Risk factors associated with mental health symptoms among health care workers during the COVID-19 pandemic in EMRO countries: a systematic review

During the COVID-19 pandemic, healthcare workers (HCWs) have been psychologically impacted by SARS-CoV-2. The pandemic presented substantial challenges to healthcare systems globally. Given the limited data available from EMRO countries, our systematic review aimed to specifically examine risk factors correlated with mental health symptoms among HCWs within this region. We investigated PubMed, Scopus, and Embase databases from January 2020 to August 2024. Relevant research articles that examined risk factors correlated with mental health symptoms among HCWs during the COVID-19 pandemic in the EMRO region were included. We identified 21,126 studies in total. After eliminating 9,554 duplicates, 11,572 studies were screened. Records were excluded if they were from outside EMRO countries (n = 11,220), unrelated to HCWs (n = 12), lacked full-text access (n = 2), or had only abstracts available (n = 16). Following this, 322 reports were evaluated for eligibility, and 89 studies were ultimately included in the review. This study followed the guidelines set by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. This study was not preregistered in any protocol registry. The included investigations were conducted in Bahrain, Emirates, Iran, Iraq, Jordan, Lebanon, Morocco, Oman, Pakistan, Palestine, Kuwait, Egypt, Qatar, Saudi Arabia, Sudan, Tunisia, and Yemen. We reviewed 89 studies which included 62,454 HCWs. Nurses and physicians constituting the majority of the participants. In these investigations, the most frequent mental health symptoms were anxiety (range: 3.4–89.7%), depression (range: 12.4–98%), insomnia (range: 24.5–68.8%), and stress (range: 5.2–95.7%). However, factors such as being female, younger age, fears of transmitting the virus to others, work-related sleep disturbances, and insufficient protective equipment could be associated with these mental health symptoms. The COVID-19 pandemic has been associated with a significant mental health burden among HCWs in EMRO countries, as highlighted by the predominance of cross-sectional studies reviewed. These studies indicate a high prevalence of mental health problems, including anxiety, depression, and insomnia. Additionally, risk factors such as female sex and younger ages have been identified as being associated with more frequent or severe mental health symptoms. While the findings suggest significant mental health impacts, it is important to recognize that most of the studies are cross-sectional, providing only snapshots of the data. Consequently, future research should aim to explore long-term trends and causal relationships. The identified risk factors can guide policymakers in prioritizing mental health support for HCWs in the EMRO region.