Mental health of clinical staff working in high-risk epidemic and pandemic health emergencies a rapid review of the evid
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REVIEW
Mental health of clinical staff working in high‑risk epidemic and pandemic health emergencies a rapid review of the evidence and living meta‑analysis Vaughan Bell1,2 · Dorothy Wade3,4 Received: 20 May 2020 / Accepted: 10 November 2020 © The Author(s) 2020
Abstract Purpose The SARS-CoV-2 / COVID-19 pandemic has raised concerns about the potential mental health impact on frontline clinical staff. However, given that poor mental health is common in acute medical staff, we aimed to estimate the additional burden of work involving high exposure to infected patients. Methods We report a rapid review, meta-analysis, and living meta-analysis of studies using validated measures from outbreaks of COVID-19, Ebola, H1N1 influenza, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS). Results A random effects meta-analysis found that high-exposure work is not associated with an increased prevalence of above cut-off scoring (anxiety: RR = 1.30, 95% CI 0.87–1.93, Total N = 12,473; PTSD symptoms: RR = 1.16, 95% CI 0.75– 1.78, Total N = 6604; depression: RR = 1.50, 95% CI 0.57–3.95, Total N = 12,224). For continuous scoring, high-exposure work was associated with only a small additional burden of acute mental health problems compared to low-exposure work (anxiety: SMD = 0.16, 95% CI 0.02–0.31, Total N = 6493; PTSD symptoms: SMD = 0.20, 95% CI 0.01–0.40, Total N = 5122; depression: SMD = 0.13, 95% CI -0.04–0.31, Total N = 4022). There was no evidence of publication bias. Conclusion Although epidemic and pandemic response work may add only a small additional burden, improving mental health through service management and provision of mental health services should be a priority given that baseline rates of poor mental health are already very high. As new studies emerge, they are being added to a living meta-analysis where all analysis code and data have been made freely available: https://osf.io/zs7ne/. Keywords COVID-19 · Mental health · Staff · Depression · Anxiety · PTSD
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-020-01990-x) contains supplementary material, which is available to authorized users. * Vaughan Bell [email protected] 1
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
2
South London and Maudsley NHS Foundation Trust, London, UK
3
University College London Hospitals Critical Care Department, London, UK
4
Research Department of Behavioural Science and Health, University College London, London, UK
The recent SARS-CoV-2/COVID-19 pandemic has seen an increased demand on clinical staff, who need to treat large numbers of patients, often in newly-purposed wards, with little disease-specific evidence to guide treatment. Many clinical staff have been moved into new roles and may be managing acutely unwell patients using unfamiliar equipment. Stresses caused by high patient mortality rates, staffing shortages, concerns about in
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