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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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Agorastos, A., & Tsamakis, K. (2021) · Psychiatriki · doi:10.22365/jpsych.2021.010 · Cited by 24
Norkienė, I., Jovarauskaitė, L., Kvedaraitė, M., Uppal, E., Phull, M., Chander, H., Halford, K., & Kazlauskas, E. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052660 · Cited by 23
“to the general population or even non-healthcare related hospital staff, HCWs displayed significantly higher rates of various mental health problems during the pandemic [6,7].”
BackgroundSteudte‐Schmiedgen, S., Stieler, L., Erim, Y., Morawa, E., Geiser, F., Beschoner, P., Jerg‐Bretzke, L., Albus, C., Hiebel, N., & Weidner, K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.686667 · Cited by 25
Mira, J. J., Vargas, Á. C., Astier-Peña, M. P., Pérez-Pérez, P., Carrillo, I., Guilabert, M., Pérez‐Jover, V., Fernández, C., Vicente, M. A., Silvestre, C., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182212010 · Cited by 28
de Snyder, V. N. S., Villatoro, A. P., McDaniel, M. D., Ocegueda, A. S., García, D., & Parra-Medina, D. M. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.782846 · Cited by 32
Psychological well‐being and family distress of Italian caregivers during the COVID‐19 outbreak
Fusar‐Poli, L., Surace, T., Meo, V., Patania, F., Avanzato, C., Pulvirenti, A., Aguglia, E., & Signorelli, M. S. (2021) · Journal of Community Psychology · doi:10.1002/jcop.22772 · Cited by 23
Hochwarter, W. A., Jordan, S. L., Kiewitz, C., Liborius, P., Lampaki, A., Franczak, J., Deng, Y., Babalola, M. T., & Khan, A. K. (2022) · Journal of Managerial Psychology · doi:10.1108/jmp-01-2021-0037 · Cited by 26
Chen, X., Chen, J., Zhang, M., Dong, R. K., Li, J., Dong, Z., Ye, Y., Tong, L., Zhao, R., Cao, W., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.833865 · Cited by 23
Jovarauskaitė, L., Murphy, D., Truskauskaitė‐Kunevičienė, I., Dumarkaitė, A., Andersson, G., & Kazlauskas, E. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056289 · Cited by 23
Solmi, M., Thompson, T., Estradé, A., Agorastos, A., Raduà, J., Cortese, S., Dragioti, E., Vancampfort, D., Thygesen, L. C., Aschauer, H. N., et al. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.115972 · Cited by 22
Self-citationWang, Y., & Ma, Q. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1391415 · Cited by 29
Ferreira, S., Sousa, M. M., Moreira, P. S., Sousa, N., Picó‐Pérez, M., & Morgado, P. F. (2021) · JMIR Public Health and Surveillance · doi:10.2196/24312 · Cited by 21
“Furthermore, previous outbreaks of other infectious diseases (eg, severe acute respiratory syndrome, Middle East respiratory syndrome, and A/H1N1 influenza) were associated with an increase in stress, distress, and burnout symptoms among health care professionals [53,54].”
BackgroundAltwaijri, Y. A., Bilal, L., Almeharish, A., Binmuammar, A., Devol, E. B., Hyder, S., Naseem, M. T., AlFattani, A. A. G., Alshehri, A. A., & Almatrafi, R. (2022) · PLoS ONE · doi:10.1371/journal.pone.0268976 · Cited by 25
“Our findings underline the need for psychological intervention plans to address the distress experienced by HCWs in KSA, and are similar to global findings [7, 12, 63].”
ResultLeadership through crisis: fighting the fatigue pandemic in healthcare during COVID-19
Whelehan, D. F., Algeo, N., & Brown, D. A. (2021) · BMJ Leader · doi:10.1136/leader-2020-000419 · Cited by 25
Vancappel, A., Jansen, E., Ouhmad, N., Desmidt, T., Étain, B., Bergey, C., d’Ussel, M., Krebs, M., Paquet, C., Réveillère, C., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.701127 · Cited by 21
Ferreres-Galán, V., Navarro-Haro, M. V., Peris-Baquero, Ó., Guillén-Marín, S., de Luna-Hermoso, J., & Osma, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095715 · Cited by 21
“[7]) being the most prevalent disorders in this population [8,9].”
BackgroundCyr, S., Marcil, M.-J., Houchi, C., Marin, M., Rosa, C., Tardif, J., Guay, S., Guertin, M., Genest, C., Forest, J., et al. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04457-2 · Cited by 25
Alkubati, S. A., Alsaqri, S., Alrubaiee, G. G., almoliky, M. A., Alqalah, T. A. H., Pasay-an, E. A., Almeaibed, H., & Elsayed, S. M. (2024) · Australian Critical Care · doi:10.1016/j.aucc.2024.04.008 · Cited by 27
de Pablo, G. S., Davies, C., Ruiz, H. D. D., Solmi, M., Shin, J. I., Carvalho, A. F., Raduà, J., & Fusar‐Poli, P. (2021) · European Psychiatry · doi:10.1192/j.eurpsy.2021.2222 · Cited by 20
“We did not evaluate publication bias because studies included in the meta-analyses of proportions are noncomparative; thus, there are no “negative” or “undesirable” results or study characteristics like significance levels that may have biased the publications [31, 32].”
MethodSelf-citationBaygi, F., Blome, C., Smith, A. P., Khonsari, N. M., Agoushi, A., Maghoul, A., Esmaeili‐Abdar, M., Gorabi, A. M., & Qorbani, M. (2022) · BMC Public Health · doi:10.1186/s12889-022-12673-4 · Cited by 26
Psychosis and substance abuse increase the COVID-19 mortality risk
Catalán, A., Aymerich, C., Bilbao, A., Pedruzo, B., Pérez, J. L., Aranguren, N., de Pablo, G. S., Hedges, E. P., Gil, P., Segarra, R., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291722000976 · Cited by 19
“The COVID-19 pandemic has affected the mental health of the general population, vulnerable psychiatric groups and healthcare professionals (Salazar de Pablo et al., 2020).”
Self-citationBerger‐Estilita, J., Abegglen, S., Hornburg, N., Greif, R. T., & Fuchs, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19106053 · Cited by 20
Zebrak, K. A., Yount, N. D., Sorra, J., Famolaro, T., Gray, L., Carpenter, D., & Caporaso, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19116815 · Cited by 21
Hernández‐Bojorge, S., Campos, A., Parikh, J., Beckstead, J. W., Lajeunesse, M. J., & Wildman, D. E. (2023) · International Journal of Mental Health Nursing · doi:10.1111/inm.13257 · Cited by 37
Fleuren, B. P. I., Poesen, L. T., Gifford, R. E., Zijlstra, F., Ruwaard, D., Baan, F. C. V. D., & Westra, D. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094701 · Cited by 23
International survey for assessing COVID-19’s impact on fear and health: study protocol
Lok, K. Y. W., Fong, D., Wong, J. Y. H., Ho, M. M., Choi, E. P. H., Pandian, V., Davidson, P. M., Duan, W., Tarrant, M., Lee, J. J., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-048720 · Cited by 20
Neuropsychiatric Disorders and COVID-19: What We Know So Far
Majolo, F., da Silva, G. L., Vieira, L., Anli, C., Timmers, L. F. S. M., Laufer, S., & Goettert, M. I. (2021) · Pharmaceuticals · doi:10.3390/ph14090933 · Cited by 22
“Studies in which brain autopsy was performed support the hypothesis that SARS-CoV-2 infiltrates and destroys the brain, as RNA of SARS was found in 30–40% of the brains [65].”
ResultIndicadores de sofrimento e prazer em trabalhadores de saúde na linha de frente da COVID-19
Baptista, P. C. P., Lourenção, D. C. D. A., Silva-Júnior, J. S., da Cunha, A. A., & Gallasch, C. H. (2022) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.5707.3555 · Cited by 19
Dong, A., Huang, J., Lin, S., Zhu, J., Zhou, H., Jin, Q., Zhao, W., Zhu, L., & Guo, W. (2022) · Journal of Medical Internet Research · doi:10.2196/38108 · Cited by 21
Lewis, M., Palmer, V. J., Kotevski, A., Densley, K., O'Donnell, M. L., Johnson, C., Wohlgezogen, F., Gray, K. M., Robins–Browne, K., & Burchill, L. J. (2021) · JMIR Research Protocols · doi:10.2196/26168 · Cited by 24
“The mental health and well-being of health care workers should be a major public health priority [1] both during the COVID-19 pandemic and beyond to support the successful functioning of the health care system.”
BackgroundImpacto de la pandemia de COVID-19 en los síntomas de salud mental y actuaciones de fisioterapia
Conesa, A. G. (2020) · Fisioterapia · doi:10.1016/j.ft.2020.11.001 · Cited by 21
Lin, K., Selvanayagam, N., Patnaik, S., & Kuo, C. (2025) · Journal of Emergency Nursing · doi:10.1016/j.jen.2025.02.007 · Cited by 23
Telemedicine During COVID-19 Response: A Welcome Shift for Younger Female Healthcare Workers
Brault, M. E., Laudermith, A. L., & Kroll‐Desrosiers, A. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-022-07785-x · Cited by 18
Mancinelli, E., Gritti, E. S., Lomoriello, A. S., Salcuni, S., Lingiardi, V., & Boldrini, T. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.726864 · Cited by 23
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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