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Review
. 2025 May 19;11(3):e110.
doi: 10.1192/bjo.2025.51.

Secondary stressors and their psychosocial impacts on healthcare staff: lessons from a qualitative systematic review from the COVID-19 pandemic in the UK

Evangelos Ntontis  1 , Richard Williams  2 , Katarzyna Luzynska  1 , Abigail Wright  3 , Anastasia Rousaki  4
Affiliations
Review

Secondary stressors and their psychosocial impacts on healthcare staff: lessons from a qualitative systematic review from the COVID-19 pandemic in the UK

Evangelos Ntontis et al. BJPsych Open. .

Abstract

Background: Extreme events (e.g. floods and disease outbreaks) can overwhelm healthcare workers (HCWs) and healthcare systems. During the COVID-19 pandemic, high levels of distress and mental ill health were reported by HCWs.

Aims: To examine and synthesise research findings reported in the qualitative literature regarding the stressors, and their psychosocial impacts, faced by HCWs in the UK during the COVID-19 pandemic, and to provide lessons for future support.

Method: Qualitative articles were identified in EMBASE and OVID (preregistered on PROSPERO: CRD42022304235). Studies were required to have been published between January 2021 and January 2022 and to have examined the impact of COVID-19 on UK HCWs. We included 27 articles that represented the experiences of 2640 HCWs, assessed their quality using National Institute for Health and Care Excellence criteria and integrated their findings using thematic synthesis.

Results: Several secondary stressors were identified, including lack of personal protective equipment, ineffective leadership and communication, high workloads and problems stemming from uncertainty and a lack of knowledge. Stressors were related to adverse psychosocial outcomes including worry, fatigue, lack of confidence in oneself and senior managers, impacts on teamwork and feeling unappreciated or that one's needs are not recognised.

Conclusions: Our thematic synthesis moves beyond simply mapping stressors faced by HCWs by considering their antecedents, origins and psychosocial impacts. Utilising a theoretical framework that points towards systemic deficiencies, we argue that secondary stressors can be modified to remove their negative effects. Consequently, workforce planning should shift from focusing on individual change towards amending psychosocial environments in which HCWs work.

Keywords: COVID-19; extreme events; healthcare; secondary stressors; stress.

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Conflict of interest statement

R.W. is a Deputy Editor of BJPsych Open. He played no part in the journal’s review and editorial processes for this paper. A.W. is employed by the Institute for Clinical and Economic Review (ICER), but completed this work independently of ICER. E.N., K.L. and A.R. have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of search and selection process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
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