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Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis
Open accessAbstract
Background Health care workers (HCW) are at high risk of developing physical/mental health outcomes related to coronavirus syndromes. Nature and frequency of these outcomes are undetermined.Methods PRISMA/MOOSE-compliant (PROSPERO-CRD42020180205) systematic review of Web of Science/grey literature until 15th April 2020, to identify studies reporting physical/mental health outcomes in HCW infected/exposed to Severe Acute Respiratory Syndrome -SARS-, Middle East Respiratory Syndrome -MERS-, Novel coronavirus -COVID-19-. Proportion random effect meta-analyses, I 2 statistic, quality assessment and sensitivity analysis.Results 115 articles were included (n=60,458 HCW, age 36.1±7.1, 77.1% female). Physical health outcomes: 75.9% HCW infected by SARS/MERS/COVID-19 reported fever (95%CI=65.9-83.7%, k=12, n=949), 47.9% cough (95%CI=39.2-56.8%, k=14, n=970), 43.6% myalgias (95%CI=31.9-56.0%, k=13, n=898), 42.3% chills (95%CI=20.2-67.9%, k=7, n=716), 41.2% fatigue (95%CI=18.2-68.8%, k=6, n=386), 34.6% headaches (95%CI=23.1-48.2%, k=11, n=893), 31.2% dyspnoea (95%CI=23.2-40.5%, k=12, n=1003), 25.3% sore throat (95%CI=18.8-33.2%, k=8, n=747), 22.2% nausea/vomiting (95%CI=14.9-31.8%, k=6, n=662), 18.8% diarrhoea (95%CI=11.9-28.4%, k=9, n=824). Mental health outcomes: 62.5% HCW exposed to SARS/MERS/COVID-19 reported general health concerns (95%CI=57.0-67,8%, k=2, n=2254), 43.7% fear (95%CI=33.9-54.0%, k=4, n=584), 37.9% insomnia (95%CI=30.9-45.5%, k=6, n=5067), 37.8% psychological distress (95%CI=28.4-48.2%, k=15, n=24,346), 34.4% burnout (95%CI=19.3-53.5%, k=3, n=1337), 29.0% anxiety features (95%CI=14.2-50.3%, k=6, n=9191), 26.3% depressive symptoms (95%CI=12.5-47.1%, k=8, n=9893), 20.7% post-traumatic stress disorder features (95%CI=13.2-31%, k=11, n=3826), 16.1% somatisation (95%CI=0.2-96.0%, k=2, n=2184), 14.0% stigmatisation feelings (95%CI=6.4-28.1%, k=2, n=411).Limitations Limited amount of evidence for some outcomes and suboptimal design in several studies included.Conclusions SARS/MERS/COVID-19 have a substantial impact on the physical and mental health of HCW, which should become a priority for public health strategies.
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“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 [182]
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“During this pandemic, burnout was identified among HW and persistent burnout was found to be able to contribute to higher levels of anxiety, acute stress, and depersonalization symptoms [18,19,20].”
From Anxiety, depression and risk of post-traumatic stress disorder in health workers: the relationship with burnout during COVID-19 pandemic in Italy (2021) · cites this paper as [18]
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“As mentioned above, burnout is already high among physicians and other HCWs in ordinary times with prevalence rates up to or over 50% [67] and was also a frequently associated feature during previous epidemics particularly for HCWs working long hours [39,68].”
Adibi, A., Golitaleb, M., Farahi-Ashtiani, I., Pirani, D., Yousefi, K., Jamshidbeigi, Y., & Sahebi, A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.658846 · Cited by 72
Chutiyami, M., Bello, U. M., Salihu, D., Ndwiga, D. W., Kolo, M. A., Maharaj, R., Naidoo, K., Devar, L., Pratitha, P., & Kannan, P. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104211 · Cited by 73
Zhao, Y.-J., Jin, Y., Rao, W., Li, W., Zhao, N., Cheung, T. C. C., Ng, C. H., Wang, Y. Y., Zhang, Q., & Xiang, Y. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.03.016 · Cited by 71
Rogers, J. P., Chesney, E., Oliver, D., Begum, N., Saini, A., Wang, S., McGuire, P. K., Fusar‐Poli, P., Lewis, G., & David, A. S. (2021) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796021000214 · Cited by 72
Self-citationPauksztat, B., Andrei, D. M., & Grech, M. R. (2021) · Safety Science · doi:10.1016/j.ssci.2021.105542 · Cited by 84
Symptoms related to mental disorder in healthcare workers during the COVID-19 pandemic in Brazil
Campos, J. Á. D. B., Martins, B. G., Campos, L. A., Dias, F. V., & Marôco, J. P. (2021) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-021-01656-4 · Cited by 65
“(2020), in a New York hospital study (nurse: n = 313 and physicians: n = 344), and Salazar de Pablo (2020), in a systematic review reported an impact of the pandemic on mental (insomnia, psychological distress, anxiety, and depressive symptoms), physical (cough, fatigue, fever, headaches, and sore…”
BackgroundAlfalasi, B., al Mazrouei, M., al Ali, M., al Dhamani, M., Ali, A. A., al Kindi, M., Dalkilinc, M., Qubaisi, M. A., Campos, L. A., Tunaiji, H. A., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18042182 · Cited by 68
Singh, R. K., Bajpai, R. C., & Kaswan, P. (2021) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2021.100737 · Cited by 62
Mansueto, G., Lopes, F. L., Grassi, L. G., & Cosci, F. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2644 · Cited by 63
“Healthcare workers had more fatigue than the general population; fatigue prevalence was described between 35% and 56% according to the studies (Hou et al., 2020; Salazar de Pablo et al., 2020; Zhan et al., 2020).”
Sahebi, A., Abdi, K., Moayedi, S., Torres, M., & Golitaleb, M. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110597 · Cited by 61
“Pappa [31] United Kingdom 33,062 34⋅32% (27⋅45–41⋅54) 98%) NA ISI, AIS Physicians, nurses Other HCWs de Pablo [32] United”
BackgroundThe Psychological Impact of COVID-19 on Front Line Nurses: A Synthesis of Qualitative Evidence
González, S. H., Selva-Medrano, D., López‐Espuela, F., Caro‐Alonso, P. A., Novo, A., & Rodríguez‐Martin, B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182412975 · Cited by 60
“Our results are in line with those of a quantitative systematic review [43] which analyzes the psychological impacts of other pandemics and highlights that fear is considered by professionals as the main psychological manifestation along with anxiety and depression.”
ResultMental Health and COVID-19: The Psychological Implications of a Pandemic for Nurses
Shah, M., Roggenkamp, M., Ferrer, L., Bürger, V. K., & Brassil, K. J. (2021) · Clinical journal of oncology nursing · doi:10.1188/21.cjon.69-75 · Cited by 66
Akbari, M., Spada, M. M., Nikčević, A. V., & Zamani, E. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2628 · Cited by 63
Bell, C., Williman, J. A., Beaglehole, B., Stanley, J., Jenkins, M., Gendall, P. J., Rapsey, C. M., & Every‐Palmer, S. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-048107 · Cited by 62
Carmassi, C., Dell’Oste, V., Bui, É., Foghi, C., Bertelloni, C. A., Atti, A. R., Buselli, R., Paolo, M. D., Goracci, A., Malacarne, P., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.128 · Cited by 61
Irfan, M., Shahudin, F., Hooper, V. J., Akram, W., & Ghani, R. A. (2021) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580211056217 · Cited by 67
Maqbali, M. A. H. A., Alsayed, A. R., Hughes, C., Hacker, E. D., & Dickens, G. L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0302597 · Cited by 65
Blake, H., Gupta, A., Javed, M., Wood, B., Knowles, S., Coyne, E., & Cooper, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073626 · Cited by 53
Hou, T., Zhang, R., Song, X., Zhang, F., Cai, W., Liu, Y., Dong, W., & Deng, G. (2020) · PLoS ONE · doi:10.1371/journal.pone.0243884 · Cited by 55
“7%, which is higher than a systematic review summarizing the prevalence of fatigue among HCWs during COVID-19 with an overall incidence rate of fatigue among paramedics of 38% [58].”
BackgroundPrevalence and associated factors of psychosocial distress among seafarers during COVID-19 pandemic
Baygi, F., Khonsari, N. M., Agoushi, A., Gelsefid, S. H., Gorabi, A. M., & Qorbani, M. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03197-z · Cited by 59
Alshamrani, M. M., El‐Saed, A., Zunitan, M. A., Almulhem, R., & Almohrij, S. A. (2021) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2021.07.009 · Cited by 55
Lulli, L. G., Giorgi, G., Pandolfi, C., Foti, G., Finstad, G. L., Arcangeli, G., & Mucci, N. (2021) · Sustainability · doi:10.3390/su132413869 · Cited by 59
Anxiety and depression among healthcare workers during COVID-19 pandemic: A cross-sectional study
Motahedi, S., Aghdam, N. F., Khajeh, M., Baha, R., Aliyari, R., Bagheri, H., & Mardani, A. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e08570 · Cited by 51
“…systematic review concluded that diseases such as SARS, Middle East respiratory syndrome (MERS), and COVID-19 had a substantial impact on the HCWs ’ mental health so that they experienced fear, insomnia, psychological distress, burnout, anxiety features, depression symptoms, and PTSD features [22].”
BackgroundGreenwald, A., Kelly, A., Mathew, T. T., & Thomas, L. A. (2023) · Medical Education Online · doi:10.1080/10872981.2023.2178366 · Cited by 49
“…of “Any questions?” to create space for questions and make it clear that they are welcomed and expected. supported by studies which report increased anxiety, posttraumatic stress disorder, and other mental health disorders in health care workers on the front lines of the pandemic [1,52,4,62,63].”
BackgroundRapid Review on COVID-19, Work-Related Aspects, and Age Differences
Bellotti, L., Zaniboni, S., Balducci, C., & Grote, G. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105166 · Cited by 47
Krok, D., Zarzycka, B., & Telka, E. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10010132 · Cited by 51
“Recent studies conducted during the COVID-19 pandemic also revealed that psychological distress was associated with fear of being infected with COVID-19 from patients [6,7].”
BackgroundMediavilla, R., Fernández-Jiménez, E., Martínez‐Alés, G., Moreno‐Küstner, B., Martínez-Morata, I., Jaramillo, F., Morán‐Sánchez, I., Minué, S., Torres-Cantero, A. M., Alvarado, R., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.08.059 · Cited by 47
Safiye, T., Vukčević, B., Gutić, M., Milidrag, A., Dubljanin, D., Dubljanin, J., & Radmanović, B. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116577 · Cited by 54
Yan, H., Ding, Y., & Guo, W. (2021) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000922 · Cited by 46
“In the present meta-analysis and the previous meta-analysis (45), the pooled prevalence of somatic symptoms was 16%.”
Datta, K., & Tripathi, M. (2021) · Neurology India · doi:10.4103/0028-3886.310073 · Cited by 44
Sharma, R., Bansal, P., Chhabra, M., Bansal, C., & Arora, M. (2021) · Asian Journal of Social Health and Behavior · doi:10.4103/shb.shb_9_21 · Cited by 46
Efectos de la pandemia por COVID-19 en la salud mental de la población trabajadora
Ruíz-Frutos, C., & Gómez-Salgado, J. C. (2021) · Archivos de Prevención de Riesgos Laborales · doi:10.12961/aprl.2021.24.01.01 · Cited by 45
“Se ha sugerido que el impacto en la salud mental de los profesionales sanitarios, durante la primera ola de COVID-19, puede haber reducido la capacidad de resiliencia ante las futuras oleadas(8).”
BackgroundSolmi, M., Estradé, A., Thompson, T., Agorastos, A., Raduà, J., Cortese, S., Dragioti, E., Leisch, F., Vancampfort, D., Thygesen, L. C., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.07.048 · Cited by 45
Self-citationHall, C. E., Davidson, L., Brooks, S. K., Greenberg, N., & Weston, D. (2023) · BMC Psychology · doi:10.1186/s40359-023-01221-3 · Cited by 39
Ghio, L., Patti, S., Piccinini, G., Modafferi, C., Lusetti, E., Mazzella, M., & Del Sette, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189929 · Cited by 43
Occupational Stress Monitoring Using Biomarkers and Smartwatches: A Systematic Review
Morales, A. S., Barbosa, M. L. K., Morás, L. D., Cazella, S. C., Sgobbi, L. F., Junior, I. G. S., & Marques, G. (2022) · Sensors · doi:10.3390/s22176633 · Cited by 46
Vagni, M., Giostra, V., Maiorano, T., Santaniello, G., & Pajardi, D. (2020) · Sustainability · doi:10.3390/su12219071 · Cited by 54
Metadata
- Authors
- Salazar de Pablo, G., Vaquerizo-Serrano, J., Catalan, A., Arango, C., Moreno, C., Ferre, F., Shin, J. I., Sullivan, S., Brondino, N., Solmi, M., & Fusar-Poli, P.
- Affiliations
- Hospital General Universitario Gregorio Marañón (ES)
- Universidad Complutense de Madrid (ES)
- Yonsei University (KR)
- University of Bristol (GB)
- University of Pavia (IT)
- University of Padua (IT)
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 275
- Pages
- 48-57
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC7314697
- OpenAlex
- W3037551969
- Cited by
- 631
- References
- 121
- Citations by year
- 2026: 9 · 2025: 37 · 2024: 72 · 2023: 99 · 2022: 152 · 2021: 224 · 2020: 37
- FWCI
- 10.01
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, cc-by-nc-nd)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- Seventh Framework Programme
- Oficina Regional de Coordinación de Salud Mental, Comunidad de Madrid
- Fundación Mutua Madrileña
- H2020 Euratom
- Fundación Alicia Koplowitz
- Instituto de Salud Carlos III
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Clinical Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- healthcare workers, COVID-19 pandemic, SARS, MERS, physical health outcomes, mental health outcomes, post-traumatic stress disorder, depression, anxiety, occupational exposure, fever, fatigue, psychological distress
- MeSH terms
- COVID-19, Anxiety, Burnout, Professional, Fatigue, Female, Health Personnel, Humans, Male, Mental Health, Middle Aged, Pneumonia, Viral, Stress Disorders, Post-Traumatic, Coronavirus Infections, Severe Acute Respiratory Syndrome, Pandemics
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