Impacts of the COVID-19 pandemic on the mental health of frontline hospital-based nurses: rapid review and meta-analysis

Figures & data

Figure 1. PRISMA diagram of literature search results.

Table 1. Descriptive characteristics and 18 mental health outcomes of the 12 studies included in the meta-analysis.

Reference	Target Population Descriptive statistics Place Baseline to follow-up	Research design, response rate Sampling frame Baseline & follow-up samples or COVID frontline vs comparison Mental health measures Covariates accounted for	Outcomes Descriptive statistics Baseline vs follow-up or COVID frontline vs comparison Risk ratio (95% CI)
Li et al., 2021a	Hospital nurses 18 or older, Mage = 33, 92% female Wuhan city (COVID-19 frontline) vs Other places in Liaoning province, China Early crisis phase of pandemic	Online probability survey Hospital Nurse Rosters 452 & 438 IES-R & SAS Age & gender	Mild to severe anxiety 10.7% vs 6.4 % PR = 1.67 (1.08, 2.58) Moderate to severe PTSD 81.3% vs 36.6% PR = 2.22 (1.97, 2.50) PRpooled = 2.17 (2.09, 2.32)
Li et al., 2021b	Hospital nurses Mage = 31, 86% female Anhui province, China January 2020 to March 2020	Successive online surveys; trend study College-Affiliated Hospital 356 & 356 PCL-5	Probable PTSD 1.7% vs 61.8% PR = 36.35 (24.48, 53.97)
Ren et al., 2021	Hospital nurses 20 or older, 93% female Wuhan city (COVID-19 frontline) vs non-Hubei province cities, China March 2020	Online survey Hospital Nurse Rosters 202 & 391 GAD-7 & PHQ-9 None	Probable anxiety disorder 18.3% vs 5.9% PR = 3.10 (1.95, 4.93) Probable major depression 31.2% vs 13.8% PR = 2.26 (1.64, 3.11) PRpooled = 2.51 (2.24, 2.80)
Temsah et al., 2021	HCWs, 86% hospital nurses 31–40 years of age (52%), 83% female Saudi Arabia Prior to 1st COVID-19 case to April 2020	Successive online surveys; trend study Social Media Advertisements 582 & 957 Original Single-Item Measure None	Level of anxiety from COVID-19 (0-11) M = 4.9 vs 8.6 OR = 13.60 (2.84, 65.11)
Reverté-Villarroya et al., 2021	Final (4th)-year nursing students Mdnage = 24, 87% female Catalonia, Spain May 2017 to May 2020	Successive offline (2017) & online (2020) surveys; trend study3 University Teaching Hospitals 146 & 159 GHQ Age, gender, stress	Mental health problems 35.9% vs 59.7% PR = 1.66 (1.31, 2.11)
Havaei et al., 2021	Acute care nurses 18 or older, 92% female British Columbia, Canada September 2019 to July 2020	Successive emailed surveys; trend study British Columbia Nurses Union 3,197 & 2,143 GAD-7 & PHQ-9 Age, gender & 3 other covariates	Potential anxiety disorder 30.8% vs 43.7% PR = 1.42 (1.33, 1.52) Potential major depression 20.1% vs 29.3% PR = 1.46 (1.33, 1.60) PRpooled = 1.43 (1.42, 1.44)
Zakeri et al., 2021	Hospital nurses Mage = 33, 77% female Southern Iran April–July 2019 to April–July 2020	Successive offline surveys; trend study, 66% & 48% Public Hospital Nurses 266 & 242 DASS-21 None	Symptoms of anxiety M = 8.74 vs 12.65 OR = 2.26 (1.39, 3.67) Symptoms of depression M = 9.90 vs 12.23 OR = 1.60 (1.15, 2.22) ORpooled = 1.77 (1.57, 1.98)
Katsuta et al., 2021	Hospital nurses Subsample of hospital staff Tokyo, Japan 2019 to July–August 2020	Successive online surveys; trend study Juntendo University Hospital Nurses 1295 & 1314 CES-D Age & gender	Depressed (CES-D > 16) 40.0% vs 43.2% PR = 1.08 (0.99, 1.18)^ab
Oosthuizen et al., 2022	HCWs, 85% hospital nurses or midwives 25–68 years of age, Mage = 42, 99% female South Africa, Tshwane Health District Pre-COVID-19 to Sep–Dec 2020	Offline survey with retrospective measures 10 Obstetric Units & 4 Hospitals 114 Original single-item measure Age & gender	Perceived anxiety change OR = 3.13 (1.58, 6.21) Perceived depression change OR = 3.13 (1.58, 6.21) ORpooled = 3.13 (1.58, 6.21)
Harry, 2021	Nurses, 78% Hospital/medical center 45% ED & 37% ICU 22 to 62 years of age, Mage = 32, 69% female USA December 2020	Online survey with retrospective measures Social Media Advertisements 249 Self-reported mental health None	Self-Reported Mental Health Fair to Very Poor 9.2% vs 41.0% PR = 4.46 (3.12, 6.39)
Obeidat et al., 2022	HCWs, 71% hospital nurses 18–40 years of age (80%), 60% female Jordan Pre-COVID-19 to Nov 2020–Jan 2021	Successive online Arabic surveys; Trend study General Hospitals (61%) 937 & 876 PROMIS None	1+ symptom increase Anxiety (M = 9.2 vs 11.1) OR = 2.46 (1.43, 4.22) Depression (M = 7.3 vs 8.9) OR = 2.06 (1.34, 3.18) ORpooled = 2.21 (1.90, 2.57)
Duru, 2022	ICU HCWs, 63% nurses 20–50 years of age, Mage = 33, 82% female Rize, Turkey Jan 2019–Jan 2020 to Jan–April 2021	Successive offline surveys; Panel study Single Tertiary Care Hospital ICU 51 & 51 Cigarette consumption Age, gender & 3 other covariates	Cigarette packs per day M = 0.4 vs 0.7 OR = 2.30 (1.14, 4.63)

Notes. CES-D: Center for Epidemiologic Studies Depression Scale; CI: confidence interval; DASS-21: Depression: Anxiety and Stress Scale; ED: emergency department; GAD-7: Generalized Anxiety Disorder screen; GHQ: General Health Questionnaire; HCWs: health care workers; IES-R: Impact of Event Scale-Revised; M: mean; MBI: Maslach Burnout Inventory; Mdn: median; OR: odds ratio; PCL-5: Posttraumatic Stress Disorder Checklist; PHQ-9: Patent Health Questionnaire screen; PR: prevalence ratio; PROMIS: Patient-Reported Outcome Measurement Information System; PTSD: posttraumatic stress disorder; SAS: Self-Rating Anxiety Scale.

^ap = 0.09.

^bCOVID-19 impact was twice as great among nurses as among other HCWs, the majority of whom were physicians (OR = 2.60 [95% CI 2.03, 3.34]).

*Li, J., Su, Q., Li, X., Peng, Y., & Liu, Y. (2021a). COVID-19 negatively impacts on psychological and somatic status in frontline nurses. Journal of Affective Disorders, 294, 279–285. https://doi.org/10.1016/j.jad.2021.07.031

 PubMed Web of Science ®Google Scholar

*Li, X., Zhou, Y., & Xu, X. (2021b). Factors associated with the psychological well-being among front-line nurses exposed to COVID-2019 in China: A predictive study. Journal of Nursing Management, 29(2), 240–249. https://doi.org/10.1111/jonm.13146

 PubMed Web of Science ®Google Scholar

*Ren, H., Luo, X., Wang, Y., Guo, X., Hou, H., Zhang, Y., Yang, P., Zhu, F., Hu, C., Wang, R., Sun, Y., Du, Y., Yin, Q., Xu, G., Zuo, H., Hu, Q., & Wang, Y. (2021). Psychological responses among nurses caring for patients with COVID-19: A comparative study in China. Translational Psychiatry, 11(1), 273. https://doi.org/10.1038/s41398-020-00993-1

 PubMed Web of Science ®Google Scholar

*Temsah, M. H., Al Huzaimi, A., Alrabiaah, A., Alamro, N., Al-Sohime, F., Al-Eyadhy, A., Alhasan, K., Kari, J. A., Alhaboob, A., Alsalmi, A., AlMuhanna, W., Almaghlouth, I., Aljamaan, F., Halwani, R., Saddik, B., Barry, M., Al-Zamil, F., AlHadi, A. N., Al-Subaie, S., Jamal, A., & Somily, A. M. (2021). Changes in healthcare workers’ knowledge, attitudes, practices, and stress during the COVID-19 pandemic. Medicine, 100(18), e25825. https://doi.org/10.1097/MD.0000000000025825

 PubMed Web of Science ®Google Scholar

*Reverté-Villarroya, S., Ortega, L., Lavedán, A., Masot, O., Burjalés-Martí, M. D., Ballester-Ferrando, D., Fuentes-Pumarola, C., & Botigué, T. (2021). The influence of COVID-19 on the mental health of final-year nursing students: Comparing the situation before and during the pandemic. International Journal of Mental Health Nursing, 30(3), 694–702. https://doi.org/10.1111/inm.12827

 PubMed Web of Science ®Google Scholar

*Havaei, F., Smith, P., Oudyk, J., & Potter, G. G. (2021). The impact of the COVID-19 pandemic on mental health of nurses in British Columbia, Canada using trends analysis across three time points. Annals of Epidemiology, 62, 7–12. https://doi.org/10.1016/j.annepidem.2021.05.004

 PubMed Web of Science ®Google Scholar

*Zakeri, M. A., Rahiminezhad, E., Salehi, F., Ganjeh, H., & Dehghan, M. (2021). Burnout, anxiety, stress, and depression among Iranian nurses: Before and during the first wave of the COVID-19 pandemic. Frontiers in Psychology, 12, 789737. https://doi.org/10.3389/fpsyg.2021.789737

 PubMed Web of Science ®Google Scholar

*Katsuta, N., Ito, K., Fukuda, H., Seyama, K., Hori, S., Shida, Y., Nagura, R., Nojiri, S., & Sato, H. (2021). Elevated depressive symptoms among newer and younger healthcare workers in Japan during the COVID-19 pandemic. Neuropsychopharmacology Reports, 41(4), 544–547. https://doi.org/10.1002/npr2.12217

 PubMed Web of Science ®Google Scholar

*Oosthuizen, S., Bergh, A.-M., Silver, A., Malatji, R., Mfolo, V., & Botha, T. (2022). Maternity healthcare providers’ self-perceptions of well-being during COVID-19: A survey in Tshwane Health District, South Africa. African Journal of Primary Health Care & Family Medicine, 14(1), e1–e10. https://doi.org/10.4102/phcfm.v14i1.3034

 PubMed Web of Science ®Google Scholar

*Harry, S. (2021). Predictors of burnout for frontline nurses in the COVID-19 pandemic: Well-being, satisfaction with life, social support, fear, work setting factors, psychological impacts, and self-efficacy for nursing tasks (Publication No. 28498893) [Doctoral dissertation]. Columbia University. ProQuest Dissertations & Theses Global.

 Google Scholar

*Obeidat, N. A., Dodin, Y. I., Hawari, F. I., Albtoosh, A. S., Manasrah, R. M., & Mansour, A. H. (2022). Mitigating psychological distress in healthcare workers as COVID-19 waves ensue: A repeated cross-sectional study from Jordan. Human Resources for Health, 20(1), 32. https://doi.org/10.1186/s12960-022-00728-x

 PubMed Web of Science ®Google Scholar

*Duru, H. (2022). The continuing effect of COVID-19 pandemic on physical well-being and mental health of ICU healthcare workers in Turkey: A single-centre cross-sectional later-phase study. Journal of Intensive Care Medicine, 37(9), 1206–1214. https://doi.org/10.1177/08850666211070740

 PubMed Web of Science ®Google Scholar