Impact of Viral Epidemic Outbreaks on Mental Health of Healthcare Workers: A Rapid Systematic Review and Meta-Analysis

Background: We aimed to examine the impact of providing healthcare during or after health emergencies caused by viral epidemic outbreaks on healthcare workers´(HCWs) mental health, and to assess the available evidence base regarding interventions to reduce such impact. Methods: In this systematic rapid review and meta-analysis we searched MEDLINE, Embase, and PsycINFO between inception and 23 March 2020 for observational and experimental studies examining the impact on mental health of epidemic outbreaks on HCWs. We assessed risk of bias for each individual study and used GRADE to ascertain the certainty of the evidence. We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems. Results: We identified 61 studies. The pooled prevalence was higher for anxiety (45%, 95% CI 21 to 69%), followed by depression (38%, 95% CI 15 to 60%), acute stress disorder (31%, 95% CI 0 to 82%), burnout (29%, 95% CI 25 to 32%), and post-traumatic stress disorder (19%, 95% CI 11 to 26%). Based on 37 studies, we identified sociodemographic, social, and occupational factors associated with the likelihood of developing those problems. Five studies reported interventions for frontline HCW. Two educational interventions increased confidence in support and training, pandemic self-efficacy, and interpersonal problems solving (very low certainty). One multifaceted intervention improved anxiety, depression, and sleep quality (very low certainty). Two additional interventions (multifaceted and psychotherapy) did not assess their impact. Interpretation: The prevalence of mental health problems was high both during and after the outbreaks. In light of the limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified in this study represent important targets for future interventions. Funding: No specific funding for this study. IRC is a recipient of a Miguel Servet Fellowship (project number CP17/00017) funded by the Spanish Government. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.