Few, if any, lives have been left unaffected by the COVID-19 pandemic. For some groups of people — among them healthcare workers, children and adolescents, and individuals with other medical conditions — the impact is especially profound.
A new systematic review from researchers at the University of York’s Centre for Reviews and Dissemination and the Mental Health Foundation, both in the United Kingdom, seeks to capture the pandemic’s mental health toll.
“[L]earning from the early months of the COVID-19 pandemic can help us prepare for the future, including for future pandemics,” write the authors.
The review reports high levels of anxiety, depression, post-traumatic stress disorder (PTSD), and burn-out among the pandemic’s frontline healthcare workers and staff.
The researchers also found high levels of mental health issues among children, adolescents, and people dealing with health conditions in addition to COVID-19.
According to lead author Dr. Noortje Uphoff, “This review indicates which types of support should be explored to protect the mental health of healthcare workers and other vulnerable groups during this pandemic and any future coronavirus outbreaks.”
The study appears in
The present review synthesizes 25 other reviews that were themselves analyses of primary research performed during the early months of the COVID-19 pandemic. A panel of six U.K. healthcare experts also shared their experiences with the researchers.
Dr. Jo Billings of University College London, U.K., who was not involved in the research, explained to Medical News Today the value of this review.
“By synthesizing findings from across a range of reviews, this study shows that a serious and detrimental impact on mental health is being replicated consistently across numerous studies. This gives us confidence in saying that this negative impact is very real and enduring,” she told us.
Most of the reviews under analysis — 19 of them — were focused on healthcare workers. Additionally, researchers considered children and adolescents in five studies, COVID-19 patients with preexisting conditions in two studies, and homeless individuals in one study.
Dr. Billings pointed out, “the review identified only a small number of other reviews [that] had considered these populations, highlighting that these vulnerable groups warrant more consideration and research.”
The systematic review explored the experiences of people from many countries. Scientists included China in all the reviews under study. Two of the reviews were concerned strictly with that country.
Twelve of the reviews under study considered the mental health effects of COVID-19 alone. Another 12 investigated a mix of conditions, including COVID-19, SARS, MERS, Ebola, influenza A/H1N1 (swine flu), or influenza A/H7N9, known as “avian influenza” or “bird flu.” A final review was concerned only with SARS.
“Healthcare workers,” notes Dr. Uphoff, “may already have a higher risk of adverse mental health outcomes due to the stressful nature of their work. However, there were some indications that mental health may be further affected as a result of working on the frontline during an infectious disease outbreak.”
For example, a year after the SARS outbreak, healthcare workers were six times more likely than others to be experiencing mental health issues. Two years after the crisis, 30% of those most closely exposed to SARS patients still reported significant emotional exhaustion.
Quarantines were also linked to increased alcohol consumption, acute stress disorder, and PTSD, while insomnia was more common in healthcare workers than in the general population.
Dr. Billings noted that it is hard to keep track of frontline workers’ mental state during a crisis in a way that is “not invasive or overly burdensome.”
She was also concerned about workers’ willingness to speak up, saying: “Stigma about mental ill health is still pervasive in healthcare settings. We need to create a culture in which healthcare workers can openly talk about their own mental health difficulties without this being detrimental to their career.”
The researchers found that quarantine and worry about the pandemic had links to a higher risk of “acute stress disorder, adjustment disorder, symptoms of grief, and PTSD” in children and adolescents.
There was a broad range of estimates for the percentage of children and adolescents experiencing anxiety, from 19% to 37%, while 35–44% had depression symptoms. Six percent of young people reported symptoms of PTSD, 40% symptoms of psychological distress, and 17% acute stress disorder.
The authors write that “[c]hildren and adolescents may be at increased risk of experiencing adverse mental health outcomes when experiencing stigma, social change, such as school closures, and changes in household interactions.”
College students reported symptoms of anxiety, depression, substance abuse, eating disorders, and sleeping disorders.
Researchers also surveyed children with cystic fibrosis in a study, reporting lower levels of anxiety about the pandemic than other children experienced. In contrast, their parents reported greater levels of anxiety.
Estimates for the prevalence of anxiety among COVID-19 patients with preexisting physical health conditions ranged from 40% to 82%. For depression, it was 50%. There were also indications that existing mental health issues may have worsened.
The researchers convened a panel of six hospital or community U.K. healthcare workers for a 2-hour review of the systematic review’s findings and a discussion.
The panel emphasized to the researchers the importance of support from coworkers and clear communication in the workplace. Where this was not in place, for example, for healthcare workers working from home, this was reported to be a source of stress.
Dr. Uphoff told MNT that one of the more surprising and positive findings of their analysis was the prevalence of helpful workplace support. But the areas where healthcare professionals could make improvements were also clear.
“What came back in review after review,” said Dr. Uphoff, “were the things we all hope to find in a workplace: clear communication and guidance from managers, a balanced workload, access to mental health support, and the availability of training and education.”
“We have identified types of mental health support, which could protect the mental health of healthcare workers in a pandemic,” said Dr. Uphoff. “Although research is needed on their effectiveness, we hope governments and organizations will consider implementing some of these measures.”
Dr. Uphoff also described further research that could be helpful.
“The nature of systematic reviews is that they are always running slightly behind — we found mostly evidence from hospital workers in China,” she notes.
“I would like to conduct another systematic review of mental health during the COVID-19 pandemic with the evidence we have available now, focusing on other groups who may be more vulnerable in terms of their mental health. This includes children and [older adults], key workers outside the hospital, [historically marginalized groups], and people with physical health conditions.”