








key: cord-287361-cpd4yl6c
authors: Ng, Qin Xiang; De Deyn, Michelle Lee Zhi Qing; Lim, Donovan Yutong; Chan, Hwei Wuen; Yeo, Wee Song
title: The Wounded Healer: A Narrative Review of the Mental Health Effects of the COVID-19 Pandemic on Healthcare Workers
date: 2020-06-20
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102258
sha: 
doc_id: 287361
cord_uid: cpd4yl6c

nan

Health systems and healthcare workers worldwide are experiencing tremendous stress because of the growing Coronavirus Disease 2019 pandemic. In many ways, the causative virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is unlike the common flu or the 2003 SARS virus. It is highly contagious and infected persons may remain relatively asymptomatic (Tandon, 2020) . Much J o u r n a l P r e -p r o o f about the virus also remains unknown, including its incubation period and transmission dynamics . Cases increase at an exponential rate, may have complicated needs and are typically not discharged until at least 10 days later .

Expectedly, there have been increasing reports of high rates of anxiety and depressive symptoms amongst frontline medical staff (Lai et al., 2020; Tan et al., 2020) , and calls for healthcare workers involved in the fight against COVID-19 to receive screening and counselling by professional mental health providers. A rapid review of the PubMed and Google Scholar databases using the text words, "COVID-19" OR "nCoV" OR "SARS" OR "SARS-CoV-2" AND "mental health" OR "psychiatry" OR "psychology", "anxiety" OR "depression" OR "stress", up to 5 May, 2020, we found ten observational studies on the mental health effects of the COVID-19 pandemic on healthcare workers. These studies and their key findings are summarised in Table 1 . -Levels of social support for medical staff were significantly associated with self-efficacy and sleep quality and negatively associated with the level of anxiety and stress.

-Levels of anxiety were significantly associated with the levels of stress. This negatively impacted self-efficacy and sleep quality.

-Anxiety, stress, and self-efficacy were mediating variables associated with social support and sleep quality. Notably, the studies were all from Asia (Singapore, India and China). The Chinese studies generally found that female gender and direct contact with COVID-19 patients were significant risk factors associated with higher levels of psychological distress (Lai et al., 2020; Lu et al., 2020; Kang et al., 2020; . Poor sleep quality and insomnia may also be more prevalent amongst healthcare workers (Huang & Zhao, 2020; Xiao et al., 2020; . Besides the demanding nature of the work and other occupational hazards, being in direct contact with a COVID-19 patient puts healthcare workers at higher risk of disease exposure. There may also be anticipatory anxiety and fear of spreading the virus to family members living in the same household.

The studies conducted in Singapore found overall lower prevalence of psychological symptoms compared to the Chinese studies Chew et al., 2020) , but reported higher prevalence of physical symptoms e.g. headache, which could reflect somatization. The studies also highlighted the importance of pandemic readiness and preparedness, especially for non-medical staff, who may be less familiar with communicable diseases.

Wearing full PPE is exhausting and proper work-rest cycles should be ensured. Skin damage due to frequent handwashing and enhanced infection-prevention measures could also compound one's psychological distress (Lan et al., 2020) . In the current climate, even the best among us can feel overwhelmed, emotionally distressed and be left with the scars of vicarious traumatization.

An effective pandemic response must also include a mental health response, both for the public and also the healthcare force. It is important to continually support healthcare workers and their psychological needs. As resources could be scarce at the moment, timely psychological support could take many forms (Ng et al., 2020) . These include availing counselling services, informal or formal supervision and establishing peer support systems J o u r n a l P r e -p r o o f among colleagues. Future studies on this subject should also employ a mixed-methods design to explore specific themes and intervention strategies.

Swiss psychiatrist Carl Jung famously said that, "it is his own hurt that gives the measure of his power to heal [..] this, and nothing else, is the meaning of the Greek myth of the wounded physician." In the same vein, I hope all healthcare workers can draw strength from their struggles and transform despair into hope.

Keywords: covid-19; pandemic; mental health; healthcare workers; doctors; nurses

No conflict of interest to declare.

None. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Not applicable.

none

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