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Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis
Open accessAbstract
Background COVID-19 pandemic has the potential to significantly affect the mental health of healthcare workers (HCWs), who stand in the frontline of this crisis. It is, therefore, an immediate priority to monitor rates of mood, sleep and other mental health issues in order to understand mediating factors and inform tailored interventions. The aim of this review is to synthesize and analyze existing evidence on the prevalence of depression, anxiety and insomnia among HCWs during the Covid-19 outbreak.Methods A systematic search of literature databases was conducted up to April 17th, 2020. Two reviewers independently assessed full-text articles according to predefined criteria. Risk of bias for each individual study was assessed and data pooled using random-effects meta-analyses to estimate the prevalence of specific mental health problems. The review protocol is registered in PROSPERO and is available online.Findings Thirteen studies were included in the analysis with a combined total of 33,062 participants. Anxiety was assessed in 12 studies, with a pooled prevalence of 23·2% and depression in 10 studies, with a prevalence rate of 22·8%. A subgroup analysis revealed gender and occupational differences with female HCPs and nurses exhibiting higher rates of affective symptoms compared to male and medical staff respectively. Finally, insomnia prevalence was estimated at 38·9% across 5 studies.Interpretation Early evidence suggests that a considerable proportion of HCWs experience mood and sleep disturbances during this outbreak, stressing the need to establish ways to mitigate mental health risks and adjust interventions under pandemic conditions.
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TL;DR
This systematic review and meta-analysis pooled 13 cross-sectional studies of healthcare workers during the COVID-19 pandemic and found substantial pooled prevalence of anxiety, depression, and insomnia. It reports roughly one in four workers with anxiety or depression and about one in three with insomnia, with higher estimates among women and nursing staff.
Key findings
- Pooled prevalence was 23.21% for anxiety (95% CI 17.77–29.13, I² = 99%; 12 studies), 22.8% for depression (95% CI 15.1–31.51, I² = 99.62%; 10 studies), and 34.32% for insomnia (95% CI 27.45–41.54, I² = 98%; 5 studies).
- Subgroup estimates were higher for women than men for anxiety (29.06% vs 20.92%) and depression (26.87% vs 20.34%), and higher for nurses than doctors for anxiety (25.80% vs 21.73%) and depression (30.30% vs 25.37%).
- Mild symptoms were more common than moderate/severe symptoms: anxiety 17.93% vs 6.88%; depression 24.60% vs 16.18%. Scale-specific pooled estimates varied, e.g., GAD-7 anxiety 36.92% vs SAS anxiety 16.47%, and PHQ-9 depression 36.72 vs SDS depression 32.81.
Methods
- The review followed PRISMA and MOOSE guidance and was registered in PROSPERO (CRD42020180313). Searches covered MEDLINE, PubMed, Google Scholar, MedRxiv, and SSRN through April 17, 2020, with no language restrictions, and included cross-sectional studies of healthcare workers in COVID-19-affected areas that used validated measures for depression, anxiety, or insomnia.
- The meta-analysis included 13 cross-sectional studies with 33,062 participants; 12 were conducted in China (2 in Wuhan) and 1 in Singapore. Median study size was 1,563 (range 134–11,118), median male representation was 18%, and median questionnaire participation was 85.3%.
- Pooled prevalence was estimated with a random-effects model in MetaXL using double arcsine transformation. Subgroup analyses examined gender, rating scales, symptom severity, and professional group; sensitivity analyses excluded each study in turn. Study quality was assessed with a modified Newcastle-Ottawa scale.
Limitations
- Stated in the paper: heterogeneity was high across studies because of different assessment scales and cut-offs; some studies may have sampled overlapping populations from the same region or country; most studies were from China, limiting generalizability; all included studies were cross-sectional, so long-term mental health effects remain unknown; and the number of available studies was relatively small early in the pandemic.
- Evident from the text: the very high I² values (often near 99%) indicate substantial unexplained between-study variability, and the inclusion of preprints means some data may not have been peer-reviewed.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled prevalence was 23·21% (95% CI 17·77-29·13, I2 = 99%) as presented in Fig. 2 .”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Anxiety prevalence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“when both were excluded, the recalculated pooled prevalence was 16·94% (95% CI, 10·38-24·67, I2 = 99·56%).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Depression prevalence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“low risk of bias studies (n = 9) revealed a total pooled anxiety prevalence of 24·06% (95% CI 16·84-32·09, I2 = 99%).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Anxiety prevalence
Strength:plain· not yet calibratedn = 9Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“four studies (Huang and Zhao, 2020, Lai et al., 2020, Zhang et al., 2020a, Zhu et al., 2020) used the GAD-7 scale with a pooled prevalence of 36·92% (95% CI 26·06-48·23, I2 = 99%).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Anxiety prevalence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled prevalence was calculated as 34·32% (95% CI 27·45–41·54, I2 = 98%).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Insomnia prevalence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Three (Lai et al., 2020, Zhang et al., 2020a, Zhu et al., 2020) studies used the PHQ-9 score for which the pooled prevalence was 36·72 (95% CI 7·69–69·16, Ι2 = 100%)”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Depression prevalence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among low risk of bias studies (n = 8) the pooled prevalence was 22·93% (95% CI 13·16–34·38).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Depression prevalence
Strength:plain· not yet calibratedn = 8Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“four studies (Guo et al., 2020, Huang et al., 2020b, Liu et al., 2020, Liu et al., 2020)used the Zung Self-Rating Anxiety Scale (SAS) with a pooled prevalence of 16·47% (95% CI 14·66-18·63, I2 = 84%)”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Anxiety prevalence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Prevalence of depression by severity could be calculated in four (Du et al., 2020, Liu et al., 2020, Lu et al., 2020, Tan et al., 2020)studies, with respective values for mild and moderate/severe of 24·60% and 16·18%.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Subgroup analysis
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In sensitivity analysis, no study affected the pooled prevalence by over 2% when excluded.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Anxiety prevalence
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- It may state two separate claims as one. 17
- Probably not a substantial claim. 16
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After de-duplication and screening, thirteen studies (Du et al., 2020, Guo et al., 2020, Huang et al., 2020b, Huang and Zhao, 2020, Lai et al., 2020, Liu et al., 2020, Liu et al., 2020, Lu et al., 2020, Qi et al., 2020, Tan et al., 2020, Zhang et al., 2020a, Zhang et al., 2020b, Zhu et al., 2020) with a total of 33,062 participants were included in the analysis.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Characteristics of included studies
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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In the paper
“Out of the 13 studies, 12 were undertaken in China, two of which were in Wuhan (Lai et al., 2020, Zhu et al., 2020), while one took place in Singapore (Tan et al., 2020).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Characteristics of included studies
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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In the paper
“Regarding the severity of the anxiety, data were available in six studies with a pooled prevalence of 17·93% for mild anxiety and 6·88% for moderate/severe”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Subgroup analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it appears that the majority of the HCWs experienced mild symptoms both for depression and anxiety, while moderate and severe symptoms were less common among the participants.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Between doctors and nurses, in the five studies with available data on depression, the pooled prevalence was calculated as 30.30% for nurses and 25.37% for doctors”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Subgroup analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In doctor and nurse groups, prevalence could be calculated in six studies, with respective values of 21·73%and 25·80%”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Results > Subgroup analysis
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- The authors state this as an assumption: One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prevalence rate of anxiety and depression appeared to be higher in females”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“nursing staff exhibited higher prevalence estimates both for anxiety and depression compared to doctors.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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In the paper
“These results may be partly confounded by the fact that nurses are mostly female but could be also attributed to the fact they may face a greater risk of exposure to COVID-19 patients as they spend more time on wards, provide direct care to patients and are responsible for the collection of sputum for virus detection”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
What the sources say
- Not checked yetcites Liu et al., 2020
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None of the sources cited for this claim have been checked yet.
In the paper
“a number of other studies published in recent weeks provide emerging evidence that COVID-19 is severely affecting the wellbeing of healthcare professionals.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
What the sources say
- Not checked yetcites Cheung et al., 2020
- Not checked yetcites Bohlken et al., 2020
- Not checked yetcites Xu et al., 2020
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“The systematic review was conducted in accordance with the PRISMA statement”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Materials and methods
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In the paper
“physicians are already at an increased risk of suicide compared to the general population (West et al., 2018).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
What the sources say
- Not checked yetcites West et al., 2018 source
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“the studies included in our meta-analysis were all cross-sectional, thus the long-term implications of COVID-19 pandemic on HCW’s mental health warrant further research.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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“Two authors independently identified records published until April 17th 2020 that reported on the prevalence of depression, anxiety, and insomnia in HCWs during the coronavirus pandemic through systematically searching MEDLINE, PubMed and Google Scholar databases.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Materials and methods > Research strategy and selection criteria
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In the paper
“another study performed in the original center of the epidemic, Wuhan, showed that a large proportion of HCW in Wuhan were affected and that mental health support was necessary even for mild psychological reactions (Kang et al., 2020).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
What the sources say
- Not checked yetcites Kang et al., 2020 source
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“Another limitation is that several studies might have included the same population as they were broadly conducted in the same region/country.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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“The following data were extracted from each article by two reviews independently”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Materials and methods > Data extraction and quality assessment
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In the paper
“The MOOSE (Meta-analyses Of Observational Studies in Epidemiology) Checklist was followed.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Materials and methods
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In the paper
“considering the fact that China was severely affected, they provide a reliable indication of the potential of COVID-19 pandemic to affect the mental health of HCWs.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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- Rests on an assumption: China was severely affected by COVID-19.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Potential differences, however, between these outbreaks and the COVID-19 pandemic could be explained on the basis of the extremely high infectious potential and mortality rate of the former but also the experience acquired in the interim in these areas.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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In the paper
“The accuracy of the extracted or calculated data was confirmed by comparing the collection forms of the two investigators.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Materials and methods > Data extraction and quality assessment
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In the paper
“Different assessment scales were utilized for population screening and different cut offs set even though several studies used the same tests. Thus, threshold criteria for case definition varied”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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In the paper
“The review protocol is registered in PROSPERO and is available online (CRD42020180313).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Materials and methods
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In the paper
“two authors independently evaluated the risk of bias of the included cross-sectional studies using a modified form of the Newcastle-Ottawa scale. Potential disagreements were resolved by a third author.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Materials and methods > Data extraction and quality assessment
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“our systematic review and meta-analysis provide a timely and comprehensive synthesis of the existing evidence highlighting the high prevalence rates of depression, anxiety and insomnia of healthcare professionals.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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In the paper
“Findings can help to quantify staff support needs and inform tiered and tailored interventions under pandemic conditions that enhance resilience and mitigate vulnerability.”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
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In the paper
“level of social support was found to positively correlate with self-efficacy and sleep quality and negatively with anxiety and stress (Xiao et al., 2020).”
§ Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis > Discussion
What the sources say
- Not checked yetcites Xiao et al., 2020
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The paper relies on this without support.
The impact of the COVID-19 crisis on the psychological well-being of medical and nursing staff had not yet been established at the time of the review.
“However, to date, the impact of the current unprecedented crisis on the psychological well-being of medical and nursing staff is yet to be established.”
The paper relies on this without support.
This is the first systematic review and meta-analysis to examine the pooled prevalence of depression, anxiety and insomnia in healthcare workers during the COVID-19 outbreak.
“To our knowledge, this is the first systematic review and meta-analysis to examine the pooled prevalence of depression, anxiety and insomnia on HCW during the COVID-19 outbreak.”
The authors state this as an assumption.
One true effect size cannot be assumed across studies due to different patient populations, regions, and assessment methods.
“Due to the different patient populations, regions, and assessment methods across studies, one true effect size cannot be assumed; therefore, a random effects model (DerSimonian & Laird) was used to extract the pooled prevalence.”
The paper relies on this without support.
China was severely affected by COVID-19.
“considering the fact that China was severely affected, they provide a reliable indication of the potential of COVID-19 pandemic to affect the mental health of HCWs.”
The paper relies on this without support.
Healthcare systems vary greatly between countries.
“generalizing this type of results could pose severe flaws as healthcare systems vary greatly between countries.”
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In the citing paper
“A meta-analysis of 13 studies of mental health among healthcare workers found that almost a quarter exhibited elevated COVID-19 related symptoms of anxiety (23.2%) and depression (22.8%), and more than a third (38.9%) experienced problems with insomnia (Pappa et al. 2020).”
From Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic (2021) · cites this paper as Pappa et al. 2020
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Several factors have been reported to increase the risk for psychological symptoms in healthcare workers, including being a nurse, female gender, and frontline work (Muller et al., 2020; Pappa et al., 2020).”
From Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic. (2025) · cites this paper as Pappa et al., 2020
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Several factors have been reported to increase the risk for psychological symptoms in healthcare workers, including being a nurse, female gender, and frontline work (Muller et al., 2020; Pappa et al., 2020).”
From Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic. (2025) · cites this paper as Pappa et al., 2020
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The COVID-19 pandemic led to increased stress, distress, and burnout across the health and social care workforce,9–12 including palliative care13–16 and exacerbated the need for healthcare staff support internationally.13–17”
From Feasibility of RESTORE: An online Acceptance and Commitment Therapy intervention to improve palliative care staff wellbeing. (2023) · cites this paper as [9]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Several factors have been reported to increase the risk for psychological symptoms in healthcare workers, including being a nurse, female gender, and frontline work (Muller et al., 2020; Pappa et al., 2020).”
From Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic. (2025) · cites this paper as Pappa et al., 2020
In the citing paper
“These findings were supported by a systematic review of 13 studies including more than 33 000 participants.6”
From COVID-19: a heavy toll on health-care workers (2021) · cites this paper as [6]
In the citing paper
“These findings provide new knowledge, since in most of the emergent scientific literature on this topic, these levels have been studied in health workers rather than undergraduates (Pappa et al., 2020).”
From Fear of COVID-19, Stress, and Anxiety in University Undergraduate Students: A Predictive Model for Depression (2020) · cites this paper as Pappa et al., 2020
In the citing paper
“However, most of these studies were carried out in samples of health workers (Pappa et al., 2020), and much less is known about young people.”
From Fear of COVID-19, Stress, and Anxiety in University Undergraduate Students: A Predictive Model for Depression (2020) · cites this paper as Pappa et al., 2020
In the citing paper
“With regard to the risk factor related to psychopathology, consistently with previous epidemiological studies, we have found that females, and patients with positive previous psychiatric diagnoses, suffered more in all psychopathological dimensions (Vindegaard and Eriksen Benros, 2020, Ozamiz-Etxebarria et al., 2020, Pappa et al., 2020).”
From Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors (2020) · cites this paper as Pappa et al., 2020
In the citing paper
“The published literature posits that the distress and anxiety among individuals in this COVID-19 pandemic may increase the incidence of mental disorders [53,54,99]”
From Psychosocial Effects of the COVID-19 Pandemic: Large-scale Quasi-Experimental Study on Social Media (2020) · cites this paper as [99]
In the citing paper
“The stressful situation of healthcare workers, specially the fear to infect relatives, may lead to depressive symptoms (12.2–26.3%), anxiety (13–29%), and PTSS (3–20.7%) as well.”
From Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology (2021) · cites this paper as [184]
In the citing paper
“Meta-analyses have found a high prevalence of anxious and depressive symptoms among HCWs, especially among women and nurses (Pan et al., 2020; Pappa et al., 2020).”
From Traumatic Stress in Healthcare Workers during COVID-19 Pandemic: A Review of the Immediate Impact (2020) · cites this paper as Pappa et al., 2020
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“2% of the population experienced anxiety [139].”
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“The fear of contracting the virus, known as "Corona Disease Anxiety," can lead to mental and psychological disturbances, weakening the immune system and hampering the body’s ability to combat diseases within the community, including healthcare professionals such as nurses and doctors (6, 7).”
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Finucane, A., Hulbert-Williams, N. J., Swash, B., Spiller, J. A., Lydon, B., & Gillanders, D. (2022) · AMRC Open Research · doi:10.12688/amrcopenres.13035.2 · Cited by 2
Metadata
- Authors
- Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P.
- Affiliations
- West London Mental Health NHS Trust (GB)
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Pappa, Sofia
- ORCID
- Venue
- Brain Behavior and Immunity
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 88
- Pages
- 901-907
- ISSN
- 0889-1591 (ISSN-L)
- PMC
- PMC7206431
- OpenAlex
- W3021065879
- Cited by
- 3,617
- References
- 62
- Citations by year
- 2026: 161 · 2025: 231 · 2024: 357 · 2023: 568 · 2022: 885 · 2021: 1070 · 2020: 342
- FWCI
- 56.00
- Type
- journal article
- Language
- en
- Update notices
- erratum (2021-02-01)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Brain Behavior and Immunity (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- COVID-19 pandemic, healthcare workers, depression, anxiety, insomnia, mental health, prevalence, nurses, gender differences, occupational differences, mood disorders, sleep disorders
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Anxiety, Depression, Health Personnel, Humans, Sleep Initiation and Maintenance Disorders, Nurses, Physicians, Pneumonia, Viral, Prevalence, Sex Distribution, Coronavirus Infections, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-28, under version 3 of the claim definition (prompt extract-v3).
A second model labelled each claim on 2026-09-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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