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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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Deep Learning for Neuroimaging-Based Brain Disorder Detection: Advancements and Future Perspectives
Ocen, S., Yohannis, M. A., & Muchemi, L. (2024) · Advances in Alzheimer s Disease · doi:10.4236/aad.2024.134007 · Cited by 2
Hussain, S. A. S., Hussain, S. A. S., Haider, M. H., Butt, M. S., Zahid, A., & Majid, U. (2025) · Healthcare · doi:10.3390/healthcare13162009 · Cited by 2
“They faced the pressure of managing an unwieldy patient load while grappling with a novel virus with real implications for human life [6].”
Shah, S., Neupane, S., Adhikari, K., & Mallik, M. (2022) · Journal of Chitwan Medical College · doi:10.54530/jcmc.572 · Cited by 2
Zabrzygraj, A., & Świtaj, P. (2021) · Postępy Psychiatrii i Neurologii · doi:10.5114/ppn.2021.106815 · Cited by 2
Å pleie covid-19-pasienter har vært en belastning for mange sykepleiere
Furnes, T., & Eines, T. F. (2021) · Sykepleien Forskning · doi:10.4220/sykepleiens.2021.86581 · Cited by 2
Villa, G., Dellafiore, F., Caruso, R., Arrigoni, C., Galli, E., Moranda, D., Prampolini, L., Bascapè, B., Merlo, M. G., Giannetta, N., et al. (2021) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v92is6.12311 · Cited by 2
“Providing care to patients with COVID-19 has increased levels of anxiety, depression, stress (4), and sleep problems (5), consequently exacerbating the risk of burnout (6,7) and compromising the efficacy”
BackgroundEffects of COVID-19 on the Design of the Hospital
Garg, A. K., & Dewan, A. (2022) · Springer eBooks · doi:10.1007/978-981-16-8456-2_9 · Cited by 2
IMPACT OF THE COVID-19 PANDEMIC ON RADIOGRAPHY & RADIOTHERAPY PRACTICE IN MALAYSIA
Ibrahim, M. I., AKIB, R., & JAFFAR, M. F. (2021) · Malaysian Applied Biology · doi:10.55230/mabjournal.v50i2.1984 · Cited by 2
“Provision of appropriate PPE and work rotation schedules to enable adequate rest in facing longlasting disasters such as the COVID-19 pandemic seem to be an excellent practice to reduce the stress among healthcare worker especially radiographers (Muller et al., 2020).”
BackgroundImpact of COVID‐19 pandemic on foot care services in Ontario, Canada
Lu, S. H., McLaren, A., & Pinsker, E. B. (2022) · Journal of Foot and Ankle Research · doi:10.1186/s13047-022-00555-2 · Cited by 2
d’Ussel, M., Adam, F., Fels, A., Châtellier, G., & Philippart, F. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.913126 · Cited by 2
“A systematic review of 29 studies reported a median prevalence of 24% for anxiety and 21% for depression among HCWs (50).”
BackgroundMental health assessment of Spanish frontline healthcare workers during the SARS-CoV-2 pandemic
Sangrà, P. S., Ribeiro, T. C., Esteban‐Sepúlveda, S., Pagès, E. G., López, B., Aguiló, J., Moya-Prats, J. L. P., Pintor, L., & Mir, S. A. (2022) · Medicina Clínica (English Edition) · doi:10.1016/j.medcle.2021.11.010 · Cited by 3
The interactive dimensions of encounters in HIV care: From trauma to relational traumatic growth
Catalán, J., Ridge, D., Hedge, B., & Cheshire, A. (2022) · Health Expectations · doi:10.1111/hex.13619 · Cited by 2
“As back then, there are some suggestions that many COVID workers prefer informal and organizational support over formalized professional help.(46) Our work to understand the factors that could CATALAN ET AL.”
BackgroundRothman, A., Offerman, E., & Trottier, D. G. (2022) · Drama Therapy Review · doi:10.1386/dtr_00107_1 · Cited by 2
Pietrzyk, K., & Szczepańska, A. (2022) · Acta Scientiarum Polonorum Administratio Locorum · doi:10.31648/aspal.8102 · Cited by 2
“…Pamidimukkala & Kermanshachi, 2021; Ogunnusi et al., 2020; infrastructure sector – Jallow et al., 2020; the other – Meyer et al., 2021; Yu et al., 2021; Lancet, 2020; Buselli et al., 2020; Spoorthy et al., 2020; Saragih et al., 2021; Muller et al., 2020; Niebuhr et al., 2022; ParentLamarche, 2022).”
BackgroundPinillos-Patiño, Y., Fernández, M. A., Torres, S. J., & Gauna-Quiñonez, A. (2022) · Revista de Salud Pública · doi:10.15446/rsap.v24n2.97527 · Cited by 2
Lepièce, B., Lenoir, A.-L., & de Rouffignac, S. (2022) · Santé Publique · doi:10.3917/spub.225.0675 · Cited by 2
Camila Valencia, A., Carolina Bernal, A., Diana Mercedes Ramírez, J., John Jairo Zuleta, T., & Delgado, C. E. Y. (2022) · Revista chilena de neuro-psiquiatría · doi:10.4067/s0717-92272022000400433 · Cited by 4
Salud mental del talento humano en salud durante el covid-19 en Colombia
Agudelo‐Hernández, F., Buitrago, J. B., Vélez-Botero, H., Poveda, A. M. P., Bautista, N. B., & Rodríguez, A. Y. R. (2023) · Revista Colombiana de Salud Ocupacional · doi:10.18041/2322-634x/rcso.2.2022.8989 · Cited by 2
Ishak, H., Silim, U. A., & Suhaimi, A. F. (2023) · Malaysian Journal of Medicine and Health Sciences · doi:10.47836/mjmhs.19.1.28 · Cited by 2
Khazaee-Pool, M., Moradi, M., Pashaei, T., & Ponnet, K. S. (2023) · Human Resources for Health · doi:10.1186/s12960-023-00862-0 · Cited by 2
Don't Postpone! Mental Health of Healthcare Professionals Needs Attention!
van den Broek, A. H. S., & de Vroege, L. (2023) · Exploratory Research and Hypothesis in Medicine · doi:10.14218/erhm.2023.00006 · Cited by 2
Fernández‐Ávalos, M. I., Pérez‐Marfil, M. N., Fernández‐Alcántara, M., Ferrer‐Cascales, R., Cruz‐Quintana, F., & Turnbull, O. H. (2021) · Healthcare · doi:10.3390/healthcare10010048 · Cited by 2
“This resilience (discussed below) may relate to strategies such as practicing sports, leisure, occupational tasks other than the work environment, and receiving formal and informal social support [15,28], all of which might help professionals to disconnect from the loop of negativity in which they find themselves [27,…”
BackgroundPomen pandemije covida-19 za duševno zdravje medicinskih sester in zdravnikov:
Višič, U., & Sočan, M. (2022) · Slovenian Nursing Review · doi:10.14528/snr.2022.56.4.3113 · Cited by 1
Güven, D. C. (2021) · Internal Medicine Journal · doi:10.1111/imj.15130 · Cited by 2
Missed Nursing Care in COVID-19 Patients in IranPreprint
Hosseini, Z., Reisi, L., Maghari, A., & Karimollahi, M. (2021) · Research Square · doi:10.21203/rs.3.rs-814476/v1 · Cited by 2
de Carvalho, T. M., Lourenção, L. G., Pinto, M. H., Viana, R. A. P. P., Moreira, A. M. B. D. S. G., de Mello, L. P., Matos, C. G. C., Beccária, L. M., Amêndola, C. P., de Oliveira, A. M. R. R., et al. (2022) · Preprints.org · doi:10.20944/preprints202202.0025.v1 · Cited by 2
“However, we emphasize that although engagement is considered a stable phenomenon, it is related to organizational and work characteristics [42,43].”
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Gender Equality: Flying blind in a time of crisis, The Global Health 50/50 Report 2021
50/50, G. H. (2021) · doi:10.56649/zdyq5195 · Cited by 2
Czorniej, K. P., Krajewska-Kułak, E., & Kułak, W. (2023) · Medical Science Monitor · doi:10.12659/msm.940766 · Cited by 1
“…Mental Health According to the studies analyzed in a systematic review by, among others, researchers at the Norwegian Institute of Public Health, during the COVID-19 pandemic, up to 97% of health-care workers experienced distress stress negatively affecting their preparedness and mental state [41].”
Kwong, K. (2021) · International Journal of Healthcare · doi:10.5430/ijh.v7n2p15 · Cited by 1
“These findings were consistent with the literature[8, 9] and these factors as well as other possible risk factors should be investigated more extensively in future studies.”
BackgroundResultHassam, Z., Gulzar, N., & Latif, A. (2021) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe8847 · Cited by 1
“preferring to take responsibility for their own mental health.(6) In pharmacy, pharmacists and support staff have experienced rapid changes to workloads and workflows, with some feeling unprepared and exhausted, resulting in anxiety, insomnia, posttraumatic stress disorder, and/or depression.”
BackgroundÖzdemir, L., Birbiçer, H., Doruk, N., & Sagün, A. (2022) · Türk anesteziyoloji ve reanimasyon derneği dergisi · doi:10.5152/tjar.2021.21423 · Cited by 1
Srivastava, N. K., Rathia, S. K., Dey, C., Shukla, A. K., Thangaraju, P., Singh, S., & Anand, V. (2023) · Cureus · doi:10.7759/cureus.41073 · Cited by 1
“Many HCPs faced psychological distress during the COVID-19 pandemic as they were more susceptible to emotional, behavioral, and psychological stress due to their duty to maintain a balance between patient care and taking care of their loved ones [20,21].”
BackgroundGonzález-Casanova, I., Rodríguez, D. L. M., Brunel, J. O., Gómez, M. G. R., de Groot, M., & Fernández, A. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1268253 · Cited by 1
“This is in line with recommendations from a recent review of health provider mental health during the COVID-19 pandemic that found that healthcare workers relied on social support and contact to address mental health problems (20).”
ResultHilvano‐Cabungcal, A. M., & Shiela R. Bonito, R. (2024) · Acta Medica Philippina · doi:10.47895/amp.vi0.8590 · Cited by 1
Chakraborty, L., Maitre, C. L. L., Chahine, N. O., Fields, A. J., Gawri, R., Giers, M. B., Smith, L. J., Tang, S. Y., Zehra, U., Haglund, L., et al. (2024) · Journal of Orthopaedic Research® · doi:10.1002/jor.25866 · Cited by 4
“20,21 24 Academic research was also affected by COVID ‐ 19.”
On the Relationships Between Humour, Stress and Flow Experience: Introducing the Humour-Flow Model
Bartzik, M., & Peifer, C. (2024) · Springer eBooks · doi:10.1007/978-3-031-52288-8_29 · Cited by 1
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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