Antonovsky A. Health, stress, and coping.San Francisco, CA: Jossey-Bass Publishers; 1979

Bhargava S, Rokde R, Rathod D Employing dermatologists on the. front-line against COVID-19: All hands on deck. Dermatol Ther. 2020; 33:(5)

Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. [COVID-19 pandemic: stress experience of healthcare workers—a short current review]. Psychiatr Prax. 2020; 47:(4)190-197

Brewin CR. Systematic review of screening instruments for adults at risk of PTSD. J Trauma Stress. 2005; 18:(1)53-62

Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, Turner S, Foa EB. Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry. 2002; 181:(2)158-162

Cabello IR, Echavez JFM, Serrano-Ripoll MJ Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review. 2020;

Chen J, Liu X, Wang D Multiple risk factors of depression and anxiety in medical staffs: a cross-sectional study at the outbreak of SARS-CoV-2 in China. 2020;

Chiu HY, Chang LY, Hsieh YJ, Tsai PS. A meta-analysis of diagnostic accuracy of three screening tools for insomnia. J Psychosom Res. 2016; 87:85-92

De Stefano C, Orri M, Agostinucci JM Early psychological impact of Paris terrorist attacks on healthcare emergency staff: A cross-sectional study. Depress Anxiety. 2018; 35:(3)275-282

Dixon-Woods M, Baker R, Charles K Culture and behaviour in the English National Health Service: overview of lessons from a large multimethod study. BMJ Qual Saf. 2014; 23:(2)106-115

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020; 20:(5)533-534

European Centre for Disease Prevention and Control. COVID-19 situation update worldwide, as of week 21, updated 3 June 2021. 2021. (accessed 3 June 2021)

Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress. 1993; 6:(4)459-473

Holmes EA, O'Connor RC, Perry VH Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020; 7:(6)547-560

Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. [Mental health survey of medical staff in a tertiary infectious disease hospital for COVID-19]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2020; 38:(3)192-195

Intensive Care National Audit and Research Centre. ICNARC report on COVID-19 in critical care: England, Wales and Northern Ireland. 2021. (accessed 30 May 2021)

Ji D, Ji YJ, Duan XZ, Li WG Prevalence of psychological symptoms among Ebola survivors and healthcare workers during the 2014-2015 Ebola outbreak in Sierra Leone: a cross-sectional study. Oncotarget. 2017; 8:(8)12784-12791

Karanikola M, Giannakopoulou M, Mpouzika M, Kaite CP, Tsiaousis GZ, Papathanassoglou EDE. Dysfunctional psychological responses among Intensive Care Unit nurses: a systematic review of the literature. Rev Esc Enferm USP. 2015; 49:(5)847-857

Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003; 41:(11)1284-1292

Liang S-Y, Li Y, Xu Q. Investigation of the psychological status of frontline medical staff during the fight against COVID-19 and coping strategies (original in Chinese). Smart Healthcare. 2020; 6:(14)42-53

Liu X, Kakade M, Fuller CJ Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry. 2012; 53:(1)15-23

Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005; 58:(2)163-171

Lung FW, Lu YC, Chang YY, Shu BC. Mental symptoms in different health professionals during the SARS attack: a follow-up study. Psychiatr Q. 2009; 80:(2)107-116

Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public – A systematic review and meta-analysis. Psychiatry Res. 2020; 291

Manea L, Gilbody S, Hewitt C Identifying depression with the PHQ-2: A diagnostic meta-analysis. J Affect Disord. 2016; 203:382-395

Mealer ML, Shelton A, Berg B, Rothbaum B, Moss M. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med. 2007; 175:(7)693-697

Nguyen LH, Drew DA, Graham MS Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Health. 2020; 5:(9)e475-e483

The potential impact of COVID-19 on mental health outcomes and the implications for service solutions (rapid review). 2020. (accessed 11 May 2021)

Ohayon MM, Caulet M, Lemoine P. Comorbidity of mental and insomnia disorders in the general population. Compr Psychiatry. 1998; 39:(4)185-197

Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020; 323:(18)1775-1776

Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun. 2020; 88:901-907

Peters L, Cant R, Payne S How death anxiety impacts nurses' caring for patients at the end of life: a review of literature. Open Nurs J. 2013; 7:14-21

Petersen E, Koopmans M, Go U Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics. Lancet Infect Dis. 2020; 20:(9)e238-e244

Qi J, Xu J, Li BZ The evaluation of sleep disturbances for Chinese frontline medical workers under the outbreak of COVID-19. Sleep Med. 2020; 72:1-4

Qiu J, Shen B, Zhao M A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry. 2020; 33:(2)

Richardson S, Hirsch JS, Narasimhan M Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020; 323:(20)2052-2059

Schäfer SK, Lass-Hennemann J, Groesdonk H Mental health in anesthesiology and ICU staff: sense of coherence matters. Front Psychiatry. 2018; 9

Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res. 2000; 48:(6)555-560

Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian J Psychiatr. 2020; 51

Sull A, Harland N, Moore A. Resilience of health-care workers in the UK; a cross-sectional survey. J Occup Med Toxicol. 2015; 10:(1)

Survey Coordination Centre NHS England. NHS Staff Survey 2020. National results briefing. 2021. (accessed 30 may 2021)

Theodorsson-Norheim E. Kruskal-Wallis test: BASIC computer program to perform nonparametric one-way analysis of variance and multiple comparisons on ranks of several independent samples. Comput Methods Programs Biomed. 1986; 23:(1)57-62

World Health Organization. Keep health workers safe to keep patients safe: WHO. 2020. (accessed 11 May 2021)

Willan J, King AJ, Jeffery K, Bienz N. Challenges for NHS hospitals during covid-19 epidemic. BMJ. 2020; 368

Wu K, Wei X. Analysis of psychological and sleep status and exercise rehabilitation of front-line clinical staff in the fight against COVID-19 in China. Med Sci Monit Basic Res. 2020; 26

Wu Y, Wang J, Luo C A comparison of burnout frequency among oncology physicians and nurses working on the front lines and usual wards during the COVID-19 epidemic in Wuhan, China. J Pain Symptom Manage. 2020; 60:(1)e60-e65

Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020; 26:e923549-e1

Experience of frontline clinicians fighting against covid-19: a qualitative study. 2020a. (accessed 11 May 2021)

Zhang W, Wang K, Yin L Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom. 2020b; 89:(4)242-250

Zhu J, Sun L, Zhang L Prevalence and influencing factors of anxiety and depression symptoms in the first-line medical staff fighting against COVID-19 in Gansu. Front Psychiatry. 2020; 11

The global mental health burden of COVID-19 on critical care staff

10 June 2021
Volume 30 · Issue 11



Although the mental health burden in healthcare workers caused by COVID-19 has gained increasing attention both within the profession and through public opinion, there has been a lack of data describing their experience; specifically, the mental wellbeing of healthcare workers in the intensive care unit (ICU), including those redeployed.


The authors aimed to compare the mental health status of ICU healthcare workers (physicians, nurses and allied health professionals) affected by various factors during the COVID-19 pandemic; and highlight to policymakers areas of staff vulnerabilities in order to improve wellbeing strategies within healthcare systems.


An online survey using three validated scales was conducted in France, the UK, Italy, Mainland China, Taiwan, Egypt and Belgium.


The proportion of respondents who screened positive on the three scales across the countries was 16–49% for depression, 60–86% for insomnia and 17–35% for post-traumatic stress disorder. The authors also identified an increase in the scores with longer time spent in personal protective equipment, female gender, advancing age and redeployed status.


The high prevalence of mental disorders among ICU staff during the COVID-19 crisis should inform local and national wellbeing policies.

The vulnerability of healthcare workers to COVID-19 is enhanced by the fast spreading of the coronavirus (the reproduction rate of SARS-CoV-2 is around 2.5 compared with 0.9 for MERS-CoV) (Petersen et al, 2020) and unexpected transmission by air travel, because many countries had limited or no time to prepare well. As of 3 June 2021, there were over 210 countries and territories suffering from COVID-19, with around 171 million confirmed cases and 3.5 million deaths (European Centre for Disease Prevention and Control, 2021). Among the COVID-19 cases reported to the World Health Organization (WHO), 14% are among health workers in which the loss of lives accounts for thousands (WHO, 2020). Similarly, the observational cohort study conducted by Nguyen et al (2020) presented that frontline healthcare workers in the UK and USA had at least a threefold increased risk of COVID-19 infection compared with the general community.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content