AccScience Publishing / GHES / Online First / DOI: 10.36922/ghes.2530
REVIEW

Preparing for disease X: A look at the psychological impact of COVID-19 on frontline healthcare workers and responses to reduce their burden

Jarryd S. Ludski1*
Show Less
1 Department of Emergency Medicine, University of Notre Dame Australia, School of Medicine Sydney, Sydney, New South Wales, Australia
Submitted: 26 December 2023 | Accepted: 20 May 2024 | Published: 26 September 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

The coronavirus 2019 (COVID-19) pandemic placed enormous strain on healthcare workers (HCWs) and systems. With over 766 million cases, a high risk of workplace-acquired infection, and a constantly evolving disease trajectory, COVID-19 placed an incredible burden on frontline HCWs. Studies on previous pandemics have highlighted the presence of significant psychological distress in HCWs; yet, mental health remained a secondary consideration in many hospitals’ pandemic responses. This review explores the psychological impact of COVID-19 on frontline HCWs during the early stages of the pandemic and describes responses implemented by health services to reduce it. In addition, it aims to provide a structure for the implementation and evaluation of future evidence-based programs that support the well-being of frontline HCWs helping to prepare for disease X. A narrative review with a systematic approach was completed using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases. Twenty publications were included in the study. Symptoms of psychological distress were reported in up to 70% of frontline HCWs, with as many as 50% suffering depression, 62% reporting anxiety, and 45% of those who required quarantine experiencing insomnia. Mindfulness training, safe rest areas, mental health practitioners, and pandemic rostering are responses that were implemented across health services during the pandemic. While the impact of COVID-19 has been enormous, its final toll remains unknown. High rates of psychological distress among frontline HCWs mean that the impact will extend far beyond the virus itself. Health services must implement evidence-based resilience strategies to ensure the safety of their frontline staff now and in the future.

Keywords
Coronavirus 2019
Frontline healthcare workers
Psychological impact
Psychological distress
Responses
Disease X
Funding
None.
Conflict of interest
The author declares that there are no competing interests.
References

An, Y., Yang, Y., Wang, A., Li, Y., Zhang, Q., Cheung, T., et al. (2020). Prevalence of depression and its impact on quality of life among frontline nurses in emergency departments during the COVID-19 outbreak. Journal of Affective Disorders, 276:312-315. https://doi.org/10.1016/j.jad.2020.06.047

 

Australasian College for Emergency Medicine. (2020). Workforce and Wellbeing. Australasian College for Emergency Medicine. Available from: https://acem.org.au/content-sources/advancing-emergency-medicine/covid-19/resources/ clinical-guidelines/workforce-wellbeing [Last accessed on 2020 Nov 01].

 

Barattucci, M., Padovan, A., Vitale, E., Rapisarda, V., Ramaci, T., & De Giorgio, A. (2019). Mindfulness-based IARA model® proves effective to reduce stress and anxiety in health care professionals. A six-month follow-up study. International Journal of Environmental Research and Public Health, 16(22):4421. https://doi.org/10.3390/ijerph16224421

 

BBC News Visual and Data Journalism Team. (2020). Covid-19 Pandemic: Tracking the Global Coronavirus Outbreak. BBC News. Available from: https://www.bbc.com/news/world- 51235105 [Last accessed on 2020 Oct 27].

 

Braganza, S., & Popham, S. (2020). Oneed Covid-19 Staff Wellness Support Plan. Australasian College of Emergency Medicine. Available from: https://acem.org.au/ getmedia/008a96f5-0a2a-4314-865b-219780e6292b/oneed_ staffwellnesssupportplan [Last accessed on 2020 Nov 01].

 

Braganza, S., Young, J., Sweeny, A., & Brazil, V. (2018) oneEd: Embedding a mindfulness-based wellness programme into an emergency department. Emergency Medicine Australasia, 30(5):678-686. https://doi.org/10.111/1742-6723.12977

 

Braithwaite, J., Herkes, J., Ludlow, K., Testa, L., & Lamprell, G. (2017). Association between organisational and workplace cultures, and patient outcomes: Systematic review. BMJ Open, 7(11):e017708. https://doi.org/10.1136/bmjopen-2017-017708

 

Chua, W.L.T., Quah, L.J.J., Shen, Y., Zakaria, N.D., Wan, P.W., Tan, K., et al. (2020). Emergency department “outbreak rostering” to meet challenges of COVID-19. Emergency Medicine Journal, 37(7):407-410. https://doi.org/10.1136/emermed-2020-209614

 

Felice, C., Di Tanna, G., Zanus, G., & Grossi, U. (2020). Impact of covid-19 outbreak on healthcare workers in Italy: Results from a national e-survey. Journal of Community Health, 45(4):675-683. https://doi.org/10.1007/s10900-020-00845-5

 

Firew, T., Sano, E., Lee, J., Flores, S., Lang, K., Salman, K., et al. (2020). Protecting the front line: A cross-sectional survey analysis of the occupational factors contributing to healthcare workers’ infection and psychological distress during the COVID-19 pandemic in the USA. BMJ Open, 10(10):e042752. https://doi.org/10.1136/bmjopen-2020-042752

 

Flett, J., Hayne, H., Riordan, B., Thompson, L., & Conner, T. (2018). Mobile mindfulness meditation: A randomised controlled trial of the effect of two popular apps on mental health. Mindfulness, 10(5):863-876. https://doi.org/10.1007/s12671-018-1050-9

 

Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenged faced by healthcare workers during covid-19 pandemic. BMJ, 368:m1211. https://doi.org/10.1136/bmj.m1211

 

Grover, S., Mehra, A., Sahoo, S., Avasthi, A., Tripathi, A., D’Souza, A., et al. (2020). State of mental health services in various training centers in India during the lockdown and COVID-19 pandemic. Indian Journal of Psychiatry, 62(4):363. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_567_20

 

Gupta, S., & Sahoo, S. (2020). Pandemic and mental health of the front-line healthcare workers: A review and implications in the Indian context amidst COVID-19. General Psychiatry, 33(5):e100284. https://doi.org/10.1136/gpsych-2020-100284

 

Horesh, D., & Brown, A. (2020). Traumatic stress in the age of covid-19: A call to close critical gaps and adapt to new realities. Psychological Trauma: Theory, Research, Practice and Policy, 12(4):331-335. https://doi.org/10.1037/tra0000592

 

Jenkins, K.S.M., Thomas, J., Duggan, M., Scott, H., & Lang, J. (2023). Looking after each other in a crisis-lessons from novichok and the parallels with covid-19. Nursing in Critical Care, 28(1):30-35. https://doi.org/10.1111/nicc.12677

 

Kunzler, A., Helmreich, I., Chmitorz, A., König, J., Binder, H., Wessa, M., et al. (2020). Psychological interventions to foster resilience in healthcare professionals. Cochrane Database of Systematic Reviews, 7:CD012527. https://doi.org/10.1002/14651858.CD012527.pub2

 

Lee, A., Wong, J., McAlonan, G., Cheung, V., Cheung, C., Sham, P., et al. (2007). Stress and psychological distress among sars survivors 1 year after the outbreak. The Canadian Journal of Psychiatry, 52(4):233-240. https://doi.org/10.1177/070674370705200405

 

Master, A., Su, X., Zhang, S., Guan, W., & Li, J. (2020). Psychological impact of COVID‐19 outbreak on frontline nurses: A cross‐sectional survey study. Journal of Clinical Nursing, 29(21-22):4217-4226.

 

Ong, J.J.Y., Bharatendu, C., Goh, Y., Tang, J.Z.Y., Sooi, K.W.X., Tan, Y.L., et al. (2020). Headaches associated with personal protective equipment - a cross‐sectional study among frontline healthcare workers during covid‐19. Headache: The Journal of Head and Face Pain, 60(5):864-877. https://doi.org/10.111/head.13811

 

Poonian, J., Walsham, N., Kilner, T., Bradbury, E., Brooks, K., & West, E. (2020). Managing healthcare worker well‐being in an Australian emergency department during the COVID ‐19 pandemic. Emergency Medicine Australasia, 32(4):700-702. https://doi.org/10.1111/1742-6723.13547

 

Presti, G., Dal Lago, B., Fattori, A., Mioli, G., Moderato, P., Sciaretta, L., et al. (2020). Mental health support to staff in a major hospital in Milan (Italy) during the COVID-19 pandemic: A framework of actions. General Psychiatry, 33(4):e100244. https://doi.org/10.1136/gpsych-2020-100244

 

Prevedini, A., Presti, G., Rabitti, E., Miselli, G., & Moderato, P. (2011). Acceptance and commitment therapy (ACT): The foundation of the therapeutic model and an overview of its contribution to the treatment of patients with chronic physical diseases. Giornale Italiano di Medicina del Lavoro ed Ergonomia, 33(1 Suppl A):A53-A63.

 

Proulx, B. (2020). Covid-19 care model: leveraging advanced practice providers. Nursing Economics, 38(3):149-151.

 

Que, J., Shi, L., Deng, J., Liu, J., Zhang, L., Wu, S., et al. (2020). Psychological impact of the COVID-19 pandemic on healthcare workers: A cross-sectional study in China. General Psychiatry, 33(3):e100259. https://doi.org/10.1136/gpsych-2020-100259

 

Roberts, T., Daniels, J., Hulme, W., Horner, D., Lyttle, M., Samuel, K., et al. (2020). COVID-19 emergency response assessment study: A prospective longitudinal survey of frontline doctors in the UK and Ireland: study protocol. BMJ Open, 10(8):e039851. https://doi.org/10.1136/bmjopen-2020-039851

 

Serrano-Ripoll, M.J., Meneses-Echavez, J.F., Ricci-Cabello, I., Fraile-Navarro, D., Fiol-deRoque, M.A., Pastor-Moreno, G., et al. (2020). Impact of viral epidemic outbreaks on mental health of healthcare workers: A rapid systematic review and meta-analysis. Journal of Affective Disorders, 277:347-357. https://doi.org/10.1016/j.jad.2020.08.034

 

Smith, C., Hancock, H., Blake-Mortimer, J., & Eckert, K. (2007). A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complementary Therapies in Medicine, 15(2):77-83. https://doi.org/10.1016/j.ctim.2006.05.001

 

Spinelli, C., Wisener, M., & Khoury, B. (2019). Mindfulness training for healthcare professionals and trainees: A meta-analysis of randomized controlled trials. Journal of Psychosomatic Research, 120:29-38. https://doi.org/10.1016/j.jpsychores.2019.03.003

 

Vadi, S., Shah, S., Bajpe, S., George, N., Santhosh, A., Sanwalka, N., et al. (2022). Mental health indices of intensive care unit and emergency room frontliners during the severe acute respiratory syndrome coronavirus 2 pandemic in India. Indian Journal of Critical Care Medicine, 26(1):100-107. https://doi.org/10.5005/jp-journals-10071-24081

 

World Health Organisation. (2020). Keep Health Workers Safe to Keep Patients Safe: WHO. Available from: https://www. who.int/news/item/17-09-2020-keep-health-workers-safe-to-keep-patients-safe-who [Last accessed on 2023 May 18].

 

World Health Organisation. (2020). WHO Emergencies Coronavirus Emergency Committee Second Meeting. Available from: https://www.who.int/docs/default-source/ coronaviruse/transcripts/ihr-emergency-committee-for-pneumonia-due-to-the-novel-coronavirus-2019-ncov-press-briefing-transcript-30012020.pdf?sfvrsn=c9463ac12 [Last accessed on 2023 May 18].

 

World Health Organisation. (2022). WHO to Identify Pathogens that could cause Future Outbreaks and Pandemics. Available from: https://www.who.int/news/item/21-11-2022-who-to-identify-pathogens-that-could-cause-future-outbreaks-and-pandemics [Last accessed on 2023 May 18].

 

World Health Organisation. (2023). WHO Coronavirus (Covid-19) Dashboard. Available from: https://covid19. who.int [Last accessed on 2023 May 18].

 

Zhang, Y., Pi, D., Liu, J., Li, J., & Xu, F. (2022). Psychological impact of the COVID-19 epidemic among healthcare workers in paediatric intensive care units in China. PLoS One, 17(5):e0265377. https://doi.org/10.1371/journal.pone.0265377

Share
Back to top
Global Health Economics and Sustainability, Electronic ISSN: 2972-4570 Published by AccScience Publishing