The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review
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Abstract
Background: The covid-19 pandemic has heavily burdened, and in some cases overwhelmed, healthcare systems throughout the world. Healthcare workers are not only at heightened risk of infection, but also of adverse mental health outcomes. Identification of organizational, collegial and individual risk and resilience factors impacting the mental health of healthcare workers are needed to inform preparedness planning and sustainable response. Methods: We performed a rapid systematic review to identify, assess and summarize available research on the mental health impact of the covid-19 pandemic on healthcare workers. On 11 May 2020, we utilized the Norwegian Institute of Public Health's Live map of covid-19 evidence, the visualization of a database of 20,738 screened studies, to identify studies for inclusion. We included studies reporting on any type of mental health outcome in any type of healthcare workers during the pandemic. We described interventions reported by the studies, and narratively summarized mental health-related outcomes, as study heterogeneity precluded meta-analysis. We assessed study quality using design-specific instruments. Results: We included 59 studies, reporting on a total of 54,707 healthcare workers. The prevalence of general psychological distress across the studies ranged from 7-97% (median 37%), anxiety 9-90% (median 24%), depression 5-51% (median 21%), and sleeping problems 34-65% (median 37%). Seven studies reported on implementing mental health interventions, and most focused on individual symptom reduction, but none reported on effects of the interventions. In most studies, healthcare workers reported low interest in and use of professional help, and greater reliance on social support and contact with family and friends. Exposure to covid-19 was the most commonly reported correlate of mental health problems, followed by female gender, and worry about infection or about infecting others. Social support correlated with less mental health problems. Discussion: Healthcare workers in a variety of fields, positions, and exposure risks are reporting anxiety, depression, sleep problems, and distress during the covid-19 pandemic, but most studies do not report comparative data on mental health symptoms. before the pandemic. There seems to be a mismatch between risk factors for adverse mental health outcomes among healthcare workers in the current pandemic and their needs and preferences, and the individual psychopathology focus of current interventions. Efforts to help healthcare workers sustain healthy relationships to colleagues, family and friends over time may be paramount to safeguard what is already an important source of support during the prolonged crisis. Expanding interventions' focus to incorporate organizational, collegial and family factors to support healthcare workers responding to the pandemic could improve acceptability and efficacy of interventions. Other: The protocol for this review is available online. No funding was received.
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Frontline work has been reported to increase the risk for psychological symptoms in healthcare workers.
“Several factors have been reported to increase the risk for psychological symptoms in healthcare workers, including being a nurse, female gender, and frontline work (Muller et al., 2020; Pappa et al., 2020).”
From Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic. (2025) · cites this paper as Muller et al., 2020
Female gender has been reported to increase the risk for psychological symptoms in healthcare workers.
“Several factors have been reported to increase the risk for psychological symptoms in healthcare workers, including being a nurse, female gender, and frontline work (Muller et al., 2020; Pappa et al., 2020).”
From Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic. (2025) · cites this paper as Muller et al., 2020
Being a nurse has been reported to increase the risk for psychological symptoms in healthcare workers.
“Several factors have been reported to increase the risk for psychological symptoms in healthcare workers, including being a nurse, female gender, and frontline work (Muller et al., 2020; Pappa et al., 2020).”
From Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic. (2025) · cites this paper as Muller et al., 2020
The Results section on risk and resilience factors identifies exposure to COVID-19 patients, being a woman, and worry about infection as common risk factors, but does not identify being a nurse as one. A separate Results passage describes fear and anxiety among frontline nurses; it does not establish that nursing itself increases risk. I searched for nursing occupation as a risk factor and comparisons with other healthcare workers; no passage in our copy substantiated that specific claim. Page numbers were unavailable. (LLM, conf=0.72)
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The Impact of COVID-19 Pandemic on Spine Surgeons Worldwide
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“In three studies, worrying about family members being infected was a risk factor 42 ,58 .”
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“This focus on the individual rather than system-level factors is also common in interventions for healthcare worker burn-out before the pandemic 86 .”
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“We also call on journals and researchers to balance the need for rapid publication with properly conducted studies, reviews and guidelines 94 .”
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Systematic literature review of psychological interventions for first responders
Alden, L. E., Matthews, L. R., Wagner, S. L., Fyfe, T., Randall, C., Regehr, C., White, M., Buys, N. J., Carey, M. G., Corneil, W., et al. (2020) · Work & Stress · doi:10.1080/02678373.2020.1758833 · Cited by 46 · see citing works
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“The most common risk factors correlated with increased risk of mental health problems were exposure to covid-19 patients 28 ,39 ,46 ,49 ,60 ,63 ,74 , being female 8 ,25 ,39 ,46 ,54 ,60 , and worry about being infected 25 ,46 ,58 ,63 .”
Zhang, C., Yang, L., Liu, S., Ma, S., Wang, Y., Cai, Z., Du, H., Li, R., Kang, L., Su, M., et al. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3542175 · Cited by 38 · cited 2× · see citing works
“The most common risk factors correlated with increased risk of mental health problems were exposure to covid-19 patients 28 ,39 ,46 ,49 ,60 ,63 ,74 , being female 8 ,25 ,39 ,46 ,54 ,60 , and worry about being infected 25 ,46 ,58 ,63 .”
Stressors of nurses in psychiatric hospitals during the COVID-19 outbreak
Wu, D., Jiang, C., He, C., Li, C., Yang, L., & Yue, Y. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112956 · Cited by 33 · cited 1× · see citing works
“Wu et al. 71 explored reasons for stress during interviews with healthcare workers at a psychiatric hospital.”
Gautam, M., Kaur, M., & Mahr, G. (2020) · Psychosomatics · doi:10.1016/j.psym.2020.04.009 · Cited by 32 · see citing works
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Anxiety and Depression Survey of Chinese Medical Staff Before and During COVID-19 DefensePreprint
Lv, Y. Y., Zhang, Z., Zeng, W., Li, J., Wang, X., & Luo, G. H. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3551350 · Cited by 31 · cited 1× · see citing works
“Lv et al. 22 surveyed healthcare workers before and during the outbreak, reporting no further information about the timeline.”
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COVID-19 outbreak situation and its psychological impact among surgeons in training in France
Abdessater, M., Morgan Rouprêt, A., Misraï, V., Pinar, U., Matillon, X., Gondran‐Tellier, B., Freton, L., Vallée, M., Dominique, I., Felber, M., et al. (2020) · World Journal of Urology · doi:10.1007/s00345-020-03207-x · Cited by 27 · see citing works
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Addressing Faculty Emotional Responses during the Coronavirus 2019 Pandemic
Schulte, E. E., Bernstein, C. A., & Cabana, M. D. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.04.057 · Cited by 22 · see citing works
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Self-citationBrief Psychotic Disorder Triggered by Fear of Coronavirus
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Foley, D. A., Kirk, M., Jepp, C., Brophy‐Williams, S., Tong, S. Y. C., Davis, J. S., Blyth, C. C., O'Brien, M. P., Bowen, A. C., Yeoh, D. K., et al. (2020) · Journal of Paediatrics and Child Health · doi:10.1111/jpc.14903 · Cited by 16 · see citing works
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“Only one study explored how healthcare workers would be willing to provide mental health services to other healthcare workers: twelve psychiatry residents were re-deployed as frontline workers for one shift in Benham et al.’s 78 study.”
Pu, J., Li, G., Cao, L., Wu, Y., & Xu, L. (2020) · Chongqing yixue · doi:10.3760/cma.j.issn.9999-998x.2020.0015 · Cited by 8 · see citing works
Hong, X., Cao, J., Wei, J., Duan, Y., Zhao, X., Jing, J., Jiang, Y., Geng, W., & Zhu, H. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3566244 · Cited by 5 · cited 2× · see citing works
“Hong et al. 70 called it a “comprehensive psychological intervention” for frontline workers undergoing a mandatory two-week quarantine in a vocational resort, following two-to three-week hospital shifts.”
Mixed and Indirect Treatment Comparisons
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“The principle of homogeneity tends to be overlooked by systematic reviewers eager to produce a summary estimate, but if met, means that all studies included were similar enough that their participants can be considered participants of one large study 92 .”
Hu, L., Li, H., Wang, T., Xue, H., Liu, J., Panayi, A. C., Xu, K., Xie, X., Lin, Z., Xiong, Y., et al. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3569843 · Cited by 2 · see citing works
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- Vestrheim D. Iversen B. Flottorp S. Should Healthcare Personnel in Nursing Homes Without Respiratory Symptoms Wear Facemasks for Primary Prevention of COVID-19? – a Rapid Review 2020 Norwegian Institute of Public Health Oslo 42
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Sorted by citations
Søvold, L. E., Naslund, J. A., Kousoulis, A. A., Saxena, S., Qoronfleh, M. W., Grobler, C., & Münter, L. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.679397 · Cited by 973 · see citing works
Pollock, A., Campbell, P., Cheyne, J., Cowie, J., Davis, B., McCallum, J., McGill, K., Elders, A., Hagen, S., McClurg, D., et al. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013779 · Cited by 631 · see citing works
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“A recent systematic review of 59 studies with 54,707 participants showed that one or two of every five healthcare professionals reported anxiety, depression, distress and/or sleep problems during the current COVID-19 pandemic, which were primarily associated with increased workload [31].”
BackgroundCOVID-19 pandemic effects on health worker's mental health: systematic review and meta-analysis
Aymerich, C., Pedruzo, B., Pérez, J. L., Laborda, M., Herrero, J., Blanco, J., Mancebo, G., Andrés, L., Estévez, O., Fernandez, M., et al. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.1 · Cited by 234 · see citing works
Hospital nurses' moral distress and mental health during COVID‐19
Lake, E. T., Narva, A. M., Holland, S., Smith, J. G., Cramer, E., Rosenbaum, K. E. F., French, R., Clark, R. R. S., & Rogowski, J. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.15013 · Cited by 230 · see citing works
“Research shows that in the early pandemic months, HCWs experienced high rates of anxiety, depression and sleep problems (Muller et al., 2020).”
BackgroundHealth care workers’ experiences during the COVID-19 pandemic: a scoping review
Chemali, S., Sáez, A. M., Bcheraoui, C. E., & Weishaar, H. B. (2022) · Human Resources for Health · doi:10.1186/s12960-022-00724-1 · Cited by 230 · see citing works
COVID-19 is having a destructive impact on health-care workers’ mental well-being
Vanhaecht, K., Seys, D., Bruyneel, L., Cox, B., Kaesemans, G., Cloet, M., den Broeck, K. V., Cools, O., Witte, A. D., Lowet, K., et al. (2020) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzaa158 · Cited by 231 · see citing works
“Symptoms as distress [12, 13, 16] and decreased appetite or indigestion are also frequently reported [12].”
BackgroundChutiyami, M., Cheong, A. M. Y., Salihu, D., Bello, U. M., Ndwiga, D. W., Maharaj, R., Naidoo, K., Kolo, M. A., Jacob, P., Chhina, N., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.804525 · Cited by 206 · see citing works
Zhou, T., Xu, C., Wang, C., Sha, S., Wang, Z., Zhou, Y., Zhang, X., Hu, D., Liu, Y., Tian, T., et al. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-07608-z · Cited by 218 · see citing works
“Social support has been considered an important resource to cope with job-related stressors [30].”
BackgroundChigwedere, O. C., Sadath, A., Kabir, Z., & Arensman, E. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18136695 · Cited by 181 · see citing works
Buselli, R., Corsi, M., Veltri, A., Baldanzi, S., Chiumiento, M., Lupo, E. D., Marino, R., Necciari, G., Caldi, F., Foddis, R., et al. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113847 · Cited by 162 · see citing works
Lamb, D., Gnanapragasam, S., Greenberg, N. L., Bhundia, R., Carr, E., Hotopf, M. H., Razavi, R., Raine, R., Cross, S., Dewar, A., et al. (2021) · Occupational and Environmental Medicine · doi:10.1136/oemed-2020-107276 · Cited by 154 · see citing works
“%) and a higher average age (51 years), 6 and more white participants (93.6% 6 ; 95% 7 ).”
InfluentialLee, B. E. C., Ling, M., Boyd, L., Olsson, C., & Sheen, J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.03.012 · Cited by 120 · see citing works
Psychiatric symptoms and moral injury among US healthcare workers in the COVID-19 era
Amsalem, D., Lazarov, A., Markowitz, J. C., Naiman, A., Smith, T. E., Dixon, L. B., & Neria, Y. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03565-9 · Cited by 132 · see citing works
“Other studies that surveyed psychopathology in HCWs found lower rates of anxiety (13–23%) and depression (18–23%) [4, 9, 41, 42].”
BackgroundAfulani, P. A., Gyamerah, A. O., Nutor, J. J., Laar, A. K., Aborigo, R., Malechi, H., Sterling, M., & Awoonor‐Williams, J. K. (2021) · PLoS ONE · doi:10.1371/journal.pone.0250294 · Cited by 133 · see citing works
Morawa, E., Schug, C., Geiser, F., Beschoner, P., Jerg‐Bretzke, L., Albus, C., Weidner, K., Hiebel, N., Borho, A., & Erim, Y. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110415 · Cited by 127 · see citing works
Global impact of the COVID-19 pandemic on mental health services: A systematic review
Duden, G. S., Gersdorf, S., & Stengler, K. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.08.013 · Cited by 124 · see citing works
Social Support Mediates the Effect of Burnout on Health in Health Care Professionals
Ruisoto, P., Ramírez, M. R., López, P. A. G., Paladines-Costa, B., Vaca, S., & Clemente‐Suárez, V. J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.623587 · Cited by 111 · see citing works
Schug, C., Morawa, E., Geiser, F., Hiebel, N., Beschoner, P., Jerg‐Bretzke, L., Albus, C., Weidner, K., Steudte‐Schmiedgen, S., Borho, A., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073827 · Cited by 113 · see citing works
“Working in direct contact with patients infected with COVID-19 was shown to be a correlate for adverse mental health outcomes among HCWs [12].”
BackgroundA hidden pandemic? An umbrella review of global evidence on mental health in the time of COVID-19
Bower, M., Smout, S., Donohoe‐Bales, A., O’Dean, S., Teesson, L., Boyle, J., Lim, D., Nguyen, A., Calear, A. L., Batterham, P. J., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1107560 · Cited by 111 · see citing works
Zaçe, D., Hoxhaj, I., Orfino, A., Viteritti, A. M., Janiri, L., & Di Pietro, M. L. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.02.019 · Cited by 105 · see citing works
Olaya, B., Pérez-Moreno, M. A., Bueno‐Notivol, J., Gracia‐García, P., Lasheras, I., & Santabárbara, J. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10153406 · Cited by 107 · see citing works
“[82] conducted a rapid systematic review in May 2020 focusing on several outcomes such as mental health problems and risk or resilience factors from quantitative and qualitative data.”
BackgroundCompassion fatigue in mental health nurses: A systematic review
Marshman, C., Hansen, A., & Munro, I. (2021) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12812 · Cited by 98 · see citing works
Mortier, P., Vilagut, G., Ferrer, M., Serra, C., Molina, J. D. D., López‐Fresneña, N., Puig, T., Pelayo‐Terán, J. M., Pijoán, J. I., Emparanza, J. I., et al. (2021) · Depression and Anxiety · doi:10.1002/da.23129 · Cited by 91 · see citing works
“In line with these concerns, rates of depression, anxiety, and sleep problems among healthcare workers during COVID‐19 outbreaks are high (Muller et al., 2020; Pappa et al., 2020; Vindegaard & Benros, 2020), and those in direct contact with affected patients report posttraumatic stress and…”
BackgroundThe Psychological Impact of COVID-19 on Health-Care Workers in African Countries
Olashore, A. A., Akanni, O. O., Fela-Thomas, A. L., & Kadimo, K. (2021) · Asian Journal of Social Health and Behavior · doi:10.4103/shb.shb_32_21 · Cited by 89 · see citing works
Kunzler, A. M., Chmitorz, A., Röthke, N., Staginnus, M., Schäfer, S. K., Stoffers‐Winterling, J., & Lieb, K. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104312 · Cited by 87 · see citing works
Pappa, S., Barnett, J., Berges, I., & Sakkas, N. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094457 · Cited by 84 · see citing works
“4%), which was one of Europe’s hardest hit areas [41].”
BackgroundStigmatization from Work-Related COVID-19 Exposure: A Systematic Review with Meta-Analysis
Schubert, M., Ludwig, J., Freiberg, A., Hahne, T. M., Starke, K. R., Girbig, M., Faller, G., Apfelbacher, C., Knesebeck, O. V. D., & Seidler, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18126183 · Cited by 82 · see citing works
“Four of the reviews [28,30,33,46] only included one original study in their review, which we all iden-”
BackgroundWoon, L. S.-C., Sidi, H., Nik Jaafar, N. R., & Leong Bin Abdullah, M. F. I. (2020) · doi:10.20944/preprints202011.0422.v1 · Cited by 76 · see citing works
“In fact, a systematic review of studies on the psychological impact of the COVID-19 pandemic on healthcare workers highlighted that social support is the most common protective factor against mental health complications in the COVID-19 pandemic [38].”
BackgroundInfluentialExperiences of Healthcare Workers in Long-Term Care during COVID-19: A Scoping Review
Boamah, S. A., Weldrick, R., Havaei, F., Irshad, A., & Hutchinson, A. (2022) · Journal of Applied Gerontology · doi:10.1177/07334648221146252 · Cited by 76 · see citing works
“Perceived social support and availability of resources were found to have protective effects Nyashanu et al. (2022) United Kingdom To explore the triggers of mental health problems among healthcare workers in care homes during the COVID-19 pandemic Qualitative (semistructured interviews) n = 40 (20 female, 10 male) Tr…”
BackgroundInfluentialPérez, V., Menéndez-Crispín, E. J., Sarabia-Cobo, C., de Lorena, P., Fernández-Rodríguez, A., & González-Vaca, J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811441 · Cited by 77 · see citing works
Pappa, S., Sakkas, N., & Sakka, E. (2021) · Sleep Medicine · doi:10.1016/j.sleep.2021.07.009 · Cited by 78 · see citing works
“[33] while the median prevalence of at 21% for depression and 24% for anxiety in another rapid systematic review [34].”
Yang, Y., Wang, P., Kelifa, M. O., Wang, B., Liu, M., Lu, L., & Wang, W. (2022) · Journal of Nursing Management · doi:10.1111/jonm.13325 · Cited by 73 · see citing works
Curtin, M., Richards, H. L., & Fortune, D. G. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102173 · Cited by 74 · see citing works
Salfi, F., Lauriola, M., D’Atri, A., Amicucci, G., Viselli, L., Tempesta, D., & Ferrara, M. (2021) · Scientific Reports · doi:10.1038/s41598-021-90993-y · Cited by 71 · see citing works
Cole, A., Ali, H., Ahmed, A., Hamasha, M., & Jordan, S. (2021) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s308397 · Cited by 67 · see citing works
Psychological impact of COVID-19 on health workers in Ghana: A multicentre, cross-sectional study
Ofori, A. A., Osarfo, J., Agbeno, E. K., Manu, D. O., & Amoah, E. (2021) · SAGE Open Medicine · doi:10.1177/20503121211000919 · Cited by 66 · see citing works
Wert, M. J. V., Gandhi, S., Gupta, I., Singh, A., Eid, S. M., Burhanullah, M. H., Michtalik, H. J., & Malik, M. A. (2022) · Journal of General Internal Medicine · doi:10.1007/s11606-021-07251-0 · Cited by 67 · see citing works
Sun, J., Sarfraz, M., Ivaşcu, L., Iqbal, K., & Mansoor, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610359 · Cited by 77 · see citing works
“The authors of one study observed that the significant repercussions of COVID-19 have damaged employees’ psychological well-being, thereby negatively impacting their normal intellectual functioning [9].”
BackgroundUmbetkulova, S., Kanderzhanova, A., Foster, F., Stolyarova, V., & Cobb-Zygadlo, D. (2023) · Evaluation & the Health Professions · doi:10.1177/01632787231165076 · Cited by 71 · see citing works
“Identical protective factors were revealed in previous studies (Kang et al., 2020; Kisely et al., 2020; Muller et al., 2020; Sahebi et al., 2021; Vizheh et al., 2020).”
BackgroundResultInfluentialSteenkiste, E. V., Schoofs, J., Gilis, S., & Messiaen, P. (2021) · Acta Clinica Belgica · doi:10.1080/17843286.2021.1903660 · Cited by 62 · see citing works
“The questionnaire consists of 14 subscales and can be analyzed separately: [1] self-distraction, [2] active coping, [3] denial, [4] substance use, [5] emotional support, [6] informational support, [7] behavioral disengagement, [8] venting, [9] positive reframing, [10] planning, [11] humor, [12] acceptance, [13] religi…”
BackgroundSymptoms 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 · see citing works
Engelbrecht, M., Heunis, C., & Kigozi, G. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18157919 · Cited by 62 · see citing works
Hawari, F. I., Obeidat, N. A., Dodin, Y., Albtoosh, A. S., Manasrah, R. M., Alaqeel, I. O., & Mansour, A. H. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248741 · Cited by 61 · see citing works
“Unlike most other studies [7, 8, 41, 44], working in a Covid-19 designated ward or working directly with Covid-19 patients did not significantly correlate with higher distress levels in our multivariable model.”
ResultBias, Burnout, and Imposter Phenomenon: The Negative Impact of Under-Recognized Intersectionality
Cawcutt, K. A., Clance, P. R., & Jain, S. (2021) · Women s Health Reports · doi:10.1089/whr.2021.0138 · Cited by 58 · see citing works
“mental health in health care during the COVID-19 pandemic must not go unrecognized in this discussion.(12) The high burden of workload, combined with the distress related to many uncertainties throughout”
BackgroundThe Early Impact of the Covid-19 Emergency on Mental Health Workers: A Survey in Lombardy, Italy
Rapisarda, F., Vallarino, M., Cavallini, E., Barbato, A., Brousseau‐Paradis, C., Benedictis, L. D., & LESAGE, A. D. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17228615 · Cited by 57 · see citing works
“of post-traumatic stress disorder [1,2].”
Rodríguez-López, A. M., Rubio-Valdehita, S., & Díaz-Ramiro, E. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18030983 · Cited by 55 · see citing works
“Several studies this year have studied the impact of the CoViD-19 pandemic on healthcare workers’ mental health [62].”
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Impact of COVID-19 on the Mental Health of Healthcare Workers: A Cross-Sectional Study From Pakistan
Hayat, K., Arshed, M., Fiaz, I., Afreen, U., Khan, F. U., Khan, T. A., Kadirhaz, M., Shukar, S., Saeed, A., Gill, M. R., et al. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.603602 · Cited by 58 · see citing works
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“In particular, the mental toll of COVID-19 challenged the frontline workers to deal with high-stress situations such as long working hours, thus influencing normal healthcare functioning [8].”
BackgroundSermeus, W., Aiken, L. H., Ball, J., Bridges, J., Bruyneel, L., Busse, R., Witte, H. D., Dello, S., Drennan, J., Eriksson, L. E., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059159 · Cited by 54 · see citing works
“20 104 The research activities conducted within the project are expected to improve significantly the work environment of health professionals in hospitals, especially after the COVID-19 pandemic.”
BackgroundBurnout Status of Italian Healthcare Workers during the First COVID-19 Pandemic Peak Period
Conti, C. M., Fontanesi, L., Lanzara, R., Rosa, I., Doyle, R., & Porcelli, P. (2021) · Healthcare · doi:10.3390/healthcare9050510 · Cited by 56 · see citing works
“stress disorder (PTSD) due to the clinical work and close contact with COVID-19 patients during the outbreak [11,12].”
BackgroundLi, Y., Fan, R., Lu, Y., Li, H., Liu, X., Kong, G., Wang, J., Yang, F., Zhou, J., & Wang, J. (2023) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2022.100618 · Cited by 50 · see citing works
Mental Health Outcomes Amongst Health Care Workers During COVID 19 Pandemic in Saudi Arabia
Ammari, M. A., Sultana, K., Thomas, A., Swaidan, L. A., & Harthi, N. A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.619540 · Cited by 53 · see citing works
Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint
Ong, T., Wilczewski, H., Paige, S. R., Soni, H., Welch, B. M., & Bunnell, B. E. (2021) · JMIR Serious Games · doi:10.2196/26520 · Cited by 55 · see citing works
“Experts anticipate severe downstream impacts upon health care workers, and urge for evidence-based therapeutic interventions responsive to the impacts of COVID-19 and for methods to reduce health care workers’ exposure to the virus [78-81].”
BackgroundFactors associated with nurses emotional distress during the COVID-19 pandemic
Rosa, P. D., Brown, R., Pravecek, B., Carotta, C. L., Garcia, A. S., Carson, P., Callies, D., & Vukovich, M. D. (2021) · Applied Nursing Research · doi:10.1016/j.apnr.2021.151502 · Cited by 50 · see citing works
Collins, C., Clays, E., Poel, E. V., Cholewa, J., Tripković, K., Nessler, K., de Rouffignac, S., Santric-Milicevic, M. M., Bukumirić, Z., Adler, L., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095675 · Cited by 49 · see citing works
“A systematic review of 59 studies exploring the impact of COVID-19 on the mental health of professionals fighting against the pandemic [17] concluded that healthcare workers valued contact with and the social support of collaborators, resulting in less frequent mental health problems.”
BackgroundAnxiety and depression among nurses in COVID and non‐COVID intensive care units
Tamrakar, P., Pant, S. B., & Acharya, S. P. (2021) · Nursing in Critical Care · doi:10.1111/nicc.12685 · Cited by 50 · see citing works
“Studies have shown that long working shifts, poor quality of sleep, and sleep deprivation also adversely influence the well-being and job efficiency of nurses.(30,32) In our study, the mean duration of sleep was 6.”
BackgroundCarmassi, C., Dell’Oste, V., Bertelloni, C. A., Pedrinelli, V., Barberi, F. M., Malacarne, P., & Dell’Osso, L. (2021) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2021.103154 · Cited by 49 · see citing works
Messeri, A., Bonafede, M., Pietrafesa, E., Pinto, I., de'Donato, F. K., Crisci, A., LEE, J. K. W., Marinaccio, A., Levi, M., Morabito, M., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18083861 · Cited by 49 · see citing works
“In addition, COVID-19′s PPE worn for long shifts and associated with environmental heat may further aggravates effects such as skin reactions [16], respiratory difficulties, nausea, digestive discomfort, headaches [17] and mental health impacts [18,19].”
BackgroundBartzik, M., Aust, F., & Peifer, C. (2021) · BMC Nursing · doi:10.1186/s12912-021-00770-5 · Cited by 51 · see citing works
“Due to the COVID-19 pandemic, nurses stress levels rose [12, 13, 27, 28], so that the level of moderate physiological activation was most likely often exceeded.”
BackgroundResultde Figueiredo, A., Simas, C., & Larson, H. J. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.10.051 · Cited by 47 · see citing works
The impact of COVID ‐19 on the mental health workforce: A rapid review
Crocker, K. M., Gnatt, I., Haywood, D., Butterfield, I., Bhat, R. S., Lalitha, A. R. N., Jenkins, Z., & Castle, D. J. (2022) · International Journal of Mental Health Nursing · doi:10.1111/inm.13097 · Cited by 47 · see citing works
“This is particularly concerning since social support is an important coping mechanism utilized by MHWs to protect their mental well-being (Dorociak et al. 2017; Muller et al. 2020).”
BackgroundPeng, J., Wu, W. H., Doolan, G., Choudhury, N., Mehta, P., Khatun, A., Hennelly, L., Henty, J., Jury, E. C., Liao, L., et al. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.928107 · Cited by 46 · see citing works
DeTore, N. R., Sylvia, L., Park, E. R., Burke, A., Levison, J. H., Shannon, A., Choi, K. W., Jain, F. A., Coman, D. C., Herman, J., et al. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.11.011 · Cited by 45 · see citing works
Dale, L. P., Cuffe, S. P., Kołacz, J., Leon, K. G., Biernacki, N. B., Bhullar, A., Nix, E. J., & Porges, S. W. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.830926 · Cited by 44 · see citing works
Priede, A., López‐Álvarez, I., Sanchidrián, D. C., & González‐Blanch, C. (2021) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2021.01.005 · Cited by 45 · see citing works
Jordan, J., Shannon, C., Browne, D., Carroll, E., Maguire, J., Kerrigan, K., Hannan, S., McCarthy, T. J., Tully, M. A., Mulholland, C. C., et al. (2021) · BJPsych Open · doi:10.1192/bjo.2021.988 · Cited by 44 · see citing works
“18,21 Examples of interventions include psychological assistance hotlines, online courses and group activities to help with stress.”
Leong Bin Abdullah, M. F. I., Ahmad Yusof, H., Mohd Shariff, N., Hami, R., Nisman, N. F., & Law, K. S. (2021) · Current Psychology · doi:10.1007/s12144-021-01492-2 · Cited by 43 · see citing works
Bonardi, O., Wang, Y., Li, K., Jiang, X., Krishnan, A., He, C., Sun, Y., Wu, Y., Boruff, J. T., Markham, S., et al. (2022) · The Canadian Journal of Psychiatry · doi:10.1177/07067437211070648 · Cited by 43 · see citing works
Ali, M., Uddin, Z., Ahsan, N. F., Haque, M. Z., Bairagee, M., Khan, S. A., & Hossain, A. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e06985 · Cited by 43 · see citing works
“Other studies conducted amid pandemic time also found a higher prevalence of insomnia among female and single HCWs (Lai et al., 2020; Muller et al., 2020; Qi et al., 2020).”
Hesselink, G., Straten, L., Gallée, L., Brants, A., Holkenborg, J., Barten, D. G., & Schoon, Y. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06555-5 · Cited by 44 · see citing works
“Finally, the provision of sufficient and appropriate personal protective equipment, and work rotation schedules which enable sufficient rest in the face of this ongoing pandemic seem paramount [35, 36].”
BackgroundTh’ng, F., Rao, K. A., Ge, L., Mao, D. R., Neo, H. N., Molina, J. A. D. C., & Seow, E. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111228 · Cited by 42 · see citing works
“Another vulnerable subgroup of HCWs in our study were those living with elderly family member(s)—a subgroup with poorer MHOs which has also been demonstrated in other COVID-19 studies [4].”
Lekagul, A., Chattong, A., Rueangsom, P., Waleewong, O., & Tangcharoensathien, V. (2022) · Globalization and Health · doi:10.1186/s12992-022-00861-1 · Cited by 44 · see citing works
“Moreover, health workforce stress from heavy workload related to pandemic responses have led to mental health problems and other psychological consequences [28].”
BackgroundRobins–Browne, K., Lewis, M., Burchill, L. J., Gilbert, C. A., Johnson, C., O'Donnell, M. L., Kotevski, A., Poonian, J., & Palmer, V. J. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-061317 · Cited by 44 · see citing works
Havaei, F., Smith, P. M., Oudyk, J., & Potter, G. G. (2021) · Annals of Epidemiology · doi:10.1016/j.annepidem.2021.05.004 · Cited by 41 · see citing works
Resilience, coping, and distress among healthcare service personnel during the COVID-19 pandemic
Elliott, T. R., Perrin, P. B., Bell, A.-S., Powers, M. B., & Warren, A. M. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03506-6 · Cited by 41 · see citing works
Ménard, A. D., Soucie, K. M., Freeman‐Gibb, L., & Ralph, J. (2022) · Health Policy · doi:10.1016/j.healthpol.2022.01.002 · Cited by 41 · see citing works
Dong, F., Liu, H.-L., Yang, M., Lu, C.-L., Dai, N., Zhang, Y., Robinson, N., & Liu, J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.645460 · Cited by 41 · see citing works
“Some studies provided only a qualitative description of existing literature as part of their narrative evaluations or general reviews (Barello et al., 2020; Bohlken et al., 2020; Braquehais et al., 2020; Chow et al., 2020; Fu et al., 2020; Heath et al., 2020; Magill et al., 2020; Muller et al., 2020; Paiano et al., 20…”
BackgroundJerg‐Bretzke, L., Kempf, M., Jarczok, M. N., Weimer, K., Hirning, C., Gündel, H., Erim, Y., Morawa, E., Geiser, F., Hiebel, N., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910531 · Cited by 40 · see citing works
“Furthermore, international studies emphasize the need for intervention options [23,24] and also draw conclusions based on previous pandemics [14,15,25].”
BackgroundGrailey, K., Lound, A., & Brett, S. J. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-053680 · Cited by 38 · see citing works
Miller, A. P., Mugamba, S., Bulamba, R., Kyasanku, E., Nkale, J. M., Nalugoda, F. K., Nakigozi, G. F., Kigozi, G., Nalwoga, G. K., Kagaayi, J., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263827 · Cited by 40 · see citing works
“While increases in depression, anxiety and stress have been observed in the general population, some populations may be disproportionately affected including healthcare workers [11], persons infected with COVID-19 [12], persons who have lost a loved one to COVID-19, vulnerable populations at increased risk of severe i…”
BackgroundBurnout syndrome among healthcare workers during COVID-19 Pandemic in Accra, Ghana
Konlan, K. D., Asampong, E., Dako‐Gyeke, P., & Glozah, F. N. (2022) · PLoS ONE · doi:10.1371/journal.pone.0268404 · Cited by 40 · see citing works
“Individuals with high level of resilience tend to have increased capacity to deal with stressors and therefore adapt better to stressful situations at the workplace [31, 32].”
BackgroundJob satisfaction among healthcare workers in the aftermath of the COVID-19 pandemic
Barili, E., Bertoli, P., Grembi, V., & Rattini, V. (2022) · PLoS ONE · doi:10.1371/journal.pone.0275334 · Cited by 45 · see citing works
Fteropoulli, T., Kalavana, T. V., Yiallourou, A., Karaiskakis, M., Koliou Mazeri, M., Vryonides, S., Hadjioannou, A., & Nikolopoulos, G. K. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.15938 · Cited by 37 · see citing works
“Another key finding of the study was that profession and work setting was associated with psychological outcomes.”
InfluentialKamberi, F., Sinaj, E., Jaho, J., Subashi, B., Sinanaj, G., Jaupaj, K., Stramarko, Y., Arapi, P., Dine, L., Gurguri, A., et al. (2021) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2021.100824 · Cited by 37 · see citing works
Yoon, S., Goh, H., Nadarajan, G. D., Sung, S. C., Teo, I., Lee, J., Ong, M. E. H., Graves, N., & Teo, T. L. (2021) · Journal of Medical Internet Research · doi:10.2196/26282 · Cited by 38 · see citing works
“This finding from our study reinforces that from a previous study that insufficient rapport-building led to diminished utilization of wellness support services among frontline workers [31].”
MethodResultSources of Distress and Coping Strategies Among Emergency Physicians During COVID-19
Dehon, E. E., Zachrison, K. S., Peltzer-Jones, J. M., Tabatabai, R. R., Clair, E., Puskarich, M. A., Ondeyka, A., Dixon–Gordon, K. L., Walter, L. A., Situ-LaCasse, E., et al. (2021) · Western Journal of Emergency Medicine · doi:10.5811/westjem.2021.9.53406 · Cited by 37 · see citing works
“December 2020 18% (46) Current Living Arrangements Alone 11% (28) With children 65% (169) With elderly people 5% (13)”
Virtual Reality for Health Care Professionals During a Pandemic: A Pilot Program
Croghan, I. T., Hurt, R. T., Aakre, C. A., Fokken, S. C., Fischer, K. M., Lindeen, S. A., Schroeder, D. R., Ganesh, R., Ghosh, K., & Bauer, B. A. (2022) · Journal of Primary Care & Community Health · doi:10.1177/21501319221086716 · Cited by 36 · see citing works
Instruments to measure fear of COVID-19: a diagnostic systematic review
Muller, A. E., Himmels, J. P. W., & de Velde, S. V. (2021) · BMC Medical Research Methodology · doi:10.1186/s12874-021-01262-5 · Cited by 36 · see citing works
“[8], as well as a diagnostic accuracy review that used the map as one of multiple sources [62]).”
BackgroundSelf-citationChu, T. H., Yeo, T. E. D., & Su, Y. (2022) · Journalism & Mass Communication Quarterly · doi:10.1177/10776990211068857 · Cited by 37 · see citing works
“…the finding that health care profession moderates the association between media exposure and stress is particularly significant, given that healthcare workers were observed to be at higher risk of mental health problems than the general population during the COVID-19 pandemic (Muller et al., 2020).”
BackgroundHospital clinicians’ psychosocial well-being during the COVID-19 pandemic: longitudinal study
Wynter, K. H., Holton, S., Trueman, M., Bruce, S., Sweeney, S., Crowe, S., Dabscheck, A., Eleftheriou, P., Booth, S., Hitch, D., et al. (2022) · Occupational Medicine · doi:10.1093/occmed/kqac003 · Cited by 34 · see citing works
“A limitation of almost all studies reporting psychological distress or well-being among healthcare workers is that these studies have been cross-sectional in design [1-6].”
InfluentialThe mental health of healthcare workers during the COVID-19 pandemic: a narrative review
Kock, J. H. D., Latham, H. A., & Cowden, R. G. (2022) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000805 · Cited by 35 · see citing works
O'Hare, D., Gaughran, F., Stewart, R. J., & da Costa, M. P. (2024) · BJPsych Open · doi:10.1192/bjo.2024.7 · Cited by 36 · see citing works
Landa–Blanco, M., Mejía-Suazo, C. J., Landa-Blanco, A. L., Martínez‐Martínez, C. A., Vásquez, D., Vásquez, G., Moraga-Vargas, P., Echenique, Y., Cid, G. M. D., & Montoya, B. D. (2021) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.113933 · Cited by 35 · see citing works
“Recent research has found that healthcare workers are not prioritizing mental health, instead, they focus on occupational protection, rest, and social support (Muller et al., 2020).”
BackgroundShaigetz, V. G., Proulx, C., Cabral, A., Choudhury, N., Hewko, M. D., Kohlenberg, E. M., Segado, M., Smith, M. S. D., & Debergue, P. (2021) · JMIR Rehabilitation and Assistive Technologies · doi:10.2196/26629 · Cited by 34 · see citing works
Vilca, L. W., Chávez, B. V., Fernández, Y. S., Caycho‐Rodríguez, T., & White, M. (2022) · Current Psychology · doi:10.1007/s12144-021-02542-5 · Cited by 36 · see citing works
“Various studies have described the mental health problems associated with this pandemic in different groups such as healthcare workers (Muller et al., 2020), clinic patients (Hu et al., 2020), adults (Wang et al., 2020; Xiong et al., 2020), police (Caycho-Rodríguez et al., 2020), school children…”
BackgroundImpact of COVID-19 pandemic on nurses' burnout and related factors: A rapid systematic review
Hür, G., Cinar, N. D., & Suzan, Ö. K. (2022) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2022.09.002 · Cited by 38 · see citing works
Ali, M., Uddin, Z., & Hossain, A. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e06715 · Cited by 33 · see citing works
- Authors
- Muller, A. E., Hafstad, E. V., Himmels, J. P. W., Smedslund, G., Flottorp, S., Stensland, S. Ø., Stroobants, S., Van de Velde, S., & Vist, G. E.
- Affiliations
- Norwegian Institute of Public Health (NO)
- Oslo University Hospital (NO)
- Corresponding author
- Muller, Ashley Elizabeth
- ORCID
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 293
- Pages
- 113441
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC7462563
- OpenAlex
- W3081708086
- Cited by
- 895
- References
- 114
- Citations by year
- 2026: 24 · 2025: 71 · 2024: 116 · 2023: 177 · 2022: 258 · 2021: 237 · 2020: 12
- FWCI
- 13.37
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psychiatry Research (publishedVersion, cc-by)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion, cc-by)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- COVID-19 pandemic, healthcare workers, mental health, anxiety, depression, sleep disorders, psychological distress, social support, occupational exposure to COVID-19, gender differences, mental health interventions, help-seeking
- MeSH terms
- Occupational Stress, Betacoronavirus, COVID-19, SARS-CoV-2, Female, Health Personnel, Humans, Male, Mental Health, Pneumonia, Viral, Risk Factors, Social Support, Coronavirus Infections, Internationality, Pandemics
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