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
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]. | |
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. | |
2 | 2 | 2 | Inconsistency in these findings [39]. | |
3 | 2 | 2 | No serious inconsistencies. | |
Factor: Lack of personal protective equipment (PPE) [24, 28, 40, 46] | ||||
4 | 2 | 2 | No serious inconsistencies. | |
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. | |
Factor: Rural location [47] | ||||
1 | 2 | 0 | Only one study reported findings on effect of rurality. | |
3 | 2 | 2 | No serious inconsistencies. | |
4 | 2 | 1 | This theme was predominantly raised in qualitative literature. | |
3 | 2 | 2 | Age was found to be a complex risk factor where the focus of anxiety depended on the age group assessed [24]. | |
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. | |
2 | 2 | 1 | No serious inconsistencies. | |
2 | 2 | 0 | No serious inconsistencies. | |
Moderate
Moderate
Moderate
High
High
Low
Very low
High
Moderate
Low
Low
Moderate
Low- 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 - 3
Moderate = This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different** is moderate - 2
Low = This research provides some indication of the likely effect. However, the likelihood that it will be substantially different** is high - 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 - ** Substantially different = a large enough difference that it might affect a decision
High = This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different** is low
Moderate = This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different** is moderate
Low = This research provides some indication of the likely effect. However, the likelihood that it will be substantially different** is high
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