OBJECTIVE: To examine the psychological effects on clinicians of working to manage novel viral outbreaks, and successful measures to manage stress and psychological distress. DESIGN: Rapid review and meta-analysis. DATA SOURCES: Cochrane Central Register of Controlled Trials, PubMed/Medline, PsycInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to late March 2020. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Any study that described the psychological reactions of healthcare staff working with patients in an outbreak of any emerging virus in any clinical setting, irrespective of any comparison with other clinicians or the general population. RESULTS: 59 papers met the inclusion criteria: 37 were of severe acute respiratory syndrome (SARS), eight of coronavirus disease 2019 (covid-19), seven of Middle East respiratory syndrome (MERS), three each of Ebola virus disease and influenza A virus subtype H1N1, and one of influenza A virus subtype H7N9. Of the 38 studies that compared psychological outcomes of healthcare workers in direct contact with affected patients, 25 contained data that could be combined in a pairwise meta-analysis comparing healthcare workers at high and low risk of exposure. Compared with lower risk controls, staff in contact with affected patients had greater levels of both acute or post-traumatic stress (odds ratio 1.71, 95% confidence interval 1.28 to 2.29) and psychological distress (1.74, 1.50 to 2.03), with similar results for continuous outcomes. These findings were the same as in the other studies not included in the meta-analysis. Risk factors for psychological distress included being younger, being more junior, being the parents of dependent children, or having an infected family member. Longer quarantine, lack of practical support, and stigma also contributed. Clear communication, access to adequate personal protection, adequate rest, and both practical and psychological support were associated with reduced morbidity. CONCLUSIONS: Effective interventions are available to help mitigate the psychological distress experienced by staff caring for patients in an emerging disease outbreak. These interventions were similar despite the wide range of settings and types of outbreaks covered in this review, and thus could be applicable to the current covid-19 outbreak.

https://www.bmj.com/content/bmj/369/bmj.m1642.full.pdf

Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis.

Prevalence of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis.

Background

The COVID-19 pandemic has created an unprecedented global crisis necessitating drastic changes to living conditions, social life, personal freedom and economic activity. No study has yet examined the presence of psychiatric symptoms in the UK population in similar conditions.

Aims

We investigated the prevalence of COVID-19 related anxiety, generalised anxiety, depression and trauma symptoms in a representative sample of the UK population during an early phase of the pandemic, and estimated associations with variables likely to influence these symptoms.

Method

Between March 23rd and March 28th 2020, a quota sample of 2025 UK adults 18 years and older, stratified by age, sex and household income, was recruited by online survey company Qualtrics. Participants completed measures of depression (PHQ9), generalised anxiety (GAD7), and trauma symptoms relating to the pandemic (ITQ). Bivariate and multivariate associations were calculated for age, gender, rural vs urban environment, presence of children in the household, income, loss of income, pre-existing health conditions in self and someone close, infection in self and someone close, and perceived risk of infection over the next month.

Results

Higher levels of anxiety, depression and trauma symptoms were reported compared to previous population studies, but not dramatically so. Meeting the criteria for either anxiety or depression, and trauma symptoms was predicted by young age, presence of children in the home, and high estimates of personal risk. Anxiety and depression symptoms were also predicted by low income, loss of income, and pre-existing health conditions in self and other. Specific anxiety about COVID-19 was greater in older participants.

Conclusions

The UK population, especially older citizens, were largely resilient in the early stages of the pandemic. However, several specific COVID-related variables are associated with psychological distress: particularly having children at home, loss of income because of the pandemic, as well as having a pre-existing health condition, exposure to the virus and high estimates of personal risk. Further similar surveys, particularly of those with children at home, are required as the pandemic progresses.

/pdf/anxiety-depression-traumatic-stress-and-covid-19-related-35yoqfgo3w.pdf

Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic

We aim to provide quantitative evidence on the psychological impact of epidemic/pandemic outbreaks (i.e., SARS, MERS, COVID-19, ebola, and influenza A) on healthcare workers (HCWs). Forty-four studies are included in this review. Between 11 and 73.4% of HCWs, mainly including physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms lasting after 1–3 years in 10–40%. Depressive symptoms are reported in 27.5–50.7%, insomnia symptoms in 34–36.1%, and severe anxiety symptoms in 45%. General psychiatric symptoms during outbreaks have a range comprised between 17.3 and 75.3%; high levels of stress related to working are reported in 18.1 to 80.1%. Several individual and work-related features can be considered risk or protective factors, such as personality characteristics, the level of exposure to affected patients, and organizational support. Empirical evidence underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs’ mental health. Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services.

/pdf/the-psychological-impact-of-epidemic-and-pandemic-outbreaks-3jcd0kp9du.pdf

The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence.

Objective:To conduct a systematic literature review to identify social and occupational factors affecting the psychological wellbeing of healthcare workers involved in the severe acute respiratory syndrome (SARS) crisis.Methods:Four literature databases were searched and data extracted from relevant

/pdf/a-systematic-thematic-review-of-social-and-occupational-4h3w16c6kb.pdf

A Systematic, Thematic Review of Social and Occupational Factors Associated With Psychological Outcomes in Healthcare Employees During an Infectious Disease Outbreak.

Aims: In order for hospitals to work efficiently in a pandemic, it is important to know how a pandemic affects the hospital staff. The aim of the present study was to investigate the psychological impact of the pandemic (H1N1) 2009 on hospital workers and how it was affected by the characteristics of the hospital, gender, age, job and work environment.



Methods:  In late June 2009, soon after the pandemic had ended in Kobe city, Japan, a questionnaire was distributed consisting of questions on sociodemographic characteristics, 19 stress-related questions and the Impact of Event Scale (IES) to all 3635 employees at three core general hospitals in Kobe. Exploratory factor analysis was applied to the 19 stress-related questions, and this produced four factors for evaluation (anxiety about infection, exhaustion, workload, and feeling of being protected). Multiple regression models were used to evaluate the association of personal characteristics with each score of the four factors and the IES.



Results:  Valid answers were received from 1625 employees. Workers at a hospital with intense liaison psychiatric services felt less psychological impact. Workers at a hospital that provided staff with information about the pandemic less frequently, felt unprotected. Workers in work environments that had a high risk of infection felt more anxious and more exhausted. The total IES score was higher in workers in high-risk work environments.



Conclusions:  It is important for hospitals to protect hospital workers during a pandemic and to rapidly share information about the pandemic. Liaison psychiatric services can help to reduce the impact of the pandemic on hospital workers.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1440-1819.2012.02336.x

Keiko Miyake

Papers

Psychological impact of the pandemic (H1N1) 2009 on general hospital workers in Kobe.