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      IMPACT OF CORONAVIRUS SYNDROMES ON PHYSICAL AND MENTAL HEALTH OF HEALTH CARE WORKERS: SYSTEMATIC REVIEW AND META-ANALYSIS

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          Highlights

          • This systematic review and meta-analysis has identified the top 10 physical and mental health outcomes in health care workers infected or exposed to coronavirus syndromes (Severe Acute Respiratory Syndrome -SARS-, Middle East Respiratory Syndrome -MERS-, Novel coronavirus -COVID-19-).

          • The physical and mental health burden associated with SARS/MERS/COVID-19 in health care workers is high.

          • These findings could inform public health strategies to detect the most frequent physical and mental health outcomes in health care workers, monitor their course and implement preventive/treatment measures to mitigate their effect in this vulnerable population

          Abstract

          Background

          Health care workers (HCW) are at high risk of developing physical/mental health outcomes related to coronavirus syndromes. Nature and frequency of these outcomes are undetermined.

          Methods

          PRISMA/MOOSE-compliant (PROSPERO-CRD42020180205) systematic review of Web of Science/grey literature until 15th April 2020, to identify studies reporting physical/mental health outcomes in HCW infected/exposed to Severe Acute Respiratory Syndrome -SARS-, Middle East Respiratory Syndrome -MERS-, Novel coronavirus -COVID-19-. Proportion random effect meta-analyses, I 2 statistic, quality assessment and sensitivity analysis.

          Results

          115 articles were included (n=60,458 HCW, age 36.1±7.1, 77.1% female). Physical health outcomes: 75.9% HCW infected by SARS/MERS/COVID-19 reported fever (95%CI=65.9%-83.7%, k=12, n=949), 47.9% cough (95%CI=39.2%-56.8%, k=14, n=970), 43.6% myalgias (95%CI=31.9%-56.0%, k=13, n=898), 42.3% chills (95%CI=20.2%-67.9%, k=7, n=716), 41.2% fatigue (95%CI=18.2%-68.8%, k=6, n=386), 34.6% headaches (95%CI=23.1%-48.2%, k=11, n=893), 31.2% dyspnoea (95%CI=23.2%-40.5%, k=12, n=1003), 25.3% sore throat (95%CI=18.8%-33.2%, k=8, n=747), 22.2% nausea/vomiting (95%CI=14.9%-31.8%, k=6, n=662), 18.8% diarrhoea (95%CI=11.9%-28.4%, k=9, n=824). Mental health outcomes: 62.5% HCW exposed to SARS/MERS/COVID-19 reported general health concerns (95%CI=57.0%-67,8%, k=2, n=2254), 43.7% fear (95%CI=33.9%-54.0%, k=4, n=584), 37.9% insomnia (95%CI=30.9%-45.5%, k=6, n=5067), 37.8% psychological distress (95%CI=28.4%-48.2%, k=15, n=24,346), 34.4% burnout (95%CI=19.3%-53.5%, k=3, n=1337), 29.0% anxiety features (95%CI=14.2%-50.3%, k=6, n=9191), 26.3% depressive symptoms (95%CI=12.5%-47.1%, k=8, n=9893), 20.7% post-traumatic stress disorder features (95%CI=13.2%-31%, k=11, n=3826), 16.1% somatisation (95%CI=0.2%-96.0%, k=2, n=2184), 14.0% stigmatisation feelings (95%CI=6.4%-28.1%, k=2, n=411).

          Limitations

          Limited amount of evidence for some outcomes and suboptimal design in several studies included.

          Conclusions

          SARS/MERS/COVID-19 have a substantial impact on the physical and mental health of HCW, which should become a priority for public health strategies.

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          Most cited references112

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

            Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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              Meta-analysis in clinical trials

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                Author and article information

                Contributors
                Journal
                J Affect Disord
                J Affect Disord
                Journal of Affective Disorders
                Elsevier B.V.
                0165-0327
                1573-2517
                25 June 2020
                25 June 2020
                Affiliations
                [a ]Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
                [b ]Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
                [c ]Mental Health Department. Biocruces Bizkaia Health Research Institute. Basurto University Hospital. Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Bizkaia, Spain
                [d ]Institute of Psychiatry and Mental Health. Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Madrid, Spain
                [e ]Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
                [f ]Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K.
                [g ]Section of Psychiatry, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
                [h ]Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
                [i ]Neurosciences Department, University of Padua, Padua, Italy
                [j ]Padua Neuroscience Center, University of Padua, Padua, Italy
                [k ]OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
                [l ]National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
                Author notes
                [* ]Correspondence to: Dr. Gonzalo Salazar de Pablo, Department of Psychosis Studies, 5th Floor, Institute of Psychiatry, Psychology & Neuroscience, PO63, 16 De Crespigny Park, SE5 8AF London, UK. gonzalo.salazar_de_pablo@ 123456kcl.ac.uk
                Article
                S0165-0327(20)32380-6
                10.1016/j.jad.2020.06.022
                7314697
                32658823
                fb379110-b530-4ab5-a57d-702b06256390
                © 2020 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 13 May 2020
                : 17 June 2020
                : 22 June 2020
                Categories
                Article

                Clinical Psychology & Psychiatry
                coronavirus,covid-19,sars,mers,health care workers,meta-analysis
                Clinical Psychology & Psychiatry
                coronavirus, covid-19, sars, mers, health care workers, meta-analysis

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