• Users Online: 265
  • Print this page
  • Email this page

 Table of Contents  
Year : 2020  |  Volume : 4  |  Issue : 5  |  Page : 25-27

Understanding the Psychological Stress and Optimizing the Psychological Support for the Acute-Care Health-Care Workers during the COVID-19 Pandemic

1 Department of Pediatric, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission08-Nov-2020
Date of Acceptance18-Nov-2020
Date of Web Publication7-Dec-2020

Correspondence Address:
Shuliweeh Alenezi
Department of Psychiatry, King Saudi University, Riyadh 11451
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sccj.sccj_62_20

Rights and Permissions

In this narrative review, we examined the psychological issues related to healthcare workers (HCWs) in acute-care areas during the COVID-19 pandemic. PubMed was searched on 18 Aug 2020 for published articles, with the following keywords: “COVID-19”, “mental health”, “health-care workers”, “front-lines”, “psychology”, “anxiety”, “depression”, “burnout” and “stress” in various combinations. We identified 23 studies, out of which 15 were selected. Data from several international studies indicate that HCWs are prone to developing mental health problems such as anxiety, depression, and substance abuse; thus, screening and supporting the HCWs who are at bigger risk for such psychological distress is warranted. We conclude that the healthcare system should have processes for providing support to minimize possible post-traumatic consequences among HCWs.

Keywords: COVID-19 pandemic, front lines, health-care workers, psychological support

How to cite this article:
Temsah MH, Alenezi S. Understanding the Psychological Stress and Optimizing the Psychological Support for the Acute-Care Health-Care Workers during the COVID-19 Pandemic. Saudi Crit Care J 2020;4, Suppl S1:25-7

How to cite this URL:
Temsah MH, Alenezi S. Understanding the Psychological Stress and Optimizing the Psychological Support for the Acute-Care Health-Care Workers during the COVID-19 Pandemic. Saudi Crit Care J [serial online] 2020 [cited 2023 Feb 3];4, Suppl S1:25-7. Available from: https://www.sccj-sa.org/text.asp?2020/4/5/25/302588

  Introduction Top

COVID-19 has caused tremendous psychological pressure on the health-care workers (HCWs), especially those on the front lines. Facing a novel “enemy” with many uncertainties, most of the HCWs needed to rush to rescue an unprecedented number of victims who overwhelmed the emergency rooms (ERs) and intensive care units (ICUs). As a result, many HCWs reported psychological symptoms during the COVID-19 pandemic, such as acute stress (57%), depressive (48%), and anxiety (33%) symptoms.[1] Exploring these factors more among the ER and ICU HCWs is vital to optimizing the support needed for these frontliners.

  Methodology Top

The current article is a narrative review of the current literature on psychological health and interventions linked to the COVID-19 pandemic. A search of PubMed was undertaken on August 18, 2020, using the following search terms: “COVID-19,” “mental health,” “health-care workers,” “front-lines,” “Stress, Psychological,” “Depression,” “Intensive Care Units,” “Emergency Medical Services,” “Health Personnel, “burnout,” and “stress” in various combinations. Twenty-three citations were retrieved using this method. Upon reviewing the above citations, eight articles were excluded: three were available only in non-English language and five focused on other aspects of the COVID-19 outbreak. A focused, narrative review of the selected articles is presented.

  Psychological Manifestations among Acute Health-Care Workers: Prevalence and Risk Factors Top

Frontline HCWs have a much higher risk of becoming positive for COVID-19, with an estimated risk of 3-5 folds as compared to that of the general population.[2] Data from several international studies indicate that HCWs are predisposed to developing mental health disorders such as anxiety, depression, and substance abuse.[3],[4] However, in pandemic situations such as severe acute respiratory syndrome (SARS), a study found 57% of HCWs to have experienced psychological distress, having higher levels of job-related stress and poor physical health, and were less willing to work in SARS units.[4] The psychological impact on the frontline HCWs involved in the immediate diagnosis and management of patients with COVID-19 was described originally from China, with an increased risk of anxiety, insomnia, depression, and distress.[5] ICU nurses also reported decreased appetite, indigestion, fatigue, nervousness, and even suicidal thoughts.[6] Subsequently, similar data were published from other international sites, and the World Health Organization (WHO) issued a report on how to address such an issue.[1],[7],[8]

Babore et al. reported that the positive attitude among HCWs during a stressful condition was the chief protecting psychological feature.[9] In contrast, female gender, seeking social assistance, practicing avoidance techniques, or working in direct contact with COVID-19 patients were reported as psychological risk factors.[5],[9] The main concern for the HCWs was the possibility of spreading the infection to their families or acquiring it themselves.[10]

During the COVID-19 crisis, ICU nurses have been reported to experience immense workload, exhaustion, infection hazards, and difficulty with the loss of patients whom they attend, with some extreme incidents being reported, such as suicide among nurses caring for the critically ill patients in Italy.[6]

  Mental Health Issues Specific to COVID-19 and Organizational Response Top

Shechter et al. found that HCWs used empirically supported coping practices and noticed signs of resilience; nevertheless, HCWs were also interested in further wellness resources.[1] The psychological stress is identified to affect the immune system, and relaxation and balance of work shift may decrease the distress.[7] Health-care institutes and policymakers should strive to optimize the psychological support systems that best suit their own HCWs and setting. [Table 1] lists some of the reported psychological risks and relievers among frontline HCWs that health-care institutes can consider when planning a balanced lifestyle for their staff. Other social aspects, such as providing a suitable work environment, housing, and supportive family and friends and avoiding stigmatization, were also described to improve the HCWs’ psychological health.[7]
Table 1: Psychological risks and relievers among front-line health care workers: a balanced lifestyle between stress factors and stress relievers among HCWs

Click here to view

Greenberg et al. proffered that HCWs are more prone to develop moral injuries and are likely to experience negative ideations about themselves or others. Conversely, it was found that HCW in disaster-exposed organizations who have had useful contributions could lead to better confidence, self-worth, and compassion. Additionally, they were found to feel more dedicated to fulfilling a full life, valuing life more, feeling more belonging to their community, and an augmented sense of purpose.[12] To mitigate the psychological stress of ICU nurses in the time of COVID-19, some ICUs adopted an early assessment and active resolution algorithm, promoting that their nurses may experience lesser adverse events during the fight against COVID-19.[6] Others implemented a national e-package for psychological support to the HCWs that included evidence-based guidance, support, and signposting relating to psychological well-being.[14] However, such models need to be investigated in other settings.

  Potential Solutions Top

Literature supports evaluating the long-term psychological implications of COVID-19 among the frontline HCWs.[5] Addressing the specific factors that affect this population’s well-being would optimize their performance and maintain their productivity in the health-care system. The WHO has recommended to administrators in health-care facilities to ensure that all staff are protected from prolonged stress and inadequate mental health to have a greater ability to achieve their roles.[8] HCWs should not be provided false reassurance but an honest assessment of what they will face, delivered in simple language. After the crisis ceases, a reflection is warranted to learn from the experiences to create a meaningful narrative.[15] Single-session debriefing did not affect the onset of posttraumatic stress disorder nor reduce mental stress; therefore, it should not be attempted.[16] The subsequent step is to screen and support HCWs who are at an increased risk for recurring or protracting the mental or professional consequences of the outbreak by discovering the HCWs who did not achieve psychological normalization within the following months after the crisis is over.[13] There is strong evidence supporting the fact that health-care managers have an essential role in protecting their staff’s mental health and helping those who need additional care and support to access it.[17]

  Conclusion Top

The pandemic has been causing major psychological impacts on frontline HCWs, highlighting the need for appropriate psychological staff support measures. Identifying those at risk and providing rapid access to effective evidence-based interventions is an essential step. Health-care managers have a significant role and should provide support and reflect after the crisis to create a meaningful narrative to minimize possible posttraumatic consequences.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2020;66:1-8.  Back to cited text no. 1
Nguyen LH, Drew DA, Joshi AD, Guo CG, Ma W, Mehta RS, et al. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. medRxiv [Preprint]. 2020:2020.04.29.20084111. doi: 10.1101/2020.04.29.20084111.  Back to cited text no. 2
Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377-85.  Back to cited text no. 3
Mavroforou A, Giannoukas A, Michalodimitrakis E. Alcohol and drug abuse among doctors. Med Law 2006;25:611-25.  Back to cited text no. 4
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.  Back to cited text no. 5
Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Crit Care 2020;24:200.  Back to cited text no. 6
Widjaja FF, Shatri H, Putranto R. Health issues among healthcare workers during COVID-19 pandemic: A psychosomatic approach. Acta Med Indones 2020;52:172-6.  Back to cited text no. 7
World Health Organization. Mental Health and Psychosocial Considerations During the COVID-19 Outbreak. World Health Organization; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf. [Last accessed on 2020 Aug 28].  Back to cited text no. 8
Babore A, Lombardi L, Viceconti ML, Pignataro S, Marino V, Crudele M, et al. Psychological effects of the COVID-2019 pandemic: Perceived stress and coping strategies among healthcare professionals. Psychiatry Res 2020;293:113366.  Back to cited text no. 9
Temsah MH, Al-Sohime F, Alamro N, Al-Eyadhy A, Al-Hasan K, Jamal A, et al. The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country. J Infect Public Health 2020;13:877-82.  Back to cited text no. 10
Shaukat N, Ali DM, Razzak J. Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review. Int J Emerg Med 2020;13:40.  Back to cited text no. 11
Brooks S, Amlôt R, Rubin GJ, Greenberg N. Psychological resilience and post-traumatic growth in disaster-exposed organisations: Overview of the literature. BMJ Mil Health 2020;166:52-6.  Back to cited text no. 12
Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis 2006;12:1924-32.  Back to cited text no. 13
Citiation edited Blake, H.; Bermingham, F.; Johnson, G.; Tabner, A. Mitigating the Psychological Impact of COVID-19 on Healthcare Workers: A Digital Learning Package. Int. J. Environ. Res. Public Health 2020;17:2997.  Back to cited text no. 14
Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ 2020;368:m1211.  Back to cited text no. 15
Brooks SK, Rubin GJ, Greenberg N. Traumatic stress within disaster-exposed occupations: Overview of the literature and suggestions for the management of traumatic stress in the workplace. Br Med Bull 2019;129:25-34.  Back to cited text no. 16
Greenberg N. Mental health of health-care workers in the COVID-19 era. Nat Rev Nephrol 2020;16:425-6.  Back to cited text no. 17


  [Table 1]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Psychological Ma...
Mental Health Is...
Potential Solutions
Article Tables

 Article Access Statistics
    PDF Downloaded147    
    Comments [Add]    

Recommend this journal