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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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The Relationships Between COVID-19 Anxiety, Ageism, and Ableism
Arcieri, A. A. (2021) · Psychological Reports · doi:10.1177/00332941211018404 · Cited by 15
“…ableism The recent COVID-19 pandemic has been a source of mental health stress across the globe (Cai et al., 2020; González-Sanguino et al., 2020; Salazar de Pablo et al., 2020; Shigemura & Kurosawa, 2020), negatively impacting healthcare workers (Cai et al., 2020; Salazar de Pablo et al.,…”
BackgroundJin, Y., Li, Y., Li, X.-Y., Zhao, Y.-J., Cheung, T. C. C., Ungvari, G. S., Li, M., An, F., & Xiang, Y. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.678917 · Cited by 11
“Fatigue has been underestimated, despite it was also common in health professionals during the SARS/MERS outbreaks (7, 14).”
Background“Sleep Quality and Depression Level in Nurses in COVID-19 Pandemic”
TOSUN, A., Tosun, H., Özkaya, B. Ö., Erdoğan, Z., & Gül, A. (2022) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228221123159 · Cited by 12
Psychiatric and neuropsychiatric syndromes and COVID-19 – Authors' reply
Rogers, J. P., Chesney, E., Oliver, D., Pollak, T. A., McGuire, P. K., Fusar‐Poli, P., Zandi, M. S., Lewis, G., & David, A. S. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30304-7 · Cited by 11
Self-citationRoth, K., Köppen, J., & Henschke, C. (2025) · Human Resources for Health · doi:10.1186/s12960-025-01026-y · Cited by 11
“The COVID-19 pandemic has, among other issues, such as workload pressure and skill shortages [12], additionally contributed to an increase in burnout among health care workers [13, 14].”
da Silva, R. R., & da Silva, L. A. (2021) · Revista de Pesquisa Cuidado é Fundamental Online · doi:10.9789/2175-5361.rpcfo.v13.11097 · Cited by 10
Nagle, E., Cerela-Boltunova, O., Blumberga, S., Mihailova, S., & Griškēviča, I. (2023) · Social Sciences · doi:10.3390/socsci12030175 · Cited by 11
“…as a consequence of the pandemic, HCWs were exposed to; greater emotional burnout—approximately 50%, post-traumatic stress syndrome—25%, anxiety—25%, and depression—15% (Batra et al. 2020; Ching et al. 2021; Galanis et al. 2021; de Pablo et al. 2020; Sheraton et al. 2020; da Silva and Neto 2021).”
BackgroundKabasinguzi, I., Ali, N., & Ochepo, P. (2023) · BMC Public Health · doi:10.1186/s12889-023-15423-2 · Cited by 12
Seddik, S. A., Abdelhai, R., Aboushady, A. T., Nawwar, A. E., Essawy, R. A. E., & Hegazy, A. A. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1277056 · Cited by 10
Lavell, A. H. A., Sikkens, J. J., Buis, D. T. P., Smulders, Y. M., Vinkers, C. H., Bomers, M. K., & Tijdink, J. K. (2025) · PLOS mental health. · doi:10.1371/journal.pmen.0000333 · Cited by 10
“…health care workers (HCWs) face notably more stressors during pandemics, including increased mortality among their patients, moral dilemmas concerning the utilization of scarce resources, changing work environment, and the physical dangers of the increased risk of contracting an infection [1–3].”
Nurses Who Are More Willing to Participate in the Fight against COVID-19: Evidence from China
Tong, L. K., Zhu, M., Wang, S.-C., Cheong, P. L., & Van, I. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18147357 · Cited by 10
“Nurses may be more affected by the COVID-19 outbreak than other HCW, with higher rates of SARS-CoV-2 infection and psychological distress [3,4].”
BackgroundOsório, F. D. L., Zuardi, A. W., Silveira, I. L. M., Crippa, J. A. S., Hallak, J. E. C., Pereira‐Lima, K., & Loureiro, S. R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.852157 · Cited by 11
Vivion, M., Jauvin, N., Nicolakakis, N., Pelletier, M., Letellier, M.-C., & Biron, C. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20126116 · Cited by 10
Diest, A. P.-V., Vilagut, G., Alayo, I., Ferrer, M., Amigo, F., Amann, B. L., Peña, A. A., Aragonès, E., Asúnsolo, Á., Campos, M., et al. (2023) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796023000628 · Cited by 11
“…is in line with pooled estimates found in meta-analyses of post-TSSs among HCWs active during coronavirus outbreaks (13–22%; Y. Li et al. , 2021b; Salazar de Pablo et al. , 2020; Salehi et al. , 2021; Serrano-Ripoll et al. , 2020) and higher than the prevalence of 15.8% estimated in the Spanish…”
InfluentialWang, J., Huang, X., Wang, M., Huang, L., & Wang, Y. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05006-1 · Cited by 10
Leira-Sanmartín, M., Madoz‐Gúrpide, A., Mangado, E. O., & Ibáñez, Á. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073608 · Cited by 11
“Experience gained in previous epidemic outbreaks (Severe Acute Respiratory Syndrome - SARS, Middle-East Respiratory Syndrome - MERS, Ebola crisis) shows that both HCWs and the general population can be affected by psychiatric symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) when exposed to the…”
BackgroundElliott, D., Ochieng, C., Jepson, M., Blencowe, N., AVERY, K. N. L., Paramasivan, S., Cousins, S., Skilton, A., Hutchinson, P. J., Jayne, D. G., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-046662 · Cited by 11
Giving birth during a pandemic: From elation to psychopathology
Puertas‐Gonzalez, J. A., Mariño-Narváez, C., Romero‐Gonzalez, B., & Peralta‐Ramírez, M. I. (2021) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.13803 · Cited by 11
COVID-19–Related Stigma and Mental Health of Children and Adolescents During Pandemic
Özbaran, B., Türer, F., Yılancıoğlu, H. Y., Köse, S., Pilan, B. Ş., Guzel, O., Başkol, D., Polat, F., Bildik, T., Sertoz, S. R., et al. (2021) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045211059408 · Cited by 11
Ting, C., Chan, A. Y., Chan, L. G., & Hildon, Z. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19042477 · Cited by 10
Kaczmarski, K., Pasha, A., Inusah, A. S., Li, X., & Qiao, S. (2024) · medRxiv · doi:10.1101/2024.10.10.24315244 · Cited by 10
“Previous systematic reviews have focused on the effects of the pandemic on overall mental health outcomes among healthcare workers instead of particularly investigated resilience (Chemali et al., 2022; De Pablo et al., 2020; Neto & Silva, 2023; Sheraton et al., 2020).”
BackgroundHealthcare worker burnout during a persistent crisis: a case–control study
Appelbom, S., Nordström, A., Finnes, A., Wicksell, R. K., & Bujacz, A. (2024) · Occupational Medicine · doi:10.1093/occmed/kqae032 · Cited by 11
Salvador, A. P., Jaloto, A. M., Zuanazzi, A. C., Gonçalves, A. P., Machado, G. M., & Carvalho, L. D. F. (2021) · Archives of Psychiatry and Psychotherapy · doi:10.12740/app/133639 · Cited by 9
“The high levels of anxiety found in our sample, for the COVID-19 health workers group, were also found in investigations in Spain [11], China [13], and Iran [32], in addition to being observed in systematic reviews [17, 18, 19, 20].”
ResultMadden, M. J., Kneavel, M. E., & Bowman, T. G. (2022) · Journal of Athletic Training · doi:10.4085/1062-6050-0541.21 · Cited by 9
Factors Affecting the Psychological Well-Being of Health Care Workers During the COVID-19 Crisis
Alharthi, M. H., Alshomrani, A. T., Bazaid, K., Sonpol, H. M. A., Ibrahim, I. A. E., & El‐Ashkar, A. M. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s370456 · Cited by 9
Social and economic wellbeing of seafarers across coastal Nigeria amidst Corona virus disease
Ozabor, F., Efe, S. I., Kpang, M. B. T., & Obisesan, A. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e18275 · Cited by 9
“To them, travel restrictions imply that mariners can’t leave their ships, get home or even receive urgent medical help outside the ship [28,29].”
BackgroundCondições de trabalho e saúde de profissionais da linha de frente na pandemia de covid-19
Alves, L. I. D. N., de Siqueira, G. R., Santos, G. D. S., Soares, A. R. D. S., de Souza, A. I. G., Dantas, D. D. S., & Tenório, A. D. S. (2024) · Saúde em Debate · doi:10.1590/2358-289820241418791p · Cited by 16
Early intervention in psychosis during the COVID-19 pandemic: Maudsley recommendations
Jauhar, S., Lai, S., Bonoldi, I., de Pablo, G. S., Forti, M. D., Alameda, L., Donocik, J. G., Iacoponi, E., Spencer, T. J., Haege, B., et al. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.02.005 · Cited by 9
Self-citationEnd of Life Intervention Program During COVID-19 in Vall d'Hebron University Hospital
Beneria, A., Panisello, E. C., Sorribes-Puertas, M., Forner-Puntonet, M., Serrat, L., García-González, S., Garriga, M., Simon, C., Raya, C., Montes, M. J., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.608973 · Cited by 9
Liu, M., Li, N., Cai, X., Feng, X., Wang, R., & Xiong, P. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.708698 · Cited by 12
Donne, V. D., Massaroni, V., Ciccarelli, N., Borghetti, A., Ciccullo, A., Baldin, G., Giuliano, G., Dusina, A., Visconti, E., Tamburrini, E., et al. (2023) · La Medicina del Lavoro · doi:10.23749/mdl.v114i2.13829 · Cited by 9
“Moreover, HCWs who were involved in handling the pandemic showed symptoms of stress and burnout [11].”
BackgroundLópez‐López, L., Mateo, A. C., Ortíz‐Rubio, A., Santiago, M. G., Ciuró, A. H., Núñez, J. M., & Valenza, M. C. (2023) · Healthcare · doi:10.3390/healthcare11162306 · Cited by 7
Educar en las emociones en tiempos de crisis
Cassà, È. L., & Alzina, R. B. (2024) · RELIEVE - Revista Electrónica de Investigación y Evaluación Educativa · doi:10.30827/relieve.v30i1.30381 · Cited by 19
“Desde el inicio de la pandemia se han realizado estudios sobre su impacto en la salud mental (Imran, 2020; Orgiles et al., 2020; Salazar de Pablo et al., 2020; Xiong et al., 2020).”
BackgroundLiu, Y., Huang, S., Zhang, X., Liao, H., Liu, W., Zhang, Z., Qu, X., & Wang, Z. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1511930 · Cited by 8
Yang, H.-J., Li, M. W., & Chen, T.-C. (2025) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2025.101973 · Cited by 12
The impact of the pandemic on moral panics in society
Tolmacheva, S. V., Tkachev, A., & Shamshin, M. (2021) · International Journal of Health Sciences · doi:10.53730/ijhs.v5n3.1485 · Cited by 7
“Feelings of anxiety and depression pass away, and the person begins to adapt to the changes more effectively (de Pablo et al., 2020; Tang et al., 2020).”
BackgroundKibar, F. A., Muharremoğlu, Z. D., OTURAK, G., Çokluk, S. T., Güven, E. A., İsmail, O. N. U. R., & Öğütlü, A. (2022) · Turkish Journal of Family Medicine & Primary Care · doi:10.21763/tjfmpc.989004 · Cited by 9
Quintana, G. R. (2022) · International Journal of Sexual Health · doi:10.1080/19317611.2022.2053921 · Cited by 8
“…distancing, canceled public gatherings, etc. Subsequently, the sustained social isolation along with the rapidly changing economic and social landscape throughout the pandemic took an undeniable toll on people’s health (e.g., Dai et al., 2021; Salazar de Pablo et al., 2020; Talevi et al., 2020).”
Background
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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