Psychological effects caused by the COVID-19 pandemic in health professionals: a systematic review with meta-analysis
Open accessAbstract
Background Psychological suffering by health professionals may be associated with the uncertainty of a safe workplace. Front-line professionals exposed and involved in the diagnosis and treatment of COVID-19 patients are more susceptible.Method This review was conducted based on papers that were published at MEDLINE, BMJ, PsycINFO, and LILACS, the according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA).Results Health professionals had a higher level of anxiety (13.0 vs. 8.5%, p < 0.01, OR = 1.6152; 95%CI 1.3283 to 1.9641; p < 0.0001) and depression 12.2 vs. 9.5%; p = 0.04; OR = 1.3246; 95%CI 1.0930 to 1.6053; p = 0.0042), besides somatizations and insomnia compared to professionals from other areas.Conclusion Health professionals, regardless of their age, showed significant levels of mental disorders. We observed a prevalence of anxiety and depression. Insomnia was a risk factor for both.
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Frontline health workers have higher rates of insomnia and posttraumatic stress.
“Frontline health workers have higher rates of insomnia and posttraumatic stress [40]”
From Overview of sleep management during COVID-19. (2022) · cites this paper as [40]
The Results (page unavailable) report higher insomnia prevalence among medical health workers than non-medical health workers, and the Introduction says frontline professionals are more susceptible to psychological suffering than those not directly treating patients. The Discussion (page unavailable) mentions posttraumatic stress among health professionals, but does not establish a higher rate of it among frontline workers. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHealth workers have a significantly higher incidence of insomnia, anxiety, and depression symptoms than other professionals.
“A literature review by da Silva and Neto showed health workers to have a significantly higher incidence of insomnia, anxiety and depression symptoms than other professionals [40].”
From Overview of sleep management during COVID-19. (2022) · cites this paper as [40]
The stressful situation of healthcare workers may lead to depressive symptoms (12.2-26.3%), anxiety (13-29%), and PTSS (3-20.7%).
“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 [180]
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“Our results are identical to two reports [26, 52].”
ResultHernández‐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 35 · see citing works
Keim, R., Pfitscher, G., Leitner, S., Burger, K., Giacomoni, F., & Wiedermann, C. J. (2022) · Public Health · doi:10.1016/j.puhe.2022.04.006 · Cited by 19 · see citing works
Hachesu, V. R., Feli, S. N., Maajani, K., & Golbabaei, F. (2022) · Journal of Occupational Health and Epidemiology · doi:10.52547/johe.11.1.48 · Cited by 19 · see citing works
Depressão, ansiedade e estresse em profissionais da linha de frente da COVID-19
Cavalcante, F. L. N. F., Negreiros, B., Maia, R. D. S., & Maia, E. M. C. (2022) · Revista Portuguesa de Enfermagem de Saúde Mental · doi:10.19131/rpesm.321 · Cited by 18 · see citing works
Bazán, P. R., Neto, R. M. D. A., Dias, J. A., Salvatierra, V. G., Sanches, L. G., Lacerda, S. S., Amaro, E., Kozasa, E. H., & Balardin, J. B. (2020) · Einstein (São Paulo) · doi:10.31744/einstein_journal/2020ao6127 · Cited by 19 · see citing works
“Recent metaanalyses suggest health professionals are prone to mental health issues during the COVID-19 pandemic,(3-5) although the role of information consumption still needs further evaluation.”
BackgroundBahadırlı, S., & Sağaltıcı, E. (2021) · Psychiatry and Clinical Psychopharmacology · doi:10.5152/pcp.2021.20180 · Cited by 18 · see citing works
Elliott, R. M., Crowe, L., Pollock, W., & Hammond, N. E. (2022) · Australian Critical Care · doi:10.1016/j.aucc.2022.10.001 · Cited by 16 · see citing works
Glowacz, F., Schmits, É., & Kinard, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192114410 · Cited by 16 · see citing works
Alqahtani, I. M., Al-Garni, A. M., Abumelha, M. S., Alsagti, S. A., Alshehri, F. A. D., Alqahtani, A. A., & Alkhidhran, S. S. S. (2023) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1943_22 · Cited by 19 · see citing works
“Previous studies on the general population The previous studies have been conducted on the general population and assessed depression, anxiety, and stress among the general population; however, one of them was conducted only in China,[25] another evaluated the prevalence of depression, anxiety, and stress among the fr…”
BackgroundTauro, E., Gorini, A., Caglio, C., Gabanelli, P., & Caiani, E. G. (2022) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2022.103993 · Cited by 16 · see citing works
“As largely discussed in previous literature, prolonged distress and related psychological symptoms can affect cognitive and technical performance of workers [8] other than triggering pre-existing mental health disturbances [9] or resulting in severe psychological illnesses, such as post-traumatic stress disorder (PTSD…”
BackgroundHasan, A. A., & Waggas, D. S. (2022) · International Journal of Disaster Risk Reduction · doi:10.1016/j.ijdrr.2022.103025 · Cited by 16 · see citing works
Vulnerability to rumours during the COVID-19 pandemic in Singapore
Long, V. J. E., Koh, W. S., Saw, Y. E., & Liu, J. C. (2021) · Annals of the Academy of Medicine Singapore · doi:10.47102/annals-acadmedsg.2020523 · Cited by 15 · see citing works
“For each rumour, participants indicated whether they: (1) had heard the claim before (yes/no); (2) thought the claim was true (yes/no); or (3) had shared the claim on social media such as Facebook and WhatsApp (yes/ no).”
BackgroundVarrasi, S., Guerrera, C. S., Platania, G. A., Castellano, S., Pirrone, C., Caponnetto, P., Nicolosi, C., Insanguine, F., Greco, E., Perrone, M., et al. (2023) · Health Psychology Research · doi:10.52965/001c.67961 · Cited by 15 · see citing works
Linares-Chamorro, M., Domènech-Oller, N., Jerez‐Roig, J., & Piqué-Buisan, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19169793 · Cited by 12 · see citing works
Yıldırım, M., Çağış, Z. G., & Gómez-Salgado, J. C. (2024) · International Journal of Public Health · doi:10.3389/ijph.2024.1607127 · Cited by 14 · see citing works
“Compared to the general population, healthcare workers have been found to experience higher levels of anxiety, somatization, insomnia, and depressive symptoms [11].”
BackgroundAlenko, A., Agenagnew, L., Beressa, G., Tesfaye, Y., Woldesenbet, Y. M., & Girma, S. (2021) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s305164 · Cited by 14 · see citing works
“Systematic review and meta-analysis conducted between April and May 2020 show about 13% of health care professionals developed anxiety during the COVID19 pandemic.(13) The prevalence of anxiety symptoms among health care workers in China is 46%.”
BackgroundResultInfluentialEpidemiology of dog bites to people in Uruguay (2010–2020)
Román, J., Willat, G., Piaggio, J., Correa, M. T., & Damián, J. P. (2023) · Veterinary Medicine and Science · doi:10.1002/vms3.1242 · Cited by 13 · see citing works
“(2021) who found a marked increase in the incidence of dog bites during the first months of the COVID-19 pandemic in the United States and the United Kingdom, respectively.”
BackgroundInfluentialHassanie, S., Karadaş, G., Olugbade, O. A., & Saidy, J. (2024) · SAGE Open · doi:10.1177/21582440231225553 · Cited by 13 · see citing works
Yılmaz, G. G., Yazıcı, G. Z., Temuçin, K., Gürbüz, D. A., & Akı, E. (2021) · Australian Occupational Therapy Journal · doi:10.1111/1440-1630.12762 · Cited by 13 · see citing works
“**P < .001. et al., 2020), physical fatigue in long-term use of protective equipment, limited resources (Çankaya, 2020), and busy working hours (Nakata et al., 2012) are important factors that affect healthcare professionals’ mental health and psychological well-being (da Silva & Neto, 2020).”
BackgroundMondragón, N. I., Munitis, A. E., Sancho, N. B., & Ozamiz-Etxebarria, N. (2022) · Psychology and Health · doi:10.1080/08870446.2022.2066103 · Cited by 13 · see citing works
Gonz醠es-Gutierrez, V., Álvarez-Risco, A., Estrada‐Merino, A., Anderson-Seminario, M. D. L. M., Mlodzianowska, S., Del-Aguila-Arcentales, S., & Yáñez, J. A. (2022) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2022.021176 · Cited by 13 · see citing works
Mallon, A., Mitchell, G., Carter, G., McLaughlin, D. F., & Wilson, C. B. (2023) · BMC Geriatrics · doi:10.1186/s12877-023-03860-y · Cited by 14 · see citing works
Rarani, M. A., Aghdash, S. A., Isfahani, H. M., & Mohseni, M. (2024) · BMC Public Health · doi:10.1186/s12889-024-19729-7 · Cited by 14 · see citing works
Munn, L. T., Huffman, C., Connor, C. D., Swick, M., Danhauer, S. C., & Gibbs, M. A. (2022) · Journal of Advanced Nursing · doi:10.1111/jan.15215 · Cited by 12 · see citing works
“In a systematic review that only included prospective studies conducted in both general and healthcare workforces, burnout was significantly related to the development of type II diabetes, hypercholesterolaemia, hospitalization for cardiovascular disease, musculoskeletal pain, prolonged fatigue and…”
Lin, C. Y., & Fu, X. (2022) · International Journal of Public Health · doi:10.3389/ijph.2022.1604723 · Cited by 13 · see citing works
Zemni, I., Dhouib, W., Sakly, S., Bennasrallah, C., Gara, A., Kacem, M., Fredj, M. B., Abroug, H., Elbaroudi, A., Bouanène, I., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282318 · Cited by 11 · see citing works
“As various studies [18, 28], we found no difference in the predictors of burnout according to age and sex.”
BackgroundThe association between BIS/BAS and fear of COVID-19 infection among women
Oniszczenko, W. (2021) · Current Issues in Personality Psychology · doi:10.5114/cipp.2021.106139 · Cited by 11 · see citing works
“For example, higher levels of anxiety and depression were typically displayed in health professionals (da Silva & Neto, 2021) and in the general Italian population – one of those most affected by COVID-19 (Mazza et al., 2020).”
BackgroundCOVID-19 Pandemic in a Vulnerable Population: Prevalence and Correlates of Anxiety
Shalaby, R., Eboreime, E., Nkire, N., Agyapong, B., Pazderka, H., Obuobi-Donkor, G., Adu, M. K., Mao, W., Owusu, E., Oluwasina, F., et al. (2022) · Behavioral Sciences · doi:10.3390/bs12010013 · Cited by 11 · see citing works
“Higher levels of depression, anxiety, and stress have been observed in community members, including healthcare workers [1,2] students [3,4], seniors [5], and patients with health problems including mental health conditions [3], and COVID-19 infection [5].”
BackgroundGagliardi, L., Grumi, S., Gentile, M., Cacciavellani, R., Placidi, G., Vaccaro, A., Maggi, C., Gambi, B., Magi, L., Crespin, L., et al. (2022) · The Italian Journal of Pediatrics/Italian journal of pediatrics · doi:10.1186/s13052-022-01305-7 · Cited by 11 · see citing works
Harnessing Event Report Data to Identify Diagnostic Error During the COVID-19 Pandemic
Shen, L., Levie, A., Singh, H., Murray, K., & Desai, S. P. (2021) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2021.10.002 · Cited by 11 · see citing works
Cena, L., Rota, M., Calza, S., JANOS, J. A., Trainini, A., & Stefana, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182211843 · Cited by 11 · see citing works
“onset or worsening of mental health issues such as stress, anxiety, depression, rage, denial, somatization, and sleep disturbance [13,14] that may compromise the quality of their care delivery [15,16] as well as their psychological well-being [17].”
BackgroundSandín, B., Chorot, P., García-Escalera, J., & Valiente, R. M. (2021) · Acción Psicológica · doi:10.5944/ap.18.1.29520 · Cited by 10 · see citing works
Paterlini, M., Neri, E., Nicoli, A., Genova, F., Villani, M. T., Santi, S., & Agostini, F. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19105899 · Cited by 10 · see citing works
Mental Health States Experienced by Perinatal Healthcare Workers during COVID-19 Pandemic in Italy
Cena, L., Rota, M., Calza, S., Massardi, B., Trainini, A., & Stefana, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18126542 · Cited by 11 · see citing works
“As a result, these professionals have developed mental health problems such as anxiety, depression, rage, denial, somatization, insomnia, and burnout [11,12], which could severely affect their work performance (including attention, understanding, and decision-making capability) and, more broadly, their overall well-be…”
BackgroundOrtega, A. C., Valtierra, E., Rodríguez-Cuevas, F. G., Aranda, Z., Preciado, G., & Mohar, S. (2021) · Global Health Action · doi:10.1080/16549716.2021.1997410 · Cited by 10 · see citing works
“the death of their colleagues, ethical concerns in clinical practice and excessive work hours have added to the detrimental effect of the pandemic on the mental wellbeing of these professionals [39,61].”
BackgroundAnxiety and Coping Stress Strategies in Researchers During COVID-19 Pandemic
Batista, P., Afonso, A., Lopes, M. J., da Fonseca, C. J. V., Oliveira‐Silva, P., Pereira, A., & de Pinho, L. G. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.850376 · Cited by 10 · see citing works
Rosenström, T. H., Tuisku, K., Suvisaari, J., Pukkala, ., Junttila, K., Haravuori, H., Elovainio, M. J., Haapa, T., Jylhä, P. J., & Laukkala, T. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04389-x · Cited by 10 · see citing works
Gustavsson, K., Goetz-Kundera, Z., Flaga-Łuczkiewicz, M., & Wichniak, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20042870 · Cited by 10 · see citing works
Pienkowska, A., Ravaut, M., Mammadova, M., Ang, C., Wang, H., Ong, Q. C., Bojić, I., Qin, V. M., Sumsuzzman, D. M., Ajuebor, O., et al. (2024) · JMIR Formative Research · doi:10.2196/53574 · Cited by 9 · see citing works
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 · see citing works
“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].”
BackgroundResultGómez-Salgado, J. C., Adanaqué-Bravo, I., Ortega‐Moreno, M., Allande‐Cussó, R., Arias-Ulloa, C. A., & Ruíz-Frutos, C. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257661 · Cited by 10 · see citing works
Keyan, D., Dawson, K. S., Azevado, S., Yadav, S., Tran, J., & Bryant, R. A. (2021) · BMC Public Health · doi:10.1186/s12889-021-10529-x · Cited by 9 · see citing works
Work-related stress amongst health professionals in a pandemic
Leal‐Costa, C., Agea, J. L. D., Ruzafa‐Martínez, M., & Ramos‐Morcillo, A. J. (2021) · Anales del Sistema Sanitario de Navarra · doi:10.23938/assn.0940 · Cited by 9 · see citing works
Fortin, J., Rivest‐Beauregard, M., Defer, C., Leblanc, M., Louis, L. A. T., Roy, C.-A., Lapierre, I., Brunet, A., Montreuil, M., & Marin, M. (2022) · Canadian Journal of Nursing Research · doi:10.1177/08445621221097520 · Cited by 9 · see citing works
The impact of COVID-19 upon student radiographers and clinical training in Latin America
Solis-Barquero, S., Valerio, M. P. R., McNulty, J. P., Riquelme-Contreras, P., Ríos, J., González, H., Raza, N. B. O., Ezquerra, V., & Rainford, L. A. (2022) · Radiography · doi:10.1016/j.radi.2022.06.003 · Cited by 9 · see citing works
Eby, L. T. D. T., Robertson, M. M., Facteau, D. B., & Anker, J. G. (2023) · Journal of Occupational and Organizational Psychology · doi:10.1111/joop.12431 · Cited by 8 · see citing works
Hernández-Torres, R., Martínez-Lozano, M., Torres, I., Rosario-Hernández, E., Ramos-Pibernus, A. G., Soto, A. V., Ortiz, L., Mascayano, F., & Rivera-Segarra, E. (2023) · PLOS Global Public Health · doi:10.1371/journal.pgph.0001784 · Cited by 8 · see citing works
“For example, there is an ongoing increased migration of HCWs from the Caribbean archipelago to the mainland US, mainly due to insufficient healthcare infrastructure, severe funding cuts, and poor working conditions [15].”
BackgroundResultInfluentialMohseni, M., Aghdash, S. A., Bashzar, S., Isfahani, H. M., Parnian, E., & Rarani, M. A. (2024) · BMC Public Health · doi:10.1186/s12889-024-21085-5 · Cited by 8 · see citing works
Deng, Y., & Yang, J. (2021) · Psychiatry and Clinical Psychopharmacology · doi:10.5152/pcp.2021.21123 · Cited by 8 · see citing works
Barbosa-Granados, S., Castañeda-Lozano, W., & Reyes-Bossio, M. A. (2021) · Revista Digital de Investigación en Docencia Universitaria · doi:10.19083/ridu.2021.1438 · Cited by 8 · see citing works
“…ansiedad, sensibilidad emocional, baja sensación de bienestar y diversas dificultades relacionadas con la salud mental (Henriksen et al., 2019; da Silva et al., 2021; Urzúa et al., 2020); resultado de la situación de confinamiento y de incertidumbre asociada con un mayor efecto de…”
BackgroundGilbert‐Ouimet, M., Harsini, A. Z., Biron, C., Langlois, L., Ménard, C., Lebel, M., Pelletier, J., Duchaine, C. S., Beaulieu, M., & Truchon, M. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100124 · Cited by 8 · see citing works
- Authors
- da Silva Neto, R. M., Benjamim, C. J. R., de Medeiros Carvalho, P. M., & Neto, M. L. R.
- Affiliations
- Universidade de Pernambuco (BR)
- Universidade Federal do Cariri (BR)
- Corresponding author
- Neto, Modesto Leite Rolim
- Venue
- Progress in Neuro-Psychopharmacology and Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-01
- Volume
- 104
- Pages
- 110062
- ISSN
- 0278-5846 (ISSN-L)
- PMC
- PMC7409979
- OpenAlex
- W3046942365
- Cited by
- 219
- References
- 30
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 28 · 2023: 37 · 2022: 63 · 2021: 65 · 2020: 9
- FWCI
- 3.44
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Progress in Neuro-Psychopharmacology and Biological Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Suicidology Research Group from Universidade Federal do Ceará
- Brazilian National Council for Scientific and Technological Development
- 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 › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Keywords
- COVID-19 pandemic, healthcare workers, psychological distress, anxiety, depression, insomnia, somatization, workplace mental health, frontline workers, risk factors
- MeSH terms
- COVID-19, Mental Disorders, Health Personnel, Humans, Occupational Diseases, Pneumonia, Viral, Stress, Psychological, Prevalence, Coronavirus Infections, Pandemics
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