Abstract
BackgroundMass outbreaks such as pandemics are associated with mental health problems requiring effective psychological interventions. Although several forms of psychological interventions may be advocated or used, some may lack strong evidence of efficacy and some may not have been evaluated in mass infectious disease outbreaks. This paper reports a systematic review of published studies (PROSPERO CRD:42020182094. Registered: 24.04.2020) examining the types and effectiveness of psychological support interventions for the general population and healthcare workers exposed to mass infectious disease outbreaks.MethodsA systematic review was conducted. Randomised Controlled Trials (RCT) were identified through searches of electronic databases: Medline (Ovid), Embase (Ovid), PsycINFO (EBSCO) and the Cochrane Library Database from inception to 06.05.2021 using an agreed search strategy. Studies were included if they assessed the effectiveness of interventions providing psychological support to the general population and / or healthcare workers exposed to mass infectious disease outbreaks. Studies were excluded if they focused on man-made or natural disasters or if they included armed forces, police, fire-fighters or coastguards.ResultsTwenty-two RCTs were included after screening. Various psychological interventions have been used: therapist-guided therapy (n = 1); online counselling (n = 1); ‘Emotional Freedom Techniques’ (n = 1); mobile phone apps (n = 2); brief crisis intervention (n = 1); psychological-behavioural intervention (n = 1); Cognitive Behavioural Therapy (n = 3); progressive muscle relaxation (n = 2); emotional-based directed drawing (n = 1); psycho-educational debriefing (n = 1); guided imagery (n = 1); Eye Movement Desensitization and Reprocessing (EMDR) (n = 1); expressive writing (n = 2); tailored intervention for patients with a chronic medical conditions (n = 1); community health workers (n = 1); self-guided psychological intervention (n = 1), and a digital behaviour change intervention (n = 1). Meta-analyses showed that psychological interventions had a statistically significant benefit in managing depression (Standardised Mean Difference [SMD]: -0.40; 95% Confidence Interval [CI]: − 0.76 to − 0.03), and anxiety (SMD: -0.72; 95% CI: − 1.03 to − 0.40). The effect on stress was equivocal (SMD: 0.16; 95% CI: − 0.19 to 0.51). The heterogeneity of studies, studies’ high risk of bias, and the lack of available evidence means uncertainty remains.ConclusionsFurther RCTs and intervention studies involving representative study populations are needed to inform the development of targeted and tailored psychological interventions for those exposed to mass infectious disease outbreaks.
Highlights
Mass outbreaks such as pandemics are associated with mental health problems requiring effective psychological interventions
Further Randomised Controlled Trials (RCT) and intervention studies involving representative study populations are needed to inform the development of targeted and tailored psychological interventions for those exposed to mass infectious disease outbreaks
Several forms of psychological interventions [19] may be advocated or used, some are recognised as being harmful, others lack strong evidence of efficacy and some have not been evaluated in mass infectious disease outbreaks [16, 19,20,21,22]. Specific population groups such as children and young people, ethnic minorities, and people on low incomes, may be more vulnerable to mental health problems associated with mass infectious disease outbreaks and require targeted interventions [23,24,25,26,27,28]. Such uncertainties call for the development and implementation of effective targeted interventions for all those exposed to mass infectious disease outbreaks [11, 16, 26]
Summary
Mass outbreaks such as pandemics are associated with mental health problems requiring effective psychological interventions. Registered: 24.04.2020) examining the types and effectiveness of psychological support interventions for the general population and healthcare workers exposed to mass infectious disease outbreaks. It is evident that the effects of the COVID-19 pandemic are pervasive affecting the mental health of many of those exposed [6, 7], including healthcare workers [8,9,10,11]. Reducing the mental health impact of those exposed to such mass infectious disease outbreaks is fundamental to the continued provision of health and social care [2, 5]. The planning and delivery of such psychological support may differ within and between countries [16,17,18]
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