The Mental Health of Healthcare Workers in the COVID-19 Pandemic: A Systematic Review Essay

Abstract

This paper is a systematic review that discusses the consequences of the current COVID-19 pandemic scenario on healthcare workers' mental health outcomes. The sources from which the articles used in this paper were systematically researched are PubMed, Lilacs, and BVS. The search for articles occurred between January to October of the year 2020. In searching the electronic databases, the following keywords were employed to create a search strategy: nervousness or social anxiety or anxieties, depressive or depression or emotional depression, mental or mental hygiene or hygiene, social or anxiety, mental and COVID-19 or Coronavirus, social or social anxieties or anxiety and depressions or depressive symptoms or depressive symptom or symptom, emotional or depressions, emotional or emotional depressions, and health. The systematic review findings showed that exposure to COVID-19 increased the incidence rate of symptoms of mental conditions such as anxiety and depression. The conclusion drawn from the review's findings is that lifestyle strategies aided by psychological care can be fundamental in improving the consequences of the mental conditions caused by the COVID-19 pandemic. 

Introduction

The recent outbreak of the novel COVID-19 disease put much strain on the healthcare systems, particularly on the healthcare workers (Muller, Stensland & van den Velde, 2020). The World Health Organisation (WHO) has put forward this immense strain imposed on healthcare workers who are in the duty of saving lives during the outbreak and called for measures to relieve this burden to protect the physical and mental well-being of healthcare workers (WHO, 2020).

From the history of previous viral outbreaks, it is apparent that frontline and non-front line healthcare workers are at a higher risk of infection and other adverse physical health outcomes (Muller et al., 2020). During and up until after the years of an epidemic, the occupational activities of healthcare workers put healthcare workers at risk of developing mental health problems with symptoms such as post-traumatic stress, depression, burnout, and anxiety. Moreover, during the events of the current global health crisis, reports of the mental toll on healthcare workers have persistently appeared (Tsamakis et al., 2020).

The symptoms of psychological distress and mental illness which have been observed in the general public in the present time are attributed to the distressing nature of the widespread COVID-19 pandemic; these symptoms are even more exaggerated in the healthcare workers who are dealing with patients infected with the disease (Thapa et al., 2020). There have been various research efforts to appraise healthcare workers' mental distress during pandemic events and introduce measures that relieve this mental stress.

PICO clinical question

This aim of this current research is to determine: How has the current COVID-19 pandemic (I) affected (C) healthcare workers' (P) mental status (O)?

Aim of review

This review aims to create a summary of existing literature that addresses the mental health outcomes on society and, in particular, healthcare workers by creating a literature base of research work relevant to this issue.

Literature review

The events of every major epidemic outbreak greatly increase the demand for healthcare workers. Moreover, the scenarios of these outbreaks are usually similar for healthcare workers; there is a constant rise in the number of the infected, a rise in the number of the dead, a lack of medicine or vaccine to combat the disease, extensive media coverage of the outbreak, a large workload, lack of adequate personal protective equipment and feelings of inadequate support. All these contribute to the mental distress healthcare workers suffer during these times (Vizheh et al., 2020). To keep up with the heavy demand for medical aid during disease outbreaks, healthcare workers work long hours under great pressure, being exposed to a high risk of contracting the disease when treating patients. Moreover, healthcare workers are susceptible to the public's same foibles by becoming anxious after listening to fake news and rumors. In the initial stage of the COVID-19 outbreak, 29% of all hospitalized patients were healthcare workers who had contracted the disease (Vizheh et al., 2020). Studies to find out how the infections came about indicate that the healthcare workers became infected due to the close contact maintained with patients while administering treatment (Xiao et al., 2020). A combination of all these factors raises the risk of healthcare workers developing a psychological illness and physical and emotional distress. 

Research conducted on the consequences of outbreaks of other infectious diseases such as Severe Acute Respiratory Syndrome (SARS), the Ebola Virus, and the Middle East Respiratory Syndrome (MERS) indicates that a significant number of healthcare workers active during these events suffer a high level of emotional distress (Lee et al., 2018). A study conducted on 1257 healthcare workers treating SARS-infected patients revealed somatic and cognitive symptoms of anxiety in a significant number of healthcare workers. These symptoms are attributed to the rapid proliferation of the infection in the initial phase of the epidemic, the feeling of uncertainty healthcare workers experience, the constant threat to life, and the feeling of vulnerability brought on by the event (Chong et al., 2004). A further study conducted after the outbreak showed symptoms such as depression, anxiety, burnout, traumatic stress, and avoidance. The consequences of poor mental health caused by the current outbreak are more worrying, considering that the number of the infected and the dead due to SARS-CoV-2 are several times more than that of SARS. The disastrous impact of SARS-CoV-2 has been so great; the outbreak has received some reference as a world-ending event. The hospitals are ill-equipped to keep a handle on the situation, and there is a growing concern for the public's survival (Lima et al., 2020). A crisis of this magnitude is unprecedented, and healthcare workers active during this time are susceptible to psychological problems. In light of this circumstance, all medical staff's mental health should be a priority public health concern. 

The knowledge of the mental health consequences acquired from the history of past global outbreaks tells of the need for early assessment of medical staff's mental health and psychological strategies to manage any problem that might arise (Xiang et al., 2020). At this present time, very few studies have appraised the mental health of healthcare workers active during the current COVID-19 outbreak, but this study discusses the few research work that has made investigations into the topic. This work also provides several psychological strategies to assist healthcare workers…

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…between men and women: 10 [3.4%] vs. 56 [5.8%]; p = .001; a comparison of the statistics of severe insomnia occurrence among frontline workers vs. second-line workers: 9 [1.7%] vs. 3 [0.4%]; p < .001; statistics of the appearance of severe distress among workers in Wuhan vs. workers in Hubei outside Wuhan, and among workers outside Hubei: 96 [12.6%] versus. 19 [7.2%] among those in Hubei outside Wuhan, as well as 17 [7.2%] among those outside Hubei; p <.001).

Zhang & Ma, (2020)

China

To provide an assessment of the consequences on mental health and the quality of life brought about by the onset of the COVID-19 outbreak among local Chinese residents of Liaoning Province, mainland China, 18 years and over. 

Cross-sectional

There were 263 participants in the study (106 male and 157 female) with the participants' range of age between 18 and 30 years. All the participants in the study are Chinese.

Very little stress was identified in the population, with no significant statistical difference between genders [p=0.173]. The average intrusive score registered in men was higher than that registered in women (13.0 vs. 12.3) [P=0.027].

74.5% of the participants reported no significant increase in home life stress. The emotional responses of the participants on the pandemic registered during the study are a feeling of horror [p=0.002], a feeling of apprehension [p=0.001], and a feeling of helplessness [P=0.049].

Li et al. (2020)

China

To assess the outcome of the COVID-19 pandemic on the populace's mental health, assist the government by introducing ideas of actionable policies, and help clinical social workers (social workers, psychiatrists, and psychologists) provide medical aid to affected populations.

Cross-sectional

17,865 active Weibo users were ranging from 9 to 40.1 years old. The study analyzed the participants' Weibo posts using the approach of (OER) based on several machine-learning predictive models.

The study identified an increase in negative emotions among the participants, emotions such as anxiety (p<0.000), depression (p<0.000), and indignation (p<0.000); and sensitivity to social risks were also recorded to have increased, while positive emotions among the participants such as Oxford happiness) Life satisfaction was registered as reduced (p<0.0002) due to the COVID-19 pandemic.

Wang et al. (2020)

China

This is a study on the mental welfare of China's population to identify symptoms of mental disorders such as anxiety, depression, and stress during the immediate period following the COVID-19 outbreak. 

Cross-sectional

1210 participants from 194 cities in China. 67.3% of the participants were women with an age range between 21.4 to 30.8 years of age.

Minimal psychological impact was identified in 296 (24.5%) of the study sample (score<23); 263 participants (21.7%) reported mild psychological impact (scores 24-32); and 651 participants (53.8%) reported moderate or severe psychological impact (score>33).

Mild depression symptoms were identified in 167 participants (13.8%) (score: 10–12); 148 participants (12.2%) suffer from mild depression (score: 13-20); and 52 participants (4.3%) were considered to suffer from severe or extremely severe depression (score: 21-42).

The investigation on anxiety levels revealed that 91 participants (7.5%) report mild levels of anxiety (score: 7-9); 247 participants (20.4%) suffer from moderate anxiety (score: 10-14); and…