Fatores de risco à saúde mental dos profissionais da saúde durante a pandemia de COVID-19: revisão sistemática

Silva, Mariane Alexandra Xavier da; Santos, Mairana Maria Angélica; Araújo, Angélica Barros; Galvão, Cláudia Regina Cabral; Barros, Márcia Maria Mont’Alverne de; Silva, Ana Cristina de Oliveira e; Souza, Marina Batista Chaves Azevedo de; Barroso, Bárbara Iansã de Lima

doi:10.1590/1413-812320232810.12102023

Resumo

Neste estudo, nosso objetivo foi mapear as evidências disponíveis sobre os fatores de risco à saúde mental dos profissionais de saúde trabalhadores da linha de frente durante a pandemia de COVID-19. Trata-se de uma revisão sistemática que seguiu os critérios dos Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada independentemente, por quatro pesquisadores, seguindo os critérios de seleção nas bases de dados eletrônicas PubMed Central, Ovid Technologies, GALE Academic Onefile, Science Citation Index Expanded. No processamento de dados foi utilizado o software Zotero, responsável por criar e importar itens de acordo com os critérios estabelecidos pela pesquisa. Foram encontrados 18.733 artigos, dos quais 2.722 foram excluídos, a partir do programa Zotero, por estarem duplicados, e outros 366 excluídos manualmente. Após aplicação dos critérios de seleção, 43 artigos entraram na análise final desta revisão. Recomenda-se a elaboração de novas pesquisas científicas, sobretudo colocando como objeto a análise da saúde mental desses trabalhadores, com o objetivo de embasar a elaboração e implementação de programas e políticas públicas de saúde mental para os trabalhadores.

Palavras-chave:
Profissional de saúde; COVID-19; SARS-CoV-2; Saúde mental; Trabalhadores

Introdução

O surto da COVID-19 (sigla em inglês para doença do coronavírus), teve origem em dezembro de 2019 em Wuhan, cidade localizada na província de Hubei, China. Devido à capacidade de alta propagação do coronavírus, ele se espalhou por todo o mundo, causando um grande problema de saúde pública mundial. Com isso, em 11 de março de 2020 foi declarada uma pandemia global pela Organização Mundial da Saúde (OMS)¹1 World Health Organizatio (WHO). Coronavirus Disease 2019 (COVID-19) Situation Report-87 [Internet]. 2019. [cited 2023 mar 9]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200416-sitrep-87-COVID-19.pdf?sfvrsn=9523115a_2
https://www.who.int/docs/default-source/... ^,²2 Gold JA. COVID-19: adverse mental health outcomes for healthcare workers. BMJ 2020; 369:m1815. Com o aumento no número de casos de pessoas contaminadas pelo coronavírus, o sistema de saúde passou por vários problemas devido à falta de conhecimento científico sobre a nova doença, que apresentava alta taxa de mortalidade¹1 World Health Organizatio (WHO). Coronavirus Disease 2019 (COVID-19) Situation Report-87 [Internet]. 2019. [cited 2023 mar 9]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200416-sitrep-87-COVID-19.pdf?sfvrsn=9523115a_2
https://www.who.int/docs/default-source/... .

Com a chegada do vírus e suas várias mutações, os sistemas de saúde entraram em colapso e enfrentaram grandes dificuldades em razão da ausência de protocolos efetivos no combate ao vírus e de tratamentos com comprovações científicas²2 Gold JA. COVID-19: adverse mental health outcomes for healthcare workers. BMJ 2020; 369:m1815. Ainda, a ausência ou inadequação de treinamento apropriado nas equipes de assistência à COVID-19 com relação à prevenção e controle de infecções causou um alto número de contaminação dos profissionais da saúde. Somado a isso, a falta de fornecimento de equipamentos de proteção individual no início da pandemia tornou ainda mais precária a situação dos trabalhadores e trabalhadoras da área de saúde que estavam na linha de frente do combate à COVID-19.

Diante da situação apresentada, que demandou grande responsabilidade dos profissionais de saúde e risco à vida, percebe-se que é necessário preocupar-se com os possíveis impactos na saúde mental dos profissionais, sobretudo aqueles que estiveram ligados diretamente ao enfrentamento da pandemia, nas ditas linhas de frente. Sendo assim, é importante a realização de pesquisas científicas do tipo revisão sistemática, para que seja possível reunir evidências provenientes de estudos que tiveram como objetivo mapear as evidências disponíveis sobre os fatores de risco à saúde mental dos profissionais de saúde trabalhadores da linha de frente durante a pandemia de COVID-19.

No que diz respeito ao caráter inédito deste estudo, foi evidenciado que no momento de sua produção não havia revisões cadastradas na base de dados do PROSPERO abordando esse assunto. Destaca-se o modo como os artigos foram categorizados e a forma de avaliação da qualidade dos estudos. O PROSPERO é uma base gratuita de registro para protocolos de revisões sistemáticas. Ressalta-se que a relevância científica desta base é reconhecida internacionalmente e possibilita a identificação de revisões inéditas, a exemplo desta revisão, e também de vieses de desfecho.

Método

Esta revisão sistemática foi realizada seguindo o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Conforme as orientações do comitê PRISMA³3 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. RevPanm Salud Publica 2022; 31(2):e112.. A pesquisa foi registrada no International Prospective Register of Systematic Reviews (PROSPERO) em 26 de abril de 2021, com o número de registo CRD42021241088.

Critérios de elegibilidade - seleção dos estudos

Os estudos foram selecionados por meio de critérios pré-definidos estabelecidos por dois pesquisadores líderes. Para a questão-chave 1, a amostra/população do estudo era de profissionais de saúde que atuavam na assistência e cuidado a pacientes infectados e diagnosticados com COVID-19 e trabalhadores da linha de frente de hospitais, clínicas e/ou centros de reabilitação e triagem para COVID-19. Para a pergunta-chave 2, os fatores de risco potenciais foram características demográficas - país e/ou cidade pesquisada, histórico de exposição e fatores administrativos, como carga de trabalho. Dois pesquisadores revisaram cada etapa de seleção dos estudos incluídos nesta pesquisa e um “juiz” foi reportado quando não houve consenso entre os pesquisadores.

De acordo com o modelo PICOS, foram adotados os seguintes critérios de elegibilidade: participantes (P): profissionais de saúde que cuidassem ou assistissem pacientes com infecção por COVID-19 e trabalhadores que atuassem na linha de frente de hospitais, clínicas e centros de reabilitação e triagem para COVID-19; desfecho (O): prevalência de transtornos mentais comuns relatados nos estudos; estudo (S): transversal, longitudinal ou coorte (dados da linha de base). Por se tratar de uma revisão sistemática, nem todas as perguntas receberam uma resposta satisfatória.

Como critérios de inclusão foram considerados: o artigo indexado nas bases de dados selecionadas, com disponibilidade completa de - forma livre e integral - do texto; artigos de revistas revisadas por pares; pesquisas publicadas em inglês, espanhol e/ou português; filtro de data de 2019 a 1º de junho de 2021. Não foram colocadas restrições quanto ao local em que o manuscrito foi produzido.

Fontes de informação e estratégia de busca

Foi realizada uma busca de forma independente, por quatro pesquisadores, seguindo os critérios de seleção estabelecidos pelo guia de orientação PRISMA-2020. Foram consultadas as seguintes bases de dados eletrônicas: PubMed Central (PMC), OVID Technologies, OneFile (GALE) e Science Citation Index Expanded. Para o processamento de dados foi utilizado o software Zotero, responsável por criar e importar itens de acordo com os critérios estabelecidos pela equipe de pesquisa.

Os termos utilizados na consulta foram estabelecidos pelos descritores do Medical Subject Headings (MeSH Terms). Foi realizada uma busca na bibliografia literária a partir dos seguintes descritores: “Health professional” AND “COVID-19” OR “SARS-CoV-2” AND “Mental Health” AND “Workers”. As variações nos descritores serviram para que fosse encontrada uma maior gama de resultados significativos para esta pesquisa.

Processo de coleta de dados

A gestão, importação, sincronização, e armazenamento dos dados foi efetuada por meio do software Zotero. A extração dos dados foi realizada inicialmente por dois autores, e depois analisada e revisada, em caso de discordância, por um terceiro pesquisador, de forma independente e sem intervenção no momento da extração; o consenso foi alcançado pela discussão entre os pesquisadores, a utilização de um árbitro final não foi necessária. O processo de seleção para a pesquisa incluiu hierarquicamente um procedimento de coleta de dados em três etapas para identificar os estudos relevantes: (1) análise e seleção por rastreio dos títulos; (2) análise e seleção da leitura dos resumos; e (3) análise e seleção pela leitura completa dos textos elegíveis.

Lista de dados

Todos os artigos atingiram nível máximo de domínio das medidas de desfecho escolhidas para esta pesquisa. Como forma de mapear as características dos artigos, as seguintes variáveis foram coletadas: título e ano; grupo analisado e categoria profissional; tipo de estudo e amostra; objetivo da pesquisa; as medidas de resultados; e os principais desfechos e limitações dos estudos, apresentados no Quadro 1 (Disponível em: https://drive.google.com/file/d/1L_9UvMQ5R329MYnfLFMErJIO_WNqMkjt/view?usp=sharing).

Métodos de síntese

Para a avaliação da qualidade dos estudos selecionados, participaram dois investigadores, que extraíram os dados dos estudos selecionados e os organizaram no Quadro 2 (disponível em: https://drive.google.com/file/d/1Jwi0Zfot8K9ldwhTN-Ptf8G3yzUvHlDl/view?usp=sharing), resultados que contêm a avaliação de qualidade feita com base nos critérios determinados pelo National Heart, Lung, and Blood Institute (NHLBI).

Considerando a importância de mensurar a qualidade dos estudos em revisões sistemáticas, o NHLBI desenvolveu um conjunto de ferramentas personalizadas que orientam essa mensuração, a exemplo da Guidance for Assessing the Quality of Observational Cohort and Cross-Sectional Studies⁴4 Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Military Med Res 2020; 7(1):7. (que em português significa orientação para avaliação da qualidade de estudos de coorte observacional e transversal). Essa ferramenta é composta por 14 itens, e cada um deles corresponde a uma pergunta, que pode ser respondida com “sim”, “não” ou “não reportado’’. Na ferramenta, pontua-se 1 para cada resposta “sim” e 0 para todas as outras respostas. De forma geral, a pontuação total do estudo seria o número de respostas “sim”. Notas superiores a 12 são consideradas “boas”, significando que o estudo tem um risco baixo de viés. Notas inferiores a 9 são consideradas “medianas”, o que significa que o estudo é de uma qualidade entendida como aceitável. Já as avaliações menores de 9 significam que o estudo é “razoável”⁵5 National Heart, Lung, and Blood Institute (NIH). Quality Assessment Tool for Observation-al Cohort and Cross-Sectional Studies [Internet]. 2017. [cited 2021 abr 30]. Available from: https://www.nhlbi.nih.gov/health-topics/studyquality-assessment-tools.
https://www.nhlbi.nih.gov/health-topics/... , ou seja, que detém pontos fortes e fracos, mas que apresenta um risco de viés significativo. Para este estudo, apenas os artigos de coorte observacional tiveram sua qualidade avaliada.

Resultados

Seleção dos estudos

A varredura inicial no banco de dados de palavras-chave retornou 18.733 artigos potencialmente elegíveis nas bases de pesquisa: PubMed Central: 9.987; Ovid Technologies: 6.864; GALE Academic Onefile: 1.354; Science Citation Index Expanded: 528.

Os resultados da varredura são apresentados na Figura 1 - PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only. Posteriormente à seleção dos 18.733 artigos, os materiais foram importados para o programa Zotero, com 2.722 sendo excluídos por duplicidade e 366 de forma manual, restando 15.645. Foram elegíveis 5.679 para inclusão na triagem de resumos. Após a triagem de resumos, 4.632 pesquisas foram excluídas, restando 1.047 artigos para triagem de texto completo, dos quais 1.004 artigos foram excluídos, restando 43 artigos para extração de dados - selecionados e apresentados nos Quadros 1 (disponível em: https://drive.google.com/file/d/1L_9UvMQ5R329MYnfLFMErJIO_WNqMkjt/view?usp=sharing) e 2 (disponível em: https://drive.google.com/file/d/1Jwi0Zfot8K9ldwhTN-Ptf8G3yzUvHlDl/view?usp=sharing) e na Figura 1.

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Figura 1
Identificação de estudos por meio de bancos de dados e registros.

Características gerais dos estudos incluídos e avaliação da qualidade

A pontuação média de avaliação de qualidade NHLBI dos artigos foram: sete tiveram pontuação acima de 9, sendo considerados medianos 9/5²⁷27 Amal M. Qasem Surrati, Farah M. Asad Mansuri, Abeer A. Ayadh Alihabi. Psychological impact of the COVID-19 pandemic on health care workers. J Taibah Univ Med Sci 2020; 15(6):536-543.^,³⁸38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.

39 Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136.^-⁴⁰40 Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environment Health 2020; 46(6):639-644.^,⁴⁴44 Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.; 10/1²⁶26 Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.; 11/1³³33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.. Os estudos considerados razoáveis foram a grande maioria 6/2²⁹29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.^,⁴⁷47 Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114.; 7/5²⁸28 Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930.^,³⁰30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.

35 Hong X, Cao J, Wei J, Duan Y, Zhao X, Jiang J, Jiang Y, Geng W, Zhu H. Stress and psychological impact of the COVID-19 outbreak on the healthcare staff at the fever clinic of a tertiary general hospital in Beijing: a cross-sectional study. BJPsych Open 2020; 7(3):e76.^-³⁶36 Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Morozov PV, Lutova NB, Mazo GE. Stress and stigmatization in health-care workers during the COVID-19 pandemic. Indian J Psychiatry 2020; 62(Suppl 3):S445-S453.; 8/9²⁵25 Wang N, Li Y, Wang Q, Lei C, Liu Y, Zhu S. Psychological impact of COVID-19 pandemic on healthcare workers in China Xi'an central hospital. Brain Behav 2021; 11(3):e02028.^,³¹31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.^,³²32 Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci 2020; 18:Doc05.^,³⁷37 Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.^,⁴²42 Chen X, Arber A, Gao J, Zhang L, Ji M, Wang D, Wu J, Du J. The mental health status among nurses from low-risk areas under normalized COVID-19 pandemic prevention and control in China: a cross-sectional study. Int J Ment Health Nurs 2021; 30(4):975-987.

43 Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16(1):e0245294.^-⁴⁴44 Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.^,⁴⁶46 Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.^,⁴⁷47 Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114. . Todos os estudos elegíveis para a avaliação de qualidade do NHLBI estão expostos no Quadro 2 (disponível em: https://drive.google.com/file/d/1Jwi0Zfot8K9ldwhTN-Ptf8G3yzUvHlDl/view?usp=sharing).

As características das pesquisas (grupo analisado/categorias profissionais; país de origem; objetivo), assim como os resultados do estudo, foram apresentados no Quadro 1 (disponível em: https://drive.google.com/file/d/1L_9UvMQ5R329MYnfLFMErJIO_WNqMkjt/view?usp=sharing. Com relação às características metodológicas dos estudos elegíveis, 34 eram transversais ⁶6 Kibret S, Teshome D, Fenta E, Hunie M, Tamire T. Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia. PLoS One 2020; 15(12):e0243022.

7 Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care 2020; 9(9):4904-4910.

8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.

9 Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in special. Asia Pac Psychiatry 2022; 14(1):e12427.^-¹⁰10 Guo WP, Min Q, Gu WW, Yu L, Xiao X, Yi WB, Li HL, Huang B, Li JL, Dai YJ, Xia J, Liu J, Li B, Zhou BH, Li M, Xu HX, Wang XB, Shi WY. Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: a cross-sectional study. Health Qual Life Outcomes 2021; 19(1):103.^,¹²12 Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26.

13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.^-¹⁴14 Skoda EM, Teufel M, Stang A, Jöckel KH, Junne F, Weismüller B, Hetkamp M, Musche V, Kohler H, Dörrie N, Schweda A, Bäuerle A. Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the international context. J Public Health (Oxf) 2020; 42(4):688-695.^,¹⁶16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.

17 Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.

18 Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.

19 Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre, cross-sectional study. SAGE Open Med 2021; 9:20503121211000919.

20 Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, Li J, Zhang SK, Ren ZF, Ren R, Liu YL, Qiao YL. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020; 9(1):113.

21 Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 2020; 29(21-22):4217-4226.

22 Leira-Sanmartín M, Madoz-Gúrpide A, Ochoa-Mangado E, Ibáñez Á. Psychological impact of COVID-19 pandemic and related variables: a cross-sectional study in a sample of workers in a Spanish tertiary hospital. Int J Environ Res Public Health 2021; 18(7):3608.^-²³23 Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320.^,²⁵25 Wang N, Li Y, Wang Q, Lei C, Liu Y, Zhu S. Psychological impact of COVID-19 pandemic on healthcare workers in China Xi'an central hospital. Brain Behav 2021; 11(3):e02028.

26 Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.^-²⁷27 Amal M. Qasem Surrati, Farah M. Asad Mansuri, Abeer A. Ayadh Alihabi. Psychological impact of the COVID-19 pandemic on health care workers. J Taibah Univ Med Sci 2020; 15(6):536-543.^,³²32 Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci 2020; 18:Doc05.

33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.

34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.

35 Hong X, Cao J, Wei J, Duan Y, Zhao X, Jiang J, Jiang Y, Geng W, Zhu H. Stress and psychological impact of the COVID-19 outbreak on the healthcare staff at the fever clinic of a tertiary general hospital in Beijing: a cross-sectional study. BJPsych Open 2020; 7(3):e76.

36 Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Morozov PV, Lutova NB, Mazo GE. Stress and stigmatization in health-care workers during the COVID-19 pandemic. Indian J Psychiatry 2020; 62(Suppl 3):S445-S453.

37 Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.

38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.^-³⁹39 Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136.^,⁴¹41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.

42 Chen X, Arber A, Gao J, Zhang L, Ji M, Wang D, Wu J, Du J. The mental health status among nurses from low-risk areas under normalized COVID-19 pandemic prevention and control in China: a cross-sectional study. Int J Ment Health Nurs 2021; 30(4):975-987.

43 Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16(1):e0245294.

44 Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.

45 Chen B, Li QX, Zhang H, Zhu JY, Yang X, Wu YH, Xiong J, Li F, Wang H, Chen ZT. The psychological impact of COVID-19 outbreak on medical staff and the general public. Curr Psychol 2020; 41(8):5631-5639.

46 Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.

47 Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114.^-⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149., duas pesquisas longitudinais¹¹11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.^,²⁴24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1., um estudo comparativo¹⁵15 Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465., uma coorte observacional²⁸28 Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930., um estudo observacional e descritivo transversal³⁰30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580., um observacional transversal³¹31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970. e um prospectivo de coorte⁴⁰40 Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environment Health 2020; 46(6):639-644.. Dos 43 estudos incluídos, 42 foram realizados e publicados em 2020⁶6 Kibret S, Teshome D, Fenta E, Hunie M, Tamire T. Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia. PLoS One 2020; 15(12):e0243022.

7 Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care 2020; 9(9):4904-4910.^-⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.^,¹⁰10 Guo WP, Min Q, Gu WW, Yu L, Xiao X, Yi WB, Li HL, Huang B, Li JL, Dai YJ, Xia J, Liu J, Li B, Zhou BH, Li M, Xu HX, Wang XB, Shi WY. Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: a cross-sectional study. Health Qual Life Outcomes 2021; 19(1):103.

11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.

12 Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26.

13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.

14 Skoda EM, Teufel M, Stang A, Jöckel KH, Junne F, Weismüller B, Hetkamp M, Musche V, Kohler H, Dörrie N, Schweda A, Bäuerle A. Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the international context. J Public Health (Oxf) 2020; 42(4):688-695.

15 Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465.

16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.

17 Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.

18 Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.

19 Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre, cross-sectional study. SAGE Open Med 2021; 9:20503121211000919.

20 Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, Li J, Zhang SK, Ren ZF, Ren R, Liu YL, Qiao YL. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020; 9(1):113.

21 Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 2020; 29(21-22):4217-4226.

22 Leira-Sanmartín M, Madoz-Gúrpide A, Ochoa-Mangado E, Ibáñez Á. Psychological impact of COVID-19 pandemic and related variables: a cross-sectional study in a sample of workers in a Spanish tertiary hospital. Int J Environ Res Public Health 2021; 18(7):3608.

23 Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320.

24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.

25 Wang N, Li Y, Wang Q, Lei C, Liu Y, Zhu S. Psychological impact of COVID-19 pandemic on healthcare workers in China Xi'an central hospital. Brain Behav 2021; 11(3):e02028.

26 Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.

27 Amal M. Qasem Surrati, Farah M. Asad Mansuri, Abeer A. Ayadh Alihabi. Psychological impact of the COVID-19 pandemic on health care workers. J Taibah Univ Med Sci 2020; 15(6):536-543.

28 Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930.

29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.

30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.

31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.

32 Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci 2020; 18:Doc05.

33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.

34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.

35 Hong X, Cao J, Wei J, Duan Y, Zhao X, Jiang J, Jiang Y, Geng W, Zhu H. Stress and psychological impact of the COVID-19 outbreak on the healthcare staff at the fever clinic of a tertiary general hospital in Beijing: a cross-sectional study. BJPsych Open 2020; 7(3):e76.

36 Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Morozov PV, Lutova NB, Mazo GE. Stress and stigmatization in health-care workers during the COVID-19 pandemic. Indian J Psychiatry 2020; 62(Suppl 3):S445-S453.

37 Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.

38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.

39 Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136.

40 Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environment Health 2020; 46(6):639-644.

41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.

42 Chen X, Arber A, Gao J, Zhang L, Ji M, Wang D, Wu J, Du J. The mental health status among nurses from low-risk areas under normalized COVID-19 pandemic prevention and control in China: a cross-sectional study. Int J Ment Health Nurs 2021; 30(4):975-987.

43 Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16(1):e0245294.

44 Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.

45 Chen B, Li QX, Zhang H, Zhu JY, Yang X, Wu YH, Xiong J, Li F, Wang H, Chen ZT. The psychological impact of COVID-19 outbreak on medical staff and the general public. Curr Psychol 2020; 41(8):5631-5639.

46 Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.

47 Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114.^-⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149., somente um foi publicado em 2021⁹9 Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in special. Asia Pac Psychiatry 2022; 14(1):e12427..

No que respeita às amostras, o número total da população pesquisada nos estudos foi de 49.117 pessoas. Todas as pesquisas tinham de forma detalhada o perfil e a população estudada. A maioria dos estudos com abordagem transversal utilizou métodos não probabilísticos de amostragem. Quanto às características demográficas relacionadas à origem dos estudos, a maioria era de origem chinesa (15), onde o surto da COVID-19 começou. Todavia, foram encontrados trabalhos conduzidos na Espanha (4), Estados Unidos (3), Itália (3), Turquia (2), Alemanha (2), Índia (2), Japão (2), Arábia Saudita (2), Sri Lanka (1), Gana (1), Irlanda (1), França (1), Reino Unido (1), Rússia (1), Omã (1) e Etiópia (1).

A categoria profissional que mais foi relatada nas pesquisas foi a de enfermeiro, seguida de médicos, profissionais técnicos, cirurgiões dentistas, trabalhadores da administração, limpeza e segurança.

Perfil da população dos estudos

As categorias profissionais mais pesquisadas foram as de enfermeiros e médicos, e grande parte dos estudos apontou que havia sobrecarga de trabalho, relatada em 37 pesquisas^{6-17,20-25, 27-32,34,36-48}, e os profissionais de enfermagem pesquisados eram mulheres⁷7 Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care 2020; 9(9):4904-4910.^,⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.^,¹⁶16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.^,³⁰30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.^,³¹31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.^,³⁷37 Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.^,⁴¹41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.^,⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149.. Os preditores para o surgimento de transtornos mentais e/ou sofrimento mental mais descritos nesses 37 estudos foram: exposição constante a pacientes infectados ou portadores do vírus; falta de equipamentos de proteção individual; elevada possibilidade de contágio no ambiente de trabalho; desconforto causado pelo uso contínuo de equipamentos de proteção individual; escassez crônica de profissionais de saúde; alta carga/jornada de trabalho; falta de uma política global mais eficiente em relação ao controle de infecção.

Seleção final: descrição dos riscos aos quais estão expostos os trabalhadores de saúde envolvidos no atendimento de pacientes diagnosticados com COVID-19 durante a pandemia

Durante a seleção final, 43 artigos foram incluídos para leitura na íntegra e extração de dados. Foram evidenciados quatro principais riscos aos quais estão expostos os trabalhadores de saúde envolvidos no atendimento de pacientes diagnosticados com COVID-19 durante a pandemia, os quais foram agrupados em três categorias, duas que tratam dos riscos e uma terceira que tem o objetivo de descrever a incidência de sintomas/transtornos mentais na população estudada, a saber: i) descrição dos riscos associados à ocupação e ambiente, ii) descrição dos riscos associados à escassez de programas educacionais e de treinamento, e iii) descrição das repercussões na saúde mental dos profissionais - incidência de sintomas/transtornos relacionados à saúde mental descritos nos estudos.

Descrição dos riscos associados à ocupação e ao ambiente de trabalho

Com relação às questões que envolvem a organização do trabalho e a falta de equipamento de proteção individual (EPI), todos os 43 estudos relataram algum tipo de déficit de EPI, algo que foi considerado um fator que elevou o nível de estresse entre os profissionais de saúde.

A exposição a pacientes infectados, principalmente por meio do trabalho em departamentos/ambientes de alto risco - Unidade de Tratamento Intensivo (UTI) - e em outros locais com grande circulação de fluidos/aerossóis contaminados foram relatados como importante fator de risco para contaminação de COVID-19 entre os profissionais de saúde⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.^,¹⁹19 Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre, cross-sectional study. SAGE Open Med 2021; 9:20503121211000919.^,²¹21 Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 2020; 29(21-22):4217-4226.^,²⁸28 Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930..

O cansaço, o sono e a insônia, que se relacionam com as jornadas e as sobrecargas de trabalho, foram os principais preditores para o surgimento de estresse e ansiedade no trabalho³3 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. RevPanm Salud Publica 2022; 31(2):e112.^,⁴4 Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Military Med Res 2020; 7(1):7.^,⁶6 Kibret S, Teshome D, Fenta E, Hunie M, Tamire T. Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia. PLoS One 2020; 15(12):e0243022.^,¹¹11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.^,¹⁸18 Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.^,²⁴24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.^,²⁹29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.^,³³33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.. Quatro estudos apresentaram dados sobre essa associação, que resultou em falta de descanso, privação de sono, insônia e exposição prolongada a pacientes infectados⁴4 Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Military Med Res 2020; 7(1):7.^,⁶6 Kibret S, Teshome D, Fenta E, Hunie M, Tamire T. Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia. PLoS One 2020; 15(12):e0243022.^,¹⁸18 Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285., como fatores que levavam os trabalhadores ao estresse.

Os efeitos combinados de estressores, de carga viral e ambientes não preparados para suprir a necessidade de combate ao vírus foram alguns dos itens identificados na varredura da revisão sistemática⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.^,²³23 Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320..

Os achados de Chang e colaboradores⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177. demonstraram que os trabalhadores do departamento de emergência (31,64%) eram mais propensos a contrair COVID-19 do que os profissionais de saúde na UTI (23,17%) e ambientes de internação (25,53%), esses achados têm relação com o ambiente de trabalho e a estrutura organizacional e de educação de cada ambiente.

Descrição dos riscos associados à escassez de programas de treinamento e educacionais

O treinamento inadequado dos profissionais de saúde foi um fator relatado como preditor do surgimento de transtornos mentais e/ou sofrimento mental, e consequentemente para a contaminação por COVID-19. A falta de adesão aos protocolos de controle de infecção e a um sistema de apoio psicossocial que acompanhasse os trabalhadores em contraturno ao trabalho, bem como treinamento e atualização de acesso e uso de equipamentos de proteção individual, também foram questões relacionadas aos riscos educacionais²⁹29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.^,³⁹39 Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136.^,⁴³43 Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16(1):e0245294., elevando a possibilidade de transtornos mentais entre os trabalhadores.

Descrição das repercussões na saúde mental dos profissionais: incidência de sintomas/transtornos relacionados à saúde mental descritos nos estudos

As pesquisas descreveram uma ampla variedade de resultados sobre as repercussões na saúde mental. Essas repercussões, consideradas decorrentes da pandemia de COVID-19 na saúde mental dos trabalhadores de saúde, foram agrupadas em duas categorias, a saber: 1) questões relacionadas aos transtornos mentais e 2) questões ligadas ao processo de trabalho.

Com relação aos sintomas/transtornos citados, a ansiedade, o humor deprimido, a insônia, a angústia, a exaustão emocional, o esgotamento e/ou o transtorno obsessivo-compulsivo (TOC) foram os mais relatados nos 43 estudos analisados⁶6 Kibret S, Teshome D, Fenta E, Hunie M, Tamire T. Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia. PLoS One 2020; 15(12):e0243022.

7 Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care 2020; 9(9):4904-4910.

8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.

9 Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in special. Asia Pac Psychiatry 2022; 14(1):e12427.

10 Guo WP, Min Q, Gu WW, Yu L, Xiao X, Yi WB, Li HL, Huang B, Li JL, Dai YJ, Xia J, Liu J, Li B, Zhou BH, Li M, Xu HX, Wang XB, Shi WY. Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: a cross-sectional study. Health Qual Life Outcomes 2021; 19(1):103.

11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.

12 Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26.

13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.

14 Skoda EM, Teufel M, Stang A, Jöckel KH, Junne F, Weismüller B, Hetkamp M, Musche V, Kohler H, Dörrie N, Schweda A, Bäuerle A. Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the international context. J Public Health (Oxf) 2020; 42(4):688-695.

15 Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465.

16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.^-¹⁷17 Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.^,²⁰20 Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, Li J, Zhang SK, Ren ZF, Ren R, Liu YL, Qiao YL. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020; 9(1):113.

21 Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 2020; 29(21-22):4217-4226.

22 Leira-Sanmartín M, Madoz-Gúrpide A, Ochoa-Mangado E, Ibáñez Á. Psychological impact of COVID-19 pandemic and related variables: a cross-sectional study in a sample of workers in a Spanish tertiary hospital. Int J Environ Res Public Health 2021; 18(7):3608.

23 Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320.

24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.

25 Wang N, Li Y, Wang Q, Lei C, Liu Y, Zhu S. Psychological impact of COVID-19 pandemic on healthcare workers in China Xi'an central hospital. Brain Behav 2021; 11(3):e02028.

26 Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.

27 Amal M. Qasem Surrati, Farah M. Asad Mansuri, Abeer A. Ayadh Alihabi. Psychological impact of the COVID-19 pandemic on health care workers. J Taibah Univ Med Sci 2020; 15(6):536-543.

28 Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930.

29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.

30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.

31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.

32 Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci 2020; 18:Doc05.

33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.^-³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.^,³⁶36 Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Morozov PV, Lutova NB, Mazo GE. Stress and stigmatization in health-care workers during the COVID-19 pandemic. Indian J Psychiatry 2020; 62(Suppl 3):S445-S453.

37 Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.

38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.

39 Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136.

40 Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environment Health 2020; 46(6):639-644.

41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.

42 Chen X, Arber A, Gao J, Zhang L, Ji M, Wang D, Wu J, Du J. The mental health status among nurses from low-risk areas under normalized COVID-19 pandemic prevention and control in China: a cross-sectional study. Int J Ment Health Nurs 2021; 30(4):975-987.

43 Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16(1):e0245294.

44 Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.

45 Chen B, Li QX, Zhang H, Zhu JY, Yang X, Wu YH, Xiong J, Li F, Wang H, Chen ZT. The psychological impact of COVID-19 outbreak on medical staff and the general public. Curr Psychol 2020; 41(8):5631-5639.

46 Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.

47 Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114.^-⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149..

No âmbito geral, a proporção de sintomas graves a extremamente graves de depressão e ansiedade foi relatada em 40% da população pesquisada nesta revisão, em 27 estudos, fazendo com que se possa compreender que existe uma associação significativa entre contato dos trabalhadores com intervenções junto aos pacientes com COVID-19 e sintomas de ansiedade e estresse no trabalho⁶6 Kibret S, Teshome D, Fenta E, Hunie M, Tamire T. Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia. PLoS One 2020; 15(12):e0243022.

7 Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care 2020; 9(9):4904-4910.

8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.

9 Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in special. Asia Pac Psychiatry 2022; 14(1):e12427.^-¹⁰10 Guo WP, Min Q, Gu WW, Yu L, Xiao X, Yi WB, Li HL, Huang B, Li JL, Dai YJ, Xia J, Liu J, Li B, Zhou BH, Li M, Xu HX, Wang XB, Shi WY. Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: a cross-sectional study. Health Qual Life Outcomes 2021; 19(1):103.^,¹²12 Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26.

13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.

14 Skoda EM, Teufel M, Stang A, Jöckel KH, Junne F, Weismüller B, Hetkamp M, Musche V, Kohler H, Dörrie N, Schweda A, Bäuerle A. Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the international context. J Public Health (Oxf) 2020; 42(4):688-695.

15 Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465.

16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.^-¹⁷17 Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.^,²³23 Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320.^,²⁴24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.^,²⁶26 Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.

27 Amal M. Qasem Surrati, Farah M. Asad Mansuri, Abeer A. Ayadh Alihabi. Psychological impact of the COVID-19 pandemic on health care workers. J Taibah Univ Med Sci 2020; 15(6):536-543.

28 Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930.

29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.^-³⁰30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.^,³²32 Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci 2020; 18:Doc05.^,³³33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.^,³⁷37 Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.^,⁴¹41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.^,⁴⁴44 Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.

45 Chen B, Li QX, Zhang H, Zhu JY, Yang X, Wu YH, Xiong J, Li F, Wang H, Chen ZT. The psychological impact of COVID-19 outbreak on medical staff and the general public. Curr Psychol 2020; 41(8):5631-5639.

46 Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.

47 Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114.^-⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149.. Os sintomas psicológicos foram avaliados nos estudos usando diferentes medidas validadas. Para mensurar os níveis de esgotamento profissional, por exemplo, foi utilizado o Maslach Burnout Inventory (MBI)¹²12 Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26.

13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.^-¹⁴14 Skoda EM, Teufel M, Stang A, Jöckel KH, Junne F, Weismüller B, Hetkamp M, Musche V, Kohler H, Dörrie N, Schweda A, Bäuerle A. Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the international context. J Public Health (Oxf) 2020; 42(4):688-695.^,⁴¹41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.. Esses achados sugerem diferenças marcantes na prevalência de sintomas depressivos entre os estudos rastreados nesta revisão.

Três estudos transversais, todos oriundos da China, reportaram a resiliência, o bom preparo da equipe profissional e a boa gestão do sistema de saúde, bem como a capacidade de enfrentamento psicológico dos profissionais e da gestão diante de emergências de saúde pública, como fatores positivos que poderiam evitar ou amenizar o adoecimento mental dos profissionais de saúde¹⁸18 Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.^,¹⁹19 Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre, cross-sectional study. SAGE Open Med 2021; 9:20503121211000919.^,³⁵35 Hong X, Cao J, Wei J, Duan Y, Zhao X, Jiang J, Jiang Y, Geng W, Zhu H. Stress and psychological impact of the COVID-19 outbreak on the healthcare staff at the fever clinic of a tertiary general hospital in Beijing: a cross-sectional study. BJPsych Open 2020; 7(3):e76..

Discussão

A pandemia da SARS-CoV-2 foi declarada em março de 2020 pela OMS, colocando mais de 200 países em alerta. Enquanto o mundo estava preocupado e empenhado em salvar vidas, apostando na qualidade e na rapidez do trabalho dos profissionais dos serviços de saúde que atuavam junto a indivíduos diagnosticados com o vírus, a saúde mental desses trabalhadores foi negligenciada¹1 World Health Organizatio (WHO). Coronavirus Disease 2019 (COVID-19) Situation Report-87 [Internet]. 2019. [cited 2023 mar 9]. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200416-sitrep-87-COVID-19.pdf?sfvrsn=9523115a_2
https://www.who.int/docs/default-source/... ^,¹¹11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.

12 Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26.^-¹³13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.^,²¹21 Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 2020; 29(21-22):4217-4226.^,⁴⁶46 Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.^,⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149.

49 Organização Pan-Americana da Saúde (OPAS). Avaliação de risco e gerenciamento da exposição de profissionais de saúde no contexto da COVID-19 [Internet]. 2020. [acessado 2022 nov 2]. Disponível em: https://iris.paho.org/handle/10665.2/52290
https://iris.paho.org/handle/10665.2/522...

50 Sun P, Wang M, Song T, Wu Y, Luo J, Chen L, Yan L. The psychological impact of COVID-19 pandemic on health care workers: a systematic review and meta-analysis. Front. Psychol 2021; 12:626547.

51 Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
https://portal.fiocruz.br/noticia/pesqui... ^-⁵²52 Organização Pan-Americana da Saúde (OPAS). Pandemia de COVID-19 desencadeia aumento de 25% na prevalência de ansiedade e depressão em todo o mundo [Internet]. 2022. [acessado 2022 nov 2]. Disponível em: https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em
https://www.paho.org/pt/noticias/2-3-202... .

Pesquisa realizada pela Fundação Oswaldo Cruz (Fiocruz), intitulada Condições de Trabalho dos profissionais de Saúde no Contexto da COVID-19 no Brasil, contou com 25 mil participantes e retratou a realidade dos profissionais que atuavam na linha de frente, que descreveram estar marcados por dores físicas e mentais, sofrimento e tristeza, com fortes sinais de esgotamento físico e mental. Na maioria dos casos, o trabalho era realizado em ambientes de forma extenuante, onde a sobrecarga de horas e de atividades eram constantes, como forma de compensar o elevado absenteísmo que se apresentava. Além disso, o medo da contaminação e da morte iminente eram vivenciados dia após dia, em gestões marcadas pelo risco de confisco da cidadania do trabalhador (perdas dos direitos trabalhistas, terceirização, desemprego, perda de renda, salários baixos, gastos extras com compras de EPI, transporte alternativo e alimentação)⁵¹51 Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
https://portal.fiocruz.br/noticia/pesqui... .

Apesar de a maioria dos países terem conseguido controlar a pandemia de COVID-19 ao longo dos últimos anos mediante a vacinação, pesquisas incipientes contemplaram as questões de saúde mental/psiquiátricas dos profissionais da saúde que trabalharam na linha de frente durante a pandemia, e poucos são os estudos com descrições dos transtornos/doenças mentais mais relatados durante o período pandêmico. Compreende-se que a dimensão da saúde mental é um aspecto essencial, que deve ser mais valorizado no universo da realização de pesquisas em situações de pandemia, entendendo que esses estudos são importantes documentos para elaboração e implementação de práticas profissionais, organização, gestão e criação de políticas públicas de saúde e trabalho.

A Organização Mundial de Saúde (OMS) apresentou dados relevantes, alertando para o fato de o primeiro ano da pandemia de COVID-19 ter causado elevação da prevalência global de ansiedade e depressão, um aumento em 25% de casos relatados e diagnosticados. Essas preocupações com presumíveis aumentos dessas condições levaram 90% dos países pesquisados a realizarem a inclusão da saúde mental e do apoio psicossocial em seus planos de resposta à COVID-19 nos ambientes de trabalho, entretanto, permanecem lacunas expressivas e preocupações relacionadas à saúde dos trabalhadores⁵⁰50 Sun P, Wang M, Song T, Wu Y, Luo J, Chen L, Yan L. The psychological impact of COVID-19 pandemic on health care workers: a systematic review and meta-analysis. Front. Psychol 2021; 12:626547..

Em 2022, Organização Pan-Americana da Saúde (OPAS) destacou o impacto da COVID-19 na saúde mental da população mundial como apenas a ponta do iceberg. Desse modo, a OPAS apontou que todos os países (sobretudo aqueles em desenvolvimento, que sofrem mais com questões econômicas e de desigualdade na atenção/cuidado em saúde mental) precisam considerar à saúde mental como um elemento importante, pois apenas dessa forma seria possível ofertar um trabalho digno, melhor no que diz respeito ao apoio à saúde mental das populações em períodos pandêmicos⁵²52 Organização Pan-Americana da Saúde (OPAS). Pandemia de COVID-19 desencadeia aumento de 25% na prevalência de ansiedade e depressão em todo o mundo [Internet]. 2022. [acessado 2022 nov 2]. Disponível em: https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em
https://www.paho.org/pt/noticias/2-3-202... .

A diretora do Departamento de Saúde Mental e Uso de Substâncias da OMS, por sua vez, sublinhou que mesmo que a pandemia tenha gerado interesse e preocupação pela saúde mental, foi revelado um quadro de subinvestimento histórico nos serviços que ofereceram cuidados voltados à questão⁴⁹49 Organização Pan-Americana da Saúde (OPAS). Avaliação de risco e gerenciamento da exposição de profissionais de saúde no contexto da COVID-19 [Internet]. 2020. [acessado 2022 nov 2]. Disponível em: https://iris.paho.org/handle/10665.2/52290
https://iris.paho.org/handle/10665.2/522... ^,⁵¹51 Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
https://portal.fiocruz.br/noticia/pesqui... ^,⁵²52 Organização Pan-Americana da Saúde (OPAS). Pandemia de COVID-19 desencadeia aumento de 25% na prevalência de ansiedade e depressão em todo o mundo [Internet]. 2022. [acessado 2022 nov 2]. Disponível em: https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em
https://www.paho.org/pt/noticias/2-3-202... . Desse modo, os países precisam agir com urgência, com vistas à garantia de que o apoio à saúde mental esteja disponível para todos, principalmente em períodos de pandemias e pós-pandemias⁵¹51 Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
https://portal.fiocruz.br/noticia/pesqui... .

Descrição dos riscos associados à ocupação e ao ambiente de trabalho

Os trabalhadores da linha de frente ao enfrentamento da pandemia de COVID-19 estavam diretamente envolvidos na recepção, atendimento, acolhimento, diagnóstico e tratamento de pessoas com COVID-19. Os números crescentes de casos confirmados em 2020 na Europa, Ásia e América, e no início de 2021, principalmente na América Latina e África⁴⁹49 Organização Pan-Americana da Saúde (OPAS). Avaliação de risco e gerenciamento da exposição de profissionais de saúde no contexto da COVID-19 [Internet]. 2020. [acessado 2022 nov 2]. Disponível em: https://iris.paho.org/handle/10665.2/52290
https://iris.paho.org/handle/10665.2/522...

50 Sun P, Wang M, Song T, Wu Y, Luo J, Chen L, Yan L. The psychological impact of COVID-19 pandemic on health care workers: a systematic review and meta-analysis. Front. Psychol 2021; 12:626547.

51 Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
https://portal.fiocruz.br/noticia/pesqui... ^-⁵²52 Organização Pan-Americana da Saúde (OPAS). Pandemia de COVID-19 desencadeia aumento de 25% na prevalência de ansiedade e depressão em todo o mundo [Internet]. 2022. [acessado 2022 nov 2]. Disponível em: https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em
https://www.paho.org/pt/noticias/2-3-202... , elevaram os índices de contaminação por diversas variantes entre os profissionais da saúde. O agravamento da contaminação associada a alta carga de trabalho, insuficiência de leitos e hospitais, falta de EPI, aumento do risco de infecção para familiares e comunidade próxima, além da falta de planejamento e apoio adequados e incapacidade de aderir às estratégias de prevenção, contribuíram para uma sobrecarga mental dos profissionais de saúde⁷7 Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care 2020; 9(9):4904-4910.^,⁹9 Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in special. Asia Pac Psychiatry 2022; 14(1):e12427.^,¹³13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.^,²⁸28 Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930.

29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.

30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.

31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.

32 Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci 2020; 18:Doc05.

33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.

34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.

35 Hong X, Cao J, Wei J, Duan Y, Zhao X, Jiang J, Jiang Y, Geng W, Zhu H. Stress and psychological impact of the COVID-19 outbreak on the healthcare staff at the fever clinic of a tertiary general hospital in Beijing: a cross-sectional study. BJPsych Open 2020; 7(3):e76.

36 Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Morozov PV, Lutova NB, Mazo GE. Stress and stigmatization in health-care workers during the COVID-19 pandemic. Indian J Psychiatry 2020; 62(Suppl 3):S445-S453.

37 Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.

38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.

39 Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136.

40 Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environment Health 2020; 46(6):639-644.

41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.

42 Chen X, Arber A, Gao J, Zhang L, Ji M, Wang D, Wu J, Du J. The mental health status among nurses from low-risk areas under normalized COVID-19 pandemic prevention and control in China: a cross-sectional study. Int J Ment Health Nurs 2021; 30(4):975-987.

43 Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16(1):e0245294.

44 Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.

45 Chen B, Li QX, Zhang H, Zhu JY, Yang X, Wu YH, Xiong J, Li F, Wang H, Chen ZT. The psychological impact of COVID-19 outbreak on medical staff and the general public. Curr Psychol 2020; 41(8):5631-5639.

46 Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.

47 Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114.

48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149.^-⁴⁹49 Organização Pan-Americana da Saúde (OPAS). Avaliação de risco e gerenciamento da exposição de profissionais de saúde no contexto da COVID-19 [Internet]. 2020. [acessado 2022 nov 2]. Disponível em: https://iris.paho.org/handle/10665.2/52290
https://iris.paho.org/handle/10665.2/522... .

A exposição a pacientes infectados em áreas de grande fluxo e rotatividade de pessoas, como em UTIs e locais com grande circulação e contaminação por fluidos/aerossóis contaminados, salas de cirurgias e consultórios odontológicos, foram apresentados como fatores de risco ambiental para os profissionais de saúde¹³13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.^,²⁴24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.^,²⁶26 Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.^,³³33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132..

No ano de 2021, a OMS divulgou orientações provisórias sobre avaliação e gestão de risco dos profissionais de saúde no contexto do COVID-19⁴⁹49 Organização Pan-Americana da Saúde (OPAS). Avaliação de risco e gerenciamento da exposição de profissionais de saúde no contexto da COVID-19 [Internet]. 2020. [acessado 2022 nov 2]. Disponível em: https://iris.paho.org/handle/10665.2/52290
https://iris.paho.org/handle/10665.2/522... ^,⁵²52 Organização Pan-Americana da Saúde (OPAS). Pandemia de COVID-19 desencadeia aumento de 25% na prevalência de ansiedade e depressão em todo o mundo [Internet]. 2022. [acessado 2022 nov 2]. Disponível em: https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em
https://www.paho.org/pt/noticias/2-3-202... . A orientação é oferecida para os profissionais de saúde e as instalações de trabalho dessas pessoas. A falta de EPI, uma questão importante sempre apontada pela OMS, foi amplamente relatada em todos os 43 estudos que incluídos nesta revisão, além da carência de profissionais treinados e capacitados para atuarem na linha de frente em pandemias com vírus ainda desconhecidos⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.^,¹⁹19 Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre, cross-sectional study. SAGE Open Med 2021; 9:20503121211000919.^,²¹21 Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 2020; 29(21-22):4217-4226.^,²⁸28 Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930.. É possível, nesta revisão, destacar a importância de medidas mais eficazes e preventivas para proteger os profissionais da saúde da linha de frente, evitando danos psicológicos provenientes da insegurança e do medo de contrair um vírus que apresentava altas taxas de letalidade³3 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. RevPanm Salud Publica 2022; 31(2):e112.^,⁴4 Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Military Med Res 2020; 7(1):7.^,⁶6 Kibret S, Teshome D, Fenta E, Hunie M, Tamire T. Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia. PLoS One 2020; 15(12):e0243022.^,¹¹11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.^,¹⁸18 Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.^,²⁴24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.^,²⁹29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.^,³³33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285..

Descrição dos riscos associados à escassez de programas de treinamento e educacionais

Com relação às questões que envolvem a quantidade de tempo de trabalho, a proximidade entre profissionais de saúde e pacientes infectados e programas de treinamento, a pesquisa de Rodríguez-Rey et al.⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149. demonstrou que muitos profissionais de saúde da linha de frente na Espanha sofriam de depressão e ansiedade. Alguns dos motivos apresentados foram a exposição prolongada ao vírus, com o déficit de equipamento de proteção individual, o medo de infectar os familiares e a falta de capacitação da equipe médica em relação à propagação da doença, uma vez que os profissionais da linha de frente que tratam pacientes com COVID-19 provavelmente estão expostos ao maior risco de infecção devido ao contato próximo e frequente com pacientes.

A pesquisa realizada por Croghan e colaboradores³⁷37 Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448. apresentou diversas formas de apoio e de programas de treinamento para os profissionais no ambiente de trabalho como forma de um processo de curto e longo prazo de intervenções sistemáticas de mitigação do estresse na equipe de saúde, considerando que a falta de treinamento, pode acarretar elevação dos índices de contaminação entre os trabalhadores³3 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. RevPanm Salud Publica 2022; 31(2):e112.^,⁴4 Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Military Med Res 2020; 7(1):7.^,⁶6 Kibret S, Teshome D, Fenta E, Hunie M, Tamire T. Prevalence of anxiety towards COVID-19 and its associated factors among healthcare workers in a Hospital of Ethiopia. PLoS One 2020; 15(12):e0243022.^,¹¹11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.^,¹⁸18 Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.^,²⁴24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.^,²⁹29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.^,³³33 Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.^,⁵¹51 Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
https://portal.fiocruz.br/noticia/pesqui... .

Relatos do impacto psicológico agudo e dos riscos psicossociais foram evidenciados na pesquisa de Tan et al.²³23 Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320. Além disso, diversas outras pesquisas relataram altos níveis de angústia, depressão, ansiedade, medo e frustração, também foi relatada a necessidade de se estabelecer programas de acompanhamento para os trabalhadores da linha de frente¹⁵15 Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465.

16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.^-¹⁷17 Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.^,²⁰20 Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, Li J, Zhang SK, Ren ZF, Ren R, Liu YL, Qiao YL. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020; 9(1):113.^,²⁴24 Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.^,²⁶26 Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.^,⁴⁰40 Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environment Health 2020; 46(6):639-644.^,⁴⁴44 Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322..

Descrição das repercussões na saúde mental dos profissionais: incidência de sintomas/transtornos descritos nos estudos

Uma pesquisa realizada no Brasil pela Fiocruz⁵¹51 Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
https://portal.fiocruz.br/noticia/pesqui... evidenciou, entre outros aspectos, graves e prejudiciais consequências para a saúde mental daqueles que atuaram na assistência aos pacientes infectados em momentos críticos da pandemia. As alterações mais comuns em seu cotidiano foram perturbação do sono (15,8%), irritabilidade/choro frequente/distúrbios em geral (13,6%), incapacidade de relaxar/estresse (11,7%), dificuldade de concentração ou pensamento lento (9,2%), perda de satisfação na carreira ou na vida/tristeza/apatia (9,1%), sensação negativa do futuro/pensamento negativo ou suicida (8,3%) e alteração no apetite/alteração do peso (8,1%).

Estudo de Trumello et al.¹³13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358. destaca que os trabalhadores que atuavam diretamente com pacientes com COVID-19 apresentavam elevação na taxa de risco para estresse, burnout, trauma secundário, depressão e ansiedade, e aqueles que trabalhavam nas áreas geográficas mais afetadas pelo vírus tinham maior risco de desenvolver burnout e estresse, além de apresentarem baixa satisfação com o trabalho. A saúde mental dos profissionais de saúde que atuavam na linha de frente demandava maior atenção do que a dos demais profissionais do mesmo serviço de saúde, sendo necessário a implantação e utilização de programas direcionados de prevenção e intervenção¹³13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.^,¹⁵15 Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465.

16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.

17 Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.

18 Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.

19 Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre, cross-sectional study. SAGE Open Med 2021; 9:20503121211000919.^-²⁰20 Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, Li J, Zhang SK, Ren ZF, Ren R, Liu YL, Qiao YL. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020; 9(1):113..

As prevalências de ansiedade e depressão entre os profissionais de saúde da linha de frente apresentaram indicadores mais elevados do que os dos profissionais de saúde que não atuavam na linha de frente. Os enfermeiros apresentaram taxas mais altas de ansiedade, insônia e depressão do que médicos, dentistas e outros profissionais da linha de frente⁷7 Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care 2020; 9(9):4904-4910.^,⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.^,¹⁶16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.^,³⁰30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.^,³¹31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.^,³⁸38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.^,⁴¹41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.^,⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149.. Em revisão sistemática com metanálise realizada por Sun e colaboradores⁵⁰50 Sun P, Wang M, Song T, Wu Y, Luo J, Chen L, Yan L. The psychological impact of COVID-19 pandemic on health care workers: a systematic review and meta-analysis. Front. Psychol 2021; 12:626547. foram identificados níveis significativos de ansiedade entre os profissionais trabalhadores da linha de frente - 37% (IC95% 0,31-0,42, I2 = 99,9%), corroborando outros estudos em que a prevalência de depressão e insônia apresentaram níveis significativos⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.^,⁹9 Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in special. Asia Pac Psychiatry 2022; 14(1):e12427.^,¹¹11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.^,¹⁶16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.^,²³23 Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320.^,²⁹29 Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.^,³⁸38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.^,³⁹39 Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136..

O estudo de Sun et al.⁵⁰50 Sun P, Wang M, Song T, Wu Y, Luo J, Chen L, Yan L. The psychological impact of COVID-19 pandemic on health care workers: a systematic review and meta-analysis. Front. Psychol 2021; 12:626547. deflagrou ainda mais a crise estrutural que a pandemia de COVID-19 trouxe ao mundo do trabalho, principalmente ao trabalho realizado por mulheres. Em uma análise de subgrupos realizada na referida pesquisa, foram expostos elevados índices de depressão entre as profissionais mulheres que atuavam na linha de frente, em comparação com os profissionais homens, corroborando os achados desta revisão⁷7 Alzaid EH, Alsaad SS, Alshakhis N, Albagshi D, Albesher R, Aloqaili M. Prevalence of COVID-19-related anxiety among healthcare workers: a cross-sectional study. J Family Med Prim Care 2020; 9(9):4904-4910.^,⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.^,¹⁶16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.^,³⁰30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.^,³¹31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.^,³⁸38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.^,⁴¹41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.^,⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149..

Os resultados encontrados na presente pesquisa sugerem que o processo de intervenção no ambiente de trabalho precisa ser realizado de forma precoce, como forma de diminuir os altos níveis de problemas de saúde mental nos profissionais de saúde, principalmente quanto à incidência de ansiedade e depressão⁸8 Sahin MK, Aker S, Sahin G, Karabekiroglu A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health 2020; 45(6):1168-1177.

9 Pan X, Xiao Y, Ren D, Xu ZM, Zhang Q, Yang LY, Liu F, Hao YS, Zhao F, Bai YH. Prevalence of mental health problems and associated risk factors among military healthcare workers in special. Asia Pac Psychiatry 2022; 14(1):e12427.

10 Guo WP, Min Q, Gu WW, Yu L, Xiao X, Yi WB, Li HL, Huang B, Li JL, Dai YJ, Xia J, Liu J, Li B, Zhou BH, Li M, Xu HX, Wang XB, Shi WY. Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: a cross-sectional study. Health Qual Life Outcomes 2021; 19(1):103.

11 Zhou Y, Ding H, Zhang Y, Zhang B, Guo Y, Cheung T, Hall BJ, Shi T, Xiang YT, Tang Y. Prevalence of poor psychiatric status and sleep quality among frontline healthcare workers during and after the COVID-19 outbreak: a longitudinal study. Transl Psychiatry 2021; 11(1):223.

12 Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26.^-¹³13 Trumello C, Bramanti SM, Ballarotto G, Candelori C, Cerniglia L, Cimino S, Crudele M, Lombardi L, Pignataro S, Viceconti ML, Babore A. Psychological adjustment of healthcare workers in Italy during the COVID-19 pandemic: differences in stress, anxiety, depression, burnout, secondary trauma, and compassion satisfaction between frontline and non-frontline professionals. Int J Environ Res Public Health 2020; 17(22):8358.^,¹⁵15 Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465.

16 Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.^-¹⁷17 Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.^,³⁰30 Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.^,³¹31 Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.^,³⁴34 Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.^,³⁸38 Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.^,⁴¹41 Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.^,⁴⁸48 Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149..

Existem inúmeros pontos fortes e algumas limitações nesta revisão, entre elas aponta-se as questões que envolvem a divisão de categorias profissionais que atuaram junto a pacientes com COVID-19, algo que tornou complexa a análise. Para minimizar esses limites, foram também incluídos estudos que abordavam profissionais técnicos que, apesar de não serem da saúde, trabalhavam em serviços de saúde diariamente com intervenções relacionadas à linha de frente. Outro fator que se relaciona aos limites se refere à heterogeneidade inerente aos estudos. Enquanto inúmeras pesquisas apresentavam níveis consideráveis de prevalência de ansiedade, depressão, burnout e insônia, outras utilizaram os mesmos testes, porém, por meio de diferentes escalas de avaliação, estabelecendo assim limiares distintos.

Ainda que no ano de 2023 a OMS tenha declarado o tão esperado fim da Emergência de Saúde Pública de Importância Internacional (ESPII) para a COVID-19⁵³53 Organização Pan-Americana da Saúde (OPAS). OMS declara fim da Emergência de Saúde Pública de Importância Internacional referente à COVID-19 [Internet]. 2023. [acessado 2023 maio 5]. Disponível em: https://www.paho.org/pt/noticias/5-5-2023-oms-declara-fim-da-emergencia-saude-publica-importancia-internacional-referente#:~:text=%C3%A0%20COVID%2D19-,OMS%20declara%20fim%20da%20Emerg%C3%AAncia%20de%20Sa%C3%BAde%20P%C3%BAblica,Internacional%20referente%20%C3%A0%20COVID%2D19&text=Bras%C3%ADlia%2C%205%20de%20maio%20de,)%20referente%20%C3%A0%20COVID%2D19
https://www.paho.org/pt/noticias/5-5-202... , todas as pesquisas que foram analisadas nesta revisão sistemática apresentaram discussões acerca do medo de ser infectado e a angústia causada pelo medo de espalhá-lo entre os membros da família, a estigmatização por parte da população no momento crítico da pandemia, a baixa autoconfiança, a baixa segurança ocupacional e as altas jornadas/cargas de trabalho como fatores de risco vitais, que precisam ser considerados na elaboração e implementação de futuros serviços de apoio psicológico destinados aos profissionais de saúde que vivenciaram essa pandemia e aos que poderão vivenciar outras futuras.

Conclusão

Este trabalho buscou identificar artigos relacionados às repercussões decorrentes da pandemia de COVID-19 na saúde mental de trabalhadores da saúde que atuam no combate ao vírus e qual a prevalência dos impactos para esses profissionais. Nos artigos encontrados foi possível descrever as características dos estudos incluídos, mensurar sua qualidade, identificar o público-alvo (profissionais mais frequentemente envolvidos), identificar diferentes tipos de fatores de risco relacionados à execução desse trabalho (ocupacionais/ambientais, de treinamento/educação e voltados à saúde mental) e fazer reflexões pautadas na necessidade de investimento das empresas e dos governos em programas de cuidado voltados à saúde mental no mundo inteiro.

Por fim, a revisão revelou a necessidade de elaboração de novas pesquisas científicas, com diferentes metodologias, mas descrevam e analisem a experiência de trabalho dos profissionais que estiveram junto às intervenções com pacientes diagnosticados com COVID-19, sobretudo colocando como objeto de análise a saúde mental desses trabalhadores. Este estudo tem como limitação o período temporal da varredura bibliográfica.

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¹⁰
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¹³
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Skoda EM, Teufel M, Stang A, Jöckel KH, Junne F, Weismüller B, Hetkamp M, Musche V, Kohler H, Dörrie N, Schweda A, Bäuerle A. Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the international context. J Public Health (Oxf) 2020; 42(4):688-695.
¹⁵
Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465.
¹⁶
Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.
¹⁷
Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.
¹⁸
Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.
¹⁹
Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre, cross-sectional study. SAGE Open Med 2021; 9:20503121211000919.
²⁰
Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, Li J, Zhang SK, Ren ZF, Ren R, Liu YL, Qiao YL. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020; 9(1):113.
²¹
Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 2020; 29(21-22):4217-4226.
²²
Leira-Sanmartín M, Madoz-Gúrpide A, Ochoa-Mangado E, Ibáñez Á. Psychological impact of COVID-19 pandemic and related variables: a cross-sectional study in a sample of workers in a Spanish tertiary hospital. Int J Environ Res Public Health 2021; 18(7):3608.
²³
Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320.
²⁴
Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.
²⁵
Wang N, Li Y, Wang Q, Lei C, Liu Y, Zhu S. Psychological impact of COVID-19 pandemic on healthcare workers in China Xi'an central hospital. Brain Behav 2021; 11(3):e02028.
²⁶
Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.
²⁷
Amal M. Qasem Surrati, Farah M. Asad Mansuri, Abeer A. Ayadh Alihabi. Psychological impact of the COVID-19 pandemic on health care workers. J Taibah Univ Med Sci 2020; 15(6):536-543.
²⁸
Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930.
²⁹
Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.
³⁰
Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.
³¹
Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.
³²
Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci 2020; 18:Doc05.
³³
Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.
³⁴
Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.
³⁵
Hong X, Cao J, Wei J, Duan Y, Zhao X, Jiang J, Jiang Y, Geng W, Zhu H. Stress and psychological impact of the COVID-19 outbreak on the healthcare staff at the fever clinic of a tertiary general hospital in Beijing: a cross-sectional study. BJPsych Open 2020; 7(3):e76.
³⁶
Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Morozov PV, Lutova NB, Mazo GE. Stress and stigmatization in health-care workers during the COVID-19 pandemic. Indian J Psychiatry 2020; 62(Suppl 3):S445-S453.
³⁷
Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.
³⁸
Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.
³⁹
Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136.
⁴⁰
Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environment Health 2020; 46(6):639-644.
⁴¹
Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.
⁴²
Chen X, Arber A, Gao J, Zhang L, Ji M, Wang D, Wu J, Du J. The mental health status among nurses from low-risk areas under normalized COVID-19 pandemic prevention and control in China: a cross-sectional study. Int J Ment Health Nurs 2021; 30(4):975-987.
⁴³
Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16(1):e0245294.
⁴⁴
Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.
⁴⁵
Chen B, Li QX, Zhang H, Zhu JY, Yang X, Wu YH, Xiong J, Li F, Wang H, Chen ZT. The psychological impact of COVID-19 outbreak on medical staff and the general public. Curr Psychol 2020; 41(8):5631-5639.
⁴⁶
Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.
⁴⁷
Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114.
⁴⁸
Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149.
⁴⁹
Organização Pan-Americana da Saúde (OPAS). Avaliação de risco e gerenciamento da exposição de profissionais de saúde no contexto da COVID-19 [Internet]. 2020. [acessado 2022 nov 2]. Disponível em: https://iris.paho.org/handle/10665.2/52290
» https://iris.paho.org/handle/10665.2/52290
⁵⁰
Sun P, Wang M, Song T, Wu Y, Luo J, Chen L, Yan L. The psychological impact of COVID-19 pandemic on health care workers: a systematic review and meta-analysis. Front. Psychol 2021; 12:626547.
⁵¹
Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
» https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
⁵²
Organização Pan-Americana da Saúde (OPAS). Pandemia de COVID-19 desencadeia aumento de 25% na prevalência de ansiedade e depressão em todo o mundo [Internet]. 2022. [acessado 2022 nov 2]. Disponível em: https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em
» https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em
⁵³
Organização Pan-Americana da Saúde (OPAS). OMS declara fim da Emergência de Saúde Pública de Importância Internacional referente à COVID-19 [Internet]. 2023. [acessado 2023 maio 5]. Disponível em: https://www.paho.org/pt/noticias/5-5-2023-oms-declara-fim-da-emergencia-saude-publica-importancia-internacional-referente#:~:text=%C3%A0%20COVID%2D19-,OMS%20declara%20fim%20da%20Emerg%C3%AAncia%20de%20Sa%C3%BAde%20P%C3%BAblica,Internacional%20referente%20%C3%A0%20COVID%2D19&text=Bras%C3%ADlia%2C%205%20de%20maio%20de,)%20referente%20%C3%A0%20COVID%2D19
» https://www.paho.org/pt/noticias/5-5-2023-oms-declara-fim-da-emergencia-saude-publica-importancia-internacional-referente#:~:text=%C3%A0%20COVID%2D19-,OMS%20declara%20fim%20da%20Emerg%C3%AAncia%20de%20Sa%C3%BAde%20P%C3%BAblica,Internacional%20referente%20%C3%A0%20COVID%2D19&text=Bras%C3%ADlia%2C%205%20de%20maio%20de,)%20referente%20%C3%A0%20COVID%2D19

Financiamento
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) - Edital 04/2019 para Projeto de Iniciação Científica.

Datas de Publicação

Publicação nesta coleção
23 Out 2023
Data do Fascículo
Out 2023

Histórico

Recebido
01 Jun 2022
Aceito
01 Jun 2023
Publicado
02 Ago 2023

Este é um artigo publicado em acesso aberto sob uma licença Creative Commons

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[15] ¹⁵
Collantoni E, Saieva AM, Meregalli V, Girotto C, Carretta G, Boemo DG, Bordignon G, Capizzi A, Contessa C, Nesoti MV, Donato D, Flesia L, Favaro A. Psychological distress, fear of COVID-19, and resilient coping abilities among healthcare workers in a tertiary first-line hospital during the coronavirus pandemic. J Clin Med 2021; 10(7):1465.

[16] ¹⁶
Perera B, Wickramarachchi B, Samanmalie C, Hettiarachchi M. Psychological experiences of healthcare professionals in Sri Lanka during COVID-19. BMC Psychol 2021; 9(1):49.

[17] ¹⁷
Sun D, Yang D, Li Y, Zhou J, Wang W, Wang Q, Lin N, Cao A, Wang H, Zhang Q. Psychological impact of 2019 novel coronavirus (2019-nCoV) outbreak in health workers in China. Epidemiol Infect 2020; 148:e96.

[18] ¹⁸
Fu Y, Wang M, Zhao B, Liu B, Sun J, Feng Y, Wang Z, Li Q, Shi C, Xuan Y, Long S, Liu H, Chi T, Liao Z, Li B, Liu Q. Psychological impact of COVID-19 cases on medical staff of Beijing Xiaotangshan Hospital. Psychol Res Behav Manag 2021; 14:41-47.

[19] ¹⁹
Ofori AA, Osarfo J, Agbeno EK, Manu DO, Amoah E. Psychological impact of COVID-19 on health workers in Ghana: a multicentre, cross-sectional study. SAGE Open Med 2021; 9:20503121211000919.

[20] ²⁰
Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, Li J, Zhang SK, Ren ZF, Ren R, Liu YL, Qiao YL. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020; 9(1):113.

[21] ²¹
Nie A, Su X, Zhang S, Guan W, Li J. Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 2020; 29(21-22):4217-4226.

[22] ²²
Leira-Sanmartín M, Madoz-Gúrpide A, Ochoa-Mangado E, Ibáñez Á. Psychological impact of COVID-19 pandemic and related variables: a cross-sectional study in a sample of workers in a Spanish tertiary hospital. Int J Environ Res Public Health 2021; 18(7):3608.

[23] ²³
Tan BYQ, Chew NWS, Lee GKH, Jing M, Goh Y, Yeo LLL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH , Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ann Intern Med 2020; 173(4):317-320.

[24] ²⁴
Lasalvia A, Bonetto C, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Amaddeo F. Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy. Epidemiol Psychiatr Sci 2020; 30:e1.

[25] ²⁵
Wang N, Li Y, Wang Q, Lei C, Liu Y, Zhu S. Psychological impact of COVID-19 pandemic on healthcare workers in China Xi'an central hospital. Brain Behav 2021; 11(3):e02028.

[26] ²⁶
Tao J, Lin Y, Jiang L, Zhou Z, Zhao J, Qu D, Li W, Zhu Y. Psychological impact of the COVID-19 pandemic on emergency dental care providers on the front lines in China. Int Dent J 2020; 71(3):197-205.

[27] ²⁷
Amal M. Qasem Surrati, Farah M. Asad Mansuri, Abeer A. Ayadh Alihabi. Psychological impact of the COVID-19 pandemic on health care workers. J Taibah Univ Med Sci 2020; 15(6):536-543.

[28] ²⁸
Ali S, Maguire S, Marks E, Doyle M, Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study. BMJ Open 2020; 10(12):e042930.

[29] ²⁹
Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, Singh KK. Psychological impact of the COVID-19 pandemic on healthcare workers in India: an observational study. Fam Med Prim Care 2021; 9(12):5921-5926.

[30] ³⁰
Del Pozo-Herce P, Garrido-García R, Santolalla-Arnedo I, Gea-Caballero V, García-Molina P, Ruiz de Viñaspre-Hernández R, Rodríguez-Velasco FJ, Juárez-Vela R. Psychological impact on the nursing professionals of the Rioja Health Service (Spain) due to the SARS-CoV-2 virus. Int J Environ Res Public Health 2021; 18(2):580.

[31] ³¹
Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, Zhuang Q. Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China. Med Sci Monit 2020; 92(10):1962-1970.

[32] ³²
Zerbini G, Ebigbo A, Reicherts P, Kunz M, Messman H. Psychosocial burden of healthcare professionals in times of COVID-19 - a survey conducted at the University Hospital Augsburg. Ger Med Sci 2020; 18:Doc05.

[33] ³³
Mahendran K, Patel S, Sproat C. Psychosocial effects of the COVID-19 pandemic on staff in a dental teaching hospital. Br Dent J 2020; 229(2):127-132.

[34] ³⁴
Florin M, Pinar U, Chavigny E, Bouaboula M, Jarboui L, Coulibaly A, Lemogne C, Fournier L. Socio-economic and psychological impact of the COVID-19 outbreak on private practice and public hospital radiologists. Eur J Radiol 2020; 132:109285.

[35] ³⁵
Hong X, Cao J, Wei J, Duan Y, Zhao X, Jiang J, Jiang Y, Geng W, Zhu H. Stress and psychological impact of the COVID-19 outbreak on the healthcare staff at the fever clinic of a tertiary general hospital in Beijing: a cross-sectional study. BJPsych Open 2020; 7(3):e76.

[36] ³⁶
Sorokin MY, Kasyanov ED, Rukavishnikov GV, Makarevich OV, Neznanov NG, Morozov PV, Lutova NB, Mazo GE. Stress and stigmatization in health-care workers during the COVID-19 pandemic. Indian J Psychiatry 2020; 62(Suppl 3):S445-S453.

[37] ³⁷
Croghan IT, Chesak SS, Adusumalli J, Fischer KM, Beck EW, Patel SR, Ghosh K, Schroeder DR, Bhagra A. Stress, resilience, and coping of healthcare workers during the COVID-19 pandemic. J Prim Care Community Health 2021; 12:21501327211008448.

[38] ³⁸
Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: a factor analysis. Front Psychol 2021; 12:611314.

[39] ³⁹
Korkmaz S, Kazgan A, Çekiç S, Tartar AS, Balci HN, Atmaca M. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services. J Clin Neurosci 2020; 80:131-136.

[40] ⁴⁰
Sasaki N, Kuroda R, Tsuno K, Kawakami N. The deterioration of mental health among healthcare workers during the COVID-19 outbreak: a population-based cohort study of workers in Japan. Scand J Work Environment Health 2020; 46(6):639-644.

[41] ⁴¹
Çelmeçe N, Menekay M. The effect of stress, anxiety and burnout levels of healthcare professionals caring for COVID-19 patients on their quality of life. Front Psicol 2020; 11:597624.

[42] ⁴²
Chen X, Arber A, Gao J, Zhang L, Ji M, Wang D, Wu J, Du J. The mental health status among nurses from low-risk areas under normalized COVID-19 pandemic prevention and control in China: a cross-sectional study. Int J Ment Health Nurs 2021; 30(4):975-987.

[43] ⁴³
Ide K, Asami T, Suda A, Yoshimi A, Fujita J, Nomoto M, Roppongi T, Hino K, Takahashi Y, Watanabe K, Shimada T, Hamasaki T, Endo E, Kaneko T, Suzuki M, Kubota K, Saigusa Y, Kato H, Odawara T, Nakajima H, Takeuchi I, Goto T, Aihara M, Hishimoto A. The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. PLoS One 2021; 16(1):e0245294.

[44] ⁴⁴
Al Muharraq EH. The psychological impact of coronavirus disease 2019 on nurses in Saudi Arabia and their coping strategies. SAGE Open Nurs 2021; 7:23779608211011322.

[45] ⁴⁵
Chen B, Li QX, Zhang H, Zhu JY, Yang X, Wu YH, Xiong J, Li F, Wang H, Chen ZT. The psychological impact of COVID-19 outbreak on medical staff and the general public. Curr Psychol 2020; 41(8):5631-5639.

[46] ⁴⁶
Al Mahyijari N, Badahdah A, Khamis F. The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world. Ir J Psychol Med 2021; 38(3):186-191.

[47] ⁴⁷
Xiong H, Yi S, Lin Y. The psychological status and self-efficacy of nurses during COVID-19 outbreak: a cross-sectional survey. Inquiry 2020; 57:46958020957114.

[48] ⁴⁸
Rodríguez-Rey R, Garrido-Hernansaiz H, Bueno-Guerra N. Working in the times of COVID-19. Psychological impact of the pandemic in frontline workers in Spain. Int J Environ Res Public Health 2020; 17(21):8149.

[49] ⁴⁹
Organização Pan-Americana da Saúde (OPAS). Avaliação de risco e gerenciamento da exposição de profissionais de saúde no contexto da COVID-19 [Internet]. 2020. [acessado 2022 nov 2]. Disponível em: https://iris.paho.org/handle/10665.2/52290
» https://iris.paho.org/handle/10665.2/52290

[50] ⁵⁰
Sun P, Wang M, Song T, Wu Y, Luo J, Chen L, Yan L. The psychological impact of COVID-19 pandemic on health care workers: a systematic review and meta-analysis. Front. Psychol 2021; 12:626547.

[51] ⁵¹
Fundação Oswaldo Cruz (Fiocruz). Pesquisa analisa o impacto da pandemia entre profissionais de saúde [Internet]. 2021. [acessado 2022 nov 4]. Disponível em: https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude
» https://portal.fiocruz.br/noticia/pesquisa-analisa-o-impacto-da-pandemia-entre-profissionais-de-saude

[52] ⁵²
Organização Pan-Americana da Saúde (OPAS). Pandemia de COVID-19 desencadeia aumento de 25% na prevalência de ansiedade e depressão em todo o mundo [Internet]. 2022. [acessado 2022 nov 2]. Disponível em: https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em
» https://www.paho.org/pt/noticias/2-3-2022-pandemia-COVID-19-desencadeia-aumento-25-na-prevalencia-ansiedade-e-depressao-em

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Organização Pan-Americana da Saúde (OPAS). OMS declara fim da Emergência de Saúde Pública de Importância Internacional referente à COVID-19 [Internet]. 2023. [acessado 2023 maio 5]. Disponível em: https://www.paho.org/pt/noticias/5-5-2023-oms-declara-fim-da-emergencia-saude-publica-importancia-internacional-referente#:~:text=%C3%A0%20COVID%2D19-,OMS%20declara%20fim%20da%20Emerg%C3%AAncia%20de%20Sa%C3%BAde%20P%C3%BAblica,Internacional%20referente%20%C3%A0%20COVID%2D19&text=Bras%C3%ADlia%2C%205%20de%20maio%20de,)%20referente%20%C3%A0%20COVID%2D19
» https://www.paho.org/pt/noticias/5-5-2023-oms-declara-fim-da-emergencia-saude-publica-importancia-internacional-referente#:~:text=%C3%A0%20COVID%2D19-,OMS%20declara%20fim%20da%20Emerg%C3%AAncia%20de%20Sa%C3%BAde%20P%C3%BAblica,Internacional%20referente%20%C3%A0%20COVID%2D19&text=Bras%C3%ADlia%2C%205%20de%20maio%20de,)%20referente%20%C3%A0%20COVID%2D19

Saúde Pública

Saúde Pública

Fatores de risco à saúde mental dos profissionais da saúde durante a pandemia de COVID-19: revisão sistemática

Resumo

Introdução

Método

Critérios de elegibilidade - seleção dos estudos

Fontes de informação e estratégia de busca

Processo de coleta de dados

Lista de dados

Métodos de síntese

Resultados

Seleção dos estudos

Características gerais dos estudos incluídos e avaliação da qualidade

Perfil da população dos estudos

Seleção final: descrição dos riscos aos quais estão expostos os trabalhadores de saúde envolvidos no atendimento de pacientes diagnosticados com COVID-19 durante a pandemia

Descrição dos riscos associados à ocupação e ao ambiente de trabalho

Descrição dos riscos associados à escassez de programas de treinamento e educacionais

Descrição das repercussões na saúde mental dos profissionais: incidência de sintomas/transtornos relacionados à saúde mental descritos nos estudos

Discussão

Descrição dos riscos associados à ocupação e ao ambiente de trabalho

Descrição dos riscos associados à escassez de programas de treinamento e educacionais

Descrição das repercussões na saúde mental dos profissionais: incidência de sintomas/transtornos descritos nos estudos

Conclusão

Referências

Financiamento

Datas de Publicação

Histórico