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Stephen Padilla
13 May 2020
Doctors are overworked with a lack of sleep and insufficient leisure hours to keep stress at bay.

Frontline health workers caring for patients with the novel coronavirus disease (COVID-19) may benefit from effective interventions derived from previous emerging virus outbreaks, which can be employed to help mitigate psychological distress, suggest the results of a rapid review and meta-analysis.

“These interventions were similar despite the wide range of settings and types of outbreaks in this review, and thus could be applicable to the current COVID-19 outbreak,” the investigators said.

The databases of PubMed/Medline, PsychInfo, Scopue, Embase, Google Scholar, Web of Science and Cochrane Central Register of Controlled Trials were searched up to late March 2020 for studies describing the psychological reactions of healthcare staff working with patients in an outbreak of any emerging virus in any clinical setting.

Of the 59 studies eligible for the meta-analysis, 37 were of severe acute respiratory syndrome (SARS), eight of COVID-19, seven of Middle East respiratory syndrome (MERS), three each of Ebola virus disease and influenza A virus subtype H1N1, and one of influenza A virus subtype H7N9. [BMJ 2020;369:m1642]

Thirty-eight studies compared psychological outcomes of healthcare workers who had direct contact with affected patients, of which 25 contained data that could be combined in a pairwise meta-analysis comparing healthcare workers at high and low risk of exposure.

Healthcare workers in direct contact with affected patients demonstrated higher levels of both acute or post-traumatic stress (odds ratio [OR], 1.71, 95 percent confidence interval [CI], 1.28–2.29) and psychological distress (OR, 1.74, 95 percent CI, 1.50–2.03) than lower risk controls, with similar results for continuous outcomes.

“These findings were the same as in the other studies not included in the meta-analysis,” according to the investigators.

Psychological distress in a virus outbreak was associated with being younger, being more junior, being the parents of dependent children or having an infected family member. Other contributors included longer quarantine, lack of practical support and stigma.

On the other hand, morbidity could be reduced through the following strategies: clear communication, adequate rest, access to adequate personal protection, and both practical and psychological support.

“The World Health Organization has recently released resources that give specific guidance on mental health and psychosocial considerations during the COVID-19 outbreak, including psychological first aid for frontline workers,” the investigators said. [www.who.int/docs/default-source/coronaviruse/covid19-stigma-guide.pdf; www.who.int/publications-detail/mental-health-and-psychosocial-considerations-during-the-covid-19-outbreak]

Psychological first aid involved the following: assessment of needs and concerns; practical care and support; dealing with basic needs (eg, food and water, information, etc.); emphatic listening; access to information, services and social support; and protection from further harm. [www.who.int/mental_health/publications/guide_field_workers/en/]

“By contrast, psychological debriefing focusing on traumatic experiences is not usually helpful and could interfere with the natural recovery process,” the investigators noted. [Br Med Bull 2019;129:25-34]

“Further research is required into the effectiveness of these interventions, particularly during the COVID-19 pandemic,” they added.

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