What is the best way to support resilience and mental well‐being in frontline healthcare professionals during and after a pandemic?

What is ‘resilience’?

Working as a ‘frontline’ health or social care professional during a global disease pandemic, like COVID‐19, can be very stressful. Over time, the negative effects of stress can lead to mental health problems such as depression and anxiety, which, in turn, may affect work, family and other social relationships. ‘Resilience’ is the ability to cope with the negative effects of stress and so avoid mental health problems and their wider effects.

Healthcare providers can use various strategies (interventions) to support resilience and mental well‐being in their frontline healthcare professionals. These could include work‐based interventions, such as changing routines or improving equipment; or psychological support interventions, such as counselling.

What did we want to find out?

First (objective 1), we wanted to know how successfully any interventions improved frontline health professionals’ resilience or mental well‐being.

Second (objective 2), we wanted to know what made it easier (facilitators) or harder (barriers) to deliver these interventions.

What did we do?

We searched medical databases for any kind of study that investigated interventions designed to support resilience and mental well‐being in healthcare professionals working at the front line during infectious disease outbreaks. The disease outbreaks had to be classified by the World Health Organization (WHO) as epidemics or pandemics, and take place from 2002 onwards (the year before the severe acute respiratory syndrome (SARS) outbreak).

What did we find?

We found 16 relevant studies. These studies came from different disease outbreaks ‐ two were from SARS; nine from Ebola; one from Middle East respiratory syndrome (MERS); and four from COVID‐19. The studies mainly looked at workplace interventions that involved either psychological support (for example, counselling or seeing a psychologist) or work‐based interventions (for example, giving training, or changing routines).

Objective 1: one study investigated how well an intervention worked. This study was carried out immediately after the Ebola outbreak, and investigated whether staff who were training to give other people (such as patients and their family members) ‘psychological first aid’ felt less ‘burnt out’. We had some concerns about the results that this study reported and about some of its methods. This means that our certainty of the evidence is very low and we cannot say whether the intervention helped or not.

Objective 2: all 16 studies provided some evidence about barriers and facilitators to implement interventions. We found 17 main findings from these studies. We do not have high confidence in any of the findings; we had moderate confidence in six findings and low to very low confidence in 11 findings.

We are moderately confident that the following two factors were barriers to implementation of an intervention: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well‐being; and a lack of equipment, staff time or skills needed for an intervention.

We are moderately confident that the following three factors were facilitators to implementation of an intervention: interventions that could be adapted for a local area; having effective communication, both formally within an organisation and informal or social networks; and having positive, safe and supportive learning environments for frontline healthcare professionals.

We are moderately confident that the knowledge and beliefs that frontline healthcare professionals have about an intervention can either help or hinder implementation of the intervention.

Key messages

We did not find any evidence that tells us about how well different strategies work at supporting the resilience and mental well‐being of frontline workers. We found some limited evidence about things that might help successful delivery of interventions. Properly planned research studies to find out the best ways to support the resilience and mental well‐being of health and social care workers are urgently required.

How up‐to‐date is this review?

This review includes studies published up to 28 May 2020…more