outcomes | Measures | |||
AO Chan and CY Huak [8]† | Singapore (SARS) | Concurrent (Cross-sectional) | 661 HCPs (106 SARS exposed HCPs and 555 non exposed HCPs) | PTSD Psychological Distress | IES GHQ-28 | |||
SS Chan et al. [9]◈ | Hong Kong (SARS) | Concurrent (Cross-sectional) | 1470 nurses | Psychological health | SARS NSQ | |||
CS Chen et al. [10]◈ | Taiwan (SARS) | Concurrent (Cross-sectional) | 128 nurses (42 control, 21 conscripted and 65 high-risk nurses) | PTSD Psychological symptoms | IES SCL-90-R | |||
NH Chen et al. [11]† | Taiwan (SARS) | Concurrent (Longitudinal) | 172 (90 SARS exposed HCPs and 82 non HCPs) | Social support | MOS SF-36 | |||
MY Chong et al. [12]† | Taiwan (SARS) | Concurrent (Cross-sectional) | 1257 HCPs | PTSD Psychological Morbidity | IES CHQ | |||
SE Chua et al. [13]◈ | Hong Kong (SARS) | Concurrent (Cross-sectional) | 613 (271 HCPs from SARS units and 342 healthy control subjects) | Perceived stress | PSS-10 | |||
L Fiksenbaum et al. [14] | Canada (SARS) | Concurrent1 (Cross-sectional) | 333 nurses | Burnout (emotional exhaustion) State anger | MBI-EE STAXI | |||
P Goulia et al. [15] † | Greece (A/H1N1) | Concurrent (Cross-sectional) | 469 HCPs | Psychological distress | GHQ-28 | |||
D Ji et al. [16] | Sierra Leone (Ebola) | Concurrent (Longitudinal) | 161 (59 local medical staff; 21 local logistic staff; 22 local medical students; 41 Chinese medical staff and 18 Ebola survivors) | Psychological symptoms (Global severity index, obsession-compulsion) | SCL-90-R | |||
JS Kim and JS Choi [17] | South Korea (MERS) | Concurrent (Cross-sectional) | 215 nurses from emergency department (119 MERS-exposed nurses and 96 MERS non-exposed nurses) | Burnout Job stress | OLBI Parker and DeCotiis scale | |||
D Koh et al. [18]†◈ | Singapore (SARS) | Concurrent (Cross-sectional) | 10,511 HCPs | PTSD | IES | |||
WJ Lancee et al. [19]† | Canada (SARS) | Long (Cross-sectional) | 139 HWCs | Axis I diagnosis excluding the psychosis and PTSD PTSD Burnout (Emotional exhaustion) | SCID CAPS and IES MBI-EE | |||
AM Lee et al. [20] | Hong Kong (SARS) | Concurrent Long (Longitudinal) | 79 SARS patients (49 non–HCPs and 30 HCPS) 96 SARS survivors (63 non–HCPs and 33 HCPS) | Perceived Stress Perceived Stress Anxiety and Depression PTSD Psychological Distress | PSS-10 PSS-10 Subscales of DASS-21 IES-R GHQ-12 | |||
SM Lee et al. [21] | South Korea (MERS) | Concurrent (Longitudinal) | 358 hospital staff (185 doing MERS-related tasks and 173 not doing MERS-related tasks) | PTSD | IES-R | |||
M Lehmann et al. [22] | Germany (Ebola) | Concurrent (Cross-sectional) | 86 (42 internal medicine staff; 32 Ebola patient treatment staff and 12 research laboratory staff) | Health-related quality of life Generalized anxiety disorder; Depression Fatigue | SF-12 GAD-7 Depression module of the PHQ-9 Fatigue subscale of the FACIT | |||
L Li et al. [23] | Liberia (Ebola) | Concurrent2 (Cross-sectional) | 52 HCPs | Psychological health (Obsessive compulsive symptoms) | SCL-90-R (obsessive-compulsive dimension) | |||
CY Lin et al. [24]† | Taiwan (SARS) | Concurrent3 (Cross-sectional) | 92 HCPs (66 emergency department staff and 26 psychiatric ward staff) | PTSD Psychiatric morbidity | DTS-C CHQ-12 | |||
X Liu et al. [25]† | China (SARS) | Long (Cross-sectional) | 549 hospital workers | Depressive symptoms PTS symptoms | CES-D IES-R | |||
YC Lu et al. [26]† | Taiwan (SARS) | Concurrent (Cross-sectional) | 127 HCPs (24 physicians, 49 nurses and 54 other HCPs) | Psychiatric morbidity | CHQ | |||
FW Lung et al. [27]† | Taiwan (SARS) | Concurrent Long (Longitudinal) | 127 HCPs (24 physicians, 49 nurses and 54 otherHCPs) (this is a follow-up of Lu et al., 2006) | Psychiatric morbidity | CHQ | |||
IWC Mak et al. [28] | Hong Kong (SARS) | Long (Cross-sectional) | 90 SARS survivors among which 27 HCPs and 63 non-HCPs | PTSD | IES-R | |||
Z Marjanovic et al. [29]◈ | Canada (SARS) | Concurrent (Cross-sectional) | 333 nurses | Burnout (Emotional exhaustion) state anger | MBI-EE STAXI | |||
K Matsuishi et al. [30]† | Japan (H1N1) | Concurrent4 (Cross-sectional) | 1625 hospital staff (218 medical doctors, 864 nurses, and 543 others) | PTSD | IES | |||
R Maunder [31] ◈† | Canada (SARS) | Concurrent (Cross-sectional) | 1557 HCPs (430 nurses) | PTSD | IES | |||
RG Maunder et al. [32]†◈ | Canada (SARS) | Long (Longitudinal) | Survey A: 769 HCPs (587 SARS exposed HCPs and 182 SARS non exposed HCPs) Survey B: 187 HCPs | PTSD Burnout (emotional Exhaustion) Maladaptative coping; | IES MBI-EE WCQ – (escape-avoidance, self-blame, confrontative coping subscales) | |||
GM McAlonan et al. [33]†◈ | Hong Kong (SARS) | Concurrent Long (Longitudinal) | 176 HCPs (106 high risk HCPs and 70 low risk HCPs) 184 HCPs (71 high risk HCPs and 113 low risk HCPs) | Perceived stress Anxiety, depression and stress PTS symptoms | PSS-10 DASS-21 IES-R | |||
LA Nickell et al. [34]†◈ | Canada (SARS) | Concurrent (Cross-sectional) | 510 HCPs | emotional distress | GHQ-12 | |||
JS Park et al. [35] | South Korea (MERS) | Concurrent (Cross-sectional) | 187 nurses | Mental health Perceived stress | SF-36 form (mental health subscale) PSS-10 | |||
DH Phua et al. [36]† | Singapore (SARS) | Long (Cross-sectional) | 96 HCPs (38 doctors and 58 nurses) (from the method looks like the same sample as Tham et al. (2004). However, this is not stated in the study.) | psychiatric morbidity PTSD (psychological reactions) Coping strategies | GHQ-28 IES COPE | |||
E Poon et al. [37]†◈ | Hong Kong (SARS) | Concurrent (Cross-sectional) | 1926 hospital staff (534 high risk hospital staff and 1392 low risk hospital staff) | Burnout (emotional exhaustion) Anxiety | MBI-EE C-STAI | |||
K Sim et al. [38]◈ | Singapore (SARS) | Concurrent5 (Cross-sectional) | 277 HCPs (97 high risk HCPs and 180 low risk HCPs) | PTS symptoms Psychiatric morbidity Coping | IES-R GHQ-28 Brief COPE questionnaire | |||
H Son et al. [39] | South Korea (MERS) | Concurrent (Cross-sectional) | 280 hospital staff (153 HCPs and 127 non-HCPs) | Coping ability PTSD | K-CD-RISC IES-RK | |||
R Styra et al. [40]†◈ | Canada (SARS) | Concurrent (Cross-sectional) | 248 HCPs (160 high risk HCPs and 88 low risk HCPs) | PTS symptoms | IES-R | |||
T-P Su et al. [41] | Taiwan/ SARS | Concurrent (Longitudinal) | 102 nurses (70 nurses from SARS units and 32 nurses from non-SARS units) | Anxiety Depression PTS symptoms Sleep disturbance (insomnia) | STAI BDI DTS-C DSM IV and PSQI | |||
H Sun and X Ren [42] | China (SARS) | Concurrent (Cross-sectional) | 73 HCPs (35 infected HCPs and 38 uninfected HCPs) | Mental health | SCL-90 Chinese version | |||
CW Tam et al. [43]†◈ | Hong Kong (SARS) | Concurrent (Cross-sectional) | Study design | Psychological morbidty | GHQ-12 Chinese version | |||
KY Tham et al. [44] | Singapore (SARS) | Long (Cross-sectional) | Cross-sectional2b | Psychiatry morbidity PTS symptoms | GHQ-28 IES | |||
S Verma et al. [45]†◈ | Singapore (SARS) | Concurrent6 (Cross-sectional) | Cross-sectional2b | Psychological distress PTS symptoms | GHQ-28 IES | |||
TW Wong et al. [46]†◈ | Hong Kong (SARS) | Concurrent7 (Cross-sectional) | Cross-sectional2b | Coping strategies | Brief COPE questionnaire | |||
P Wu et al. [47]†◈ | China (SARS) | Long | Longitudinal1b | PTS symptoms | IES-R | |||
H Xiao et al. [48] | China (COVID-19) | Concurrent (Cross-sectional) | Cross-sectional2b | Anxiety Sleep (quality) Stress | SAS PSQI SASR | |||
Intervention Studies | ||||||||
Author (year) | Sample size | Country | Cross-sectional2b | Brief description of intervention | Impact on Mental Health (yes/no) | Which MH outcome? | Format of intervention | Timing of intervention |
R Chen et al. [49]◈ | 116 | Taiwan | Cross-sectional2b | SARS prevention programme (based on information provided by WHO and CDC): In-service training, manpower allocation, gathering sufficient protective equipment, and establishment of a mental health team for patients and professionals | yes | Anxiety Depression Sleep quality | No information | Before first patient with SARS was seen |
R Marrs et al. [50] | 31 | USA | Longitudinal1b | High consequence infectious diseases training using interprofessional simulation and TeamSTEPPS (based on Jeffries Simulation Theory): simulation of real life events such as patients vomiting, bleeding, having diarrhea, or respirator battery dying when caring for patients with a highly infectious disease | yes | State anxiety | 2 computerised simulation sessions including interprofessional TeamSTEPPS training | Before disease outbreak |
RG Maunder et al. [51] | 158 | Canada | Cross-sectional2b | Computer-assisted resilience training (interactive reflective exercises) | yes | Coping strategies: problem-solving and seeking support | Computer-assisted interactive reflective exercises of varying length: 1.75 h, 3 h and 4.5 h | Before disease outbreak |
M Sijbrandij et al. [52] | 408 | Sierra Leone | Cross-sectional2b | One-day PFA training: (1) explaining important terms (mental health, mental disorder, psychosocial support and psychosocial disorder); (2) understanding reactions to traumatic and stressful events; (3) understanding PFA; (4) understanding sources and signs of stress; (5) self-care; (6) providing PFA-prepare for your role, look, listen and link; (7) ending your assistance; (8) practicing PFA with role-play | no | Professional quality of life: burnout and compassion fatigue | One-day training | Acute aftermath of disease outbreak |
S Waterman et al. [53] | 3273 | Sierra Leone | Cross-sectional2a | CBT–based group intervention for HCPs with MH symptoms. Phase 1: PFA (discussion of challenges linked with work and the impact of this, ways of coping, and their achievements). Phase 2: Psychoeducation: information about a specific mental health problem and discussion of coping strategies based on behavioural and cognitive approaches (self-help). Phase 3: group CBT: behavioural activation, decreasing avoidance, problem solving, and coping with anxiety. | yes | PTSD, depression, anxiety, sleep, perceived stress, anger, relationship problems | Stepped intervention: 2-h workshop on psychological first aid + 2-h workshop on psychoeducation + 6 weekly sessions of brief CBT group programme | Towards the end of disease outbreak |
Reviews | ||||||||
First author (year) | Disease outbreak | Sample | Design | Mental health outcomes | ||||
SK Brooks et al. [6]◈ | SARS | HCPs | Cross-sectional | Psychological wellbeing; perceived stress; work/job-related stress; overall and emotional distress; panic; anxiety; PTSD; fatigue; sleep; health worries; fear of social contact; health fear; social isolation; depression; acute stress disorder; alcohol intake; anger; concerns for personal or family health; psychological support; social support; neurosis; stigmatisation; adjustment disorder; resilience; coping (including avoidance behaviour); burnout (including emotional exhaustion). | ||||
PJ Gardner and P Moallef [54] | SARS | SARS survivors, including HCPs | Cross-sectional | Psychotic symptomatology; fear of survival; fear of infecting others; perceived stigmatisation; quality of life; psychological/emotional distress; PTSD | ||||
M Kunin et al. [1] | SARS; H1N1 | GPs | Cross-sectional | Psychological distress; anxiety; PTSD | ||||
KJ Vyas et al. [5]† | SARS; H1N1 | HCPs | Cross-sectionnal | Psychological distress; insomnia; alcohol/drug misuse; PTSD; depression; anxiety. |
The psychological impact of an epidemic/pandemic on the mental health of healthcare professionals
First author (year) | Statistical approach | Results |
---|---|---|
SE Chua, et al. [13] | Difference between HCPs and healthy controls on stress levels (no inferential test) | Stress levels for HCPs (M = 18.6, SD = 4.9) were similar to healthy control subjects (M = 18.3, SD = 5.6), but 50% higher than the normative value for the PSS-10. |
Fiksenbaum et al. (2006) [14] | Correlations between contact with SARS patients, and emotional exhaustion and state anger. | Exposure amongst nurses was significantly correlated with emotional exhaustion (r = −.21; p < .001) and state anger (r = −.18; p < .001). |
D Ji, et al. [16] | Difference in the psychological dimensions of the SCL-90-R between 1 week after arrival of Chinese medical staff in an outbreak zone (Sierre Leone) and 1 week after withdrawal (either Man Whitney U or t-test) | Obsessive compulsion (M = 1.39, SD = .18 vs M = 1.23, SD = .36; p =. 1421); depression (M = 1.22, SD = .31 vs M = 1.18, SD = .29; p = .5480); hostility (M = 1.09, SD = .13 vs M = 1.09, SD = .18; p = 1.00); paranoid ideation (M = 1.11, SD = .19 vs M = 1.11, SD = .24; p = 1.00) and psychoticism (M = 1.14, SD = .24 vs M = 1.08, SD = .14; p = 1.706). |
JS Kim and JS Choi [17] | Group differences between MERS exposed vs not exposed nurses on MERS-related burnout (t-test) | Nurses exposed to infected/−suspected patients had higher MERS-related burnout scores (M = 3.09, SD = 0.48) than non-exposed nurses (M = 2.93, SD = 0.42, p = .013). |
WJ Lancee et al. [19] | Group differences between HCPs with vs. without history of mental illness on mental disorder development (Fischer test). | A year after the outbreak, HCPs with a history of mental illness before the outbreak had higher risk of developing a new mental DSM-IV axis 1 mental disorder (18%), compared to healthcare workers without (2%, p = .03). |
M Lehmann et al. [22] | Group differences between internal medicine staff, Ebola patient treatment staff and research laboratory staff on anxiety levels (Test unspecified). | Internal medicine staff, Ebola patient treatment staff and research laboratory staff did not significantly differ levels of anxiety. |
IWC Mak et al., 2009. [28] | Group differences between infected HCPs and infected non HCPs on PTSD prevalence (Test unspecified). | Thirty months after SARS outbreak, PTSD prevalence was higher among infected HCPs (40.7%) than among infected non HCPs (19%, p = .031). |
Z Marjanovic et al. [29] | Correlation between contact with SARS patients, and emotional exhaustion and state anger in nurses. Multiple regressions for emotional exhaustion and state anger. Correlation between avoidance behavior, and emotional exhaustion and state anger. | Contact with SARS patient was significantly correlated with emotional exhaustion (r = −.21; p < .001) and state anger (r = −.18; p < .001). Contact with SARS patients significantly predicted emotional exhaustion (β = −.15, p = .003) but did not predict state anger (β = −.09, p = .068). Avoidance behavior was significantly correlated with emotional exhaustion (r = .26; p < .001) and state anger (r = .33; p < .001). |
RG Maunder, et al. [32] | Group differences between SARS exposed vs not exposed HCPs on burnout prevalence (χ2). Group differences between SARS exposed vs not exposed HCPs on burnout (t-test or Mann-Whitney U Test) Group differences between SARS exposed vs not exposed HCPs on face-to-face patient contact (χ2). Group differences between SARS exposed vs not exposed HCPs on work hours (χ2). | Burnout prevalence is higher in exposed HCPs (30.4%) than HCPS not exposed (19.2, p = .003) Exposed HCPs had significantly higher burnout scores (Md = 19, IQR = 10–29) than non- exposed HCPs (Md = 16, IQR = 9–23) Since SARS outbreak, significantly less face-to-face patient contact was reported by exposed HCPs (16.5%) compared to those who were not exposed (8.3%, p = .007). Since SARS outbreak, significantly less work hours was reported by exposed HCPs (8.6%) compared non exposed HCPs (2.2%, p = .003). |
GM McAlonan et al. [33] | During outbreak: Group differences between high vs low risk HCPs on perceived stress (t-test). Comparison of symptom scores to norm (no inferential test) One year after outbreak: Group differences between high vs low risk HCPs on perceived stress (2-way ANOVA). Interaction between time and infection level tested with a 2 way ANOVA. | Perceived stress levels did not significantly differ between high vs low risk HCPs (t(164) = − 1.36, p = 0.176) although they were higher than the normative value (13). Perceived stress levels of high-risk HCPs (M = 18.6, SD = 4.9) were significantly higher than the low-risk HCPs (M = 14.8, SD = 5, p < .05). Change in perceived stress from 2003 to 2004 was significantly different for the 2 groups (F1,336 = 4.61, P < 0.05), with a general trend toward a decrease over time for low-risk HCPs and an increase for high-risk HCPs. |
JS Park et al. [35] | Mediation analysis of the relationship between hardiness and mental health by perceived stress Mediation analysis of the relationship between stigma and mental health by perceived stress | The relationship between hardiness and mental health was partially mediated by perceived stress (indirect effect 0.251, Boot SE = 0.638). Where increased hardiness led to descrease stress (B = −.31, SE = .05, p < .001), which subsequently led to better mental health symptoms (B = −.81, SE = .13, p < .001). The relationship between stigma and mental health was mediated by perceived stress (indirect effect = − 0.061, Boot SE = 0.020). Where increased stigma led to increase stress (B = .075, SE = .023, p = .002), which subsequently led to better mental health symptoms (B = −.81, SE = .13, p < .001). |
E Poon et al. [37] | Group differences between hospital workers who had contact with SARS patients vs no contact with SARS patients on burnout symptoms (t-test). | Hospital workers who had contact with SARS patients had significantly higher burnout symptoms (M = 7.3, SD = 5.3) than those who did not have contact with SARS patients (M = 5.1, SD = 4.7, p < .001). |
K Sim et al. [38] | Group differences between doctors and nurses with versus without psychiatric morbidities on effort coping, in context of SARS outbreak (Mann-Whitney U Test) Group differences between doctors and nurses with versus without posttraumatic morbidities on effort coping, in context of SARS outbreak (Mann-Whitney U Test). Group differences were examined between exposed and non exposed medical staff on psychiatric symptoms (Mann-Whitney test) and posttraumatic symptoms (χ2), in the context of a SARS outbreak. | Doctors and nurses with psychiatric morbidities had higher scores on effort coping (M = 49.7, SD = 13.2) than doctors and nurses without psychiatric morbidity (M = 39.7, SD = 10.4, p < .001) Doctors and nurses with psychiatric morbidities had higher scores on effort coping (M = 53.4, SD = 13.1) than doctors and nurses without psychiatric morbidity (M = 40.6, SD = 10.9, p < .001). Exposed medical staff showed no difference to non-exposed staff in psychiatric symptoms (M = 2.6, SD = 4.2 vs. M = 2.3, SD = 4.4, p = .28) or presence of posttraumatic symptoms (7.2% vs.10.6%, p = .40). |
TW Wong et al. [46] | Group differences between doctors, nurses and healthcare assistants on coping strategies, in context of SARS outbreak (ANOVA with post hoc analyses). | Planning was more likely to be used by doctors (M = 5.33, SD = 1.44) compared to nurses (M = 4.85, SD = 1.44, p < .05) and healthcare assistants (M = 4.42, SD = 1.56, p < .01). Behavioral disengagement was more likely to be used by nurses (M = 2.96, SD = 1.26) than doctors (M = 2.56, SD = 0.91, p < .01). Self-distraction was more likely to be used by healthcare assistants (M = 4.58, SD = 1.92) than doctors (M = 4.11, SD = 1.42, p < .05). |
H Xiao et al. [48] | Assessment of the indirect pathway from social support to sleep quality via perceived stress. | The relationship between social support and sleep quality was mediated by perceived stress (B = −.06, SE = .01, p = .002). Where a lack of social support (B = .57, SE = .09, p < .001) led to an increase in perceived stress, which subsequently led to lower sleep quality (B = .26, SE = .01, p < .001). |