key: cord-0925958-1ksouc34 authors: Lozada-Martínez, Ivan; Bolaño-Romero, Maria; Moscote-Salazar, Luis; Torres-Llinas, Daniela; Agrawal, Amit title: Letter to the editor. Healthcare workers on the edge of sanity due to COVID-19: rapid review of the results of systematic reviews and meta-analyzes date: 2020-12-04 journal: J Clin Neurosci DOI: 10.1016/j.jocn.2020.11.041 sha: df1d84a045c908ea002c35e5fa1406b9435ce5ac doc_id: 925958 cord_uid: 1ksouc34 • This manuscript will provide new evidence regarding the results of the highest quality evidence (systematic reviews and meta-analysis), on a topic of public interest in neuroscience (mental health), based on a publication made in your prestigious journal. We read with great interest the article published in your distinguished journal by Korkmaz et al. [1] "The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services", where the authors evaluated anxiety levels experienced by healthcare workers employed in COVID-19 services, the effects of anxiety on sleep quality and quality of life and the level of relationship between these variables and the problem-solving skills of the healthcare workers. Although the authors found statistically significant findings regarding the prevalence of anxiety, sleep disruption, decreased quality of life, alteration in problem-solving skills, and the relationship between some socio-demographic aspects, these are mainly associated with workers who were in charge of more than one clinical department during the pandemic [1] . When contrasting these findings with high-quality literature (Table 1) , it is evident that substantial changes can be observed regarding these results, not only among health workers but compared to the general population. Even, a positive correlation between risk factors for psychological morbidity, which in this study had no association (for example, living with family) with the finding. For this analysis, a non-systematic search of the literature was performed in PubMed, using the keywords "Mental Health", "Healthcare Workers", and "COVID-19". The only criterion for inclusion was that the articles should consist of systematic reviews and meta-analysis; 7 articles were finally included. When exanimating the results of the stated evidence, it was found that all studies converge in that health care workers have the highest prevalence of anxiety, depression, sleep disorders, distress, burnout, and post-traumatic stress syndrome, in comparison with other workgroups, except for the findings reported by Luo et al [4] , where interestingly, patients and the general population exceeded the prevalence of anxiety (56 % / 32 % vs 26 %, respectively) and depression ( 55 % / 27 % vs 25 % respectively) compared to health workers [4] . The prevalence of anxiety in the evaluated groups was found to be up to 29% [7] , Depression up to 50.7% [6] , Insomnia up to 37.9% [7] , and Post-traumatic stress syndrome up to 73.4% [6] , in critical times of epidemic/pandemic; highlighting that the prevalence of post-traumatic stress syndrome has been higher in the pandemic due to COVID-19 [6] . In particular, this symptomatology was higher in doctors than in other health workers [2] . A direct relationship between mental disorders and the activation of pro-inflammatory immune pathways at the systemic level exists [8] , which is strongly exacerbated during the acute phase of distressing events; and taking into account that Conti et al. [9] argue that the release of pro-inflammatory cytokines, including interleukin-1β and IL-6 of the respiratory tract, can be stimulated by the pathophysiological process of COVID-19, it can be inferred that the inflammatory response will be superior in this group specifically, having this in mind, and considering the high prevalence of psychiatric conditions, it can then be deduced that a health worker per se, has a risk of high lethality for COVID-19, regardless of the presence of other exacerbating factors. In the view of the findings, it is necessary to stipulate an effective action plan for the control of risk factors that may generate or intensify psychological/psychiatric symptoms, as the outlook for health workers shortly is not very encouraging. The physical and mental integrity of the first line of care in the face of this type of emergency must remain impeccable to ensure good clinical practice, moreover, when some risk factors are feasible to mitigate, such as administrative support for workers, financial guarantees and supplies, facilitation of stay, support for the worker's family nucleus, among others; supports that can contribute to the worker's courage. Since the COVID-19 pandemic is in its second wave globally (the curve being greater than in the first epidemiological peak) [10] , these findings serve as evidence for the design of public policies and organizational modifications It should be noted that this manuscript presents as a limitation, that several of these systematic reviews and meta-analysis, share studies, constituting an important bias against the heterogeneity of the groups evaluated. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The anxiety levels, quality of sleep and life and problem-solving skills in healthcare workers employed in COVID-19 services Psychiatric symptomatology associated with depression, anxiety, distress, and insomnia in health professionals working in patients affected by COVID-19: A systematic review with meta-analysis Psychological effects caused by the COVID-19 pandemic in health professionals: A systematic review with meta-analysis The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public -A systematic review and meta-analysis Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis The Psychological Impact of Epidemic and Pandemic Outbreaks on Healthcare Workers: Rapid Review of the Evidence Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis A longitudinal study on the mental health of general population during the COVID-19 epidemic in China Induction of proinflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): anti-inflammatory strategies COVID-19 None. The author(s) received no financial support for the research, authorship, and/or publication of this article.