近日，澳大利亚昆士兰大学Dan Siskind团队，对新兴病毒暴发对医护人员心理影响的发生、预防和管理进行了快速回顾和荟萃分析。该研究于2020年5月5日发表在《英国医学杂志》上。
为了探讨应对新型病毒暴发对临床医生的心理影响，以及管理压力和心理困扰的成功措施，研究组在Pubmed、Scopus和科学引文索引等大型数据库中对截至2020年3月的相关研究进行检索，筛选出新兴病毒爆发时与患者一起奋战的医护人员的心理反应的研究，并进行快速回顾和荟萃分析。
共有59篇论文符合入选标准：37篇为严重急性呼吸道综合症（SARS），8篇为冠状病毒病2019（covid-19），7篇为中东呼吸综合症（MERS），3篇为埃博拉病毒病，3篇为甲型H1N1流感病毒病，1篇为甲型H7N9流感病毒病。
在38项比较医护人员与感染患者直接接触的心理结局的研究中，25项包含的数据可匹配为荟萃分析，用来比较高接触风险和低接触风险的医护人员。与低风险对照组相比，与感染患者接触的工作人员急性或创伤后应激水平（比值比为1.71）和心理困扰水平（比值比为1.74）更高，连续结果亦是如此。
这些发现与荟萃分析中未包括的其他研究相同。心理困扰的危险因素包括年纪轻、子女年幼或有受感染的家庭成员。更长的隔离时间、缺乏实际支持和污名化也是造成这种情况的原因。清晰的沟通、获得充分的个人保护、充分的休息以及实际和心理支持均可降低发病率。
总之，有效的干预措施可以帮助减轻医护工作人员在新兴疾病暴发中照顾病人时所承受的心理困扰。
附：英文原文
Title: Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis
Author: Steve Kisely, Nicola Warren, Laura McMahon, Christine Dalais, Irene Henry, Dan Siskind
Issue&Volume: 2020/05/05
Abstract: Objective To examine the psychological effects on clinicians of working to manage novel viral outbreaks, and successful measures to manage stress and psychological distress.
Design Rapid review and meta-analysis.
Data sources Cochrane Central Register of Controlled Trials, PubMed/Medline, PsycInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to late March 2020.
Eligibility criteria for study selection Any study that described the psychological reactions of healthcare staff working with patients in an outbreak of any emerging virus in any clinical setting, irrespective of any comparison with other clinicians or the general population.
Results 59 papers met the inclusion criteria: 37 were of severe acute respiratory syndrome (SARS), eight of coronavirus disease 2019 (covid-19), seven of Middle East respiratory syndrome (MERS), three each of Ebola virus disease and influenza A virus subtype H1N1, and one of influenza A virus subtype H7N9. Of the 38 studies that compared psychological outcomes of healthcare workers in direct contact with affected patients, 25 contained data that could be combined in a pairwise meta-analysis comparing healthcare workers at high and low risk of exposure. Compared with lower risk controls, staff in contact with affected patients had greater levels of both acute or post-traumatic stress (odds ratio 1.71, 95% confidence interval 1.28 to 2.29) and psychological distress (1.74, 1.50 to 2.03), with similar results for continuous outcomes. These findings were the same as in the other studies not included in the meta-analysis. Risk factors for psychological distress included being younger, being more junior, being the parents of dependent children, or having an infected family member. Longer quarantine, lack of practical support, and stigma also contributed. Clear communication, access to adequate personal protection, adequate rest, and both practical and psychological support were associated with reduced morbidity.
Conclusions Effective interventions are available to help mitigate the psychological distress experienced by staff caring for patients in an emerging disease outbreak. These interventions were similar despite the wide range of settings and types of outbreaks covered in this review, and thus could be applicable to the current covid-19 outbreak.
DOI: 10.1136/bmj.m1642
Source: https://www.bmj.com/content/369/bmj.m1642
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
