冠状病毒综合征对医护人员身心健康的影响：系统评价和荟萃分析。
Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis.
机构信息
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain.
出版信息
J Affect Disord. 2020 Oct 1;275:48-57. doi: 10.1016/j.jad.2020.06.022. Epub 2020 Jun 25.
BACKGROUND
Health care workers (HCW) are at high risk of developing physical/mental health outcomes related to coronavirus syndromes. Nature and frequency of these outcomes are undetermined.
METHODS
PRISMA/MOOSE-compliant (PROSPERO-CRD42020180205) systematic review of Web of Science/grey literature until 15th April 2020, to identify studies reporting physical/mental health outcomes in HCW infected/exposed to Severe Acute Respiratory Syndrome -SARS-, Middle East Respiratory Syndrome -MERS-, Novel coronavirus -COVID-19-. Proportion random effect meta-analyses, I statistic, quality assessment and sensitivity analysis.
RESULTS
115 articles were included (n=60,458 HCW, age 36.1±7.1, 77.1% female). Physical health outcomes: 75.9% HCW infected by SARS/MERS/COVID-19 reported fever (95%CI=65.9-83.7%, k=12, n=949), 47.9% cough (95%CI=39.2-56.8%, k=14, n=970), 43.6% myalgias (95%CI=31.9-56.0%, k=13, n=898), 42.3% chills (95%CI=20.2-67.9%, k=7, n=716), 41.2% fatigue (95%CI=18.2-68.8%, k=6, n=386), 34.6% headaches (95%CI=23.1-48.2%, k=11, n=893), 31.2% dyspnoea (95%CI=23.2-40.5%, k=12, n=1003), 25.3% sore throat (95%CI=18.8-33.2%, k=8, n=747), 22.2% nausea/vomiting (95%CI=14.9-31.8%, k=6, n=662), 18.8% diarrhoea (95%CI=11.9-28.4%, k=9, n=824). Mental health outcomes: 62.5% HCW exposed to SARS/MERS/COVID-19 reported general health concerns (95%CI=57.0-67,8%, k=2, n=2254), 43.7% fear (95%CI=33.9-54.0%, k=4, n=584), 37.9% insomnia (95%CI=30.9-45.5%, k=6, n=5067), 37.8% psychological distress (95%CI=28.4-48.2%, k=15, n=24,346), 34.4% burnout (95%CI=19.3-53.5%, k=3, n=1337), 29.0% anxiety features (95%CI=14.2-50.3%, k=6, n=9191), 26.3% depressive symptoms (95%CI=12.5-47.1%, k=8, n=9893), 20.7% post-traumatic stress disorder features (95%CI=13.2-31%, k=11, n=3826), 16.1% somatisation (95%CI=0.2-96.0%, k=2, n=2184), 14.0% stigmatisation feelings (95%CI=6.4-28.1%, k=2, n=411).
LIMITATIONS
Limited amount of evidence for some outcomes and suboptimal design in several studies included.
CONCLUSIONS
SARS/MERS/COVID-19 have a substantial impact on the physical and mental health of HCW, which should become a priority for public health strategies.
背景
医护人员（HCW）患与冠状病毒综合征相关的身心健康问题的风险很高。这些结果的性质和频率尚不确定。
方法
系统检索 Web of Science/灰色文献，直到 2020 年 4 月 15 日，以确定报告 SARS、MERS、COVID-19 感染/暴露的医护人员身心健康结果的研究。采用 PRISMA/MOOSE 一致性（PROSPERO-CRD42020180205）方法进行综述。采用比例随机效应荟萃分析、I 统计量、质量评估和敏感性分析。
结果
共纳入 115 篇文章（n=60458 名 HCW，年龄 36.1±7.1 岁，77.1%为女性）。身体健康结果：75.9%的 SARS/MERS/COVID-19 感染的医护人员报告有发热（95%CI=65.9-83.7%，k=12，n=949），47.9%有咳嗽（95%CI=39.2-56.8%，k=14，n=970），43.6%有肌肉疼痛（95%CI=31.9-56.0%，k=13，n=898），42.3%有寒战（95%CI=20.2-67.9%，k=7，n=716），41.2%有疲劳（95%CI=18.2-68.8%，k=6，n=386），34.6%有头痛（95%CI=23.1-48.2%，k=11，n=893），31.2%有呼吸困难（95%CI=23.2-40.5%，k=12，n=1003），25.3%有咽痛（95%CI=18.8-33.2%，k=8，n=747），22.2%有恶心/呕吐（95%CI=14.9-31.8%，k=6，n=662），18.8%有腹泻（95%CI=11.9-28.4%，k=9，n=824）。心理健康结果：62.5%暴露于 SARS/MERS/COVID-19 的医护人员报告存在一般健康问题（95%CI=57.0-67.8%，k=2，n=2254），43.7%有恐惧（95%CI=33.9-54.0%，k=4，n=584），37.9%有失眠（95%CI=30.9-45.5%，k=6，n=5067），37.8%有心理困扰（95%CI=28.4-48.2%，k=15，n=24346），34.4%有倦怠（95%CI=19.3-53.5%，k=3，n=1337），29.0%有焦虑特征（95%CI=14.2-50.3%，k=6，n=9191），26.3%有抑郁症状（95%CI=12.5-47.1%，k=8，n=9893），20.7%有创伤后应激障碍特征（95%CI=13.2-31%，k=11，n=3826），16.1%有躯体化（95%CI=0.2-96.0%，k=2，n=2184），14.0%有污名化感觉（95%CI=6.4-28.1%，k=2，n=411）。
局限性
一些结果的证据有限，一些研究设计欠佳。
结论
SARS/MERS/COVID-19 对医护人员的身心健康有重大影响，应成为公共卫生策略的重点。
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