Table 1

Prevalence of mental health problems among the front-line healthcare workers during various pandemics

Author details Study type Participants Measures Prevalence
Severe acute respiratory syndrome (SARS) epidemic (2003)
Nickell et al
Survey questionnaireDoctors, nurses, allied HPGHQ-1229% of total: probable emotional distress
45%: among nurses
Su et al
Interview based, prospectiveNurses
SARS regular, neurology, CCU)
Attitude scale
Baseline: SARS versus non-SARS units:
depression: 38.5% vs 3.1%, insomnia: 37% vs 9.7%, PTSD: no difference.
SARS ICU, SARS regular, neurology versus CCU: PTSD: 29.7% vs 11.8%.
SARS unit nurse: significant reduction in mood ratings, insomnia rate and perceived negative feelings as well as increasing knowledge and understanding of SARS at the end of the study.
Maunder (Canada)3 Survey questionnaireHospital workersIES-R
Self-rated attitude scale towards SARS
High distress: 36.0%
High IES score related to: being a nurse, contact with patient with SARS and having children at home.
Contributory factors: job stress, perceiving stigmatisation, coping by avoiding crowds and colleagues, and feeling scrutinised.
McAlonan et al (Hong Kong)19 1 year longitudinalHealthcare workers (high vs low risk)PSS-10
Baseline: high PSS-10 score in both the groups (non-significant difference).
Follow-up: higher PSS-10 score in high risk (vs low risk).
PSS score correlated with anxiety, depression, PTS scores.
Poon et al
(Hong Kong)31
Survey questionnaireHospital and administrative staffsSTAI
Higher anxiety: among the hospital workers who had contact with patient with SARS (vs no contact).
Higher anxiety: among workmen, healthcare assistants and nurses (vs administrative staff controls or doctors).
Anxiety score correlated with the burnout score.
Wu et al (2009)
Self-report questionnaireHospital and administrative staffsIES-R10%: high level of PTS symptoms
Higher PTS symptoms among those who worked in high-risk areas (quarantined, exposed to SARS, had SARS-positive close friend).
Bai et al (2009)
Hospital and administrative staffsIES-R
Questionnaire for SARS-related risk perception
5%: acute stress reaction (ASR)
20%: felt stigmatised
15%: fear of being a contagion
Quarantine related to ASR
Marjanovic et al (Toronto)22 Online questionnaireNurseSARS-related stress reactions questionnaire
Avoidance behaviour questionnaire
Higher levels of vigour, organisational support and trust in equipment/infection control initiative; and lower levels of contact with patients with SARS, and time spent in quarantine—predicted to lower levels of avoidance behaviour, emotional exhaustion and state anger.
Middle East respiratory syndrome (MERS) (2012)
Khalid et al (Jeddah)33 Survey questionnaireHospital staff worked in high-risk areaMERS-CoV staff questionnaireInnate professional and ethical obligation pushed the healthcare workers to continue their jobs.
Main concern is about one’s safety.
Positive attitude in the workplace: biggest impact in reducing stress.
Motivator to work: PPEs, availability of a possible cure for the disease, provision of disability benefits and family support.
Park et al
(South Korea)28
Convenient samplingNurseShort Form-36
Dispositional resilience scale, Stigma scale
Stigma directly and indirectly (through stress) caused mental health problems while
hardiness directly and indirectly (by decreasing stress) reduced mental health problems.
Ebola outbreak (2014–2016)
McMahon et al (Sierra Leone)9 QualitativeFront-line HCWsDistrust and hypervigilance prevailed among themselves.
Common feelings of loneliness, ostracised, unloved, afraid, saddened and no longer respected.
Restriction in behaviour (social distancing) had ill effects on coping.
Swine flu pandemic (2009)
Mishra et al
Survey questionnaireHPs
(medical and dental)
Beck’s Anxiety Inventory
Knowledge and attitude questionnaire
98.5% HP score higher than cut-off for anxiety.
Medical professionals had higher knowledge about vaccine.
Dental professionals were more reluctant to treat the swine flu-positive patients.
COVID-19 (2020 ongoing)
Kang et al
Online surveyMedical and nursing staffPHQ-9, GAD-7, ISI, IES-R34.4% had mild, 22.4% had moderate and 6.2% had severe disturbances.
Lai et al
Multicentric, cross-sectional, hospital- based surveyHCWsPHQ-9, GAD-7, ISI, IES-R50.4%: symptoms of depression; 44.6%: anxiety; 34%: insomnia,
71.5%: distress
Nurses, women, front-line workers and those who worked in Wuhan had more severe symptoms.
Compared with tertiary care centre, those who worked in secondary care centre had severe scores on all depression, anxiety and insomnia.
Zhang et al (China)18 Online surveyHCWs and non-HCWsISI, SCL-90-R, PHQ-4Compared with non-HCWs, HCWs had higher depression, anxiety, insomnia and somatisation.
  • BDI, Beck’s Depression Inventory; CCU, childcare unit; DASS-21, Depression Anxiety Stress Scale; DTS-C, Davidson Trauma Scale (Chinese version); GAD-7, Generalized Anxiety Disorder Assessment; GHQ-12, General Health Questionnaire; HCW, healthcare worker; HP, health professional; ICU, intensive care unit; IES-R, Impact of Event Scale-Revised; ISI, Insomnia Severity Index; MBI, Maslach Burnout Inventory; MBI-GS, Maslach Burnout Inventory General Survey; PHQ-9/PHQ-4, Physical Health Questionnaire; PPE, personal protective equipment; PSQI, Pittsburgh Sleep Quality Index; PSS-10, Perceived Stress Scale; PTS, Post Tarumatic Stress Symptoms; PTSD, post-traumatic stress disorder; SCL-90-R, Symptom Checklist-90 Revised; STAEI, State-Trait Anger Expression Inventory; STAI, Spielberger State-Trait Anxiety Inventory.