Abstract

Objective: Health-care workers (HCW) are at risk for psychological distress during an infectious disease outbreak, such as the coronavirus pandemic, due to the demands of dealing with a public health emergency. This rapid systematic review examined the factors associated with psychological distress among HCW during an outbreak.Method: We systematically reviewed literature on the factors associated with psychological distress (demographic characteristics, occupational, social, psychological, and infection-related factors) in HCW during an outbreak (COVID-19, SARS, MERS, H1N1, H7N9, and Ebola). Four electronic databases were searched (2000 to 15 November 2020) for relevant peer-reviewed research according to a pre-registered protocol. A narrative synthesis was conducted to identify fixed, modifiable, and infection-related factors linked to distress and psychiatric morbidity.Results: From the 4,621 records identified, 138 with data from 143,246 HCW in 139 studies were included. All but two studies were cross-sectional. The majority of the studies were conducted during COVID-19 (k = 107, N = 34,334) and SARS (k = 21, N = 18,096). Consistent evidence indicated that being female, a nurse, experiencing stigma, maladaptive coping, having contact or risk of contact with infected patients, and experiencing quarantine, were risk factors for psychological distress among HCW. Personal and organizational social support, perceiving control, positive work attitudes, sufficient information about the outbreak and proper protection, training, and resources, were associated with less psychological distress.Conclusions: This review highlights the key factors to the identify HCW who are most at risk for psychological distress during an outbreak and modifying factors to reduce distress and improve resilience. Recommendations are that HCW at risk for increased distress receive early interventions and ongoing monitoring because there is evidence that HCW distress can persist for up to 3 years after an outbreak. Further research needs to track the associations of risk and resilience factors with distress over time and the extent to which certain factors are inter-related and contribute to sustained or transient distress.

Highlights

  • Several outbreaks of viral diseases have posed significant public health threats since 2000

  • The studies included health-care workers (HCW) working across 34 countries during COVID-19 (k = 107, N = 120,711), Syndrome-related coronavirus (SARS) (k = 21, N = 18,096), Middle East Respiratory Syndrome-related coronavirus (MERS) (k = 7, N = 1,567), H1N1 (k = 2, N = 2,094), Ebola (k = 1, N = 143), and H7N9 (k = 1, N = 102), outbreaks

  • Other reviews have documented the extent of distress experienced by HCW during an outbreak (2), the current Review highlights the profiles of HCW most at risk for psychological distress and psychiatric morbidity during an outbreak

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Summary

Introduction

Several outbreaks of viral diseases have posed significant public health threats since 2000. These include SARS, H1N1, H7N9, MERS, EBOLA, and more recently, COVID-19 (see Supplementary Table 1). Such outbreaks place a serious strain on the health-care systems that try to contain and manage them, including health-care workers (HCW) who are at increased risk for nosocomial infections (1). Psychological distress refers to a state of emotional suffering, resulting from being exposed to a stressful event that poses a threat to one’s physical or mental health (3). Psychological distress is often viewed as a transient state that negatively impacts day-to-day and social functioning, it can persist and have longer-term negative effects on mental health (4)

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