The Effect of the COVID-19 Pandemic on Health Care Workers’ Anxiety Levels: A Meta-Analysis (Preprint)

Abstract

The COVID-19 pandemic has been declared a public health emergency of international concern; this has caused excessive anxiety among health care workers. In addition, publication bias and low-quality publications have become widespread, which can result in the dissemination of unreliable findings. 

This paper presents the protocol for a meta-analysis with the following two aims: (1) to examine the prevalence of anxiety among health care workers and determine whether it has increased due to the COVID-19 pandemic, and (2) to investigate whether there has been an increase in publication bias. 

All related studies that were published/released from 2015 to 2020 will be searched in electronic databases (Web of Science, PubMed, PsyArXiv, and medRxiv). The risk of bias in individual studies will be assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. The heterogeneity of the studies will be assessed using the I2 statistic. The effect size (prevalence rates of anxiety) and a 95% CI for each paper will also be calculated. We will use a moderator analysis to test for the effect of COVID-19 on health care workers’ anxiety levels and detect publication bias in COVID-19 studies. We will also assess publication bias using the funnel plot and Egger regression. In case of publication bias, if studies have no homogeneity, the trim-and-fill procedure will be applied to adjust for missing studies.

The pooled meta-analysis prevalence was 35.3% (95% CI: 32.2%−38.4%). The moderator analysis revealed no significant difference between articles related to COVID-19 and those unrelated to COVID-19 (p = 0.831). Moreover, no significant difference was found between articles related to COVID-19 and preprints (p = 0.981). Significant heterogeneity was found in each subgroup. Egger’s tests revealed publication bias in articles related to COVID-19 and preprints (p < 0.001). 

Our study found no significant differences in the effect sizes (prevalence of anxiety) between studies related and those unrelated to COVID-19. Concluding whether the anxiety state of health care workers is altered by the COVID-19 pandemic currently is difficult. However, we have strong evidence that their anxiety levels are always high, although this could also be a false positive caused by a large publication bias. Moreover, without comparing the results with those of non-healthcare workers, we cannot be sure that their anxiety is particularly high. The present study highlights the need to generalize valid and reliable measurements to more accurately examine health care workers’ anxiety in the future. Furthermore, we found a large publication bias in studies; however, the quality of the studies is relatively stable and reliable.

RR2-10.2196/24136