A qualitative review about effective

interventions to address mental health

problems in healthcare professionals
during the COVID-19 pandemic
MPHP31: Global Public Health

September 28th, 2020

Introduction

The uncertainty of covid-19 pandemic has generated a massive impact on the physical and
mental health in healthcare professionals (HCPs) worldwide. Thus, due to the lack of options to
properly address the severity effects of the COVID-19 and the rapid increase of cases in a short
time, many HCPs started to feel the impact of the health emergency through their level of stress
and anxiety. Beyond the current worldwide health-emergency because of the pandemic, HCPs
have been facing a significant level of work-related stress concerning their responsibilities and
duties. Moreover, in the last 17 years, HCPs have been facing similar circumstances with
epidemics such as SARS in 2003 or H1N1 in 2009. (Stuijfzand et al., 2020, Ornell et al., 2020).
The internal and external factors that HCPs use to face because of their jobs are well known.
However, their quality of life started to be compromised at a highest biopsychosocial level if we
take into consideration the high workload, job stress, and time pressure they have to deal with
while trying to save as many lives as they can during the COVID-19 pandemic (Morgantini et
al., 2020). As a result, it seems that the current situation can generate a psychological impact
reflected in the proliferation of burnout cases, the amount of anxiety, depression, insomnia, and
in the more critical, alcoholism, suicidal ideation, drug addiction, and post-traumatic stress
disorder (PTSD) (Stuijfzand et al., 2020).
Subsequently, the spread of the virus has generated an overuse of healthcare services such as
hospitals and private practice, increasing the risk of contagion of HCPs. In consequence, it has
become usual that HCPs are worried about the possibility of getting sick, further escalating their
stress and anxiety levels, and thus interfering with their motivation to work (Teixeira et al.,
2020). From the beginning of the pandemic and taking into consideration the side effects related
to the caring of patients, we can find a body of research trying to figure out how affected the
mental health in HCPs during the COVID-19 pandemic is. The purpose of this paper is then to
conduct a qualitative review to understand the lack of information about effective intervention to
address mental health problems in healthcare professionals during the COVID-19 pandemic.
Recommendations on improving access to prevention and intervention mental health programs
for HCPs will then be given.
Methodology and study design

Type of Study
This is a non-systematic narrative literature review study, with the principal purpose of
summarizing evidence using a qualitative method to collect and interpret information and reports
on the topic. This qualitative approach allows the author to make a full description of the articles
related to the aim of the study.

Hypothesis
The author developed this study under the hypothesis that, despite the awareness related to the
mental health issues that HCPs could face during the COVID-19 pandemic, there is a lack of
information about effective intervention to address their mental health problems. There is not
sufficient information about how to address those issues in HCPs.

Research Question
Based on the Hypothesis the authors framed the research question and secondary question using
the PICO framework:

Central Question: Have frameworks been developed to address the mental health of healthcare
professionals during the pandemic?

Secondary Question: Have frameworks been implemented to address the mental health of
healthcare professionals during the pandemic?

P –Problem: Lack of information about effective intervention to address mental health problems
in healthcare professionals during the Covid-19 pandemic.

I – Intervention: collect the information about approaches developed worldwide to face the
mental health problems during the Covid-19 pandemic.
C – Comparison: No collection of information and persistence in the lack of evidence on the
topic

O – Outcome: Increase the evidence of mental health programs in the context of the COVID
Pandemic.

Search Method
The literature search took place in CABI (Global Health) and PubMed with the search terms:
"Mental health" AND "Healthcare professionals" AND ("Covid-19" OR "Coronavirus" OR
"SARS-CoV-2"). The titles and abstracts of a total of 45 original articles were then examined as
per the author’s criteria. Some of the results obtained during data collection were found to be the
magazine editor’s mail or opinion pieces. This type of article was disregarded during the
magazine’s articles selection process. Subsequently, articles were required to be in English so all
those that were found to be in other languages (German and Chinese) were marginated as well,
except one in Spanish that was reviewed as the author’s native language. Due to how recent the
topic is, all articles have been published in 2020. In consequence, all chosen articles for this
literature review must be peer-reviewed and published by scientific journals. Also, some of the
articles highlight that the main reason for the papers is worldwide, beyond cultural and social
factors.
In consequence, a total of 13 articles matched the selection criteria and were included in
the paper.

Results

A total of six general topics emerged as the main factors implicated in the affliction of mental
health in HCPs during the COVID-19 pandemic. The first topic is related to the awareness of
mental health issues in HCPs, which was dominant in all of the reviewed articles, considering
that HCPs are coping with high levels of psychological distress, anxiety, and depression as a
consequence of the COVID-19 pandemic (García-Iglesias et al., 2020, Stuijfzand et al., 2020). A
second topic is the possibility of an intervention providing psychosocial support to protect the
mental wellbeing of HCPs, considering previous experiences attending other
epidemics/pandemics such a COVID-19 (Fuchs et al., 2020, Stuijfzand et al., 2020). The third
topic is the recognition of preexisting conditions before the COVID-19 pandemic. In other
words, the fact that those mental health issues in HCPs existed before the COVID-19 and the
possibility that it could exacerbate them (Barzilay et al., 2020, Ruiz-Fernández et al., 2020,
Sharma et al., 2020). A fourth topic is a distinction between frontline and second-line medical
workers coping with the COVID-19 pandemic. The mental health issues that HCPs face could be
different depending on the role they occupy attending the health emergency (Wańkowicz et al.,
2020). The fifth topic is related to the social recognition of the role played by HCPs during the
COVID-19 pandemic (Ruiz-Fernández et al., 2020). Finally, the sixth topic is related to the
barriers and limitations, including socio-cultural characteristics (Ornell et al., 2020), the
variability in the perception of care and service, as well as sensation of danger and exposure
(Neto et al., 2020).

Awareness of mental health issues in HCPs

The dominating theme of awareness of mental health issues in HCPs referred to the acceptance
that coping with the COVID-19 pandemic is generating a significant impact on the mental
wellbeing of HCPs. (Barzilay et al., 2020, Fuchs et al., 2020, Neto et al., 2020, Ruiz-Fernández
et al., 2020, Sharma et al., 2020, Stuijfzand et al., 2020). Even though HCPs have been exposed
to those situations before the pandemic, it seems clear in the current circumstances the HCPs are
at risk to increase. As a result, their motivation could be resembling compromised.

Psychosocial support for HCPs

An early and properly intervention provides psychosocial support to preserve mental wellbeing
and reduce psychological distress, insomnia, anxiety, and depression. Furthermore, considering
previous experiences attending other epidemics or pandemics such a COVID-19 (i.e., SARS in
2003 or H1N1 in 2009) (Stuijfzand et al., 2020).

Recognition of preexisting mental health issues in HCPs

The COVID-19 pandemic generates that population awareness about the pressure that HCPs
have facing indistinct of the current emergency. Some articles agreed that the COVID-19 could
exacerbate aspects related to psychological distress, anxiety, and depression that have been
connected with external factors (environment) and internal factors (motivation and self-esteem)
before. Besides, new elements are affecting the mental wellbeing of HCPs such as transmitting
the COVID-19 to family and community, sense of vulnerability and exposer, and poor
communication with their supervisors and colleagues (Sharma et al., 2020).

Distinction between frontline and second-line medical workers coping with COVID-19 pandemic
Some articles explain that the sense of danger and high risk of contagion change depending on
the duties that HCPs are facing related to the COVID-19 pandemic. Therefore, the HCPs are on
the frontline response show more severe deteriorate mental well-being than that HCPs are on the
second-line medical service (Barzilay et al., 2020).

Social recognition of HCPs during the COVID-19 pandemic

Due to the COVID-19 pandemic, HCPs started to earn acknowledgment for their effort looking
to cope with the uncertainty and seeking to save as many lives as they can. Paradoxically, the
increasing information related to the pandemic generates a complicated relationship between the
general population and HCPs, exposing them to being stigmatized and even more, psychical and
psychologically attacked by the exclusion process. Therefore, psychological distress, anxiety,
and depression in HCPs are regularly increasing (Hacimusalar et al., 2020).

Barriers and Limitations

Even when some articles recognized the importance of addressing mental health problems in
HCPs, it’s not clear what kind of mental health resources HCPs can incorporate pondering the
necessity of coping with those stressful situations they are at risk of getting exposed (Morgantini
et al., 2020). Also, the internal and external resources could change in each HCPs if we take into
consideration the socio-cultural characteristics inherent to their homeland locations (Ornell et al.,
2020) despite the fact those stressful factors are common in all HCPs, indistinct of where they
belong.
Discussion

Related to the aim of the study, it has to take into consideration that the people are aware of the
mental health issues in HCPs. That could happen for multiple reasons. Firstly, because a
significant number of HCPs are using their social media as a communicational channel. Besides,
their content started to get viral, so it’s likely common that people try to figure out what is
proceeding with HCPs in both individual and social aspects. Secondly, because the people, as
potential patients or with relatives as patients, started to identify a notorious level of tiredness in
HCPs (Stuijfzand et al., 2020).

The mental health problems were the dominant topic in all the articles reviewed. Each article
remarked the common mental health issues both individual and social way. In the individual
path, it found aspects such as stress (including emotional exhaustion such a burnout experience),
anxiety, and depression. Some of the articles explore the severe cases of mental health problems,
which PSTD and suicidal ideation were the most remarkable aspect to analyze. In the social path,
it was necessary to consider the fear of being exposed to the virus affecting their relatives as a
linked consequence.

Almost all the articles referred to relate to the possible intervention provide psychosocial support
to protect the mental wellbeing of HCPs. It makes a significant reference to taking into
consideration previous experiences attending other epidemics such a COVID-19. However, it is
not clear how an effective intervention, focus on address mental health issues, could be
conducted.

Those stressful factors are common in all HCPs, beyond the socio-cultural characteristics.
Therefore, it should be outstanding to avoid underestimating the external and internal factors
related to the mental health issues in all HCPs. Also, it should be considering the value of
implementing intervention programs in both prevention and promotion of mental wellbeing and
attempting those who are facing mental health issues such as anxiety, depression, and even more
PSTD (Nahandi et al., 2020). It turns realistic to talk about the importance of developing
prevention programs to address properly mental health issues in HCPs. Nevertheless, it is
indispensable a full commitment of organizations (governmental and non-governmental) to make
improvements related to facilitate a better cope of stressful situations. The HCP's physical and
emotional needs are supporting-related issues and environmental factors (e.g., helping with
childcare, transportation, temporary housing). Those necessities impact both individual and
organizational levels. So far, none of the articles reviewed are clear about how governmental and
non-governmental can implement coping strategies for it, despite the socio-cultural characteristic
in each country.

Finally, two questions that should be fully answered in new research related to mental health
issues in HCPs: Firstly, what about mental well-being programs? It is imperative to recognize
that mental health issues in HCPs started before the pandemic. Therefore, a lack of information
about the mental health issues in HCPs obeys to aspects that have no connection with the
COVID-19 pandemic. COVID it’s not a one-time event, which means we could face ups and
downs in the treatments related to this virus.

Secondly, what about the approaches developed worldwide to face the mental health problems in
healthcare professionals before the COVID-19 pandemic? The articles reviewed focused their
attention on evaluating the current mental health affliction as a consequence of the COVID-19.
However, the possibility of verifying how bad was the situation that HCPs were facing before the
pandemic started it seems far shortly. In the same way, it looks unlikely the probability of
developing different types of interventions that should be considering taking into account the
increasing levels of psychological and emotional risks such as anxiety, depression, and in the
severe cases, alcoholism, drug-addiction, PSTD, and suicidal ideation.

Conclusion

Because of the unpredictability of COVID-19, HCPs have a considerable high risk of developing
a mental health issue. It is not clear the healthcare systems worldwide are realized of the increase
of those situations that could be affecting HCPs in a short-middle time if we consider the high-
level exposure of psychological distress they have to face for multiple reasons. Although it’s
clear the necessity to think about different strategies to help HCPs coping with their mental
health problems, it should be considered a proper intervention that takes into concern the internal
and external factors that influence mental wellbeing.

Furthers investigations should focus on developing effective interventions to address mental

health problems in HCPs. Previews research had taken into account afflictions related to the
mental health of HCPs before the pandemic. Also, the unquestionable fact that HCPs are
suffering from significant complications related to mental wellbeing and life quality.
References

Primary references

BARZILAY, R., MOORE, T. M., GREENBERG, D. M., DIDOMENICO, G. E., BROWN, L.

A., WHITE, L. K., GUR, R. C. & GUR, R. E. 2020. Resilience, COVID-19-related
stress, anxiety and depression during the pandemic in a large population enriched for
healthcare providers. Translational Psychiatry, 10.
FUCHS, A., ABEGGLEN, S., BERGER-ESTILITA, J., GREIF, R. & EIGENMANN, H. 2020.
Distress and resilience of healthcare professionals during the COVID-19 pandemic
(DARVID): study protocol for a mixed-methods research project. BMJ Open, 10,
e039832.
GARCÍA-IGLESIAS, J. J., GÓMEZ-SALGADO, J., MARTÍN-PEREIRA, J., FAGUNDO-
RIVERA, J., AYUSO-MURILLO, D., MARTÍNEZ-RIERA, J. R. & RUIZ-FRUTOS, C.
2020. [Impact of SARS-CoV-2 (Covid-19) on the mental health of healthcare
professionals: a systematic review.]. Rev Esp Salud Publica, 94.
HACIMUSALAR, Y., KAHVE, A. C., YASAR, A. B. & AYDIN, M. S. 2020. Anxiety and
hopelessness levels in COVID-19 pandemic: A comparative study of healthcare
professionals and other community sample in Turkey. Journal of Psychiatric Research,
129, 181-188.
MORGANTINI, L. A., NAHA, U., WANG, H., FRANCAVILLA, S., ACAR, Ö., FLORES, J.
M., CRIVELLARO, S., MOREIRA, D., ABERN, M., EKLUND, M., VIGNESWARAN,
H. T. & WEINE, S. M. 2020. Factors contributing to healthcare professional burnout
during the COVID-19 pandemic: A rapid turnaround global survey. PLOS ONE, 15,
e0238217.
NAHANDI, M. Z., SHAHROKHI, H., FARHANG, S. & SOMI, M. H. 2020. Virtual social
networks and mental health intervention for medical staff during the COVID-19 outbreak
in the Islamic Republic of Iran. Eastern Mediterranean Health Journal, 26, 497-498.
NETO, M. L. R., ALMEIDA, H. G., ESMERALDO, J. D. A., NOBRE, C. B., PINHEIRO, W.
R., DE OLIVEIRA, C. R. T., SOUSA, I. D. C., LIMA, O. M. M. L., LIMA, N. N. R.,
MOREIRA, M. M., LIMA, C. K. T., JÚNIOR, J. G. & DA SILVA, C. G. L. 2020. When
health professionals look death in the eye: the mental health of professionals who deal
daily with the 2019 coronavirus outbreak. Psychiatry Research, 288, 112972.
ORNELL, F., HALPERN, S. C., KESSLER, F. H. P. & NARVAEZ, J. C. D. M. 2020. The
impact of the COVID-19 pandemic on the mental health of healthcare professionals.
Cadernos de Saúde Pública, 36.
RUIZ-FERNÁNDEZ, M. D., RAMOS-PICHARDO, J. D., IBÁÑEZ-MASERO, O.,
CABRERA-TROYA, J., CARMONA-REGA, M. I. & ORTEGA-GALÁN, Á. M. 2020.
Compassion fatigue, burnout, compassion satisfaction, and perceived stress in healthcare
professionals during the COVID-19 health crisis in Spain. Journal of Clinical Nursing.
SHARMA, M., CREUTZFELDT, C. J., LEWIS, A., PATEL, P. V., HARTOG, C., JANNOTTA,
G. E., BLISSITT, P., KROSS, E. K., KASSEBAUM, N., GREER, D. M., CURTIS, J. R.
& WAHLSTER, S. 2020. Healthcare professionals’ perceptions of critical care resource
 availability and factors associated with mental well-being during COVID-19: Results
from a US survey. Clinical Infectious Diseases.
STUIJFZAND, S., DEFORGES, C., SANDOZ, V., SAJIN, C.-T., JAQUES, C., ELMERS, J. &
HORSCH, A. 2020. Psychological impact of an epidemic/pandemic on the mental health
of healthcare professionals: a rapid review. BMC Public Health, 20.
TEIXEIRA, C. F. D. S., SOARES, C. M., SOUZA, E. A., LISBOA, E. S., PINTO, I. C. D. M.,
ANDRADE, L. R. D. & ESPIRIDIÃO, M. A. 2020. A saúde dos profissionais de saúde
no enfrentamento da pandemia de Covid-19. Ciência & Saúde Coletiva, 25, 3465-3474.
WAŃKOWICZ, P., SZYLIŃSKA, A. & ROTTER, I. 2020. Assessment of Mental Health
Factors among Health Professionals Depending on Their Contact with COVID-19
Patients. International Journal of Environmental Research and Public Health, 17, 5849.

Secondary references

BLAKE, H., BERMINGHAM, F., JOHNSON, G. & TABNER, A. 2020. Mitigating the
psychological impact of COVID-19 on healthcare workers: a digital learning package.
International Journal of Environmental Research and Public Health, 17.
CAI, Q., FENG, H., HUANG, J., WANG, M., WANG, Q., LU, X., XIE, Y., WANG, X., LIU,
Z., HOU, B., OUYANG, K., PAN, J., LI, Q., FU, B., DENG, Y. & LIU, Y. 2020. The
mental health of frontline and non-frontline medical workers during the coronavirus
disease 2019 (COVID-19) outbreak in China: a case-control study. Journal of Affective
Disorders, 275, 210-215.
SETHI, B. A., AHSAN, S., SADAF, A. & AAMIR, H. S. 2020. Impact of Coronavirus disease
(COVID-19) pandemic on health professionals. Pakistan Journal of Medical Sciences, 36,
S6-S11.
SI, M., SU, X., JIANG, Y., WANG, W., GU, X., MA, L., LI, J., ZHANG, S., REN, Z., REN, R.,
LIU, Y. & QIAO, Y. 2020. Psychological impact of COVID-19 on medical care workers
in China. Infectious Diseases of Poverty, 9, (12 August 2020).
STUIJFZAND, S., DEFORGES, C., SANDOZ, V., SAJIN, C. T., JAQUES, C., ELMERS, J. &
HORSCH, A. 2020. Psychological impact of an epidemic/pandemic on the mental health
of healthcare professionals: a rapid review. BMC Public Health, 20, (12 August 2020).
SUN, N., WEI, L., SHI, S., JIAO, D., SONG, R., MA, L., WANG, H., WANG, C., WANG, Z.,
YOU, Y., LIU, S. & WANG, H. 2020. A qualitative study on the psychological
experience of caregivers of COVID-19 patients. AJIC - American Journal of Infection
Control, 48, 592-598.