key: cord-0727705-ghpe6u5d authors: Bekele, Firomsa; Machessa, Desalegn Feyissa; Sefera, Birbirsa title: Prevalence and associated factors of psychological impact of COVID-19 among community, health care workers and patients in Ethiopia: A systematic review date: 2021-05-25 journal: Ann Med Surg (Lond) DOI: 10.1016/j.amsu.2021.102403 sha: becb5890b835c998fdf8f10afc933af31cb99c5c doc_id: 727705 cord_uid: ghpe6u5d INTRODUCTION: The mental health effects of coronavirus is found to be high in health care professionals, patients and the community. Therefore, this review tried to summarize the prevalence and associated factors of psychological impact of COVID-19 among the health care workers (HCWs), patients and the community in Ethiopia. METHODS: The studies from Medline via PubMed, Science direct, and Google scholar were searched from February 17 to March 17, 2021. PRISMA-2020 (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was used to conduct this review. RESULT: Initially, 2190 publications were obtained from three databases (PubMed, Science direct, and Google scholar). Finally, 9 articles that fulfilled eligible criteria were included in the review. Among different types of mental health impacts stress was reported that lies in the range from 18% to 100%, anxiety was reported from 27.7% to 100%, depression was from 12.4% to 55.7%. Several factors were associated with psychological impacts of COVID-19 among health care workers, patients and community such as level of education, occupation, gender, age, marital status, presence of co-morbidity, lack of social support, personal/family exposure, their attitude, income level, family size, presence of respiratory symptoms, substance use, area of residence, and lack of protective equipment. CONCLUSION: There was overall high psychological impact of COVID-19 pandemic among healthcare workers, community, and patients. The most common indicators of psychological impact reported across studies were anxiety and stress. Therefore, online psychotherapy and cognitive behavioral and mindfulness-based therapies should be provided through smartphone applications to minimize psychological impacts of COVID-19. Patients have a right to privacy. Patients' and volunteers' names, initials, or hospital numbers should not be used. Images of patients or volunteers should not be used unless the information is essential for scientific purposes and explicit permission has been given as part of the consent. If such consent is made subject to any conditions, the Editor in Chief must be made aware of all such conditions. Even where consent has been given, identifying details should be omitted if they are not essential. If identifying characteristics are altered to protect anonymity, such as in genetic pedigrees, authors should provide assurance that alterations do not distort scientific meaning and editors should so note. Not applicable. No individual person's personal details, images or videos are being used in this study. Please specify the contribution of each author to the paper, eg study concept or design, data collection, data analysis or interpretation, writing the paper, others, who have contributed in other ways should be listed as contributors. In accordance with the Declaration of Helsinki 2013, all research involving human participants has to be registered in a publicly accessible database. Please enter the name of the registry and the unique identifying number (UIN) of your study. You can register any type of research at http://www.researchregistry.com to obtain your UIN if you have not already registered. This is mandatory for human studies only. Trials and certain observational research can also be registered elsewhere such as: ClinicalTrials.gov or ISRCTN or numerous other registries. Coronavirus disease (COVID-19) is a new pathogen of virus that was first discovered in Wuhan, China, and which is currently infects human unlike SARS, MERS, and influenza virus [1, 2] . The emergency of this coronavirus has resulted in a variety of mental health impact such as major depressive disorder, fear, and stress [3] . The increase in negative psychological impacts of this disease is as the result of the rapid spread of the virus, increased access to information and higher case fatality rate [4, 5] . During this pandemic period, having mental and psychological problems leads to poor self-care practice, appetite, sleep, immunity status, and compliance to the instructions given by health care provider that exposed them to infectious etiology [6] . The psychological impact of coronavirus is found to be high in health care professionals and the community [1, 7] . Among different types of psychological impacts, anxiety, depression, panic attacks, or psychotic symptoms were highly reported [8, 9] . The mental health impact of a disease outbreak is usually neglected during pandemic management although the consequences are costly. Early evidence has shown that health workers directly involved in the diagnosis, treatment, and care of patients with COVID-19 are at risk of developing mental health symptoms [10] Different risk factors can predispose to the high burden of the mental health impacts such as being female, increase in age, the presence of concomitant disease, inadequate social support, increased the number of family size, low socio-economic status, occupations and level of educations [1, 3, 6] . Besides this the fear of being contagious and infecting others, physical exhaustion, and a lack of sufficient protective equipment are a predictors of poor mental health impacts [11] [12] [13] . Know days the COVID-19 pandemic became widely affects the community, patients and health care providers in Ethiopia [11] . The psychological effects of this disease might be high in developing country including Ethiopia as the result of lack of resources, unorganized health care system, and inadequate health care professionals. Despite a scanty of reviews were conducted on the mental health impacts of COVID-19 globally, there was no systematic reviews done in Ethiopia and the culture and socio-demographic characteristics of the included participants were different which necessitates the need to summarizes the variety of findings among community, patients and HCWs in Ethiopia. The objective of the review is to conclude the magnitude and risk factors of poor mental health effects of COVID-19 in Ethiopia. The protocol of PRISMA-2020 is used to undertake this systematic review [14] . Three authors namely FB, DFM, and BS were involved in searching different literatures from three data bases like PubMed, Science direct, and Google scholar. The time period used to conduct this review was from the February 17 to March 17, 2021. The searched literatures were imported into Endnote x5 to eliminate any duplication. The MESH term for the database is (Psychological impacts) AND Coronaviruses disease-19) AND Healthcare workers) AND community) OR determinants) OR prevalence) AND Ethiopia) The findings published related to magnitude and associated factors of COVID-19 in Ethiopia having all primary outcome and full texts available were included. The articles with unknown primary outcomes, systematic reviews and meta-analysis studies, not peer reviewed and commentary to editors were not eligible. The articles fulfilling the inclusion criteria were extracted on separate data sheet. The outcome of the interest extracted were the socio-demographic characteristics, different psychological impacts along with the authors name and year of the study. To assess the quality of the methodology the National Institutes of Health (NIH) Quality Assessment tool was used15]. As per the tool 5 researches were good [11, [16] [17] [18] [19] ,3 were fair[6,1,20], 1 article was poor [21] . A total of 2,190 articles were obtained up on initial searching from PubMed, Science direct, and Google scholar. A total of 1352 articles were removed due to duplications. Finally a total of 918 articles were excluded by observing their title and abstracts. Consequently, only 20 articles were subject to a full-text review. Finally, 9 articles were selected to be included in our review ( In our review the filtered articles were cross-sectional studies. Articles included in this study were conducted among patients, health care workers and community. The majority of the participant were male in five of the articles [16, 11, 1, 21, 17] , whereas female was predominant in the three articles [6, 18, 19] and one articles was only done among female students [20] . Regarding to the study participants three of articles were conducted on health care workers [11, 1, 18] ,two of them were on community [6, 21] . Another two articles were on patients, one articles was on university students [16] , whereas one articles was on women attending perinatal services [20] ( Table 1) . The blindness and hiddenness of the outcomes were sufficient in 5 articles [6, 16, 1, 18, 19] and not known in remaining 4 articles. The study populations was unknown in 3 articles and well known in the remaining 6 [6, 16, 1, 17, 18, 19] . We have obtained complete outcome variables in all articles except one article [6] . Other types of bias were not found in our systematic review. Anxiety was the common psychological impacts in the study of Kassaw CH et al 36% [6] .and Hajure M et al 61.8% [17] , whereas three articles were only measures anxiety [11, 20, 18] [16, 20, 17, 19] . Substance use was a predictors of anxiety, depression and stress in two findings of Aylie NS et al and Hajure M et al [16, 17] .Families having COVID-19 was the most risk factors for developing the negative mental health effects in two studies of Aylie NS et al and Kibret S et al [16, 18] [Table2]. The results of our study revealed a high prevalence of anxiety and stress among patients, community and health care workers during the outbreak of COVID-19 virus. This is consistent to the finding of China [3] ,Oman [22] . However, anxiety and depression was the most commonly occurred psychological impacts according to the study of Luo M etal.,2020 [9] .The study of Nepal and China showed that anxiety, depression and insomnia were the most commonly occurred mental health impacts [10, 23] . In Saudi Arabia depression was the widely occurred psychological features [24] . The variable reports of psychological impacts might be due to the fact that different socio-demographic characteristics and psychological comorbidities of included HCW, patients and community across different country In this study, female and young participants were more likely to experience moderate to severe anxiety, stress and depression compared to males [1, 6, [16] [17] [18] [19] . Similar findings have been reported in Oman [22] . The study of Luo M etal., 2020 also founds high rates of psychological impacts among womens [9] . On the contrary, gender was not a predictors of anxiety and stress in Peru [25] . This is due to women may be more stressed during lockdown, as they may be over proportionately burdened by childcare duties It was found that Social support correlated with less mental health problems [16, 20, 17, 19] . This is consistent with the study of Muller AE etal.,2020 [12] . Similarly, perceived social support was negatively correlated to Depression, anxiety and stress scale scores in China [3] . Inadequate Protective measures and contact history were the independent risk factors for Psychological features [6, 16, 11, 21, 18] . This is inline to the study of In China [26] . However, contact history was not have determined the mental health impacts in Indian community [27] . The presence of social drug use like tobacco have a the association with the psychological effects of COVID-19 [16, 17] .This is differ to the finding of Indonesia [28] .This is due to the increase in risk of psychological features as the results of substance use that can precipitates the mental health impacts of COVID-19. As a limitation, all included studies were cross-sectional, which was difficult to identify causal effect relationships. The other weakness includes the limited number of published articles was obtained, meta-analysis was not performed and heterogeneity of the articles, all psychological impacts were not studied in some articles. Besides this, a search for the gray literature was not conducted and only published, peer-reviewed articles were included and most articles failed to report proper randomization techniques. In the current systematic review, we have observed an overall high psychological impact of COVID-19 pandemic among healthcare workers, community, and patients. The most common indicators of psychological impact reported across studies were anxiety and stress. Common risk factors of heavier psychological burden included being women, younger age, poor social support, substance use, occupation, marital status, educational status, monthly income, and contact history. Therefore, online psychotherapy and cognitive behavioral and mindfulness-based therapies should be provided through smartphone applications to minimize a various determinants of psychological impacts of COVID-19. Besides to this HCWs should strongly provide mental health support to their clients by waiving fees for mental health services, offering additional support and increasing awareness of mental health. J o u r n a l P r e -p r o o f Unique Identifying number or registration ID: reviewregistry1130 3. Hyperlink to the registration PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses; UK: United Kingdom; USA: United States of America References Perceived Stress and Its Associated Factors during COVID-19 among Healthcare Providers in Ethiopia: A Cross-Sectional Study. Advances in Public Health Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review Psychological impact of COVID-19 on medical care workers in China. 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Comprehensive psychiatry Anxiety, distress, and turnover intention of healthcare workers Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: A multi-center cross-sectional survey investigation The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country Hasinuddin m. determinants psychological distress of indonesian health care providers during covid-19 pandemic The datasets used are available from the corresponding author on a reasonable request. Not applicable. The study was registered at researchregistry.com with a unique reference number of "reviewregistry1130"Competing Interests: No conflict of interests existed.