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Table 3 Certainty of evidence for the risk factors associated with adverse mental health outcomes on health and care staff during the COVID-19 pandemic

From: A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being

No of studies Design Risk of bias Additional considerations Certainty (overall score)a
Factor: Frontline staff/Close contact with COVID-19 patients [30, 31, 34, 42]
4 2 2 Inconsistency: Higher burnout reported in non-frontline staff (Cancer hospital, Wuhan) [43].
Frontline nurses reported lower vicarious trauma scores [32].
No difference between frontline and non-frontline staff reported (This finding was not statistically significant) [33].
Moderate
Factor: Nurse [24, 26, 31]
3 2 2 Inconsistency: Doctors were found to have more sleep disturbances than nurses (This finding was not statistically significant) [42].
Not all confounding factors were dealt with in the three studies reporting nurses to be at a higher risk for adverse psychological outcomes. No studies compared nurses to primary care or social staff.
Moderate
Factor: Clinical healthcare workers [34, 47]
2 2 2 Inconsistency in these findings [39]. Moderate
Factor: Heavy workload [26, 35, 37]
3 2 2 No serious inconsistencies. High
Factor: Lack of personal protective equipment (PPE) [24, 28, 40, 46]
4 2 2 No serious inconsistencies. High
Factor: Point of outbreak [37, 58]
2 2 1 Only two studies - one was limited to the sample of a surgical department where confounding factors were not dealt with and one was a qualitative study. Low
Factor: Rural location [47]
1 2 0 Only one study reported findings on effect of rurality. Very low
Factor: Fear of infection [21, 26, 28]
3 2 2 No serious inconsistencies. High
Factor: Concern about family [24, 26, 37, 40]
4 2 1 This theme was predominantly raised in qualitative literature. Moderate
Factor: Younger age [24, 29, 33]
3 2 2 Age was found to be a complex risk factor where the focus of anxiety depended on the age group assessed [24]. Low
Factor: Gender – Female [31, 47]
2 2 1 Inconsistencies were found – for example: a large global survey of dentists found no differences based on gender [21]. Furthermore, confounding factors assessing gender in both included studies were not satisfactorily dealt with. Low
Factor: Organic illness [36, 47]
2 2 1 No serious inconsistencies. Moderate
Factor: Being an only child [35, 42]
2 2 0 No serious inconsistencies. Low
  1. a 4 High = This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different** is low
  2. 3 Moderate = This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different** is moderate
  3. 2 Low = This research provides some indication of the likely effect. However, the likelihood that it will be substantially different** is high
  4. 1 Very low = This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different** is very high
  5. ** Substantially different = a large enough difference that it might affect a decision