Prevalence of depression and anxiety among health care workers in designated hospitals during the COVID-19 epidemic: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Xueyan ¹ , WANG Guangpeng ² , ZHANG Jie ¹ ,  WANG Shuhui ³

1. School of Nursing and Rehabilitation, Shandong University, Jinan 250012, P.R.China;
2. Xiangya School of Nursing, Central South University, Changsha 410012, P.R.China;
3. Department of Hospital Infection Management, Qilu Hospital of Shandong University, Jinan 250012, P.R.China;

Corresponding?author：

WANG Shuhui, Email: wangshqlyy@163.com

Keywords：

COVID-19; Health care worker; Designated hospital; Depression; Anxiety; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202105079

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the prevalence of depression and anxiety among health care workers in designated hospitals during the COVID-19 pandemic. Methods The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect cross-sectional studies on the prevalence of depression and anxiety among health care workers from December 2019 to April 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 14.0 software. Results A total of 21 cross-sectional studies were included, involving 38 372 participants. Meta-analysis results showed that during the COVID-19 epidemic, the prevalence of depression and anxiety among health care workers in designated hospitals were 31.00% (95%CI 0.25 to 0.37) and 44.00% (95%CI 0.34 to 0.53). The results of subgroup analysis showed that individuals of female, married, bachelor degree or above, nurses, junior professional titles, and non-first-line medical staff had higher prevalence of depression and anxiety. Conclusions During the COVID-19 pandemic, the incidence of depression and anxiety among health care workers in designated hospitals remain high. Therefore, more attention should be paid to the mental health of health care workers in designated hospitals. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusions.

Citation： LIU Xueyan, WANG Guangpeng, ZHANG Jie, WANG Shuhui. Prevalence of depression and anxiety among health care workers in designated hospitals during the COVID-19 epidemic: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(9): 1035-1042. doi: 10.7507/1672-2531.202105079 Copy

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2.	Zhang WR, Wang K, Yin L, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom, 2020, 89(4): 242-250.
3.	中國疾病預防控制中心新型冠狀病毒肺炎應急響應機制流行病學組. 新型冠狀病毒肺炎流行病學特征分析. 中華流行病學雜志, 2020, 41(2): 145-151.
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7.	Liu X, Kakade M, Fuller CJ, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry, 2012, 53(1): 15-23.
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12.	Xiong M, Liang X, Wei YD. Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Br J Haematol, 2020, 189(6): 1050-1052.
13.	Lee KW, Ching SM, Ramachandran V, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 2018, 18(1): 494.
14.	徐同成, 李霞, 王文亮, 等. 分類變量 Meta 分析中偏倚的檢測-Egger 法和 Begg 法. 循證醫學, 2009, 9(3): 181-184.
15.	Feingold JH, Peccoralo L, Chan CC, et al. Psychological impact of the COVID-19 pandemic on frontline health care workers during the pandemic surge in New York city. Chronic Stress (Thousand Oaks), 2021, 5: 2470547020977891.
16.	Greenberg N, Weston D, Hall C, et al. Mental health of staff working in intensive care during Covid-19. Occup Med (Lond), 2021, 71(2): 62-67.
17.	He Q, Ren J, Wang G, et al. Psychological effects of the COVID-19 outbreak on nurses working in tertiary women's and children's hospitals from Sichuan, China: a cross-sectional study. Int J Disaster Risk Reduct, 2021, 58: 102188.
18.	Hong S, Ai M, Xu X, et al. Immediate psychological impact on nurses working at 42 government-designated hospitals during COVID-19 outbreak in China: a cross-sectional study. Nurs Outlook, 2021, 69(1): 6-12.
19.	Korkmaz S, Kazgan A, ? eki? S, et al. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci, 2020, 80: 131-136.
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21.	Peng X, Meng X, Li L, et al. Depressive and anxiety symptoms of healthcare workers in intensive care unit under the COVID-19 epidemic: an online cross-sectional study in China. Front Public Health, 2021, 9: 603273.
22.	Xing LQ, Xu ML, Sun J, et al. Anxiety and depression in frontline health care workers during the outbreak of COVID-19. Int J Soc Psychiatry, 2020: 20764020968119.
23.	Juan Y, Yuanyuan C, Qiuxiang Y, et al. Psychological distress surveillance and related impact analysis of hospital staff during the COVID-19 epidemic in Chongqing, China. Compr Psychiatry, 2020, 103: 152198.
24.	Zhu Z, Xu S, Wang H, et al. COVID-19 in Wuhan: sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. EClinicalMedicine, 2020, 24: 100443.
25.	?ahin MK, Aker S, ? ahin G, et al. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health, 2020, 45(6): 1168-1177.
26.	Song X, Fu W, Liu X, et al. Mental health status of medical staff in emergency departments during the coronavirus disease 2019 epidemic in China. Brain Behav Immun, 2020, 88: 60-65.
27.	Wang Y, Ma S, Yang C, et al. Acute psychological effects of Coronavirus Disease 2019 outbreak among healthcare workers in China: a cross-sectional study. Transl Psychiatry, 2020, 10(1): 348.
28.	陳華茂, 張艷, 董晨, 等. 新型冠狀病毒肺炎隔離病房醫護人員焦慮現狀及影響因素分析. 交通醫學, 2020, 34(2): 123-126.
29.	李睿琳, 熊振芳, 柳琳琳, 等. 武漢市首批收治新型冠狀病毒肺炎定點醫院一線護士焦慮狀況及其影響因素分析. 實用心腦肺血管病雜志, 2020, 28(3): 19-23.
30.	徐松, 吳娟娟, 許辰, 等. 武漢地區新型冠狀病毒肺炎定點醫院一線醫護人員心理健康調查及分析. 第三軍醫大學學報, 2020, 42(18): 1830-1835.
31.	尹姣, 吳學勤, 馬文帥, 等. 新型冠狀病毒肺炎定點醫院醫護人員心理狀況調查分析. 醫學與哲學, 2020, 41(8): 38-42, 67.
32.	鐘亞麗, 宋新靈, 李娟, 等. 新型冠狀病毒肺炎疫情下貴陽市急診科和發熱門診醫護人員心理健康狀況調查. 貴州中醫藥大學學報, 2020, 42(2): 16-22.
33.	周志慶, 劉歡, 馬紅梅, 等. 新型冠狀病毒肺炎疫情期間武漢市一線護士焦慮現狀及其影響因素分析. 沈陽醫學院學報, 2020, 22(4): 294-298.
34.	包延喬, 張文俐. 2019-nCoV 肺炎一線護士的心理狀況調查. 世界最新醫學信息文摘(連續型電子期刊), 2020, 20(32): 270.
35.	Pappa S, Ntella V, Giannakas T, et al. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun, 2020, 88: 901-907.
36.	Luo M, Guo L, Yu M, et al. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - a systematic review and meta-analysis. Psychiatry Res, 2020, 291: 113190.
37.	Sher L. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med, 2020, 70: 124.
38.	Hennein R, Mew EJ, Lowe SR. Socio-ecological predictors of mental health outcomes among healthcare workers during the COVID-19 pandemic in the United States. PLoS One, 2021, 16(2): e0246602.
39.	Lu W, Wang H, Lin Y, et al. Psychological status of medical workforce during the COVID-19 pandemic: a cross-sectional study. Psychiatry Res, 2020, 288: 112936.
40.	Zhu J, Sun L, Zhang L, et al. Prevalence and influencing factors of anxiety and depression symptoms in the first-line medical staff fighting against COVID-19 in Gansu. Front Psychiatry, 2020, 11: 386.
41.	Neitzke AB. An illness of power: gender and the social causes of depression. Cult Med Psychiatry, 2016, 40(1): 59-73.
42.	Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci, 2015, 40(4): 219-221.
43.	Liu CY, Yang YZ, Zhang XM, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect, 2020, 148: e98.
44.	Cag Y, Erdem H, Gormez A, et al. Anxiety among front-line health-care workers supporting patients with COVID-19: a global survey. Gen Hosp Psychiatry, 2021, 68: 90-96.
45.	Awano N, Oyama N, Akiyama K, et al. Anxiety, depression, and resilience of healthcare workers in Japan during the coronavirus disease 2019 outbreak. Intern Med, 2020, 59(21): 2693-2699.
46.	Li S, Rao LL, Ren XP, et al. Psychological typhoon eye in the 2008 Wenchuan earthquake. PLoS One, 2009, 4(3): e4964.
47.	Ito A, Gobel MS, Uchida Y. Leaders in interdependent contexts suppress nonverbal assertiveness: a multilevel analysis of Japanese University club leaders' and members' rank signaling. Front Psychol, 2018, 9: 723.
48.	Chen Q, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry, 2020, 7(4): e15-e16.
49.	Pan R, Zhang L, Pan J. The anxiety status of Chinese medical workers during the epidemic of COVID-19: a meta-analysis. Psychiatry Investig, 2020, 17(5): 475-480.
50.	Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open, 2020, 3(3): e203976.

1. Qiu J, Shen B, Zhao M, et al. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr, 2020, 33(2): e100213.
2. Zhang WR, Wang K, Yin L, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom, 2020, 89(4): 242-250.
3. 中國疾病預防控制中心新型冠狀病毒肺炎應急響應機制流行病學組. 新型冠狀病毒肺炎流行病學特征分析. 中華流行病學雜志, 2020, 41(2): 145-151.
4. Cai Z, Cui Q, Liu Z, et al. Nurses endured high risks of psychological problems under the epidemic of COVID-19 in a longitudinal study in Wuhan China. J Psychiatr Res, 2020, 131: 132-137.
5. Vilagut G, Forero CG, Barbaglia G, et al. Screening for depression in the general population with the center for epidemiologic studies depression (CES-D): a systematic review with meta-analysis. PLoS One, 2016, 11(5): e0155431.
6. Chew NWS, Lee GKH, Tan BYQ, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun, 2020, 88: 559-565.
7. Liu X, Kakade M, Fuller CJ, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry, 2012, 53(1): 15-23.
8. Montemurro N. The emotional impact of COVID-19: from medical staff to common people. Brain Behav Immun, 2020, 87: 23-24.
9. Li W, Yang Y, Liu ZH, et al. Progression of mental health services during the COVID-19 outbreak in China. Int J Biol Sci, 2020, 16(10): 1732-1738.
10. Jambunathan P, Jindal M, Patra P, et al. COVID-warriors: psychological impact of the severe acute respiratory syndrome coronavirus 2 pandemic on health-care professionals. Journal of Marine Medical Society, 2020, 22(3): 57-61.
11. 曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
12. Xiong M, Liang X, Wei YD. Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Br J Haematol, 2020, 189(6): 1050-1052.
13. Lee KW, Ching SM, Ramachandran V, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 2018, 18(1): 494.
14. 徐同成, 李霞, 王文亮, 等. 分類變量 Meta 分析中偏倚的檢測-Egger 法和 Begg 法. 循證醫學, 2009, 9(3): 181-184.
15. Feingold JH, Peccoralo L, Chan CC, et al. Psychological impact of the COVID-19 pandemic on frontline health care workers during the pandemic surge in New York city. Chronic Stress (Thousand Oaks), 2021, 5: 2470547020977891.
16. Greenberg N, Weston D, Hall C, et al. Mental health of staff working in intensive care during Covid-19. Occup Med (Lond), 2021, 71(2): 62-67.
17. He Q, Ren J, Wang G, et al. Psychological effects of the COVID-19 outbreak on nurses working in tertiary women's and children's hospitals from Sichuan, China: a cross-sectional study. Int J Disaster Risk Reduct, 2021, 58: 102188.
18. Hong S, Ai M, Xu X, et al. Immediate psychological impact on nurses working at 42 government-designated hospitals during COVID-19 outbreak in China: a cross-sectional study. Nurs Outlook, 2021, 69(1): 6-12.
19. Korkmaz S, Kazgan A, ? eki? S, et al. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci, 2020, 80: 131-136.
20. Ma Y, Rosenheck R, He H. Psychological stress among health care professionals during the 2019 novel coronavirus disease outbreak: cases from online consulting customers. Intensive Crit Care Nurs, 2020, 61: 102905.
21. Peng X, Meng X, Li L, et al. Depressive and anxiety symptoms of healthcare workers in intensive care unit under the COVID-19 epidemic: an online cross-sectional study in China. Front Public Health, 2021, 9: 603273.
22. Xing LQ, Xu ML, Sun J, et al. Anxiety and depression in frontline health care workers during the outbreak of COVID-19. Int J Soc Psychiatry, 2020: 20764020968119.
23. Juan Y, Yuanyuan C, Qiuxiang Y, et al. Psychological distress surveillance and related impact analysis of hospital staff during the COVID-19 epidemic in Chongqing, China. Compr Psychiatry, 2020, 103: 152198.
24. Zhu Z, Xu S, Wang H, et al. COVID-19 in Wuhan: sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. EClinicalMedicine, 2020, 24: 100443.
25. ?ahin MK, Aker S, ? ahin G, et al. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health, 2020, 45(6): 1168-1177.
26. Song X, Fu W, Liu X, et al. Mental health status of medical staff in emergency departments during the coronavirus disease 2019 epidemic in China. Brain Behav Immun, 2020, 88: 60-65.
27. Wang Y, Ma S, Yang C, et al. Acute psychological effects of Coronavirus Disease 2019 outbreak among healthcare workers in China: a cross-sectional study. Transl Psychiatry, 2020, 10(1): 348.
28. 陳華茂, 張艷, 董晨, 等. 新型冠狀病毒肺炎隔離病房醫護人員焦慮現狀及影響因素分析. 交通醫學, 2020, 34(2): 123-126.
29. 李睿琳, 熊振芳, 柳琳琳, 等. 武漢市首批收治新型冠狀病毒肺炎定點醫院一線護士焦慮狀況及其影響因素分析. 實用心腦肺血管病雜志, 2020, 28(3): 19-23.
30. 徐松, 吳娟娟, 許辰, 等. 武漢地區新型冠狀病毒肺炎定點醫院一線醫護人員心理健康調查及分析. 第三軍醫大學學報, 2020, 42(18): 1830-1835.
31. 尹姣, 吳學勤, 馬文帥, 等. 新型冠狀病毒肺炎定點醫院醫護人員心理狀況調查分析. 醫學與哲學, 2020, 41(8): 38-42, 67.
32. 鐘亞麗, 宋新靈, 李娟, 等. 新型冠狀病毒肺炎疫情下貴陽市急診科和發熱門診醫護人員心理健康狀況調查. 貴州中醫藥大學學報, 2020, 42(2): 16-22.
33. 周志慶, 劉歡, 馬紅梅, 等. 新型冠狀病毒肺炎疫情期間武漢市一線護士焦慮現狀及其影響因素分析. 沈陽醫學院學報, 2020, 22(4): 294-298.
34. 包延喬, 張文俐. 2019-nCoV 肺炎一線護士的心理狀況調查. 世界最新醫學信息文摘(連續型電子期刊), 2020, 20(32): 270.
35. Pappa S, Ntella V, Giannakas T, et al. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun, 2020, 88: 901-907.
36. Luo M, Guo L, Yu M, et al. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - a systematic review and meta-analysis. Psychiatry Res, 2020, 291: 113190.
37. Sher L. COVID-19, anxiety, sleep disturbances and suicide. Sleep Med, 2020, 70: 124.
38. Hennein R, Mew EJ, Lowe SR. Socio-ecological predictors of mental health outcomes among healthcare workers during the COVID-19 pandemic in the United States. PLoS One, 2021, 16(2): e0246602.
39. Lu W, Wang H, Lin Y, et al. Psychological status of medical workforce during the COVID-19 pandemic: a cross-sectional study. Psychiatry Res, 2020, 288: 112936.
40. Zhu J, Sun L, Zhang L, et al. Prevalence and influencing factors of anxiety and depression symptoms in the first-line medical staff fighting against COVID-19 in Gansu. Front Psychiatry, 2020, 11: 386.
41. Neitzke AB. An illness of power: gender and the social causes of depression. Cult Med Psychiatry, 2016, 40(1): 59-73.
42. Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci, 2015, 40(4): 219-221.
43. Liu CY, Yang YZ, Zhang XM, et al. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect, 2020, 148: e98.
44. Cag Y, Erdem H, Gormez A, et al. Anxiety among front-line health-care workers supporting patients with COVID-19: a global survey. Gen Hosp Psychiatry, 2021, 68: 90-96.
45. Awano N, Oyama N, Akiyama K, et al. Anxiety, depression, and resilience of healthcare workers in Japan during the coronavirus disease 2019 outbreak. Intern Med, 2020, 59(21): 2693-2699.
46. Li S, Rao LL, Ren XP, et al. Psychological typhoon eye in the 2008 Wenchuan earthquake. PLoS One, 2009, 4(3): e4964.
47. Ito A, Gobel MS, Uchida Y. Leaders in interdependent contexts suppress nonverbal assertiveness: a multilevel analysis of Japanese University club leaders' and members' rank signaling. Front Psychol, 2018, 9: 723.
48. Chen Q, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry, 2020, 7(4): e15-e16.
49. Pan R, Zhang L, Pan J. The anxiety status of Chinese medical workers during the epidemic of COVID-19: a meta-analysis. Psychiatry Investig, 2020, 17(5): 475-480.
50. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open, 2020, 3(3): e203976.

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Prevalence of depression and anxiety among health care workers in designated hospitals during the COVID-19 epidemic: a meta-analysis

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