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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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BackgroundResultHelper Syndrome and Pathological Altruism in nurses – a study in times of the COVID-19 pandemic
Maringgele, V., Scherr, M., Aichhorn, W., & Kaiser, A. K. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1150150 · Cited by 4
Serrano‐Ibáñez, E. R., Castelo, A. M. D. L. V., Varela, C., Montero-Matellanes, M. M., & Pulido, A. G. (2023) · SAGE Open · doi:10.1177/21582440231207269 · Cited by 5
“%) in this population, a result that was consistent with other studies (e.g., Muller et al., 2020; Tan et al., 2023), founding that this symptomatology had significantly associated with the manifestation of physical symptoms as headache (Chew et al., 2020).”
ResultManjareeka, M., Kanungo, P., Yadav, S., & Das, R. C. (2024) · The Open Public Health Journal · doi:10.2174/0118749445280047240108070649 · Cited by 4
Bourassa, K. A., Rohr, J. C., Bartek, N., Miller, S. M., Wood, S. C. J., Vasquez, N. N., Head, J., Robert-Ibarra, S. S. S., Moore, K., Marder, K., et al. (2024) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000782 · Cited by 5
Suresh, V., Nimbarte, A. D., & Choudhury, A. (2024) · Safety · doi:10.3390/safety10040103 · Cited by 8
Wisata Barokah : Alternatif Pembelajaran di Masa Pandemi Covid-19 di RA Al-Ikhlas Mantren
Maharani, S., Majid, M., & Yuhanna, W. L. (2021) · Jurnal Obsesi Jurnal Pendidikan Anak Usia Dini · doi:10.31004/obsesi.v5i2.992 · Cited by 4
Bröcker, E., Louw, K.-A., Hewett, M., Burger, H., Felix, R. T., Koker, P. D., Rossouw, J., & Seedat, S. (2021) · South African Medical Journal · doi:10.7196/samj.2021.v111i5.15648 · Cited by 4
“Barriers to help-seeking among healthcare workers have been widely documented and include fear of stigmatisation, a culture of silence, ingrained beliefs that self-care is selfish, work and time pressures, and a ‘trenches mentality’ (a culture of needing to be heroic and reluctance to approach providers who do not und…”
BackgroundBundzena-Ervika, A., Mārtinsone, K., Perepjolkina, V., Ruža, A., Kolesnikova, J., & Rancāns, E. (2021) · SOCIETY INTEGRATION EDUCATION Proceedings of the International Scientific Conference · doi:10.17770/sie2021vol7.6258 · Cited by 3
Lucas, D., Brient, S., Eveillard, B. M., Gressier, A., Grand, T. L., Pougnet, R., Dewitte, J.-D., & Loddé, B. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168413 · Cited by 4
“Collective support and a sense of work were now known to have been a preventive factor against the mental health burden during the crisis [2,26,28].”
BackgroundInfluentialRetractedNawal, A., Shoaib, M., Zámečník, R., & Rehman, A. U. (2022) · Evaluation & the Health Professions · doi:10.1177/01632787221112079 · Cited by 5
Shinkai, N., Ohnishi, K., & Yano, H. (2022) · Journal of Japan Academy of Nursing Science · doi:10.5630/jans.42.72 · Cited by 4
Baker, H., Gill, S. S., Aboaja, A. M., Kole, S., & Perry, A. (2022) · Psych · doi:10.3390/psych4040051 · Cited by 4
“A systematic review found similar results worldwide in Italy [5], Spain [6], Norway [7] and Switzerland [8].”
BackgroundResultBall, J., Mahony, E., Ray, M. J., Nehme, Z., Stub, D. A., & Smith, K. L. (2022) · Resuscitation Plus · doi:10.1016/j.resplu.2022.100341 · Cited by 4
“Those with a clinical background had a median (IQR) of 12 (5, 23) years of experience.”
Cipolletta, S., Previdi, S., & Martucci, S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032072 · Cited by 4
“As pointed out in a recent review [54], these interventions should not only be targeted to prevent or relieve mental health problems at an individual level, but must also act at”
BackgroundZeman, L. L., Roy, S., Surnis, P. P., Wasserman, J., Duchak, K., Homayouni, R., & Mulhem, E. (2023) · International Journal of Qualitative Studies on Health & Well-Being · doi:10.1080/17482631.2023.2184034 · Cited by 5
“…reports demonstrate the role that social connectedness can play in buffering against negative sequalae experienced by healthcare workers during the COVID-19 pandemic (Fernández-Castillo et al., 2021; Labrague & De Los Santos, 2020; Nelson et al., 2021; Nitschke et al., 2021; Yıldırım et al., 2021).”
BackgroundDikobe, J. M., Moagi, M. M., & Sehularo, L. A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20065078 · Cited by 4
“(2020) [20] reported that nurses utilised support from family during the COVID-19 pandemic as a major emotional and motivational factor to continue caring for COVID-19 patients.”
BackgroundMakhado, G., Ntuli, B., Zungu, L. I., Thovhogi, N., Mphekgwana, P. M., Lebelo, S. L., Madiba, S., & Modjadji, P. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21030372 · Cited by 6
Yang, S., Hao, Q., Sun, H., Yang, Y., Liu, J., Li, C., Fu, Y., Yao, C., & Luo, G. (2025) · BMC Nursing · doi:10.1186/s12912-025-02718-5 · Cited by 4
“Exposure to COVID-19, female gender, fear of infection or infecting others, and social support with less were identified as the main sources of anxiety experienced by frontline nurses [17].”
As emoções à flor da pele e seus possíveis manejos na pandemia da COVID-19
da Silva, B. S., da Fonseca, P. I. M. N., & da Silva, P. D. (2021) · Research Society and Development · doi:10.33448/rsd-v10i10.18434 · Cited by 4
Boamah, S. A., Weldrick, R., Havaei, F., Irshad, A., & Hutchinson, A. (2022) · Preprints.org · doi:10.20944/preprints202208.0239.v1 · Cited by 4
Lee, B. E. C., Ling, M., Boyd, L., Olsson, C. A., & Sheen, J. A. (2022) · medRxiv · doi:10.1101/2022.11.16.22282426 · Cited by 4
Kawakami, N., Nguyen, H. T. M., Kaewboonchoo, O., Imamura, K., Tran, T. T. T., Boonyamalik, P., Sasaki, N., Sripo, N., Tienthong, T., Asaoka, H., et al. (2023) · Preprints.org · doi:10.20944/preprints202303.0450.v1 · Cited by 4
Mental health first aid for health-care workers during crises
Segalovich, J., Levi, G., & Segev, R. (2023) · The Lancet Psychiatry · doi:10.1016/s2215-0366(23)00401-7 · Cited by 4
Ujihara, M., Tachikawa, H., Takahashi, A., Gen, T., & Cho, Y. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20064991 · Cited by 3
“Muller found that HCWs reported anxiety, depression, sleep problems, and distress during the COVID-19 pandemic [20].”
BackgroundLesmes, P. A. R., Rua, D. S., & Durán, C. (2025) · Health Services Insights · doi:10.1177/11786329251356558 · Cited by 3
The Role of Burnout in Mental Health Professionals’ Perception of Psychiatric Inpatient Care Quality
Schröder, A., Lundqvist, L., Moen, Ø. L., Skundberg‐Kletthagen, H., & Gonzalez, M. T. (2025) · Issues in Mental Health Nursing · doi:10.1080/01612840.2025.2582820 · Cited by 3
“Globally, a critical issue at present is that health care professionals themselves report psychiatric distress (Muller et al., 2020).”
Alodainy, W. A. (2022) · World Family Medicine Journal/Middle East Journal of Family Medicine · doi:10.5742/mewfm.2022.95248 · 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
“[2] Now, with a better understanding of the COVID‐19 and its medical problems, it is very important to identify psychological signs and symptoms and mitigate them at the earliest.[3] In this non‐systematic review, authors have included articles from PubMed, Medline, and Google scholar with keywords “identify strategie…”
BackgroundMathura, P. V., Li, M., Vegt, J., Penrod, Z., Suranyi, Y., Osborne, C., & Kassam, N. (2022) · BMJ Open Quality · doi:10.1136/bmjoq-2022-001878 · Cited by 5
The circadian preferences in the context of sociodemographic indicators and lifestyle
Manková, D., Novák, J. M., Sedlák, P., & Fárková, E. (2022) · Chronobiology International · doi:10.1080/07420528.2022.2134786 · Cited by 3
“as well as socio-economic variables (Aneja and Ahuja 2021; Muller et al. 2020), we have subjected our data to control measurements after finding the first results.”
MethodAdvancing safety in turbulent times: Development and validation of a pandemic safety climate scale
Huang, Y.-H., He, Y., Lee, J., Lytle, B., & Courtney, T. K. (2023) · Journal of Occupational and Organizational Psychology · doi:10.1111/joop.12479 · Cited by 5
Robbins-Welty, G. A., Nakatani, M. M., Song, Y. K., Riordan, P. A., Pieper, C. F., Price, M. J., Scoggins, C., & Galanos, A. N. (2024) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091241256106 · Cited by 3
Moraleda‐Cibrián, M., Palomares-Gonell, I., Albares-Tendero, J., & Chung, S. (2024) · Psychiatry Investigation · doi:10.30773/pi.2023.0368 · Cited by 3
Varese, F., Allsopp, K., Carter, L., Shields, G., Hind, D., Davies, L. M., Barrett, A., Bhutani, G., McGuirk, K., Huntley, F., et al. (2024) · Health and Social Care Delivery Research · doi:10.3310/hgqr5133 · Cited by 4
Salman, S., Fatima, M., Anees, R. T., & Sylvia, G. R. (2024) · Review of Education Administration and Law · doi:10.47067/real.v7i4.383 · Cited by 5
Stensland, S. Ø., Bondjers, K., Zwart, J., Rosseland, L. A., Atar, D., Christensen, J. O., Matre, D., Glad, K. A., Wentzel‐Larsen, T., Wøien, H., et al. (2025) · Public Health in Practice · doi:10.1016/j.puhip.2025.100582 · Cited by 3
Self-citationFaria, S., Fonseca, S. M., Marques, A. J., & Queirós, C. M. L. (2025) · Healthcare · doi:10.3390/healthcare13121434 · Cited by 8
“…that their well-being was affected by pandemic stressors, only 3.7% sought professional psychological support, which may reflect the reluctance to engage in mental health care, which recent literature attributes to stigma, logistical barriers, or underestimation of personal distress [7,9,124].”
InfluentialBarriers and facilitators to implementation of interventions to mitigate moral injury among nurses
Godzik, C. M., DiBenedetto, J. K., Usset, T. J., Stiles, H., Klein, H., Fortuna, K. L., Pepin, R. L., Wright, H., Locke, A., Thomason, H., et al. (2025) · Frontiers in Health Services · doi:10.3389/frhs.2025.1582700 · Cited by 3
Guarracino, F., Shernan, S. K., Tahan, M. R. E., Bertini, P., Stone, M. E., Kachulis, B., Paternoster, G., Mukherjee, C., Wouters, P. F., & Rex, S. (2021) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.02.039 · Cited by 3
Gainer, D. M., Nahhas, R. W., Bhatt, N. V., McCormack, J., McMerrill, A., & Sultan, H. (2022) · International Journal of Health Promotion and Education · doi:10.1080/14635240.2022.2028264 · Cited by 3
“Seeking social support has been reported as a common stress-control strategy of healthcare workers to take care of their own mental health (Muller et al. 2020).”
Okpua, N. C., Hami, R. B., Edeogu, C. O., & Mujar, N. M. M. (2022) · Nursing and Health Sciences · doi:10.1111/nhs.12965 · Cited by 3
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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