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.	中国疾病预防控制中心新型冠状病毒肺炎应急响应机制流行病学组. 新型冠状病毒肺炎流行病学特征分析. 中华流行病学杂志, 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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11.	曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 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. 分类变量 Meta 分析中偏倚的检测-Egger 法和 Begg 法. 循证医学, 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, Ç ekiç 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.	Şahin MK, Aker S, Ş 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.	陈华茂, 张艳, 董晨, 等. 新型冠状病毒肺炎隔离病房医护人员焦虑现状及影响因素分析. 交通医学, 2020, 34(2): 123-126.
29.	李睿琳, 熊振芳, 柳琳琳, 等. 武汉市首批收治新型冠状病毒肺炎定点医院一线护士焦虑状况及其影响因素分析. 实用心脑肺血管病杂志, 2020, 28(3): 19-23.
30.	徐松, 吴娟娟, 许辰, 等. 武汉地区新型冠状病毒肺炎定点医院一线医护人员心理健康调查及分析. 第三军医大学学报, 2020, 42(18): 1830-1835.
31.	尹姣, 吴学勤, 马文帅, 等. 新型冠状病毒肺炎定点医院医护人员心理状况调查分析. 医学与哲学, 2020, 41(8): 38-42, 67.
32.	钟亚丽, 宋新灵, 李娟, 等. 新型冠状病毒肺炎疫情下贵阳市急诊科和发热门诊医护人员心理健康状况调查. 贵州中医药大学学报, 2020, 42(2): 16-22.
33.	周志庆, 刘欢, 马红梅, 等. 新型冠状病毒肺炎疫情期间武汉市一线护士焦虑现状及其影响因素分析. 沈阳医学院学报, 2020, 22(4): 294-298.
34.	包延乔, 张文俐. 2019-nCoV 肺炎一线护士的心理状况调查. 世界最新医学信息文摘(连续型电子期刊), 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. 中国疾病预防控制中心新型冠状病毒肺炎应急响应机制流行病学组. 新型冠状病毒肺炎流行病学特征分析. 中华流行病学杂志, 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. 曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 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. 分类变量 Meta 分析中偏倚的检测-Egger 法和 Begg 法. 循证医学, 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, Ç ekiç 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. Şahin MK, Aker S, Ş 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. 陈华茂, 张艳, 董晨, 等. 新型冠状病毒肺炎隔离病房医护人员焦虑现状及影响因素分析. 交通医学, 2020, 34(2): 123-126.
29. 李睿琳, 熊振芳, 柳琳琳, 等. 武汉市首批收治新型冠状病毒肺炎定点医院一线护士焦虑状况及其影响因素分析. 实用心脑肺血管病杂志, 2020, 28(3): 19-23.
30. 徐松, 吴娟娟, 许辰, 等. 武汉地区新型冠状病毒肺炎定点医院一线医护人员心理健康调查及分析. 第三军医大学学报, 2020, 42(18): 1830-1835.
31. 尹姣, 吴学勤, 马文帅, 等. 新型冠状病毒肺炎定点医院医护人员心理状况调查分析. 医学与哲学, 2020, 41(8): 38-42, 67.
32. 钟亚丽, 宋新灵, 李娟, 等. 新型冠状病毒肺炎疫情下贵阳市急诊科和发热门诊医护人员心理健康状况调查. 贵州中医药大学学报, 2020, 42(2): 16-22.
33. 周志庆, 刘欢, 马红梅, 等. 新型冠状病毒肺炎疫情期间武汉市一线护士焦虑现状及其影响因素分析. 沈阳医学院学报, 2020, 22(4): 294-298.
34. 包延乔, 张文俐. 2019-nCoV 肺炎一线护士的心理状况调查. 世界最新医学信息文摘(连续型电子期刊), 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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