COVID-19 Pandemic and Healthcare Workers' Mental Health

Introduction

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

From the history of previous viral outbreaks, it is apparent that both frontline and non-frontline healthcare workers face a higher risk of infection and other adverse physical health outcomes (Muller et al., 2020). During and in the years following an epidemic, the occupational activities of healthcare workers put them at risk of developing mental health problems with symptoms such as post-traumatic stress, depression, burnout, and anxiety. Moreover, during 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 observed in the general public at the present time are attributed to the distressing nature of the widespread COVID-19 pandemic. These symptoms are even more pronounced in healthcare workers who are directly treating patients infected with the disease (Thapa et al., 2020). Various research efforts have sought to appraise healthcare workers' mental distress during pandemic events and to introduce measures that can relieve this mental stress.

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

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

Literature Review

Every major epidemic outbreak greatly increases the demand for healthcare workers. Moreover, the scenarios of these outbreaks are usually similar for healthcare workers: a constant rise in the number of infected individuals, a rise in the number of deaths, a lack of medicine or vaccine to combat the disease, extensive media coverage of the outbreak, an overwhelming workload, a shortage of adequate personal protective equipment, and feelings of inadequate support. All of these factors 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 while being exposed to a high risk of contracting the disease when treating patients. Moreover, healthcare workers are susceptible to the same concerns as the general public, including anxiety triggered by exposure to misinformation 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 examining how these infections occurred indicate that healthcare workers became infected through 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 psychological illness as well as 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 suffered high levels of emotional distress (Lee et al., 2018). A study conducted on 1,257 healthcare workers treating SARS-infected patients revealed somatic and cognitive symptoms of anxiety in a significant number of participants. These symptoms are attributed to the rapid proliferation of the infection in the initial phase of the epidemic, feelings of uncertainty, the constant threat to life, and a sense of vulnerability brought on by the event (Chong et al., 2004). A follow-up study conducted after the outbreak revealed symptoms such as depression, anxiety, burnout, traumatic stress, and avoidance.

The consequences of poor mental health caused by the current outbreak are more worrying, given that the number of individuals infected and killed by SARS-CoV-2 is several times greater than that of SARS. The disastrous impact of SARS-CoV-2 has been so severe that the outbreak has been referenced by some as a world-ending event. Hospitals have been ill-equipped to manage the situation, and there is a growing concern for public survival (Lima et al., 2020). A crisis of this magnitude is unprecedented, and healthcare workers active during this time are especially susceptible to psychological problems. In light of this circumstance, the mental health of all medical staff should be a priority public health concern.

The knowledge of mental health consequences acquired from past global outbreaks underscores the need for early assessment of medical staff's mental health and the development of psychological strategies to manage any problems that may arise (Xiang et al., 2020). At the time of this review, very few studies had appraised the mental health of healthcare workers active during the current COVID-19 outbreak. This paper discusses the available research investigating the topic and provides several psychological strategies to assist healthcare workers during this period.

Methodology and Search Strategy

The systematic review method is employed for conducting this study, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

The search for scientific literature used in this review began in January 2020 and concluded in October 2020. The search was conducted across three databases: PubMed (Medline), Lilacs, and the Virtual Health Library (BVS). The keywords used for the search included:

"mental health" AND "healthcare" AND ("workers" OR "givers" OR "providers" OR "professionals") AND "COVID-19"; and "mental health" AND ("doctors" OR "nurses") AND "COVID-19."

The literature used in this study was selected by two reviewers using the following inclusion criteria: (1) written in English; (2) dated from January to October 2020; (3) involving studies on COVID-19/coronavirus; (4) addressing mental health; and (5) conducted in human studies. The literature was further reviewed by two independent researchers who, by consensus, eliminated articles that did not meet the inclusion criteria. From articles considered eligible, the data extracted included each study's methodology and its main results.

Initial publications considered for use in this review were selected by a single reviewer through examination of titles and abstracts. Two reviewers then independently examined each full-text study using identical selection criteria to eliminate studies that did not meet the inclusion criteria. A final examination was performed by a third reviewer on studies that required further consideration.

Conclusion

This study assessed the impact of the current COVID-19 pandemic on the mental health of healthcare workers. Healthcare workers active in various fields and positions reported different forms of mental health problems — including anxiety, depression, insomnia, and high levels of stress — during the COVID-19 pandemic. While the causative factors for mental health concerns among healthcare workers are not universal, the leading contributors to poor mental health among frontline healthcare workers include inadequate rest, intense pressure due to the nature of their work, and a lack of personal protective equipment.

The review's findings indicate that exposure to COVID-19 increased the incidence rate of symptoms of mental conditions such as anxiety and depression. Lifestyle strategies supported by psychological care can be fundamental in improving the mental health outcomes caused by the COVID-19 pandemic, and investment in such strategies should be considered a public health priority.

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