Impacts of the COVID-19 pandemic on the mental health of frontline hospital-based nurses: rapid review and meta-analysis

Abstract

The COVID-19 pandemic focused the world’s attention on the gross relative health risks, inequities and injustices experienced by first responders, of whom front-line, hospital-based nurses may be the most vulnerable. A series of research syntheses prior to the pandemic estimated that such front-line nurses were at approximately two-fold greater risk of experiencing mental health challenges such as increased symptoms (and diagnoses) of anxiety, depression and PTSD than were nursing administrators or otherwise similar, people in the general population. Aiming to clarify how the pandemic impacted such mental health risks, we conducted a rapid review and meta-analysis of observational studies from the worldwide published and gray research literature. Twelve longitudinal studies that covered the pandemic’s pre-vaccination phase were included. The overall pooled increased relative risk of mental health challenges among frontline, hospital-based nurses from pre-pandemic to the pre-vaccination phase of the COVID-19 pandemic was 2.62 (95% CI 2.10, 3.27). But sensitivity and moderator analyses accounting for research design limitations better estimated two-fold increased risks (relative risks ranged from 1.69 to 2.00). Already at elevated risk of experiencing symptoms of anxiety, depression and PTSD and so, such increased symptoms and diagnoses among front-line, hospital-based nurses probably doubled during the early, pre-vaccination phase of the pandemic, perhaps quadrupling among women. Implications for nursing practice, health care policy, future pandemic preparedness as well as future research are discussed.