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Published in: Human Resources for Health 1/2021

Open Access 01-12-2021 | Affective Disorder | Review

Depression among healthcare workers in the Eastern Mediterranean Region: a systematic review and meta-analysis

Authors: Amit Abraham, Karima Chaabna, Sathyanarayanan Doraiswamy, Sapna Bhagat, Javaid Sheikh, Ravinder Mamtani, Sohaila Cheema

Published in: Human Resources for Health | Issue 1/2021

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Abstract

Background

Depression is a major population health challenge globally. This systematic review and meta-analysis aims to (i) determine depression prevalence and (ii) identify the risk and protective factors of depression among healthcare workers (HCWs) in the Eastern Mediterranean Region (EMR).

Methods

The protocol was registered on Open Science Framework (registration ID: https://​osf.​io/​rdv27). We searched five databases (PubMed, Embase, PsycINFO, Al Manhal, Google Scholar) till July 22, 2020 without language restrictions. We included studies from the EMR using a depression screening or diagnostic instrument to measure the depression prevalence among HCWs. Studies were assessed and data were pooled using random-effects meta-analysis based on the Cochrane handbook.

Results

The systematic review identified 108 studies from 12 EMR countries with varying quality. Working long hours, poor sleep quality and being female were risk factors for depression in EMR HCWs. The meta-analysis comprised 77 studies providing 122 prevalence measures across 7 EMR countries. The pooled prevalence of depression among EMR HCWs was 33.03% (95% CI = 27.40–39.19%). Emergency HCWs had markedly higher rates of depression [53.14% (95% CI = 26.63–77.99%)] compared to HCWs of other specialties. Most studies had an appropriate sample size.

Conclusions

Depression among EMR HCWs is a major concern. Steps must be taken to prevent, identify, and manage depression among HCWs. Fostering a compassionate and empathetic environment is critically important to building a resilient healthcare system. Generating high-quality regional data from longitudinal studies on mental health will further contribute to a better understanding and management of depression among EMR HCWs.
Appendix
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Literature
1.
World Health Organization (WHO). Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.2017.
2.
Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J. Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. J Psychiatr Res. 2020;126:134–40.PubMedCrossRef
3.
Masanotti GM, Paolucci S, Abbafati E, Serratore C, Caricato M. Sense of Coherence in Nurses: A Systematic Review. Int J Environ Res Public Health. 2020;17:6.
4.
Gómez-Salgado J, Domínguez-Salas S, Romero-Martín M, Ortega-Moreno M, García-Iglesias JJ, Ruiz-Frutos C. Sense of coherence and psychological distress among healthcare workers during the COVID-19 pandemic in Spain. Sustainability. 2020;12(17):6855.CrossRef
5.
Burton A, Burgess C, Dean S, Koutsopoulou GZ, Hugh-Jones S. How effective are mindfulness-based interventions for reducing stress among healthcare professionals? A systematic review and meta-analysis. Stress Health. 2017;33(1):3–13.PubMedCrossRef
6.
Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373–83.PubMedPubMedCentralCrossRef
7.
Maharaj S, Lees T, Lal S. Prevalence and risk factors of depression, anxiety, and stress in a cohort of australian nurses. Int J Environ Res Public Health. 2019;16(1):61.CrossRef
8.
de Oliveira GS, Jr., Chang R, Fitzgerald PC, Almeida MD, Castro-Alves LS, Ahmad S, et al. The Prevalence of Burnout and Depression and Their Association with Adherence to Safety and Practice Standards: A Survey of United States Anesthesiology Trainees. Anesthesia & Analgesia. 2013;117(1).
9.
Melnyk BM, Orsolini L, Tan A, Arslanian-Engoren C, Melkus GDE, Dunbar-Jacob J, et al. A national study links nurses’ physical and mental health to medical errors and perceived worksite wellness. J Occup Environ Med. 2018;60(2):126–31.PubMedCrossRef
10.
Sen S, Kranzler HR, Krystal JH, Speller H, Chan G, Gelernter J, et al. A prospective cohort study investigating factors associated with depression during medical internship. Arch Gen Psychiatry. 2010;67(6):557–65.PubMedPubMedCentralCrossRef
11.
Murphy JM, Laird NM, Monson RR, Sobol AM, Leighton AH. A 40-year perspective on the prevalence of depression: the Stirling County Study. Arch Gen Psychiatry. 2000;57(3):209–15.PubMedCrossRef
12.
Goldman ML, Shah RN, Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiat. 2015;72(5):411–2.CrossRef
13.
Nickell LA, Crighton EJ, Tracy CS, Al-Enazy H, Bolaji Y, Hanjrah S, et al. Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. CMAJ. 2004;170(5):793–8.PubMedPubMedCentralCrossRef
14.
Abolfotouh MA, AlQarni AA, Al-Ghamdi SM, Salam M, Al-Assiri MH, Balkhy HH. An assessment of the level of concern among hospital-based health-care workers regarding MERS outbreaks in Saudi Arabia. BMC Infect Dis. 2017;17(1):4.PubMedPubMedCentralCrossRef
15.
Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020;368:1211.CrossRef
16.
17.
Rahman A. Mental disorders in the Eastern Mediterranean Region. Int J Public Health. 2018;63(1):9–10.PubMedCrossRef
18.
Sheikh JI, Cheema S, Chaabna K, Lowenfels AB, Mamtani R. Capacity building in health care professions within the Gulf cooperation council countries: paving the way forward. BMC Med Educ. 2019;19(1):83.PubMedPubMedCentralCrossRef
19.
Shahri SS, Ghashghaee A, Behzadifar M, Bragazzi NL, Behzadifar M, Mousavinejad N, et al. Depression among Iranian nurses:a systematic review and meta-analysis. Med J Islam Repub Iran. 2017;31:130.
20.
Ameri M, Nodoushan MRH, Shahbazzadeh A, Ahmadi MA. Depression and its main determinants among Iranian operating room personnel: a systematic review and meta-analysis. Int Clin Neurosci J. 2018;5(3):81–5.CrossRef
21.
Mohammadi M, Vaisi-Raygani AA, Jalali R, Salari N, Sabbaghchi M. Prevalence of depression in nurses working in iranian hospitals: a systematic review and meta-analysis. Int J Med Rev. 2020;7(1):32–8.
22.
Fereidouni Z, Dehghan A, Najafi KM. The prevalence of depression among nurses in Iran: a systematic review and meta-analysis. Int J Med Rev. 2018;5(4):163–7.CrossRef
23.
Assadi SM, Nakhaei MR, Najafi F, Fazel S. Mental health in three generations of Iranian medical students and doctors. Soc Psychiatry Psychiatr Epidemiol. 2007;42(1):57–60.PubMedCrossRef
24.
Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019. New York: Wiley; 2019.
25.
26.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.PubMedCrossRef
27.
Beller EM, Glasziou PP, Altman DG, Hopewell S, Bastian H, Chalmers I, et al. PRISMA for Abstracts: reporting systematic reviews in journal and conference abstracts. PLoS Med. 2013;10(4):e1001419.PubMedPubMedCentralCrossRef
28.
Chaabna K, Cheema S, Abraham A, Alrouh H, Mamtani R, Sheikh JI. Gray literature in systematic reviews on population health in the Middle East and North Africa: protocol of an overview of systematic reviews and evidence mapping. Syst Rev. 2018;7(1):94.PubMedPubMedCentralCrossRef
29.
Chaabna K, Cheema S, Abraham A, Mamtani R. Strengthening literature search strategies for systematic reviews reporting population health in the Middle East and North Africa: A meta-research study. J Evid Based Med. 2020;13:192–8.PubMedPubMedCentralCrossRef
30.
Chaabna K, Cheema S, Abraham A, Alrouh H, Lowenfels AB, Maisonneuve P, et al. Systematic overview of hepatitis C infection in the Middle East and North Africa. World J Gastroenterol. 2018;24(27):3038–54.PubMedPubMedCentralCrossRef
31.
Chaabane S, Chaabna K, Abraham A, Mamtani R, Cheema S. Physical activity and sedentary behaviour in the Middle East and North Africa: an overview of systematic reviews and meta-analysis. Sci Rep. 2020;10:9363.PubMedPubMedCentralCrossRef
32.
Chaabna K, Cheema S, Abraham A, Alrouh H, Mamtani R. Adult mortality trends in Qatar, 1989–2015: National population versus migrants. PLOS ONE. 2018;13(9):e0203996.PubMedPubMedCentralCrossRef
33.
Cheema S, Maisonneuve P, Weber I, Fernandez-Luque L, Abraham A, Alrouh H, et al. Knowledge and perceptions about Zika virus in a Middle East country. BMC Infect Dis. 2017;17(1):524.PubMedPubMedCentralCrossRef
34.
Cheema S, Maisonneuve P, Al-Thani MH, Al-Thani AAM, Abraham A, Al-Mannai GA, et al. Oral health behavior and factors associated with poor oral status in Qatar: results from a national health survey. J Public Health Dent. 2017;77(4):308–16.PubMedCrossRef
35.
Cheema S, Maisonneuve P, Zirie M, Jayyousi A, Alrouh H, Abraham A, et al. Risk factors for microvascular complications of diabetes in a high-risk middle east population. J Diabetes Res. 2018;2018:8964027.PubMedPubMedCentralCrossRef
36.
Doraiswamy S, Jithesh A, Chaabane S, Abraham A, Chaabna K, Cheema S. Perinatal mental illness in the middle east and north africa region—a systematic overview. Int J Environ Res Public Health. 2020;17(15):5487.PubMedCentralCrossRef
37.
38.
39.
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:5928.CrossRef
40.
Institute of Medicine. Finding What Works in Health Care: Standards for Systematic Reviews. Eden J, Levit L, Berg A, Morton S, editors. Washington, DC: The National Academies Press; 2011. 340 p.
41.
Daniel W. Biostatistics: A foundation for analysis in the health sciences. 7th ed. New York: John Wiley and Sons; 2000.
42.
Joules N, Williams DM, Thompson AW. Depression in resident physicians: a systematic review. Open J Depr. 2014;3:12.
43.
Rahmati F, Safari S, Hashemi B, Baratloo A, Khosravi Rad R. Prevalence of Depression and Personality Disorders in the Beginning and End of Emergency Medicine Residency Program; a Prospective Cross Sectional Study. Arch Acad Emerg Med. 2019;7(1):e5.PubMedPubMedCentral
44.
AlGhamdi BS, AlAtawi Y, AlShehri FS, Tayeb HO, Taleb HAA, Binsalman A. Psychological Distress during COVID-19 Curfews and Social Distancing in Saudi Arabia: A Cross-Sectional Study. Research Square [Pre-print]. 2020.
45.
Badahdah A, Khamis F, Al Mahyijari N, Al Balushi M, Al Hatmi H, Al Salmi I, et al. The mental health of health care workers in Oman during the COVID-19 pandemic. Int J Soc Psychiatry. 2020:0020764020939596.
46.
Jabeen Z, Rani A, Ahmed S, Ghaffar S, Kazmi TH, Wasimud D. Psychological impact of COVID-19 pandemic on health care workers: a cross sectional study. Biomedica. 2020;36:209–13.CrossRef
47.
Mehdi M, Waseem M, Rehm MH, Aziz N, Anjum S, Javid MA. Depression and anxiety in health care workers during COVID-19. Biomedica. 2020;36(S2):233–8.
48.
Hassannia L, Taghizadeh F, Moosazadeh M, Zarghami M, Taghizadeh H, Fathi Dooki A, et al. Anxiety and Depression in Health Workers and General Population During COVID-19 Epidemic in IRAN: A Web-Based Cross-Sectional Study. MedRxiv [Pre-print]. 2020:2020.05.05.20089292.
49.
Naser AY, Dahmash EZ, Al-Rousan R, Alwafi H, Alrawashdeh HM, Ghoul I, et al. Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: A cross-sectional study. MedRxiv. 2020;1:e01730.
50.
Vahedian-Azimi A, Moayed MS, Rahimibashar F, Shojaei S, Ashtari S, Pourhoseingholi MA. Compare the severity of psychological distress among four groups of Iranian society in COVID-19 pandemic. Research Square [Pre-print]. 2020.
51.
Kamimura A, Chen J, Nourian MM, Stoddard M, Sarray A. Stress, Depression and Job Satisfaction among Physicians in Iraq. Diversity Equality Health Care. 2018;15(2):71–6.CrossRef
52.
Al Ghailani B, Al Nuaimi MA, Al Mazrouei A, Al Shehhi E, Al Fahim M, Darwish E. Well-being of residents in training programs of Abu Dhabi health services Ibnosina. J Med Biomed Sci. 2018;10(3):77–82.
53.
Ibrahim AY, Chamsi Basha A, Saquib J, Zaghloul MS, Al-Mazrou A, Saquib N. Sleep duration is associated with depressive symptoms among expatriate nurses. J Affect Disord. 2019;257:658–61.PubMedCrossRef
54.
Tajvar A, Saraji GN, Ghanbarnejad A, Omidi L, Hosseini SS, Abadi AS. Occupational stress and mental health among nurses in a medical intensive care unit of a general hospital in Bandar Abbas in 2013. Electron Physician. 2015;7(3):1108–13.PubMedPubMedCentral
55.
Albajjar MA, Bakarman MA. Prevalence and correlates of depression among male medical students and interns in Albaha University, Saudi Arabia. J Family Med Prim Care. 2019;8(6):1889–94.PubMedPubMedCentralCrossRef
56.
Khalid S, Irfan U, Sheikh S, Faisal M. Frequency of stress and depression in female nurses working in a teaching hospital. Kust Med J. 2010;2(1):10–4.
57.
Kashani P, Mirbaha S, Forouzanfar MM, Meschi F, Baratloo A. The Prevalence of Personality Disorders among Emergency Nurses Based on MMPI-2 Questionnaire; a Cross-sectional Study. Emerg (Tehran). 2017;5(1):e17.PubMedPubMedCentral
58.
Habibi R. The relationship between job stress and depression among nurses in Shahid Rajaie Hospitals and social security of Qazvin city in 2012. Edrak. 2014;9(35):45–50.
59.
Almutairi I, Al-Rashdi M, Almutairi A. Prevalence and predictors of depression, anxiety and stress symptoms in paramedics at Saudi Red Crescent Authority. Saudi J Med Med Sci. 2020;8(2):105.PubMedPubMedCentral
60.
Nooli AEA, Asiri AAA, Asiri ANA, Alqarni MAH, Alhilali FMS, Alayafi MAM, et al. Prevalence of depression among medical interns in King Khalid University. Int J Med Res Prof. 2017;3(6):131–3.
61.
El-Hamrawy L, Hegazy N, El-Halawany S. Prevalence of depressive symptoms among healthcare providers in Shibin El-Kom city in Menoufia governorate. Menoufia Med J. 2018;31(2):708–15.
62.
Ross CA, Goldner EM. Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature. J Psychiatr Ment Health Nurs. 2009;16(6):558–67.PubMedCrossRef
63.
Pocock L. Mental health issues in the Middle East: an overview. Middle East Journal of Psychiatry and Alzheimers. 2017;8(1):1–6.CrossRef
64.
Sewilam AM, Watson AMM, Kassem AM, Clifton S, McDonald MC, Lipski R, et al. Suggested avenues to reduce the stigma of mental illness in the Middle East. Int J Soc Psychiatry. 2014;61(2):111–20.PubMedPubMedCentralCrossRef
65.
Blue B. National mental health survey of doctors and medical students. . Beyond Blue: the national depression initiative. 2013.
66.
Elliot L, Tan J, Norris S. The mental health of doctors: a systematic literature review. Beyond Blue: The National Depression Initiative; 2010.
67.
Khan A, Teoh KRH, Islam S, Hassard J. Psychosocial work characteristics, burnout, psychological morbidity symptoms and early retirement intentions: a cross-sectional study of NHS consultants in the UK. BMJ Open. 2018;8(7):e018720.PubMedPubMedCentralCrossRef
68.
Berman R, Campbell M, Makin W, Todd C. Occupational stress in palliative medicine, medical oncology and clinical oncology specialist registrars. Clin Med (Lond). 2007;7(3):235–42.CrossRef
69.
Sakib N, Akter T, Zohra F, Bhuiyan AKMI, Mamun MA, Griffiths MD. Fear of COVID-19 and Depression: A Comparative Study Among the General Population and Healthcare Professionals During COVID-19 Pandemic Crisis in Bangladesh. International Journal of Mental Health and Addiction. 2021.
70.
Tee ML, Tee CA, Anlacan JP, Aligam KJG, Reyes PWC, Kuruchittham V, et al. Psychological impact of COVID-19 pandemic in the Philippines. J Affect Disord. 2020;277:379–91.PubMedPubMedCentralCrossRef
71.
Dave S, Parikh M, Vankar G, Valipay S. Depression, anxiety, and stress among resident doctors of a teaching hospital. Indian J Soc Psychiatry. 2018;34(2):163–71.
72.
Raza A, Zainab H. Depression among doctors of selected public and private tertiary care hospitals in district Peshawar. J Rehman Med Inst. 2017;3(12):1–8.
73.
Fawcett L. States and sovereignty in the Middle East: myths and realities. Int Aff. 2017;93(4):789–807.CrossRef
74.
Preti E, Di Mattei V, Perego G, Ferrari F, Mazzetti M, Taranto P, et al. The psychological impact of epidemic and pandemic outbreaks on healthcare workers: rapid review of the evidence. Curr Psychiatry Rep. 2020;22(8):43.PubMedPubMedCentralCrossRef
75.
Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214–36.PubMedPubMedCentralCrossRef
76.
Levy AB, Nahhas RW, Sampang S, Jacobs K, Weston C, Cerny-Suelzer C, et al. Characteristics associated with depression and suicidal thoughts among medical residents: results from the DEPRESS-Ohio Study. Acad Psychiatry. 2019;43(5):480–7.PubMedCrossRef
77.
Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488–91.PubMedPubMedCentralCrossRef
78.
Stehman CR, Testo Z, Gershaw RS, Kellogg AR. Burnout, drop out, suicide: physician loss in emergency medicine. Part I West J Emerg Med. 2019;20(3):485–94.PubMedCrossRef
79.
Lim R, Aarsen KV, Gray S, Rang L, Fitzpatrick J, Fischer L. Emergency medicine physician burnout and wellness in Canada before COVID19: a national survey. CJEM. 2020;22(5):603–7.PubMedCrossRef
80.
Outhoff K. Depression in doctors: a bitter pill to swallow. S Afr Fam Pract. 2019;61(sup1):S11–4.CrossRef
81.
Bailey E, Robinson J, McGorry P. Depression and suicide among medical practitioners in Australia. Intern Med J. 2018;48(3):254–8.PubMedCrossRef
82.
Cleary M, Kornhaber R, Thapa DK, West S, Visentin D. The effectiveness of interventions to improve resilience among health professionals: a systematic review. Nurse Educ Today. 2018;71:247–63.PubMedCrossRef
83.
Guille C, Speller H, Laff R, Epperson CN, Sen S. Utilization and barriers to mental health services among depressed medical interns: a prospective multisite study. J Grad Med Educ. 2010;2(2):210–4.PubMedPubMedCentralCrossRef
84.
Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2015;4:CD002892.
85.
Ito M, Seo E, Ogawa R, Sanuki M, Maeno T, Maeno T. Can we predict future depression in residents before the start of clinical training? Med Educ. 2015;49(2):215–23.PubMedCrossRef
Metadata
Title
Depression among healthcare workers in the Eastern Mediterranean Region: a systematic review and meta-analysis
Authors
Amit Abraham
Karima Chaabna
Sathyanarayanan Doraiswamy
Sapna Bhagat
Javaid Sheikh
Ravinder Mamtani
Sohaila Cheema
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Human Resources for Health / Issue 1/2021
Electronic ISSN: 1478-4491
DOI
https://doi.org/10.1186/s12960-021-00628-6

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