The prevalence of depressive symptoms among frontline healthcare workers during COVID-19 pandemic: A rapid umbrella review

INTRODUCTION

The COVID-19 pandemic emerged in Wuhan, China, in late 2019 and spread across the world in a short time.^[1-8] It not only caused significant mortality and morbidity rates but also had dramatic health consequences, such as mental health conditions.^[9-12]

The healthcare worker (HCW) population, especially frontline HCWs, would potentially have a higher vulnerability to such conditions.^[13-17] The fear of COVID-19 infection, witnessing COVID-caused colleague mortality, prolonged work shifts, the unavailability of effective therapeutic strategies, social distancing, separation from family/colleagues, and the severe illness of COVID-19 patients were among the factors that could pose an adverse effect on the mental health of HCWs.^[16]

There is a large body of research with multiple reviews on the rate of mental conditions in the HCW community.^[15,18-22] Earlier works have reported contradictory results on the rate of depression in HCWs.^[8,15,20-23] To the best of the authors’ knowledge, this study pioneers the analysis of the rate of depression in frontline HCWs on a global scale through the rapid umbrella approach.

MATERIAL AND METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adopted in this review.^[24]

RESULTS

Figure 1 represents the potential papers, search and screaming procedure, and reported findings.

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Figure 1:

PRISMA flowchart of literature search.

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DISCUSSION

This study used the rapid umbrella technique to tackle the inconsistency in reports on the prevalence rate of depression in frontline HCWs during the COVID-19 pandemic.

The results of this study showed that the prevalence rate of depressive symptoms among all HCWs ranged from 24% to 36%, and among frontline HCWs ranged from 14% to 53%.

A review of earlier reports demonstrated that the findings had been highly consistent, in agreement with earlier umbrella reviews on the HCW community.

A depression rate of 5–89% was reported in earlier umbrella reviews, reviews, and meta-analyses for general populations, HCWs, and frontline HCWs.^{[8,16,18,20,26,32-37]}

The included reviews were found to be significantly heterogeneous. This heterogeneity is potentially the explanation for the substantial variation of depression rates reported for HCWs and frontline HCWs. Different methodologies, depression assessment measures, sampling techniques, cut-off points, locations, methodological shortcomings/defects, and demographics can be other explanations.^[20,38]

This study found that primary studies had been conducted in a broad range of countries with various socioeconomic and cultural differences using various methodologies, e.g., different depression assessment measures with various cutoffs. This agrees with the literature.

Most of the papers had biased sampling since they did not sample participants randomly. This can be an explanation for the significant variation/inconsistency in the rates of depression prevalence. This study estimated a larger depression rate for female HCWs than for male HCWs, for nurses than for doctors, and frontline HCWs than for nonfrontline HCWs. This agrees with earlier works. Fan et al.^[11] adopted an umbrella approach and found that HCWs in high-risk settings had short- and long-term mental health conditions, including post-traumatic stress disorder, anxiety, and depression, during pandemics/epidemics.

Chigwerde et al.^[39] reported a systematic review to find potential mental health risks, e.g., frontline healthcare (high-risk) settings, nurse/female, unavailability of personal protection equipment, inadequate virus knowledge, prolonged work shifts, lack of social support, experience, poor healthcare, history of quarantine, and poor/no education.

Koontalay et al.^[40] analyzed the COVID-caused burden on HCWs through a qualitative systematic review. Insufficient equipment, emotional challenges, occupational burnout, and insufficient knowledge were categorized as themes with negative impacts on both the mental and physical health of frontline HCWs, ultimately causing depression, stress, anxiety, and fear.

CONCLUSION

This study adopted an umbrella review approach and found significant inconsistency in the reported rates of depression prevalence in HCWs and explained it by heterogeneity in earlier works. Nevertheless, HCWs, especially frontline HCWs, have been reported to have high prevalence rates of depressive symptoms during the COVID-19 pandemic. It is recommended that preventive measures be implemented to mitigate depression in the HCW community.

Due to the significant heterogeneity/inconsistency of the reported depression rates, it is suggested that efficient and effective techniques should be coupled with the same depression assessment measures in future research to minimize errors. It is also recommended that future systematic reviews, particularly meta-analyses, review primary studies of higher homogeneity to maximize prevalence rate synthesis in various papers.