Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review

Ignacio Ricci Cabello; Jose F Meneses Echavez; Maria Jesus Serrano-Ripoll; David Fraile-Navarro; Maria Antonia Fiol de Roque; Guadalupe Pastor Moreno; Adoracion Castro; Isabel Ruiz Perez; Rocio Zamanillo Campos; Daniela Goncalves-Bradley

Infectious disease outbreaks are relatively common, 1 often prompting an international response involving thousands of healthcare workers (HCWs). 2 Providing frontline healthcare during infectious outbreaks increases the risk of HCWs developing mental health problems, both short and long-term. 3 It has been suggested that specific occupational factors are associated with psychological outcomes of HCWs during an infectious disease outbreak. 2 Working in a high-risk environment, adhering to quarantine, job-related stress, and belonging to a specific cadre were all considered to aggravate psychological outcomes. Perceived safety, namely through access to protective equipment, and specialised training, mitigated those outcomes. 2 During December 2019 a new infectious disease outbreak was reported in Wuhan, Hubei province, China, 4 which was named COVID-19. 5 The World Health Organization (WHO) declared COVID-19 a pandemic by March 11th 2020, and by 30 March 2020 it had spread to most countries and territories, with more than 693,000 known cases and a death toll of over 33,000 people. 6 Early anecdotal evidence from Wuhan showed how this unprecedented situation impacted the mental health of frontline HCWs, who reported mental problems such as anxiety, depressive symptoms, anger, and fear. 7 These problems cannot only have a long-lasting effect on the mental health of HCWs, 3 but also hinder the urgent response to COVID-19, by jeopardising attention and decision-making. 7 Tackling the mental health of HCWs during this pandemic is essential, and will strengthen healthcare systems' capacity. 8 Previous systematic reviews have explored social and occupational factors associated with psychological outcomes in HCW during an infectious disease outbreak, 2 and their perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases. 9 However, to date, the impact of viral disease outbreaks on specific mental health problems and the effectiveness of interventions to ameliorate such impact have not been systematically reported.