https://doi.org/10.14528/snr.2022.56.4.3113
2022. Obzornik zdravstvene nege, 56(4), pp. 301–310.
ABSTRACT
Introduction: The covid-19 pandemic is characterised by an increased risk of post-traumatic stress disorder 
in healthcare professionals. The purpose of this systematic review was to identify the impact of the covid-19 
pandemic on the mental health of healthcare professionals. 
Methods: A systematic review of the literature was conducted. The literature search took place from November 
2020 to January 2021. The search was conducted in the Pubmed, Ebsco, Ovid and Google Scholar databases, 
using the following combinations of keywords: self-image, fear, pandemic, prevention, nurses, physicians. 
The relevant records were selected on the basis of inclusion and exclusion criteria. The course of the literature 
review is shown using the PRISMA diagram. A thematic analysis was conducted with open coding of the 
results. 
Results: From the total search set, 14 articles were selected for final analysis. The prevalence of anxiety among 
nurses and physicians ranged from 12.3 to 35.6%. The prevalence of anxiety was higher in nurses, with the 
symptoms of anxiety being significantly lower in male nurses than in their female colleagues. 
Discussion and conclusion: The pandemic has left a significant psychological burden on nurses and 
physicians. There is therefore an urgent need to include preventive psychoeducational measures such as 
"briefing" and "teambuilding" in supervising mental health of nurses and physicians. 
IZVLEČEK 
Uvod: Pandemijo covid-19 povezujemo s povečanim tveganjem za posttravmatsko stresno motnjo pri 
zdravstvenih delavcih. Namen sistematičnega pregleda literature je prepoznati vpliv pandemije covida-19 na 
duševno zdravje v tej populaciji.
Metode: Uporabljen je bil sistematičen pregled literature. Iskanje je potekalo od novembra 2020 do januarja 
2021. Vključene so bile naslednje iskalne zbirke podatkov: Pubmed, Ebsco, Ovid in Google Scholar. Pri 
iskanju so bile uporabljene kombinacije ključnih besed: samopodoba, strah, preventiva, medicinske sestre, 
zdravniki. Uporabili smo diagram PRISMA za prikaz poteka pregleda literature. Tematska analiza je potekala 
na način kodiranja rezultatov. 
Rezultati: Iz celotnega iskalnega niza več tisoč člankov smo v končno analizo prenesli štirinajst člankov. 
Prevalenca anksioznosti med zdravstvenimi delavci je 12,3–35,6 %. Zdravstveni delavci moškega spola so 
imeli bistveno blažje simptome tesnobe kot ženske. Stopnja tesnobe je bila višja v zdravstveni negi, vendar so 
bili pri moških manj izraziti simptomi tesnobe kot pri ženskah. 
Diskusija in zaključek: Pandemija covid-19 je povzročila duševne obremenitve zdravstvenih delavcev. 
Za obvladovanje duševnega zdravja pri medicinskih sestrah in zdravnikih je treba vključiti preventivne 
psihoedukativne ukrepe, kot sta briefing in teambuilding.
Key words: self-image; fear; 
pandemia; prevention; nurses; 
physicians
Ključne besede: samopodoba; 
strah, preventiva; medicinske 
sestre, zdravniki 
1 Univerzitetni klinični center 
Ljubljana, Ginekološka klinika, 
Šlajmerjeva 2, 1000 Ljubljana, 
Slovenija
2 Univerza v Novem mestu, 
Fakulteta za zdravstvene vede, 
Na loko 2, 8000 Novo mesto, 
Slovenija
3 Nacionalni inštitut za javno 
zdravje, Zaloška 29, 1000 
Ljubljana, Slovenija
4 Fakulteta za zdravstvo Angele 
Boškin, Spodnji Plavž 3, 4270 
Jesenice, Slovenija
* Korespondenčni avtor/
Corresponding author: 
urosvisic@gmail.com
Pregledni znanstveni članek/Review article
The impact of the covid−19 pandemic on nurses' and physicians' mental health: 
A literature review 
Pomen pandemije covida-19 za duševno zdravje medicinskih sester in zdravnikov: 
pregled literature
Uroš Višič1, 2, *, Maja Sočan3, 4
Received/Prejeto: 5. 7. 2021 
Accepted/Sprejeto: 2. 10. 2022
302 Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
Introduction 
The fight against the pandemic has had an indirect 
impact on the mental health of the general population 
(Krishnamoorthy, Nagarajan, Kumar, Saya, & 
Menon, 2020). Exposure to acute stress can manifest 
behaviourally (avoidance, recklessness, detachment, 
withdrawal, irritability), emotionally (numbness, 
anxiety, anger, fear, mood swings, low self-esteem), 
and cognitively (concentration disorders, memory 
disorders, wakefulness, intrusive thoughts) (Galehdar, 
Kamran, & Toulabi, 2020; Paiano et al., 2020). A 
correlation has been detected between the covid-19 
pandemic and the prevalence of mental health 
disorders in healthcare institutions (Carmassi, Foghi, 
& Dell´Oste, 2020; Muller, Hafstad, & Himmels, 2020; 
Tsamakis, Rizos, & Manolis, 2020). The constant rise in 
the number of people infected, the increase in deaths, 
the lack of targeted medicines, the extensive media 
coverage, the heavy workload, the lack of personal 
protective equipment and the feeling of insufficient 
support in the wider social environment can all 
contribute to the psychological distress of physicians 
and nurses in particular (Daugherty & Arble, 2020; Li, 
Li, & Xiang, 2020; Paiano, Jaques, & Bezzera, 2020). 
It is therefore important to identify and address the 
mental health needs of nurses and physicians who 
express such concerns or show signs of distress in a 
timely manner (Krishnamoorthy et al., 2020).
Aims and objectives
The aim of this systematic review was to determine 
the impact of the covid-19 pandemic on the mental 
health of nurses and physicians. A specific objective 
of the study was to determine the prevalence of 
psychological symptoms and risk factors for the 
development of mental health disorders in nurses and 
physicians during the pandemic. The main preventative 
measures for reducing mental distress must be based 
on the recognition mental distress symptoms so that 
effective interventions can be developed to reduce the 
mental health burden of the covid-19 pandemic. The 
following research questions were investigated:
− What were nurses and physicians' experiences of 
psychological symptoms of mental health distress 
during the covid-19 pandemic?
− Do individual nurses and physicians with pronounced 
mental health problems need support and guidance 
to cope with the consequences of the pandemic?
Methods 
A literature review was prepared following PRISMA 
recommendations (Shamseer et al., 2015). 
Review methods 
The literature search was conducted in the Pubmed, 
Ebsco, Ovid, and Google Scholar international 
databases. The following inclusion criteria were 
applied: the topic of the covid-19 pandemic and its 
impact on the mental health of nurses and physicians, 
exclusively systematic literature reviews, articles 
accessible in full text published in 2020 or later 
in English or Slovenian. Using a combination of 
keywords and the Boolean operator AND, we designed 
the following search strategy: ("sars-cov-2" AND 
"covid-19") AND ("nurses" AND "physician") AND 
(AND "mental health" AND "mental disorders"). The 
literature search took place between November 2020 
and January 2021. The literature review was based on 
the inclusion and exclusion criteria shown in Table 1. 
Results of the review 
Our database search identified 558.532 records: 
PubMed (n = 7.835), EBSCO (n = 22.569), Ovid (n = 
70.728) and Google Scholar (n = 487.400). After 
removing the hits (n = 120) that did not meet the pre-
defined inclusion criteria, a total of 558.532 hits remained 
included. A total of 588.418 records were excluded after 
the removal of duplicates and on account of title and 
summary inconsistencies. In the next step, we reviewed 
the context of the first thousand hits ordered by relevance 
in each database and selected articles based on content 
inadequacy assessment. As shown in Figure 1, a total of 
14 articles were included in the final analysis. The process 
of obtaining articles suitable for our research can be 
seen in Figure 1, where we used the PRISMA (Prefered 
Tabela 1: Inclusion and exclusion criteria 
Tabela 1: Vključitveni in izključitveni kriteriji 
Criteria/Kriteriji Inclusion criteria/Vključitveni kriteriji Exclusion criteria/Izključitveni kriteriji
Topic Covid-19 pandemic and nurses'/physicians' 
mental health. 
Exclusively physical health, other healthcare 
professionals.
Type of research Systematic literature review using quantitative 
and qualitative research. 
Reports, comments, protocols, editorials, no 
relevant content.
Access Full-text articles. Incompletely accessible articles. 
Time frame Articles published since 2020. Articles published before the covid-19 
pandemic.
Language English and Slovenian. Other languages. 
303Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
Reporting Item for Systematic review and Meta-Analysis) 
method to search the databases and check the usability of 
the sources included in the review. 
Quality assessment of the review and the description 
of data processing 
The fourteen articles included in our systematic 
literature review met all the specified inclusion criteria. 
All records were peer-reviewed research papers from 
international scientific journals and were available in 
electronic form. The articles included in the analysis 
included a total of 329 research articles. Systematic 
literature reviews were assessed for adequacy for 
inclusion in the literature review, based on the 
guidelines proposed by Streubert & Carpenter (2011). 
The results were reviewed in several rounds. In the first 
round, we carefully reviewed the titles. If we were not 
Id
en
tif
ic
at
io
n 
 
Sc
re
en
in
g 
 
El
ig
ib
ili
ty
  
In
cl
ud
ed
  
Records indentified through 
database search in Pubmed, 
Ebsco, Ovid, Google scholar 
(n = 588.532) 
Additional records 
identified through other 
sources 
(n = 6) 
Number of records after duplicates 
removed 
(1 in German, 1 in Spanish) 
(n = 588.532) 
Duplicates removed 
(1 in German and 1 
in Spanish) 
(n = 120) 
Records screened (titles and 
abstracts of relevant studies) 
(n = 588.418) 
Studies excluded for 
titles and abstracts 
not meeting the 
eligibility criteria, 
other than English 
language 
(n = 587.950) 
Full-text articles assessed for 
eligibility 
(n = 468) 
Full-text articles excluded 
for various reasons 
(not healthcare 
professionals, not an 
appropriate study, not 
using a validated measure 
of mental health, article 
not available in full text, 
not related to the 
epidemic/pandemic) 
(n = 454) 
 
 
Studies included in the analysis  
(n = 14) 
Figure 1: The PRISMA flow diagram of literature inclusion in the systematic review 
Slika 1: PRISMA diagram vključene literature v sistematični pregled
304 Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
able to decide whether to include or exclude a record 
according to its title, we also reviewed the abstract. In 
the second round, we read the abstract carefully, and 
in the third round, we read the articles and assessed 
their suitability for inclusion in the literature review. 
The assessed quality of articles varied: most of them 
were evaluated as good and suitable, two of them were 
evaluated as satisfactory. All the articles included in the 
final analysis were considered suitable based on similar 
experiences of healthcare professionals. We examined 
the quality of articles in terms of research limitations, 
source reliability, contribution structure and compliance 
with the purpose of our research. Data analysis was 
performed with the help of integrative thematic 
analysis (Aveyard & Bradbury-Jones, 2019). Coding 
units included key findings that were categorised into 
codes presented in Table 2. A thematic text analysis was 
conducted for this section of each source to be included 
in the final analysis. Codes with similar content were 
merged to form broader categories.
Results
Table 2 shows the scientific articles analysed. It 
presents the key factors identified for each source, i.e., 
the author, the research design and the sample used. 
Based on the key factors, the results are presented in 
three thematic categories: incidence of mental health 
disorders; covid-19 pandemic and impact on mental 
health; and nurses' and physicians' ways of coping 
with mental disorders. 
Of the fourteen studies included in this review, six 
studies (Krishnamoorthy et al., 2020; Muller et al., 
2020; Hooper, Saulsman, Hall, & Waters, 2020; Luo, 
Guo, Yu, Jiang, & Wang, 2020; Carmassi et al., 2020; 
Allan et al., 2020) assessed the impact on the mental 
health of nurses and physicians during the covid-19 
pandemic; three studies (Shaukat, Mansoor, & Razzak, 
2020; Sanghera et al., 2020; Vizheh et al., 2020) and five 
of them assessed the risk factors for developing PTSD 
and examined the impact of covid-19 on the mental 
health of nurses and physicians (Billings, Chi Fung 
Ching, Gkofa, Greene, & Bloomfield, 2021; Cabarkapa, 
Nadjidai, Murgier, & Chee, 2020; Fernandez et al., 
2020; Monteiro da Silva, Benjamim, de Medeiros 
Carvalho, & Rolim Neto, 2021; Sahebi, Nejati-
Zarnaqi, & Moayedi 2021). All of the studies were 
systematic reviews, and seven of them also included 
a meta-analysis. The studies compared frontline 
nurses and physicians. Seven articles (Al Thobaity 
& Alshammari, 2020; Benfante, Di Tella, Romeo, 
& Castelli, 2020; Bilings et al., 2020; Daugherty & 
Arble, 2020) discussed the incidence of mental health 
disorders among nurses and physicians working on 
the frontline during the covid-19 pandemic. 
Most articles included the prevalence of the most 
common mental disorders such as anxiety (12.3−5.6%), 
poor sleep quality or insomnia (33.8−36.1%), burnout 
(3.1−43.0%), acute stress reaction (5.2−32.9%), and 
post-traumatic stress disorder (7.4−37.4%). It has 
been reported (Vizheh et al., 2020) that in Spain, 63% 
of nurses and physicians experienced mental health 
disorders. Muller et al. (2020) reported that about 30% 
of nurses and physicians experienced fear and worry 
when caring for covid-19 patients. 
Krishnamoorthy et al. (2020) note that during the 
pandemic, the burden of mental health disorders 
was about 25% higher among nurses and physicians 
compared to the general population. Sleep deprivation 
was 40% higher among frontline nurses. Four articles 
(Bhui, Dinos, Galant-Miecznikowska, de Jongh, 
& Stansfeld, 2020; Gorini et al., 2020; Greenberg, 
Docherthy, Gnanapragasm, & Wessley, 2020; 
Huffman et al., 2020) reported the unpredictability 
of daily workloads, frequent management of patients, 
unexpected critical cases, and high levels of risk factors 
for stress. Only the well-being of nurses and physicians 
can ensure a sustainable response in the fight against 
the pandemic. Male nurses' anxiety symptoms were 
significanty less severe (β = −0.25; p < 0.001) than 
those of their female colleagues (β = −0.45; p < 0.001). 
The prevalence of anxiety and depression was higher 
among nurses (26.88%) than physicians (14.29%) 
(Krishnamoorthy et al., 2020). Data from a study on 
the psychological state of nurses and physicians show 
a higher burden of psychological symptoms among 
Italian nurses, with a 13% risk of suicide (Zhou et al., 
2020). Muller et al. (2020) report than less than 1% 
of all nurses or physicians had initiated any kind of 
psychological or psychiatric treatment. 
Some of the articles analysed (Morgantini et al., 2020; 
Paiano et al., 2020; Prescott et al., 2020; Raudenska 
et al., 2020; Walton, Murray, & Christian, 2020) also 
report healthcare professionals' feelings of fear due to 
lack of effective personal protective equipment and 
extended quarantine duration. A higher prevalence of 
anxiety and depression was identified among younger 
nurses (≤ 30 years old), women, single people and 
those with existing comorbidities (Krishnamoorthy 
et al., 2020). Perceptions of inadequate protective 
measures were found to be a risk factor for the 
development of more severe mental health disorders 
(Monteiro da Silva, Benjamin, de Medeiros Carvalho, 
& Rolim Neto, 2021). 
Some systematic reviews (Cabarkapa et al., 
2020; Carmassi et al., 2020; De Kock, et al., 2020; 
Pouralizadeh, et al., 2020; Tsamakis et al., 2020; 
Sahebi, Nejati-Zarnaqi, & Moayedi, 2020) report a 
progressive deterioration of mental health among 
nurses and physicians at all levels of health care. 
Nurses predominate, probably due to prolonged 
and direct exposure to infection when working with 
covid-19 infected patients, especially in intensive care 
units, where the needs of infected patients are greatest 
(Fernandez et al., 2020). Gorini et al. (2020) report that 
34.5% of nurses and physicians were not satisfied with 
305Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
Table 2: Analysed sources 
Tabela 2: Analizirani viri
Author, year, country/ 
Avtor, leto, država 
Research method/ 
Raziskovalna metoda 
Research purpose/
Namen raziskave 
Key findings/ 
Ključne ugotovitve 
Allan et al., 
2020
United Kingdom
Systematic literature 
review and meta- 
analysis
The prevalence of stress-
related mental health 
disorders in healthcare 
professionals
Prevalence of anxiety (12.3%; n = 1257); Post- 
traumatic symptoms of distress were severe and 
may determine the risk factors for developing 
mental disorders. The estimated prevalence of 
mental disorders in nurses is around 21%.
Billings et al., 
2021
United Kingdom
Systematic literature 
review 
Healthcare 
professionals' 
experiences of working 
on the frontline during 
covid-19
Reporting on elevated workloads that impact 
on psychosocial well-being of healthcare 
professionals; Healthcare professionals stated that 
clear, direct and compassionate communication is 
an important factor influencing the phenomenon 
of mental disorders.
Cabarkapa et al., 
2020
Australia
Systematic literature 
review
The psychological 
impact of covid-19 on 
frontline healthcare 
professionals 
Suicidal ideation in 6.5% of healthcare professionals, 
34% with mild and 6.2% with severe mental health 
disturbances; being a nurse and female represents 
a higher risk for mental challenges (higher levels of 
fear and psychological morbidity).
Carmassi et al., 
2020
Italy
Systematic literature 
review and meta- 
analysis
Post-traumatic stress 
disorder symptoms 
in healthcare workers 
facing the coronavirus 
outbreaks
One in six healthcare professionals has developed 
a significant mental health response; stress 
symptoms related to physical symptoms; 
maladaptive coping strategies result in worse 
outcomes of mental health in healthcare 
professionals.
Fernandez et al.,
2020
Australia
Systematic literature 
review 
Implications for 
covid-19 and nurses' 
experiences in acute 
care hospital settings 
Social interactions can reduce stress and anxiety; 
rapidly changing advice and knowledge about the 
contagion increased the stress levels; inadequate 
training in caring for covid-19 patients elevates 
burnout.
Hooper et al.,
2021
Ireland
Systematic literature 
review
Preventing 
psychological impact 
and positive mental 
health domains 
Anxiety (30%), burnout (28%) and post-
traumatic stress disorder (13%); increased 
working hours were directly related to anxiety 
levels; pre-existing psychiatric disorders before 
the pandemic are associated with high levels 
of depressive symptoms; lower support and 
job stress are directly related to emotional 
exhaustion.
Krishnamoorthy et al., 
2020
India
Systematic literature 
review and meta- 
analysis
Prevalence of 
psychological 
morbidities among 
healthcare professionals
Poor sleep quality (40%), stress (34%), mental 
distress (34%), insomnia (30%); severe shortage 
of personal protective equipment has been 
detected.
Luo et al., 
2020
China
Systematic review 
and meta-analysis
Impact of coronavirus 
disease on healthcare 
professionals
Risk factors for higher psychological impact 
were substantially similar among all healthcare 
professionals; pre-existing psychological 
conditions were found to have a greater impact 
on healthcare professionals, fear and frustration 
being the most common.
Monteiro da Silva et 
al., 2020
Brazil
Systematic literature 
review and meta- 
analysis
Psychological effects 
caused by the covid-19 
pandemic
Higher prevalence of mental health disorders, 
mainly due to stress, insomnia, fear of the disease 
and infectiousness; warning about not neglecting 
the mental health oh healthcare professionals by 
age because of work experience.
Muller et al., 
2020
Norway
Systematic literature 
review 
Impact of covid-19 
pandemic on healthcare 
professionals
A 46% prevalence of anxiety, 41% of distress, and 
30% of insomnia; widespread symptoms show a 
direct link between mental health and decreased 
appetite, digestive problems and fatigue, as well 
as sleep quality and other cognitive functions.
Sahebi et al., 
2021
Iran
Systematic literature 
review and meta- 
analysis
The prevalence of 
anxiety and depression 
among healthcare 
workers during the 
covid-19 pandemic:
Anxiety among healthcare professionals during 
the covid-19 pandemic was 24.94%; an evaluation 
of risk factors for psychological disorders such 
as anxiety and depression among healthcare 
professionals in order to equip them with 
practical coping strategies.
Continues/Se nadaljuje
306 Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
the provision and inadequacy of personal protective 
equipment. On the other hand, Krishnamoorthy et al. 
(2020) report social support of almost 50% for those 
on the frontline of managing the pandemic. Yet, only 
19.6% reported receiving psychological counselling. 
Discussion
Due to the widespread occurrence of the disease and 
the increased number of deaths, nurses and physicians 
are usually found to experience a higher psychological 
burden during pandemics. Frontline healthcare 
professionals show a significantly higher prevalence 
of psychological problems compared non-frontline 
workers. Familiarity with the virus, lack of training 
in dealing with outbreaks, and constantly changing 
infection control measures have been associated with 
low self-efficacy and higher stress levels (Sahebi et al., 
2020; Simms, Fear, & Greenberg, 2020). Nurses and 
physicians consistently report several risk factors 
that increase in such highly lethal outbreaks, such 
as the frequent unpredictability of daily caseloads, 
frequently caring for multiple patients and dealing 
with unexpected critical cases, high-demand and 
low-control situations related to working conditions 
(Gorini et al., 2020; Pouralizadeh et al., 2020). 
The fact that we have attempted to provide the first 
comprehensive review of the burden of mental disorders 
during the covid-19 pandemic among nurses and 
physicians represents a significant advantage of this 
literature review. There has been a lack of such studies 
in countries other than China and Italy. People under 
lockdown should be counselled on stress management 
methods and coping strategies. Employment organisations 
should be able to provide effective and protective 
mental health support. Poor communication with 
management and feeling underappreciated were most 
commonly represented among healthcare professionals. 
Many participants highlighted unfavourable working 
conditions, such as working hours, environment and 
under-staffing, as the causes of work stress, which had 
a negative impact on their professional engagement 
(Krishnamoorty et al., 2020). Muller et al. (2020) report 
on work disengagement of nurses and physicians, some 
even considering leaving their profession. Stable mental 
health of nurses also depends on the availability and 
provision of adequate personal protective equipment, 
which would prevent them from becoming physically 
infected or trasmitting infections to others. 
Coping with the pandemic without adequate 
protective equipment can severely affect the mental 
health status of nurses and physicians in terms of safety 
(Simms et al., 2020; Zhou et al., 2020). The results of 
our examination of mental health predictors show 
that separation distress and emotional symptoms 
were associated with poorer mental health and 
coping skills. Symptoms of mental distress were more 
severe in healthcare professionals than in the general 
population. The main findings of our review show 
that nurses and physicians have a high prevalence of 
mental health disorders, most commonly anxiety and 
sleep deprivation (Allan et al., 2020). It is important 
to promote the psychological well-being of nurses 
and physicians to improve their mental health status 
(Daugherty et al., 2020; Vindrola-Padros et al., 2020). 
These results also support previous studies suggesting 
that in health crisis situations men may suffer longer-
term psychological harm. One possible explanation 
would be that men tend to recognise or experience 
distress later than women (Gorini et al., 2020). It seems 
that mental health disorders can affect patient care 
and consequently increase treatment costs. There is a 
lack of evidence-based interventions and prevention 
strategies to prevent mental health disorders in nurses 
and physicians during pandemics (Luo et al., 2020). 
A strong collegial relationship was significantly 
associated with better coping skills among frontline 
nurses and physicians. As collaboration can be defined 
Author, year, country/ 
Avtor, leto, država 
Research method/ 
Raziskovalna metoda 
Research purpose/
Namen raziskave 
Key findings/ 
Ključne ugotovitve 
Sanghera et al., 
2020
United Kingdom
Systematic literature 
review and meta- 
analysis
Mental health of 
healthcare professionals 
during the pandemic
Prevalence of mental health outcomes: anxiety 
12.3‒35.6%; acute stress reaction 5.2‒32.9%, 
insomnia 33.8-36.1%, and occupational burnout 
3.1‒43.0%.; high prevalence of insomnia and 
sleep deprivation in nurses.
Shaukat et al., 
2020
Pakistan
Systematic literature 
review
Impact of covid-19 on 
healthcare professionals
Findings suggest high levels of stress, anger, 
fear, insomnia in healthcare professionals; 
female nurses were more affected by mental 
health consequences; the consequences show 
increased emotional disturbance, uncertainty and 
stigmatisation of the pandemic. 
Vizheh et al., 
2020
Iran
Systematic literature 
review 
The mental health of 
healthcare professionals 
Prevalence of anxiety 24.1‒44.6%, stress 30‒38%; 
63% of healthcare professionals reported 
experiencing mental disturbance (burnout, fear, 
frustration, sleep deprivation or low quality of 
sleep); mental disturbances were more common 
in nurses compared to the physicians. 
Legend/Legenda: % − percentage/odstotek; n – number/število 
307Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
as an act of cooperation in order to be effective, it 
needs to take place in an atmosphere of mutual trust 
and respect (Karlsson & Fraenkl, 2020; Li et al., 2020). 
It is important to provide sufficient resources in the 
form of mental health counselling, as well as personal 
protective equipment to effectively alleviate anxiety, 
stress and depression among nurses and physicians (Li 
et al. 2020). This literature review found a satisfactory 
number of studies that met the inclusion criteria. In 
future searches, it would be advisable to focus on older 
literature related to other health crises. It is important 
to conduct more cohort studies to track the pattern 
of mental health symptoms at different time points of 
pandemics and to understand long-term impacts of 
pandemics or epidemics among nurses and physicians. 
The analysis is limited to three aspects, namely the 
occurrence of mental health disorders among nurses 
and physicians, their ways of coping with mental 
health disorders, and the impact of the pandemic 
on their mental health. However, questions remain 
regarding the differences in the ways of coping with 
mental health disorders, the duration and adaptation 
to mental disorders, as well as absenteeism and 
rehabilitation in the post-pandemic period. Further 
cross-sectional studies would help address the problem 
of mental disorders and conceptualise solutions to the 
problem of maintaining optimal mental health among 
nurses and physicians in clinical setting. 
Conclusion 
This literature review highlights the urgent need for 
further research, including more extensive follow-up 
investigation of mental disorders. The review shows 
a relatively high prevalence of anxiety among nurses 
and physicians. Preventive measures should include 
shorter shifts, recruitment of new staff and mental 
health support mechanisms. Risk factors could 
be reduced through social support and protective 
interventions. To continue providing high quality 
patient care, nurses and physicians need to receive 
psychosocial support in order to protect their mental 
well-being. Age and pre-existing chronic conditions 
make a person more vulnerable to the effects of a 
pandemic. Future studies should address the link 
between these factors and mental health outcomes. The 
covid-19 pandemic has taken a severe psychological 
toll on nurses, physicians, as well as the general public. 
Psychological interventions are therefore urgently 
needed. Future studies should aim to increase the 
effectiveness of psychological interventions among 
healthcare professionals with mental health problems. 
Conflicts of interest/Nasprotje interesov 
The authors declare that no conflict of interest 
exists./Avtorja izjavljata, da ni nasprotja interesov.
Funding/Financiranje 
The study received no funding./Raziskava ni bila 
finančno podprta. 
Ethical approval/Etika raziskovanja 
The study required no special authorisation from 
the ethics committee. The study was conducted in 
accordance with the principles of the Helsinki-Tokyo 
Decleration (World Medical Association, 2013) and 
the Code of Ethics for Nurses and Nurse Assistants of 
Slovenia (2014)./Raziskava ni potrebovala posebnega 
dovoljenja komisije za etiko. Raziskava je pripravljena 
v skladu z načeli Helsinško-tokijske dekleracije (World 
Medical Association, 2013) in s Kodeksom etike v 
zdravstveni negi in oskrbi v Sloveniji (2014). 
Author contributions/Prispevek avtorjev 
The first author, under the mentorship of the 
second author, prepared the conceptual design, a 
selective overview of the literature, data processing 
and the evaluation and justification of the results. The 
second author participated in directing the contents 
of theoretical work and directed the contents of the 
theoretical part, confirmed the methodology and 
evaluated the displayed results./Prvi avtor je pod 
mentorstvom drugega avtorja pripravil idejno zasnovo, 
selektivni pregled literature, obdelavo podatkov 
ter evalvacijo in utemeljitev rezultatov. Soavtorica 
je sodelovala pri usmerjanju vsebine teoretičnega 
dela, usmerjala je vsebine teoretičnega dela, potrdila 
metodologijo ter evalvirala prikazane rezultate. 
Literature 
Allan, S., Bealey, R., Birch, J., Cushing, T., Parke S., Sergi, G. ... 
Meiser-Stedman, R. (2020). The prevalence of common and stress- 
related mental health disorders in healthcare workers based in 
pandemic- affected hospitals: A rapid systematic review and meta- 
analysis. European Journal of Psychotraumatology, 11(1), 1−12. 
https://doi.org/10.1080/20008198.2020.1810903 
PMid:33244359; PMCid:PMC7678680
Al Thobaity, A., & Alshammari, F. (2020). Nurses on the 
frontline against the COVID-19 pandemic: An integrative 
review. Dubai Medical Journal, 3(2), 87−92. 
https://doi.org/10.1159/000509361
PMCid:PMC7490501
Aveyard, H., Bradbury-Jones, C. (2019). An analysis of current 
practoces in undertaking literature reviews in nursing: Findings 
from a focused mapping review and synthesis. BMC Medical 
Research Methodology, 19(105), 1−9.
https://doi.org/10.1186/s12874-019-0751-7
PMid:31096917; PMCid:PMC6524227
308 Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
Benfante, A., Di Tella, M., Romeo, A., & Castelli, L. (2020). 
Traumatic stress in healthcare workers during COVID-19 
pandemic: A review of the immediate impact. Frontiers 
Psychology, 11(1), 1−7. 
https://doi.org/10.3389%2Ffpsyg.2020.569935 
PMid:33192854; PMCid:PMC7645025
Bhui, K., Dinos, S., Galant- Miecznikowska, M., de Jongh, B., 
& Stansfeld, S. (2016). Perception of work stress causes and 
effective interventions in employees working in public, private 
and non-governmental organisations: A qualitative study. 
Psychological Bulletin Journal, 40(6), 318−325. 
https://doi.org/10.1192%2Fpb.bp.115.050823 
PMid:28377811; PMCid:PMC5353523
Billings, J., Chi Fung Ching, B., Gkofa, V., Greene, T., & 
Bloomfield, M. (2021). Experiences of frontline healthcare 
workers and their views about support during covid-19 and 
previous pandemics: a systematic review and qualitative meta-
synthesis. BMC Health Services Research, 21, Article 923. 
https://doi.org/10.1186/s12913-021-06917-z
PMid:34488733; PMCid:PMC8419805 
Cabarkapa, S., Nadjidai, S., Murgier, J., & Chee, H. (2020). The 
psychological impact of COVID-19 and other viral epidemics 
on frontline healthcare workers and ways to address it: A rapid 
systematic review. Brain Behavior & Immunity, 8(1), 1−10. 
https://doi.org/10.1016/j.bbih.2020.100144
PMid:32959031; PMCid:PMC7494453
Carmassi, C., Foghi, C., Dell'Oste, V., Cordone, A., Bertelloni, 
CA., Bui, E., & Dell'Osso, L. (2020). PTSD symptoms in 
healthcare workers facing the three coronavirus outbreaks: 
What can we expect after the COVID- 19 pandemic. Psychiatry 
Research, 292(2), 1−10.
https://doi.org/10.1016/j.psychres.2020.113312
PMid:32717711; PMCid:PMC7370915 
Daugherty, A., & Arble, E. (2020). Prevalence of mental health 
symptoms in residential healthcare workers in Michigan during 
the covid-19 pandemic. Psychiatric Research, 291(1), 1−2. 
https://doi.org/10.1016/j.psychres.2020.113266
PMid:32623265; PMCid:PMC7324917
De Kock, J., Latham, H. A., Leslie, S. J., Grindle, M., Munoz, S. 
A., Ellis, L. ... O'Malley, C. (2020). A rapid review of the impact 
of COVID-19 on the mental health of healthcare workers: 
Implications for supporting psychological well-being. BMC 
Public health, 1(2), 1−18. 
https://doi.org/10.1016/j.psychres.2020.113441 
PMid:32898840; PMCid:PMC7462563
Fernandez, R., Lord, H., Halcomb, E., Moxham, L., Middleton, 
R., Alananzeh, I., & Ellwood, L. (2020). Implications for 
COVID-19: A systematic review of nurses' experiences of 
working in acute care hospital settings during a respiratory 
pandemic. International Journal of Nursing Studies, 111(1), 1−18. 
https://doi.org/10.1016/j.ijnurstu.2020.103637
PMid:32919358 PMCid:PMC7206441
Galehdar, N., Kamran, A., Toulabi, T., & Heydari, H. (2020). 
Exploring nurses' experiences of psychological distress during 
care of patients with COVID-19: A qualitative study. BMC 
Psychiatry, 20(4), 2−9. 
https://doi.org/10.1186/s12888-020-02898-1
PMid:33023535; PMCid:PMC7538040
Gorini, A., Fiabane, E., Sommaruga, M., Barbieri, S., Sottotetti, 
F., La Rovere, M. T. ... Gabanelli, P. (2020). Mental health 
and risk perception among Italian healthcare workers during 
the second month of the COVID-19 pandemic. Archives of 
Psychiatric Nursing, 1(1), 537−544. 
https://doi.org/10.1016/j.apnu.2020.10.007 
PMid:33280678; PMCid:PMC7577253
Greenberg, N., Docherty, M., Gnanapragasm, S., & Wessely, S. 
(2020). Managing mental health challenges faced by health care 
workers during covid-19 pandemic. British Medical Journal, 
368(1), 1−4. 
https://doi.org/10.1136/bmj.m1211
PMid:32217624
Hooper, J., Saulsman, L., Hall, T., & Waters, F. (2020). Addresing 
the psychological impact of Covid-19 on healthcare workers: 
Learning from a systematic review of early interventions for 
frontline responders. BMJ Open, 11(5), 1−15. 
https://doi.org/10.3390/ijerph18136695 
PMid:34020974; PMCid:PMC8142676
Huffman, E., Athanasiadis, D., Anton, N., Haskett, L., Doster, 
D., Stefanidis, D., & Lee, N. (2020). How resilient is your 
team: Exploring healthcare providers' well-being during the 
COVID-19 pandemic. American Journal of Surgery, 1(1), 
277−284. 
https://doi.org/10.1016/j.amjsurg.2020.09.005 
PMid:3299404;1 PMCid:PMC7486626
Karlsson, U., & Fraenkel, C. J. (2020). Covid-19: Risks to 
healthcare workers and their families. Mistakes made in the 
first wave must not be repeated in the second. BMJ Open, 
371(1), 1−2. 
https://doi.org/10.1136/bmj.m3944
PMid:33115772
Krishnamoorthy, Y., Nagarajan, R., Kumar Saya, G., & Menon, 
V. (2020). Prevalence of psychological morbidities among 
general population, healthcare workers and COVID-19 
patients amidst the COVID-19 pandemic: A systematic review 
and meta- analysis. Psychiatry Research, 293(2), 1−11. 
https://doi.org/10.1016%2Fj.psychres.2020.113382 
PMid:32829073; PMCid:PMC7417292
Li, X., Li, S., Xiang, M., Fang, Y., Qian, K., Xu, J. ... Wang, B. 
(2020). The prevalence and risk factors of PTSD symptoms 
among medical assistance workers during the COVID-19 
pandemic. Journal of Psychosomatic Research, 39(1), 1−7. 
https://doi.org/10.1016/j.jpsychores.2020.110270 
PMid:33070044; PMCid:PMC7536549
309Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
Luo, M., Guo, L., Yu, M., Jiang, W., & Wang, H.(2020). The 
psychological and mental impact of coronavirus disease 2019 
(COVID-19) on medical staff and general public: A systematic 
review and meta- analysis. Psychiatry Research, 291(1), 1−9. 
https://doi.org/10.1016/j.psychres.2020.113190
PMid:32563745; PMCid:PMC7276119
Morgantini, L., Naha, U., Wang, H., Francavilla, S., Acar, O., 
Flores, J. ... Weine, S. (2020). Factors contributing to healthcare 
professional burnout during the COVID-19 pandemic: A rapid 
turnaround global survey. Plos One, 1(15), 9−11. 
https://doi.org/10.1371/journal.pone.0238217 
PMid:32881887; PMCid:PMC7470306
Monteiro da Silva, R., Benjamim, CJR., de Medeiros Carvalho, 
P., & Rolim Neto, M. L. (2021). Psychological effects caused 
by the COVID- 19 pandemic in health professionals: A 
systematic review with meta- analysis. Progress in Neuro-
Psychopharmacology and Biological Psychiatry, 104(1), 1−7. 
https://doi.org/10.1016/j.pnpbp.2020.110062
PMid:32771337; PMCid:PMC7409979
Muller, A., Hafstad, E., Himmels, J. P. W., Smedslund, G., 
Flottorp, S., Stenslad, S. ... Vist, G. E. (2020). The mental health 
impact of the covid-19 pandemic on healthcare workers, 
and interventions to help them: A rapid systematic review. 
Psychiatry Research, 293(3), 1−11.
https://doi.org/10.1016/j.psychres.2020.113441
PMid:32898840; PMCid:PMC7462563
Paiano, M., Jaques, A. E., Bezerra Nacamura, P., Salci, M. A, 
Trindade Radovanovic, C. A., & Carreira, L. (2020). Mental 
health of healthcare professionals in China during the new 
coronavirus pandemic: An integrative review. Revista Brasileira 
de Enfermagem, 73(1), 1−8. 
https://doi.org/10.1590/0034-7167-2020-0338
PMid:32965402
Pouralizadeh, M., Bostani, Z., Maroufizadeh, S., Ghanbari, A., 
Khoshbakht, M., Amirhossein Alavi S., & Ashrafi, S. (2020). 
Anxiety and depression and the related factors in nurses 
of Guilan university of medical sciences hospital during 
COVID-19: A web-based cross-sectional study. International 
Journal of Africa Nursing Science, 13(1), 1−6.
https://doi.org/10.1016/j.ijans.2020.100233
PMid:32837911; PMCid:PMC7417274
Prescott, K., Baxter, E., Lynch, C., Jassal, S., Bashir, A., & Gray, 
J. (2020). COVID-19: How prepared are front- line healthcare 
workers in England. Journal of Hospital Infection, 105(1), 
142−145. 
https://doi.org/10.1016/j.jhin.2020.04.031
PMid:32339615; PMCid:PMC7195134
Raudenska, J., Steinerova, V., Javurkova, A., Urits, I., D 
Kaye, A., Viswanath, O., & Varrassi, G. (2020). Occupational 
burnout syndrome and post-traumatic stress among healthcare 
professionals during the novel coronavirus disease 2019 
(COVID-19) pandemic. Best Practice & Research: Clinical 
Anaesthesiology, 34(3), 553−560. 
https://doi.org/10.1016/j.bpa.2020.07.008
PMid:33004166; PMCid:PMC7367798
Sahebi, A., Nejati-Zarnaqi, B., & Moayedi, S. (2021). The 
prevalence of anxiety and depression among healthcare workers 
during the COVID-19 pandemic: An umbrella review of meta-
analysis. Progress in Neuro-Psychopharmacology and Biological 
Psychiatry, 107(1), 1−7. 
https://doi.org/10.1016/j.pnpbp.2021.110247
PMid:33476692; PMCid:PMC7817526
Sanghera, J., Pattani, N., Hashmi, Y., Varley, K., Srinivas 
Cheruvu, M., Bradley, A., & Burke, J. (2020). The impact of 
SARS-CoV-2 on the mental health of healthcare workers in a 
hospital setting: A systematic review. Journal of Occupational 
Health, 62(1), 1−16. 
https://doi.org/10.1002/1348-9585.12175
PMid:33131192; PMCid:PMC7603426
Shamseer, L., Moher, D., Shamsser, L., Clarke, M., Ghersi, D., 
Liberati, A. ... Stewart L. (2015). Preffered reporting items for 
systematic review and meta-analysis protocols (PRISMA-P) 
statement. Systematic Reviev, 4(1), 1−25.
https://doi.org/10.1136/bmj.g7647
Shaukat, N., Mansoor, A., & Razzak, J. (2020). Physical and 
mental health impacts of COVID-19 on healthcare workers: A 
scoping review. International Journal of Emergency Medicine, 
13(40), 1−8. 
https://doi.org/10.1186/s12245-020-00299-5
PMid:32689925; PMCid:PMC7370263
Simms, A., Fear, N., & Greenberg, N. (2020). The impact 
of having inadequate safety equipment on mental health. 
Occupational Medicine, 70(4), 278−281. 
https://doi.org/10.1093/occmed/kqaa101
PMid:32449770; PMCid:PMC7313819
Streubert, H. J., & Carpenter, D. R. (2011). Qualitative research 
in nursing: Advancing the Humanistic Iimperative (5th ed.). 
Philadelphia: Wolters kluwer.
Tsamakis, K., Rizos, E., Manolis, A., Chaidou, S., 
Kympouropoulos, S., Spartalis, E. ... Triantafyllis, A. (2020). 
COVID-19 pandemic and its impact on mental health of 
healthcare professionals. Experiment and Therapeutic Medicine, 
19(1), 3451−3453.
https://doi.org/10.3892/etm.2020.8646 
Vindrola-Padros, C., Andrews, L., Dowrick, A., Djellouli, N., 
Fillmore, H., Gonzalez, E. B. ... Johnson, G. (2020). Perceptions 
and experiences of healthcare workers during the COVID-19 
pandemic in the UK. BMJ Open, 1(2), 1−8. 
https://doi.org/10/11/e040503
PMid:33154060; PMCid:PMC7646318
310 Višič, U., & Sočan, M. (2022)/Obzornik zdravstvene nege, 56(4), pp. 301–310.
Vizheh, M., Qorbani, M., Arzaghi, S., Muhidin, S., Javanmard, 
Z., & Esmaeili, M. (2020). The mental health of healthcare 
workers in the COVID-19 pandemic: A systematic review. 
Journal of Diabetes, 1(1), 1967−1978. 
https://doi.org/10.1007/s40200-020-00643-9 
PMid:33134211; PMCid:PMC7586202
Walton, M., Murray, E., & Christian, M. (2020). Mental 
healthcare for medical staff and affiliated healthcare workers 
during the COVID-19 pandemic. European Heart Journal- 
Cardiovascular Imaging, 1(1), 241−247. 
https://doi.org/10.1177/2048872620922795
PMid:32342698; PMCid:PMC7189614
Zhou, Y., Wang, W., Sun, Y., Qian, W., Liu, Z., Wang, R. ... Zhang, 
X. (2020). The prevalence and risk factors of psychological 
disturbances of frontline medical staff in china under the 
COVID-19 epidemic: Workload should be concerned. Journal 
of Affective Disorders, 277(1), 510−514. 
https://doi.org/10.1016/j.jad.2020.08.059 
PMid:32882508; PMCid:PMC7448730
Cite as/Citirajte kot: 
Višić, U., & Sočan, M. (2022). The impact of the COVID-19 pandemic on nurses' and physicians' mental health: A literature review. 
Obzornik zdravstvene nege, 56(4), 301–310. https://doi.org/10.14528/snr.2022.56.4.3113