Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis

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Abstract

Objective

Pandemics negatively impact healthcare workers’ (HCW’s) mental health and well-being causing additional feelings of anxiety, depression, moral distress and post-traumatic stress. A comprehensive review and evidence synthesis of HCW’s mental health and well-being interventions through pandemics reporting mental health outcomes was conducted addressing two questions: (1) What mental health support interventions have been reported in recent pandemics, and have they been effective in improving the mental health and well-being of HCWs? (2) Have any mobile apps been designed and implemented to support HCWs’ mental health and well-being during pandemics?

Design

A narrative evidence synthesis was conducted using Cochrane criteria for synthesising and presenting findings when systematic review and pooling data for statistical analysis are not suitable due to the heterogeneity of the studies.

Data sources

Evidence summary resources, bibliographic databases, grey literature sources, clinical trial registries and protocol registries were searched.

Eligibility criteria

Subject heading terms and keywords covering three key concepts were searched: SARS-CoV-2 coronavirus (or similar infectious diseases) epidemics, health workforce and mental health support interventions. Searches were limited to English-language items published from 1 January 2000 to 14 June 2022. No publication-type limit was used.

Data extraction and synthesis

Two authors determined eligibility and extracted data from identified manuscripts. Data was synthesised into tables and refined by coauthors.

Results

2694 studies were identified and 27 papers were included. Interventions were directed at individuals and/or organisations and most were COVID-19 focused. Interventions had some positive impacts on HCW’s mental health and well-being, but variable study quality, low sample sizes and lack of control conditions were limitations. Two mobile apps were identified with mixed outcomes.

Conclusion

HCW interventions were rapidly designed and implemented with few comprehensively described or evaluated. Tailored interventions that respond to HCWs’ needs using experience co-design for mental health and well-being are required with process and outcome evaluation.

Related collections

Most cited references 71

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A brief measure for assessing generalized anxiety disorder: the GAD-7.

Robert L Spitzer, Kurt Kroenke, Janet B W Williams … (2006)

Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

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The PHQ-9: validity of a brief depression severity measure.

K Kroenke, R L Spitzer, J. Williams (2001)

While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

Daniel J. Buysse, Charles Reynolds III, Timothy H Monk … (1989)

Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2022

Publication date (Electronic): 7 November 2022

Publication date PMC-release: 7 November 2022

Volume: 12

Issue: 11

Electronic Location Identifier: e061317

Affiliations

[1 ]departmentPrimary Care Mental Health Research Program, Department of General Practice, Melbourne Medical School , The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences , University of Melbourne, Victoria, Australia

[2 ]departmentThe ALIVE National Centre for Mental Health Research Translation, Department of General Practice, Melbourne Medical School , The University of Melbourne Faculty of Medicine, Dentistry and Health Sciences , Melbourne, Victoria, Australia

[3 ]departmentDepartment of Medicine , University of Melbourne , Melbourne, Victoria, Australia

[4 ]departmentDepartment of Cardiology , The Royal Melbourne Hospital , Parkville, Victoria, Australia

[5 ]departmentThe Centre for Digital Transformation of Health Faculty of Medicine, Dentistry and Health Sciences , The University of Melbourne , Parkville, Vic, Australia

[6 ]departmentThe Department of Psychiatry, Melbourne Medical School, Facutly of Medicine, Dentistry and Health Sciences , The University of Melbourne , Parkville, Vic, Australia

[7 ]departmentEmergency Medicine , The Royal Melbourne Hospital , Melbourne, Victoria, Australia

Author notes

[Correspondence to ] Professor Victoria J Palmer; v.palmer@ 123456unimelb.edu.au

KR-B and ML are joint first authors.

Author information

Matthew Lewis http://orcid.org/0000-0001-7973-0716

Caroline Johnson http://orcid.org/0000-0002-4755-7514

Victoria J Palmer http://orcid.org/0000-0001-7212-932X

Article

Publisher ID: bmjopen-2022-061317

DOI: 10.1136/bmjopen-2022-061317

PMC ID: 9644079

PubMed ID: 36344001

SO-VID: 6cef6691-6798-49ea-a8e0-339f250dab96

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 31 January 2022

Date accepted : 24 October 2022

Funding

Funded by: Peter Doherty Philanthropic Trust Fund;

Award ID: N/A

Funded by: FundRef http://dx.doi.org/10.13039/501100001782, University of Melbourne;

Award ID: N/A

Funded by: FundRef http://dx.doi.org/10.13039/100012775, Royal Melbourne Hospital;

Award ID: N/A

Funded by: Australian Government Department of Health;

Award ID: N/A

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special-feature unlocked

access-type free

ScienceOpen disciplines: Medicine

Keywords: mental health,covid-19,adult psychiatry,accident & emergency medicine

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ScienceOpen disciplines: Medicine

Keywords: mental health, covid-19, adult psychiatry, accident & emergency medicine

Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis

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Abstract

Objective

Design

Data sources

Eligibility criteria

Data extraction and synthesis

Results

Conclusion

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 71

A brief measure for assessing generalized anxiety disorder: the GAD-7.

The PHQ-9: validity of a brief depression severity measure.

The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

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