Participants chose “patient’s fears of infection” and “providers protection measures” as reasons for decreases, and “pandemic related anxieties”, “economic stressors”, and “capacity reductions of the inpatient system” as reasons for increases of patient contact. Participants were categorized by clinical determined cut-off scores indicating the severity of depression (PHQ-9), anxiety (GAD-7) and post-traumatic stress disorder (PTSD PCL-5), based on sum scores in November 2020. Despite the generally low symptom scores and indications of resilience, the significant decline in mental health emphasizes the need for targeted support strategies during critical phases of public health crises. Lastly, our first assessment began a few months into the pandemic, so it cannot be considered a true baseline measurement of pre-pandemic mental health conditions. Additionally, we were not informed about pre-existing psychiatric conditions, which are linked to increased risks of depression, anxiety and PTSD among HCWs .

Without accounting for participants’ history of anxiety or sleep impairments, we cannot accurately assess whether a change occurred and whether the current state is attributable to the pandemic. Higher incidence of sleep disturbances related to COVID-19 in female HCWs were also reported in a study conducted in Bahrain and a review of literature . These factors may help account for the difference in anxiety among patient-facing HCWs in our study compared with others studying hospital-based HCWs. Our survey participants primarily treated outpatients screened to exclude patients with respiratory symptoms, except for those working in the respiratory clinic where patients with possible COVID-19 were treated. Gender differences in our study were less significant for moderate and severe anxiety (19.9% males vs 22.9% females) 29, 30. While these findings are comparable to those from other COVID-19 related studies , they are contrary to what one may expect given higher fatality risks of COVID-19 infection among older adults.

They found a relative increase in registered mental health problems during the pandemic, as well as relatively more care provided to patients with mental health problems. However, a study in Belgium compared the registration of mental health problems in primary care during and before the pandemic. Another study reported that 63.3% of nurses agreed with the statement, “I am worried about inadequate personal protective equipment for healthcare personnel (PPE)”. More support services are advocated for when the mental health costs of frontline workers are acknowledged.

Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review

Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has called for refining clinical guidelines for tele-mental health services, including broader adoption of telehealth for mental and substance use disorders. As policy makers continue to look at how to regulate and pay for telehealth services, it is important to Mental health providers during COVID-19 consider opportunities for patient choice so that telehealth is not necessarily given as the only option for those looking for care. Data during the pandemic suggest there is a concerning increase in the number of individuals reporting symptoms of depression or anxiety and showing signs of substance use disorder. States expanded Medicaid telehealth coverage in response to the pandemic, with nearly all states covering and paying parity for audio-visual and audio-only mental health and substance use disorder visits in their fee-for-service Medicaid programs as of July 2021. States have broad flexibility to determine Medicaid coverage of telehealth services as well as providers’ licensure requirements to practice and prescribe during a telehealth consultation.

Prevention and management

For instance, studies estimate the heritability of conditions such as schizophrenia to be approximately 80%, while MDD has a heritability estimate of approximately 37% . The basal ganglia, involved in motor control, motivation, and reward processing, also contribute to mood regulation, with dysfunctions in this region observed in conditions such as depression and OCD. The lateral hypothalamus is involved in arousal, motivation, and energy levels, with connections to depression. The hypothalamus plays a central role in regulating the body’s stress response through the HPA axis. The amygdala, which processes emotions such as fear and pleasure, is hyperactive in anxiety-related conditions such as GAD, PTSD, and panic disorders, leading to heightened emotional responses and fear processing. Mental health is intricately linked to the functioning of specific brain regions, each playing a critical role in regulating emotions, behaviors, and cognitive processes.

Harm Prevention

Contrary to our expectation (H4), neither the caregiver self-image (CRIS) nor the level of prosocialness (PSA) predicted whether a person would seek help. The majority—84% of all participants and 83% of those who supposedly needed help—indicated that they had sufficient social support outside the workplace. HPs gave various reasons for not seeking help in spite of severe psychological symptoms. Frequency of responses to ’Would you like to receive psychological support to deal with the crisis? Out of the 639 participants, 348 (54%) scored 0.5 or higher on the ISR total scale, which would give them a suspected clinical diagnosis or more severe; and yet only 49 (14%) of these participants said that they would consider seeking psychological support. Table 5 provides an overview of the stress factors and their respective mean effects.How strongly are you affected by the following aspects during the COVID-19 pandemic at your workplace?

• A study conducted in Turkey demonstrated that the psychological resilience of health care workers was higher in later years.24 This higher age phenomenon is often linked with more years of experience, as those in the higher age category would also be higher in the experience category.
• The hypothalamus plays a central role in regulating the body’s stress response through the HPA axis.
• During recent years, the mental health needs of healthcare providers have been gaining attention as a major public health concern and threat to quality care delivery.
• Out of the 639 participants, 348 (54%) scored 0.5 or higher on the ISR total scale, which would give them a suspected clinical diagnosis or more severe; and yet only 49 (14%) of these participants said that they would consider seeking psychological support.
• The identified articles illustrated the use of telemental health across settings such as homes, hospitals, and schools.

Moreover, by March 2023, HCWs’ mental health symptoms returned to November 2020 levels, indicating resilience. In comparison, the Netherlands Mental Health Survey and Incidence Studies (NEMESIS) reported a 9.8% prevalence for mood disorders and 15.2% for anxiety disorders in the general population between November 2019 and March 2022, with no differences in prevalence before and during the pandemic. Similarly, no differences were found in symptoms of stress, burn-out, insomnia, resilience, or levels of work engagement between HCWs working in patient care and those not working in patient care (S5 Table). At baseline (November 2020) the overall group reported low symptom scores of depression, anxiety and PTSD, with mean scores 4.38 (95% CI 3.98 to 4.78), 3.56 (95% CI 3.20 to 3.91) and 7.86 (95% CI 6.83 to 8.90) on PHQ-9, GAD-7 and PCL-5, respectively (Fig 1A-1C, S2 Table). Whether participants were infected with SARS-CoV-2 prior to the widespread availability of vaccination for all HCWs in the Netherlands, was determined prior to the start of the mental health study and during the entire follow-up. Questions about demographic characteristics (e.g. job function, marital status, living with children, years of experience in the field) were included in the first survey at the start of the mental health study.