Review Article

The Silent Pandemic: The Psychological Burden on Frontline Healthcare Workers during COVID-19

Table 1


ReferenceLocation and date rangeStudy typeSample sizeTopic of studyKey outcomes

Conti et al. 2020 [34]Italy
March 30th to May 5th 2020
Online cross-sectional survey933 HCWsMental health status and psychological care needs of HCWs during the COVID-19 pandemic(i) Poorer mental health: female gender, years, having experienced death of a patient
(ii) Lesser but significant effect on mental health: working in a highly infected area, frontline work

Trumello et al. 2020 [12]Italy
April 11th to April 16th 2020
Online cross-sectional survey627 HCWsPsychological adjustment in HCW during the COVID-19 pandemic, the effect of frontline work(i) Higher psychological impact in FLHCWs
(ii) Demand for psychological support is double in FLHCWs vs. non-FLHCWs

Que et al. 2020 [13]China
February 16th to February 23rd 2020
Online cross-sectional survey2285 HCWsRisk factors for the development of psychological problems in different groups of HCWs during the COVID-19 pandemic(i) Poorer mental health: frontline work, receiving negative information about the pandemic, receiving negative feedback from family or friends
(ii) Higher risk in nurses, paramedical professionals, lower risk in medical residents

Qi et al. 2020 [14]China
February 2020
Online cross-sectional survey1306 HCWsSleep disturbances and mental health in FLHCWs compared to non-FLHCWs during the COVID-19 pandemic(i) Poorer mental health: FLHCWs, female gender
(ii) Anxiety and depression associated with poor sleep quality

Jahrami et al. 2020 [15]Bahrain
April 2020
Online cross-sectional survey257 HCWsSleep quality in FLHCWs as compared to non-FLHCWs during the COVID-19 pandemic(i) High prevalence of poor sleep quality, no significant difference between FL and non-FLHCWs
(ii) Sex and professional background are most predictive of poor sleep quality

An et al. 2020 [16]China
March 15th to March 20th 2020
Online cross-sectional survey1103 ED nursesPrevalence of depression and quality of life in ED nurses during the COVID-19 pandemic(i) Frontline nurses: higher depression, lower quality of life

Cai et al. 2020 [35]China
February 11th to February 26th 2020
Online, case-control, matched1173 FLHCW vs. 1173 non-FLHCWComparison of the pandemic’s psychological impact on FLHCWs vs. non-FLHCW(i) Poorer mental health and insomnia in FLHCWs
(ii) No significant difference in help-seeking behavior

Zhang et al. 2020 [17]China
January 29th to February 3rd 2020
Online, cross-sectional survey1563 HCWInsomnia and related psychological and social factors in HCWs during the COVID-19 pandemic(i) 1/3 medical workers included had insomnia
(ii) Increased risk for insomnia: work in isolation wards, lower level of education, worry of being infected, uncertainty about effectiveness of infection control measures

Elbay et al. 2020 [18]Turkey
March 10th to March 15th
Online, cross-sectional survey442 physiciansAnxiety, depression, and stress in physicians during the COVID-19 pandemic(i) DAS-21 was higher in FLHCWs
(ii) Poorer mental health: female gender, young age, frontline work, less work experience

Macía-Rodríguez et al. 2021 [19]Spain
May 2020
Online, cross-sectional survey1015 HCWsImpact of the COVID-19 outbreak on mental health and burnout syndrome in internists(i) Higher burnout levels in FLHCWs, insufficient PPE, worry about infecting family, OH consumption, increased responsibility, longer work hours, and no rest
Erquicia et al. 2020 [20]Spain
March to April 2020
In-person, cross-sectional survey395 HCWsAnalysis of the emotional state of healthcare professionals during the COVID-19 pandemic(i) High prevalence of anxiety, depression, acute stress symptoms
(ii) Increased risk of psychological distress in females, FLHCWs, and paramedical staff; feeling of having insufficient PPE; having experienced the death of a close person from COVID-19

Si et al. 2020 [21]China
February 23rd to March 5th 2020
Online, cross-sectional survey863 HCWsPsychological impact of the COVID-19 pandemic on HCWs(i) High level of PTS symptoms
(ii) Females, nurses, and FLHCWs have higher risk
(iii) Perceived threat and passive coping increase risk for PTS

Xia et al. 2021 [22]China
February 3rd to March 30th 2020
Online, cross-sectional survey126 HCWsPsychological impact and coping mechanisms in medical staff during the COVID-19 pandemic(i) Doctors and nurses had lower anxiety levels than administrative personnel
(ii) Lower depression if bachelor’s degree or above
(iii) Negative coping mechanisms significantly correlated with anxiety/depression

Hennein et al. 2021 [23]USA
May 2020
Online, cross-sectional survey1092 HCWsSocioecological predictors of mental health outcomes in HCWs during the COVID-19 pandemic(i) Higher levels of PTSD: female gender, lower team cohesion, higher levels of social stigmatization, higher media exposure

Mosheva et al. 2021 [24]Israel
April 19th to April 23rd 2020
Online, cross-sectional survey828 HCWsComparison of PTSS, depression, and anxiety in FLHCWs vs. non-FLHCWs during the COVID-19 pandemic(i) Anxiety and depression similar in both FL- and non-FLHCWs
(ii) FLHCWs: higher risk of witnessing patient death, associated with higher PTSS
(iii) Increased anxiety and depression with increased worry about being infected, worry about infecting family, mental exhaustion

Yi et al. 2020 [25]China
April 26th to May 9th 2020
Online, cross-sectional survey723 HCWsPsychosomatic status in different groups of HCWs during the COVID-19 pandemic(i) Poorer mental health with intensity of contact with COVID-19 patients, higher occupational pressure

Barua et al. 2020 [26]Bangladesh
April 1st to May 30th 2020
Online, cross-sectional survey370 frontline doctorsAnxiety, depression, sleep disturbance, and fear of COVID-19 among frontline doctors(i) Inadequate resources to provide for patients contribute most to poor mental health symptoms

Mohd Noor et al. 2021 [27]Malaysia
May to July 2020
Online cross-sectional survey, comparative306 HCWsAnxiety in FLHCWs vs. non-FLHCWs during the COVID-19 pandemic(i) Higher levels of anxiety were reported in the group of non-FLHCWs

Shen et al. 2021 [28]China
March 3rd to March 10th 2020
Online cross-sectional survey643 frontline nursesLevels of anxiety among frontline nurses during the COVID-19 pandemic and its association with insomnia and perceived stress(i) High levels of anxiety correlated with insomnia, perceived stress, night shifts, fear of COVID-19, having experienced previous pandemics

Cag et al. 2021 [29]International (75 countries)
March 18th to April 1st 2020
Online, cross-sectional survey1416 HCWsAnxiety levels in international HCWs during the COVID-19 pandemic(i) Increased anxiety with inadequate resources, female gender, young age, insufficient knowledge of COVID-19, living in high-income countries
Tiete et al. 2020 [30]Belgium
April 17th to May 25th 2020
Online, cross-sectional survey647 HCWsDifferences in mental health between FLHCWs and non-FLHCWs(i) High prevalence of anxiety, depression, and insomnia, no significant difference between FL and non-FLHCWs
(ii) Worse mental health outcomes: nurses, young age, working in isolation wards, increased workloads

Lasalvia et al. 2021 [31]Italy
April 21st to May 6th 2020
Online, cross-sectional survey1961 HCWsBurnout levels and risk factors in HCWs working during the COVID-19 pandemic(i) High risk of burnout: junior doctors working in FL settings, interpersonal avoidance, conflicts in the workplace, increased workload

Lai et al. 2020 [32]China
January 29th to February 3rd 2020
Online, cross-sectional survey1257 HCWsMental health outcomes and associated factors in HCWs during the COVID-19 pandemic(i) Poorer mental health outcomes: nurses, women, and FLHCWs

Hu et al. 2020 [33]China
February 13th to February 24th 2020
Online, cross-sectional survey2014 frontline nursesMental health outcomes and associated factors in frontline nurses caring for COVID-19 patients(i) Lack of social support is correlated with negative mental health outcomes
(ii) Willingness to participate in frontline work is negatively correlated with burnout, stress, and anxiety