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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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“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
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“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
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“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
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BackgroundResultCOVID-19 Pandemic Influence on Healthcare Professionals
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“As COVID-19 is a prolonged crisis, it is vital to safeguard the well-being of frontline workers [84].”
BackgroundWhat Prompts Doctors to Recommend COVID-19 Vaccines: Is It a Question of Positive Emotion?
Rapisarda, V., Vella, F., Ledda, C., Barattucci, M., & Ramaci, T. (2021) · Vaccines · doi:10.3390/vaccines9060578 · Cited by 22
“HCWs are at greater risk of infection during the COVID-19 pandemic [9] and are one of the first groups to receive vaccinations and to be involved in vaccination operation, so it is important to consider their attitudes about COVID-19 vaccination to better address barriers to widespread vaccination acceptance [10,11].”
BackgroundMcFadden, P., Neill, R. D., Moriarty, J., Gillen, P. A., Mallett, J., Manthorpe, J., Currie, D., Schroder, H. S., Ravalier, J. M., Nicholl, P., et al. (2021) · Epidemiologia · doi:10.3390/epidemiologia2030017 · Cited by 24
“Emotionfocused coping appears to have a negative adverse effect on mental health and mental wellbeing [19,27,44,62,69,70].”
BackgroundBerkhout, S., Sheehan, K., & Abbey, S. E. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.18425 · Cited by 22
Vargas, I., Howie, E. K., Muench, A., & Perlis, M. L. (2021) · Brain Sciences · doi:10.3390/brainsci11111449 · Cited by 25
Mental health condition of physicians working frontline with COVID-19 patients in Bangladesh
Rahman, A., Deeba, F., Akhter, S., Bashar, F., Nomani, D., Koot, J. A. R., Koly, K. N., Salah, M. F. B., Haverlag, K., & Anwar, I. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03629-w · Cited by 22
“In coherence with the current study, a few systemic reviews from other parts of the world have also found that COVID-19 is negatively impacting the psychological health of front line health workers [48, 49].”
BackgroundCôté, J., Aita, M., Chouinard, M., Houle, J., Lavoie‐Tremblay, M., Lessard, L., Rouleau, G., & Gélinas, C. (2022) · Nursing Open · doi:10.1002/nop2.1199 · Cited by 22
“Finally, the case was made in a review involving HCWs (physicians and nurses were the main targets) for the necessity of coupling organization- level interventions with individual- level interventions to help mitigate the harm of mental health issues (Muller et al., 2020).”
BackgroundPerego, G., Cugnata, F., Brombin, C., Milano, F., Preti, E., Pierro, R. D., Panfilis, C. D., Madeddu, F., & Mattei, V. E. D. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11092317 · Cited by 22
“In line with the literature, high perceived social support from family, colleagues, and friends is helpful to deal with workrelated stress and to increase self-confidence [18,47].”
BackgroundMagnavita, N., Soave, P. M., & Antonelli, M. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19105889 · Cited by 23
Atay, N., Şahin-Bayındır, G., Buzlu, S., Koç, K., & Kuyuldar, Y. (2022) · International Journal of Nursing Terminologies and Classifications · doi:10.1111/2047-3095.12397 · Cited by 17
“In their systematic review, Muller et al. (2020) concluded that healthcare workers caring for patients with COVID-19 and trying to cope with a heavy workload (organizational factors) are likely to experience more mental problems.”
Alrashidi, N. A., Alreshidi, M. S., Dator, W. L., Maestrado, R. B., Villareal, S. C., Buta, J. B., Pangket, P. P., Mostoles, R., Gonzales, A., Mina, E., et al. (2022) · Behavioral Sciences · doi:10.3390/bs12120515 · Cited by 22
“Healthcare workers are subjected to a number of stressors at work, which may adversely affect their well-being [11].”
BackgroundMenaldi, S. L., Raharjanti, N. W., Wahid, M. H., Ramadianto, A. S., Nugrahadi, N. R., Adhiguna, G. M. Y. P., & Kusumoningrum, D. A. (2023) · PLoS ONE · doi:10.1371/journal.pone.0280313 · Cited by 25
Mental health outcomes in health care providers during the COVID-19 pandemic: an umbrella review
Majid, U., Hussain, S. A. S., Zahid, A., Haider, M. H., & Arora, R. (2023) · Health Promotion International · doi:10.1093/heapro/daad025 · Cited by 26
Padmanathan, P., Lamb, D., Scott, H. R., Stevelink, S. A. M., Greenberg, N. L., Hotopf, M. H., Morriss, R. K., Raine, R., Rafferty, A. M., Madan, I., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286207 · Cited by 22
Yang, J.-M., Ye, H., Long, Y., Zhu, Q., Huang, H., Zhong, Y.-B., Luo, Y., Yang, L., & Wang, M.-Y. (2023) · Journal of Medical Internet Research · doi:10.2196/44000 · Cited by 22
“Health care workers on the front lines of the pandemic are under immense psychological stress and are subject to many common mental disorders, such as post-traumatic stress disorder, anxiety, and depression [43-45].”
Psychological Status of High School Students 1 Year After the COVID-19 Emergency
Zhou, C., Li, R., Yang, M., Duan, S., & Yang, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.729930 · Cited by 23
Nia, H. S., Görgülü, Ö., Naghavi, N., Bello, M. A. R., Sánchez‐Teruel, D., Fomani, F. K., She, L., Rahmatpour, P., Allen, K., Arslan, G., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.754831 · Cited by 29
Ghezeljeh, T. N., Shahrestanaki, S. K., Kohne, Z. A. M., & Fakhari, E. (2022) · BMC Nursing · doi:10.1186/s12912-022-01082-y · Cited by 21
“The home care nurse usually has a close relationship with family members and the patient, so it seems that he/she has a close relationship with the social structure and family customs and has his/her own problems [20, 21].”
BackgroundMental Health of Healthcare Professionals: Two Years of the COVID-19 Pandemic in Portugal
Costa, A., de Almeida, T. C., Fialho, M., Rasga, C., Martiniano, H., Santos, O., Virgolino, A., Vicente, A. M., & Heitor, M. J. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043131 · Cited by 22
“[17], the most common factors correlated with increased risk of distress was the exposure to COVID-19 patients, being a woman and worry about infection of oneself or family members.”
BackgroundKim, M., & Yang, Y.-Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18126531 · Cited by 21
“These factors included general characteristics such as gender, working in areas with a high risk of COVID-19 infection, medical history, distress caused by traumatic events, post-traumatic stress disorder, and social support [3,4].”
BackgroundFrequency and perceived effectiveness of mental health providers’ coping strategies during COVID-19
Reilly, S., Soulliard, Z. A., McCuddy, W. T., & Mahoney, J. J. (2021) · Current Psychology · doi:10.1007/s12144-021-01683-x · Cited by 20
“…may be accomplished through provision of peer support groups (Acker, 2012), informal social support opportunities (Labrague & de los Santos, 2020; Muller et al., 2020), and/or interventions that involve exercise, in addition to formal psychological interventions that may be provided by an…”
Lamiani, G., Borghi, L., Poli, S., Razzini, K., Colosio, C., & Vegni, E. A. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115649 · Cited by 22
Esteban, R. F. C., Mamani-Benito, O. J., Zúñiga, D. Q., & Farfán-Solís, R. (2021) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2021.06.005 · Cited by 24
Review of the Psychological Impact of COVID-19 Pandemic on Healthcare Workers in Saudi Arabia
Bahamdan, A. S. (2021) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s324938 · Cited by 20
“Yet, the published findings of psychological distress among HCWs might indicate that healthcare systems are currently unable to effectively protect the helpers.(8) Psychological impacts and fear or hesitancy in HCWs may affect the efficiency, and quality of work as well as willingness to report to work which can have…”
BackgroundGori, A., Topino, E., & Caretti, V. (2021) · Journal of Contingencies and Crisis Management · doi:10.1111/1468-5973.12380 · Cited by 21
“…condition could have a broad, substantial and lasting impact on psychological wellbeing (Rosen et al., 2020); therefore, in light of the possible clinical utility (e.g., Muller et al., 2020), a large line of research has focused on the risk/protective factors for mental health during the pandemic.”
BackgroundPopova, E. S., Hahn, B. J., Morris, H., Loomis, K., Shy, E., Andrews, J., Iacullo, M., & Peters, A. (2022) · OTJR Occupational Therapy Journal of Research · doi:10.1177/15394492221091271 · Cited by 20
Nicolakakis, N., Lafantaisie, M., Letellier, M.-C., Biron, C., Vézina, M., Jauvin, N., Vivion, M., & Pelletier, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159653 · Cited by 21
“[16] stated in their COVID-19 rapid review, there is “a mismatch between the likely organizational sources of psychological distress [ .”
BackgroundAng, W. H. D., Chew, H. S. J., Ong, Y. H. N., Zheng, Z. J., Shorey, S., & Lau, Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912899 · Cited by 23
“Notwithstanding, the rising prevalence of mental health disorders can lead to a greater burden on the health care systems [19,20].”
BackgroundGlobal Healthcare Needs Related to COVID-19: An Evidence Map of the First Year of the Pandemic
Betancourt, M. A., Duarte‐Díaz, A., Vall‐Roqué, H., Seils, L., Orrego, C., Perestelo‐Pérez, L., Cortés, J. B., Martínez, M. T. B., Serrano, A. M., Bermejo‐Caja, C. J., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191610332 · Cited by 20
“Different studies have pointed out several work-related risk factors that may lead to increased occupational stress and emotional exhaustion, including access to or prolonged use of PPE, increased work pressure, lack of social support from colleagues and supervisors, and prolonged work hours [82,83].”
BackgroundTeall, A. M., & Melnyk, B. M. (2021) · Nursing Administration Quarterly · doi:10.1097/naq.0000000000000457 · Cited by 19
Vissink, C. E., van Hell, H. H., Galenkamp, N., & Rossum, I. W.-V. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100102 · Cited by 19
Perceived impact of nurse turnover on the organization: A Delphi study on managers of nursing
Sawada, S., Takemura, Y., Isobe, T., Koyanagi, H., & Kida, R. (2022) · Journal of Nursing Management · doi:10.1111/jonm.13738 · Cited by 19
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
“In the critical situation caused by the COVID-19 outbreak, HCWs experience different levels of insomnia [92, 98].”
BackgroundSikaras, C., Zyga, S., Tsironi, M., Tselebis, A., Pachi, A., Ilias, Ι., & Παναγιώτου, Α. (2023) · Healthcare · doi:10.3390/healthcare11030367 · Cited by 19
Zeeman, J. M., Pickering, E. S., Nana, A. A., & Harris, S. C. (2023) · American Journal of Pharmaceutical Education · doi:10.1016/j.ajpe.2023.100628 · Cited by 19
How COVID-19 has impacted integrated care practice: lessons from the frontlines
Cooper, Z., & Zerden, L. D. S. (2021) · Social Work in Health Care · doi:10.1080/00981389.2021.1904316 · Cited by 19
“Like recent literature amplifying the impact of COVID-19 on health-care workers mental health and wellbeing (Muller et al., 2020), CCHC staff have not been immune to these deleterious effects.”
BackgroundHossain, M. R., Patwary, M. M., Sultana, R., & Browning, M. H. E. M. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.701920 · Cited by 19
“Such a large number of patients made an already overcrowded environment in the emergency room impossible to maintain social distancing or posed serious challenges to practicing personal safety (tear-off workers’ mask) for healthcare workers (65).”
BackgroundImpact of COVID-19 on post graduate medical education and training
Enujioke, S. C., McBrayer, K., Soe, K. C., Imburgia, T. M., & Robbins, C. L. (2021) · BMC Medical Education · doi:10.1186/s12909-021-03019-6 · Cited by 18
Saúde mental dos profissionais da saúde na pandemia do coronavírus (Covid-19)
Moser, C. M., Monteiro, G. M. C., Narvaez, J. C. D. M., Ornell, F. R., Calegaro, V. C., Bassols, A. M. S., Laskoski, P. B., & Hauck, S. (2021) · Revista Brasileira de Psicoterapia · doi:10.5935/2318-0404.20210009 · Cited by 21
A meta-review of psychological resilience during COVID-19
Seaborn, K., Henderson, K., Jacek Gwizdka, A., & Chignell, M. (2022) · npj Mental Health Research · doi:10.1038/s44184-022-00005-8 · Cited by 20
“Provide social support 6 20 – 23, Organisational Provide training and/or intervention programmes 6 17 – 22 ⊕⊝⊝⊝ Very low Provide social support 6 19,21,22,46,47,53 Insuf fi cient evidence Provide mental health support 4 19,21 – 23 Insuf fi cient evidence Provide personal protective equipment (PPE) 5…”
Strategies to enhance resilience to cope with workplace adversities post-COVID-19 among ICU nurses
Zenani, N. E., Gause, G., & Sehularo, L. A. (2022) · Curationis · doi:10.4102/curationis.v45i1.2345 · Cited by 18
“caused significant psychological distress among the ICU nurses (Muller et al. 2020).”
BackgroundInfluential
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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