This meta-analysis of 358 articles, including 373 estimates with 336,518 participants from 65 countries, found that a high percentage of healthcare workers experienced anxiety symptoms. Moreover, the prevalence of anxiety symptoms among healthcare workers increased during the COVID-19 pandemic. Before the COVID-19 pandemic, the highest and lowest prevalence of anxiety symptoms were found in South America and Europe, respectively. The highest prevalence of anxiety symptoms remained in Africa during the COVID-19 pandemic but was then lowest in North America. Compared with other healthcare workers, medical students experienced the highest prevalence of anxiety symptoms both before and during the COVID-19 pandemic.
We found that the prevalence of anxiety symptoms among healthcare workers increased from 40.7% before to 41.2%during the COVID-19 pandemic. In line with this, a similarly higher rate of anxiety symptoms and serious emotional distress among healthcare workers was also observed during the Middle East respiratory syndrome and severe acute respiratory syndrome events[375, 376]. Of relevance, previous meta-analyses and reviews reported high levels of anxiety(30.0% [95%CI, 24.2-37.05]) [9] and (23.2% [95% CI 17.77–29.13]) [377] during the COVID-19 pandemic among healthcare workers. Further, we found a higher prevalence of anxiety symptoms than those given in previous results, which could be explained by several factors, including the temporal effects of the collapse of healthcare workers during the pandemic and the accumulation of abuse experiences [378], It is particularly difficult for those who are directly involved in caring for suspected or confirmed COVID-19 patients, including the increased risk of infection here and the possibility of spreading the disease to their families[379].
During the COVID-19 pandemic, healthcare workers from Africa, Europe, and Asia were found to have a higher prevalence of anxiety symptoms than they had before. First, the health system in Africa has been weak due to shortages in the overall health workforce, a lack of infrastructure, and overstretched medical facilities owing to the continuing burden of disease[380]. Moreover, the needs of some essential antiretroviral drugs, vaccines, and other essential medicines could not be met because of supply chain constraints [380]. As for Europe, for example, in the United Kingdom, the government followed the directions of their scientific experts to favor a policy that appeared to pursue herd immunity, where susceptible populations were quarantined and healthier individuals were exposed to the virus, thereby gaining immunity at a national level [381]. In addition, some Asian countries had weak medical systems and a shortage of medical resources, such as Mongolia and Turkey, which then led to the outbreak of COVID-19, producing a variety of psychological side effects, including anxiety and pressure on medical and health professionals [382, 383].
Our results highlight the fact that the COVID-19 pandemic has had a tremendous impact on the mental health of physicians, residents, and nurses. This could be explained by several factors. First, physicians are exposed to highly infectious agents during the provision of medical care for their patients [384]. They maintained nursing care for patients with COVID-19, yet a large number of those with pre-existing health conditions capitulated to illness despite all endeavors put in place by physicians[384]. Moreover, numerous physicians faced difficulties in the form of various desperate circumstances where absence of assets, pay, or access to essential personal protective gear added to their already heightened tensions while they were attempting to save lives[385].In some teaching hospitals, services, such as invasive surgery, routine physical assessments, and patient care, are primarily provided by residents under the supervision of attending physicians [386]. Therefore, residents had more exposure to COVID-19 patients during clinical training, which might explain the higher prevalence of anxiety symptoms among residents than before the COVID-19 pandemic[386]. Moreover, we discovered that nurses were more likely to experience anxiety during the COVID-19 pandemic period than before [387].Similarly, other studies have shown that the prevalence of anxiety symptoms among nurses during the COVID-19 pandemic was significantly higher due to greater exposure to both the suffering and distress of patients and families[113].
This study has several strengths. To our knowledge, this is the first study to summarize the prevalence of anxiety symptoms among healthcare workers worldwide. In addition, we compared the prevalence of anxiety symptoms among healthcare workers across subgroups, including continents, occupations, screening instruments, and publication years. Finally, we examined the effects of the COVID-19 pandemic on the prevalence of anxiety symptoms among healthcare workers.
However, this study has some notable limitations. First, the included studies were all cross-sectional in nature. Therefore, these results should be interpreted with caution. As such, causal relationship between the COVID-19 pandemic and the changes in the prevalence of anxiety symptoms among healthcare workers cannot be extrapolated. Second, although the screening instruments had been clinically validated, self-reported mental health symptoms do not constitute an actual diagnosis of mental health disorders at the clinical level[388–390].Third, the number of articles published before the COVID-19 pandemic was relatively small.