Page 11 - GHES-2-4

Global Health Economics and
Sustainability
COVID-19 and the burden on healthcare workers

Table 1. Systematic search strategy used for the narrative Records identified through Additional records identified
review database searching through other sources
(n = 53)
(n = 5)
SEARCH STRATEGY Identification
“impact” OR “psychological impact”
Records after duplicates removed
AND (n = 50)
“COVID-19” OR “coronavirus” OR “2019-ncov” or “sars-cov-2” or “cov-19”
AND Screening Records screened
“Emergency department” OR “emergency room” OR “accident and (n = 50)
emergency” OR “accident & emergency” OR “a&e” OR “a & e”
AND Records excluded
“staff” OR “healthcare workers” OR “nurses” OR “medical workers” (n = 30)
OR “medical practitioners” OR “medical workforce” OR “healthcare Eligibility & Inclusion
professionals” Studies included for full-text review
and qualitative synthesis
2.5. Screening procedure (n = 20)
Figure 1. Search strategy flow diagram
A three-step screening process of the title, abstract, and
full-text review was undertaken by the author. First, titles publications reported the psychological impact on patients
and abstracts were screened for relevance. Second, full texts rather than frontline HCWs, implications of COVID-19 on
were obtained for all potentially relevant publications and patient care, or infection rates in frontline HCWs without
reviewed. Finally, all relevant publications were selected assessing the psychological impact.
for inclusion in the review. This process is documented as
a Preferred Reporting Items for Systematic Reviews and 3.1. Mental health impacts of COVID-19 reported in
Meta-Analyses flowchart in Figure 1. frontline HCWs
COVID-19 posed a huge threat to public health and placed
2.6. Data extraction
frontline HCWs at significant risk of psychological distress,
The included studies were charted into a customized data with the literature highlighting a large proportion suffering
extraction form to extract all relevant data from each one. ill effects from mental disorders. Up to 70% of frontline
Data extraction was performed by the author, extracting HCWs have reported symptoms of anxiety, depression,
the following data: PTSD, sleep disturbances, cognitive decline, or burnout
• First author (Gupta & Sahoo, 2020; Que et al., 2020). Similar impacts
• Year of publication have been noted in the case of other psychological distress
• Year of data collection events, highlighted in those caring for Novichok-poisoned
• Study design patients just before the pandemic, with high rates of stress
• Country of data collection in managers and those directly involved in the affected
• Study population and size patients’ care (Jenkins et al., 2023).
• Cohort occupation
• Outcome measures used (e.g., questionnaires and 3.1.1. Depression
online surveys) Studies undertaken during the COVID-19 pandemic have
• Rates of psychological, physical, and emotional found a high prevalence of depressive symptoms in frontline
symptoms in frontline HCWs. HCWs. Depression was reported in 44% of 1,103 frontline
nurses (An, 2020), with 35% reporting moderate or severe
3. Results symptoms. Furthermore, a study of 4,679 frontline HCWs
A total of 58 publications were collected. Following the across 348 Chinese hospitals highlighted a 35% prevalence
removal of duplicates, 50 publications underwent an of depressive symptoms (Presti et al., 2020). Another study
abstract review, and 20 publications were deemed relevant reported symptoms in 44% of frontline HCWs, including
for inclusion in the review, as outlined in Figure 1. All physicians, medical residents, nurses, technicians, and
included publications were prospective questionnaires, public health professionals (Que et al., 2020). In addition,
cross-sectional surveys, or observational studies in nature 37% of frontline HCWs in quarantine or who worked
and completed worldwide (in China, Singapore, India, directly with COVID-19 patients reported suffering from
Italy, the US, Australia, Taiwan, and the UK). The excluded depressive symptoms (Grover et al., 2020). Finally, some

Volume 2 Issue 4 (2024) 3 https://doi.org/10.36922/ghes.2530