Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence
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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.
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SciScore for 10.1101/2020.07.23.20160879: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis In lieu of a formal assessment, we only included studies that reported findings for a sample size of greater than 80, which allows enough power to detect a medium effect size with an alpha of 0.05 (18, 19). Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data Sources and Searches: The search strategy for this pre-registered rapid review involved searching Medline, PsychInfo, Web of Science, and the first 10 pages of Google Scholar, as well as hand searching references. Medlinesuggested: (MEDLINE, RRID:SCR_002185)Google Scholarsuggested: …SciScore for 10.1101/2020.07.23.20160879: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis In lieu of a formal assessment, we only included studies that reported findings for a sample size of greater than 80, which allows enough power to detect a medium effect size with an alpha of 0.05 (18, 19). Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Data Sources and Searches: The search strategy for this pre-registered rapid review involved searching Medline, PsychInfo, Web of Science, and the first 10 pages of Google Scholar, as well as hand searching references. Medlinesuggested: (MEDLINE, RRID:SCR_002185)Google Scholarsuggested: (Google Scholar, RRID:SCR_008878)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations and strengths: There are several limitations of this rapid systematic review. Conducting the review during the ongoing outbreak of COVID-19 imposed time constraints. This meant that a formal quality appraisal was not conducted, though only studies with analytic samples over 80 were included as a proxy measure of quality control. Most study samples were quite large, increasing confidence in the generalisability of the findings. Also, we only included published peer-reviewed literature and did not search more thoroughly through grey literature or online pre-print repositories. In terms of the evidence base, the majority of the studies were cross-sectional, providing only a snapshot of the factors associated with HCW’s psychological distress. This limits conclusions about the direction of causality between the factors and distress, especially for those that are modifiable. Only three studies examined the potential long-term effects of the risk and resilience factors on HCW’s mental health by using follow-up and time-lagged designs (14, 21, 51), providing some support for the assumed effect of the factors on distress. More research is needed to track the associations of risk/resilience factors over time with distress and the extent to which certain factors are linked to sustained or transient distress. Although a number of studies investigated fixed factors and infection-related factors, there were relatively fewer studies that examined how modifiable factors were lin...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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