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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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Meta-Analytical Evidence on Mental Disorder Symptoms During the COVID-19 Pandemic in Latin AmericaPreprint
Zhang, S. X., Batra, K., Liu, T., Dong, R. K., Xu, W., Yin, A., Delios, A., Chen, B. Z., Chen, R. Z., Miller, S., et al. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.3858820 · Cited by 5
Nassif, R. M., Radjack, R., Beaini, N., Choueiri, T., Binkowski, G. I., Dozio, E., Joubert, M. L., Moro, M. R., Tarazi-Sahab, L., & Husseini, M. E. (2025) · BMC Psychology · doi:10.1186/s40359-025-02962-z · Cited by 4
Vinnakota, A., Nukala, S., Singisetti, S., Chilukuri, S., Abhilash, G. V., Sanapala, V., & Rao, L. (2020) · Telangana Journal of Psychiatry · doi:10.18231/j.tjp.2020.032 · Cited by 4
“27 In the current study, higher rates of Burnout were noted in age groups 36-45 yrs. and in female gender.”
Benzies, K., Perry, R. L., & Williams, J. C. (2021) · Social Work in Mental Health · doi:10.1080/15332985.2021.1975013 · Cited by 4
“While there is considerable literature about sources of stress, supports, and resilience for healthcare providers (Barzilay et al., 2020; De Pablo et al., 2020; Shechter et al., 2020; Tomlin, Dalgleish-Warburton, & Lamph, 2020), to our knowledge, this study is among the first to identify…”
BackgroundInfluentialRegina, M., Henny, S., & Antonio, F. (2021) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2021.7270 · Cited by 5
“This is very important to closely pay attention to employee wellbeing including mental health and job satisfaction to increase or maintain the job performance (JP) of the health care professionals [3], [43], [44], [45], [46], [47], [48], [49] [50], [51].”
BackgroundAlmulihi, Q. A., Almulihi, F. A. A., Alobaidan, S. K. S., Alsultan, S. K. A., Alsultan, D. A. H., & Alsultan, Y. M. H. (2022) · International Journal of Health Sciences · doi:10.53730/ijhs.v6ns4.6557 · Cited by 4
Marconi, A., Myers, U. S., Retamar, A. M., Freddi, I. J., Chiarelli, J., & Zamora, R. (2022) · Revista Brasileira de Medicina do Trabalho · doi:10.47626/1679-4435-2022-872 · Cited by 4
Olivares, S., Olmos, C., Maturana, J. A. R.-T., & Campaña, G. (2022) · Revista médica de Chile · doi:10.4067/s0034-98872022001001342 · Cited by 6
“A 36% (95% confidence intervals (CI) [32,8-39,2]) prevalence of high levels of burnout syndrome was found.”
BackgroundKhobragade, A. W., & Agrawal, N. (2023) · Indian Journal of Community Medicine · doi:10.4103/ijcm.ijcm_482_22 · Cited by 4
Malgaroli, M., Tseng, E., Hull, T. D., Jennings, E. L. M., Choudhury, T., & Simon, N. M. (2023) · JMIR AI · doi:10.2196/47223 · Cited by 6
Guilabert, M., Sánchez-García, A., Asencio, A., Marrades, F., García, M., & Mira, J. J. (2023) · Atención Primaria · doi:10.1016/j.aprim.2023.102809 · Cited by 4
Determinants maintaining healthcare personnel’s motivation during COVID-19 pandemic in Uganda
Komasawa, M., Aung, M. N., Nsereko, C., Saito, K., Ssekitoleko, R., Isono, M., & Yuasa, M. (2025) · Scientific Reports · doi:10.1038/s41598-025-86685-6 · Cited by 4
Aparicio, A. I. Á. (2020) · Revista de Comunicación y Salud · doi:10.35669/rcys.2020.10(2).211-248 · Cited by 4
Engagement in Meaningful Activities and Psychological Distress During the COVID-19 Pandemic
Tigershtrom, A., & Boyraz, G. (2022) · Journal of Loss and Trauma · doi:10.1080/15325024.2021.2016140 · Cited by 4
“The evidence from prior epidemics and pandemics (e.g., for reviews, see Cabarkapa et al., 2020; Preti et al., 2020; Salazar de Pablo et al., 2020; Serrano-Ripoll et al., 2020), combined with recent studies on COVID-19 (for reviews, see Boyraz & Legros, 2020; Loades et al., 2020; Luo et al., 2020;…”
Rolland, F. (2022) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2022.05.004 · Cited by 4
Mohamed, S. H. P., & Subbarayalu, A. V. (2022) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v93i5.13158 · Cited by 6
Vitale, E., Filetti, V., Vella, F., Senia, P., Rapisarda, L., Matera, S., Lombardo, C., Vinnikov, D. V., Rapisarda, V., & Ledda, C. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11247372 · Cited by 4
Wu, H., Qi, K., Luan, B., Liu, Z., & Zhao, Q. (2023) · Nursing Open · doi:10.1002/nop2.2010 · Cited by 3
The psychological impact of COVID-19 on frontline doctors in Tshwane public hospitals
Duffton, J. D., Heystek, M., Engelbrecht, A., Rajan, S., & Toit, R. D. (2023) · South African Family Practice · doi:10.4102/safp.v65i1.5807 · Cited by 4
“1,2,3,4,19 The literature suggests that burnout is exacerbated during a pandemic.”
BackgroundResultInfluentialChen, Z., Sinha, G. R., DeVylder, J., Mushonga, D. R., Mason, M. J., Fedina, L., & Amen, Z. (2024) · Social Work in Mental Health · doi:10.1080/15332985.2024.2377959 · Cited by 4
Prevalence of depression during the SARS, MERS, and COVID-19 pandemics
Du, L., Chen, Y., Li, Y., Yuan, W., & Wang, J. (2020) · Medicine · doi:10.1097/md.0000000000022235 · Cited by 4
“Salazar de Pablo et al, 2020([24]) Cross-sectional study 8 9893 Health care workers 26.”
BackgroundSomma, A., Krueger, R. F., Markon, K. E., Gialdi, G., Colanino, M., Ferlito, D., Liotta, C., & Fossati, A. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.06.024 · Cited by 4
Post, E. G., DiSanti, J. S., Eason, C. M., Root, H. J., & Abdenour, T. (2021) · Internet Journal of Allied Health Sciences and Practice · doi:10.46743/1540-580x/2021.2060 · Cited by 4
Sarfraz, Z., Sarfraz, A., Sarfraz, M., Chohan, F. A., Stringfellow, C., Jain, E., Hange, N., Loh, H., Félix, M., & Chérrez-Ojeda, I. (2021) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2021.103197 · Cited by 5
El-Tallawy, S. N., Titi, M. A., Ahmad, A. E., Abdulmomen, A., Elmorshedy, H., Aldammas, F., Baaj, J., Alharbi, M., & Ahmad, A. (2022) · International Journal of Mental Health · doi:10.1080/00207411.2022.2035905 · Cited by 4
“(Salazar de Pablo et al., 2020), anxiety (23.2%), and depression (22.8”
BackgroundInfluentialFaghankhani, M., Sodagari, F., Shokrani, M., Baradaran, H. R., Adabi, A., Zabihi, M., Adeli, A. M., Fathimakvand, M., Golalipour, E., Aghdasi, S., et al. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/07067437211004881 · Cited by 4
“Les étudiants, les personnes au foyer et les travailleurs de la santé (TDS) ont affiché un EIQ moyen plus élevé de SSP comparés aux autres groupes [23 (18-27), 22 (16-26), et 19 (14-24), respectivement].”
BackgroundInfluentialIs job seniority a protective factor against anxiety among midwives during the SARS-CoV-2 pandemic?
Gotlib, J., Rzońca, E., Baranowska, B. M., Tataj–Puzyna, U., Pawlicka, P., Jaworski, M., Wójcik‐Fatla, A., & Pańczyk, M. (2021) · Annals of Agricultural and Environmental Medicine · doi:10.26444/aaem/136572 · Cited by 5
Lozada-Martínez, I. D., Bolaño-Romero, M. P., Moscote‐Salazar, L. R., Torres-Llinás, D. M., & Agrawal, A. (2020) · Journal of Clinical Neuroscience · doi:10.1016/j.jocn.2020.11.041 · Cited by 4
“The prevalence of anxiety in the evaluated groups was found to be up to 29% [7], Depression up to 50.”
InfluentialZaheer, M. A., Anwar, T. M., Albeshr, M., Manzoor, M., & Khan, Z. (2025) · Quality Education for All · doi:10.1108/qea-12-2023-0025 · Cited by 5
Guo, Y., Zhang, Y., Han, L., Wang, Y., Zhong, T., Xiao, Y., Lam, L. T.-M., Wu, C., & Yu, X. (2025) · Scientific Reports · doi:10.1038/s41598-025-07927-1 · Cited by 3
Psychological stress among anesthesia residents during COVID-19 pandemic and how to mitigate them
Ahuja, V., Nair, L. V., Das, S. C., & Sandhu, S. (2022) · Journal of Anaesthesiology Clinical Pharmacology · doi:10.4103/joacp.joacp_104_21 · Cited by 3
Carmassi, C., Pedrinelli, V., Antonini, C., Dell’Oste, V., Gravina, D., Nardi, B., Bertelloni, C. A., Massimetti, G., Nieto‐Munuera, J., & Dell’Osso, L. (2023) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s396540 · Cited by 3
Ibrahim, M., Tiete, J., Noël, J., Pipo, C., Dethare, E., Hove, O. V., & Foucart, J. (2023) · European Journal of Physiotherapy · doi:10.1080/21679169.2023.2213255 · Cited by 4
Workers’ well-being during viral pandemics and epidemics: A scoping review
Pacheco, T., Coulombe, S., Kocovski, N. L., & Carbone, J. (2025) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2025.100286 · Cited by 4
“More broadly, numerous studies (e.g., [5 – 13]) and reviews (e.g., [14,15]) have documented the relationship between diverse virus-related crises (pandemics/epidemics) and workers ’ well-being.”
Beatrice, W. M., Apori, S. O., Flarian, M. M., Williams, O. A., Hanyabui, E., & Abdoulaye, F. F. (2021) · African Journal of Agricultural Research · doi:10.5897/ajar2021.15646 · Cited by 3
“Food demand was largely affected and thus food security in general due to mobility restrictions and reduced purchasing power which led to a greater impact on the most vulnerable population groups influencing the global food system (de Pablo 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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