Prevalence of anxiety among health professionals in times of COVID-19: a systematic review with meta-analysis

Silva, David Franciole Oliveira; Cobucci, Ricardo Ney; Soares-Rachetti, Vanessa de Paula; Lima, Severina Carla Vieira Cunha; Andrade, Fábia Barbosa de

doi:10.1590/1413-81232021262.38732020

David Franciole Oliveira Silva

Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte (UFRN). Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil. davfranci@hotmail.com

http://orcid.org/0000-0003-0940-1356

Ricardo Ney Cobucci

Programa de Pós-Graduação em Biotecnologia, Curso de Medicina, Universidade Potiguar (UnP). Natal RN Brasil.

http://orcid.org/0000-0002-0184-2061

Vanessa de Paula Soares-Rachetti

Departamento de Biofísica e Farmacologia, Centro de Biociências, UFRN. Natal RN Brasil.

http://orcid.org/0000-0002-9551-8771

Severina Carla Vieira Cunha Lima

Programa de Pós-Graduação em Nutrição, UFRN. Natal RN Brasil.

http://orcid.org/0000-0001-8268-1986

Fábia Barbosa de Andrade

Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte (UFRN). Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil. davfranci@hotmail.com

http://orcid.org/0000-0002-7055-8726

Colaboradores

Concepção, planejamento, coleta, análise, interpretação dos dados e redação do trabalho: DFO Silva, RN Cobucci e FB Andrade. Interpretação dos resultados e redação ou revisão do manuscrito: VP Soares-Rachetti e SCVC Lima. Todos os autores aprovaram a versão final encaminhada.

Editores chefes:

Romeu Gomes, Antônio Augusto Moura da Silva

Base de dados e filtros aplicados

Estratégia de busca

Base de dados: PubMed. Busca realizada em 11 de julho de 2020. Filtro utilizado - Período de publicação: 2019-2020.

Base de dados: Embase. Busca realizada em 11 de julho de 2020. Filtro utilizado - Período de publicação: 2019-2020.

Base de dados: LILACS. Busca realizada em 11 de julho de 2020. Filtro utilizado: Nenhum.

(Anxiety OR Hypervigilance OR Nervousness OR “Social Anxiety” OR “Anxieties, Social” OR “Anxiety, Social” OR “Social Anxieties” OR “Anxiety Disorders” OR “Anxiety Disorder” OR “Disorder, Anxiety” OR “Disorders, Anxiety” OR “Neuroses, Anxiety” OR “Anxiety Neuroses” OR “Anxiety States, Neurotic” OR “Anxiety State, Neurotic” OR “Neurotic Anxiety State” OR “Neurotic Anxiety States” OR “State, Neurotic Anxiety” OR “States, Neurotic Anxiety” OR “mental health”) AND (“COVID-19” OR “SARS-CoV-2” OR “Coronavirus Infection” OR “coronavirus disease 2019 virus” OR “severe acute respiratory syndrome coronavirus 2” OR “2019-nCoV” OR “2019 novel coronavirus” OR “SARS2” OR “2019 novel coronavirus infection” OR “2019-nCoV disease” OR “COVID19” OR “coronavirus disease 2019” OR “coronavirus disease-19” OR “2019 novel coronavirus disease” OR “2019-nCoV infection”) AND (“medical staff” OR “Staff, Medical” OR “Staffs, Medical” OR “Medical Staffs” OR “Medical Staff, Hospital” OR “Hospital Medical Staff” OR “Hospital Medical Staffs” OR “Staff, Hospital Medical” OR “Staffs, Hospital Medical” OR “Medical Staffs, Hospital” OR “Physicians, Junior” OR “Junior Physician” OR “Junior Physicians” OR “Physician, Junior” OR “Registrars, Hospital” OR “Hospital Registrar” OR “Hospital Registrars” OR “Registrar, Hospital” OR “Attending Physicians, Hospital” OR “Hospital Attending Physician” OR “Hospital Attending Physicians” OR “Attending Physician, Hospital” OR “Health Personnel” OR “Personnel, Health” OR “Health Care Providers” OR “Health Care Provider” OR “Provider, Health Care” OR “Providers, Health Care” OR “Healthcare Providers” OR “Healthcare Provider” OR “Provider, Healthcare” OR “Providers, Healthcare” OR “Healthcare Workers” OR “Healthcare Worker” OR “Health care Workers” OR “Health care Worker” OR “medical workers” OR “medical worker” OR “Healthcare professionals” OR “Health care professionals” OR “Health care professional” OR “Nursing Staff” OR “Staff, Nursing” OR “Staffs, Nursing” OR “Nursing Staffs” OR “Nursing Staff, Hospital” OR “Hospital Nursing Staff” OR “Staff, Hospital Nursing” OR “Staffs, Hospital Nursing” OR “Hospital Nursing Staffs” OR “Nursing Staffs, Hospital” OR “medical teams”)

Estudo	Escore NOS	País	N (SF%)	Idade (anos)	Critério diagnóstico	Prevalência de ansiedade
Apisarnthanarak et al.³⁰30 Apisarnthanarak A, Apisarnthanarak P, Siripraparat C, Saengaram P, Leeprechanon N, Weber DJ. Impact of Anxiety and Fear for COVID-19 Toward Infection Control Practices Among Thai Healthcare Workers. Infect Control Hosp Epidemiol 2020; 41(9):1093-1094. (2020).	4	Tailândia	160 (59,0)	32 (23-62).	GAD-7 (Min: 0-4; L:5-9; M:10-14: G>14.	T: 68 (42,5%)/ L: 37 (23,1%)/ M: 23 (14,4%)/ G: 8 (5%).
Badahdah et al.³¹31 Badahdah A, Khamis F, Al Mahyijari N, Al Balushi M, Al Hatmi H, Al Salmi I, Albulushi Z, Al Noomani J. The mental health of health care workers in Oman during the COVID-19 pandemic. Int J Soc Psychiatry 2020; 20764020939596. (2020).	3	Omã	509 (80,3)	37.67±7.68.	GAD-7 (Min: 0-4, L: 5-9; M: 10-14; G:15-21).	T: 64,7%/ L: 38,7%/ M: 17,7%/ G: 8,3%.
Chatterjee et al.³²32 Chatterjee SS, Bhattacharyya R, Bhattacharyya S, Gupta S, Das S, Banerjee BB. Attitude, practice, behavior, and mental health impact of COVID-19 on doctors. Indian J Psychiatry 2020; 62(3):257. (2020).	3	Índia	152 (21,7)	42.05±12.19.	DASS-21 (NI).	T: 60 (39,5%)/ L: 11 (7,2%)/ M: 27 (17,8%); G: 10 (6,6%)/ EG: 11 (7,2%).
Chen et al.³³33 Chen Y, Zhou H, Zhou Y, Zhou F. Prevalence of self-reported depression and anxiety among pediatric medical staff members during the COVID-19 outbreak in Guiyang, China. Psychiatry Res 2020; 288:113005. (2020).	3	China	105 (90,5)	32.6±6.5.	SAS (L:50-59; M: 60-69; G ≥70).	T: 19 (18,1%)/ L: 11 (10,5%) M: 6 (5,7%)/ G: 2 (1,9%).
Chew et al³⁴34 Chew QH, Chia FL, Ng WK, Lee WC, Tan PL, Wong CS, Puah SH, Shelat VG, Seah EJ, Huey CW, Phua EJ. Psychological and coping responses to COVID-19 amongst residents in training across ACGME-I accredited specialties in Singapore. Psychiatry Res 2020; 290:113146. (2020).	5	Singapura e Índia	906 (64,3)	29 (25-35).	DASS-21 (>7, L: 8-9; M: 10-14; G: 15-19; EG: 20-42).	T: 142 (15,7%)/ L: 63 (7,0%)/ M: 61 (6,7%)/ G: 9 (1,0%). EG: 9 (1,0%).
Civantos et al.³⁵35 Civantos AM, Byrnes Y, Chang C, Prasad A, Chorath K, Poonia SK, Jenks CM, Bur AM, Thakkar P, Graboyes EM, Seth R. Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: National study. Head Neck 2020; 42(7):1597-1609. (2020).	4	Estados Unidos	349 (39,3)	26-30: 26,9%; 31-35: 32,7%; 36-40: 12,6%; >40: 27,8%.	GAD-7 (N:0-4; L: 5-9; M: 10-14; G: 15-21).	T: 167 (47,9%)/ L: 101 (28,9%)/ M: 40 (11,5%)/ G: 26 (7,4%).
Consolo et al.³⁶36 Consolo U, Bellini P, Bencivenni D, Iani C, Checchi V. Epidemiological Aspects and Psychological Reactions to COVID-19 of Dental Practitioners in the Northern Italy Districts of Modena and Reggio Emilia. Int J Environ Res Public Health 2020; 17(10):3459. (2020).	4	Itália	356 (39,6)	<35: 16,6%; 35-55: 48,6%; >55: 34,8%.	GAD-7 (Min:0-4; L:5-9; M: 10-14; G: 15-21).	T: 57,2% / L: 33,3%/ M: 15,2%/ G: 8,7%.
Corbett et al.³⁷37 Corbett GA, Milne SJ, Mohan S, Reagu S, Farrell T, Lindow SW, Hehir MP, O'Connell MP. Anxiety and Depression Scores in Maternity Healthcare Workers during the Covid-19 Pandemic. Int J Gynaecol Obstet 2020; 151(2):297-298. (2020).	2	Irlanda	240 (NI para todos)	18-25: 9; 25-40: 110; 40-50: 64; 50-60: 50; >60: 7.	GAD-7 (NI).	T (M e G): 21,0%.
Dal’Bosco et al.³⁸38 Dal'Bosco EB, Floriano LSM, Skupien SV, Arcaro G, Martins AR, Anselmo ACC. Mental health of nursing in coping with COVID-19 at a regional university hospital. Rev Bras Enferm 2020; 73(Supl. 2):e20200434. (2020).	4	Brasil	88 (89,8)	21-30: 42,0%; 31-40: 36,4%; >40: 21,6%.	HAD (>8).	T: 43 (48,9%).
Du et al.³⁹39 Du J, Dong L, Wang T, Yuan C, Fu R, Zhang L, Liu B, Zhang M, Yin Y, Qin J, Bouey J. Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan. Gen Hosp Psychiatry 2020; 67:144-145. (2020).	2	China	134 (60,5)	≥35: 68; 18-34: 66.	BAI (≥8).	T: 28 (20,9%).
Elbay et al.⁴⁰40 Elbay RY, Kurtulmus A, Arpacioglu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Res 2020; 290:113130. (2020).	3	Turquia	442 (56,8),	36.05±8.69.	DASS-21 (NI).	T: 224 (51,6%)/ L: 16,3%/ M: 13,1%/ G: 10,6%/ EG: 11,5%.
Gupta et al.⁴¹41 Gupta AK, Mehra A, Niraula A, Kafle K, Deo SP, Singh B, Sahoo S, Grover S. Prevalence of anxiety and depression among the healthcare workers in Nepal during the COVID-19 pandemic. Asian J Psychiatr 2020; 54:102260. (2020).	4	Nepal	150 (42,7),	29.5±6.1.	GAD-7 (N:0-4; L:5-9; M: 10-14; M-G:15-19 e G≥15).	T: 56 (37,3%)/ L: 41 (27,3%), M: 12 (8,0%)/ M-G: 2 (1,3%)/ G: 1 (0,7%).
Hu et al.⁴²42 Hu D, Kong Y, Li W, Han Q, Zhang X, Zhu LX, Wan SW, Zuofeng LI, Qu SH, Jingqiu YA, Hong-Gu HE. Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine 2020; 24:100424. (2020).	4	China	2,014 (87,1)	30.99±6.17.	SAS (L: 50-59; M: 60-69; G: 70).	T: 41,4%/ L: 545 (27,1%)/ M: 221 (11,0%)/ G: 67 (3,3%).
Huang et al.⁴³43 Huang JZ, Han MF, Luo TD, Ren AK, Zhou XP. Mental health survey of medical staff in a tertiary infectious disease hospital for COVID-19. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2020; 38(3):192-195. (2020).	4	China	230 (81,3)	20 a 59.	SAS (≥50).	T: 53 (23,04%)/ L: 37 (16,09%)/ M: 11 (4,78%)/ G: 5 (2,17%).
Lai et al.⁴⁴44 Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, Wu J, Du H, Chen T, Li R, Tan H. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020; 3(3):e203976. (2020).	5	China	1257 (76,7)	18->40.	GAD-7 (≥5).	T: 560 (44,6%)/ L: 406 (32,3%)/ M: 88 (7,0%)/ G: 66 (5,3%)
Lin et al.⁴⁵45 Lin K, Yang BX, Luo D, Liu Q, Ma S, Huang R, Lu W, Majeed A, Lee Y, Lui LM, Mansur RB. The mental health effects of COVID-19 on health care providers in China. Am J Psychiatry 2020; 177(7):635-636. (2020).	4	China	2,316 (NI)	NI.	GAD-7 (≥5).	T: 952 (41,1%).
Liu et al.⁴⁶46 Liu CY, Yang YZ, Zhang XM, Xu X, Dou QL, Zhang WW, Cheng AS. The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect 2020; 148:e98. (2020).	5	China	512 (84,57)	18 a 39.	SAS (≥50).	T: 64 (12,5%)/ L: 53 (10,35%)/ M: 7 (1,36%)/ G: 4 (0,78%).
Lu et al.⁴⁷47 Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Res 2020; 288:112936. (2020).	5	China	2,299 (77,6)	<30 a >50.	HAMA (L e M: 7-13; G: ≥14).	T: 569 (24,8%)/ G: 63 (2,7%)
Moghadasi et al.⁴⁸48 Moghadasi AN. Evaluation of the Level of Anxiety among Iranian Multiple Sclerosis Fellowships During the Outbreak of COVID-19. Arch Iran Med 2020; 23(4):283. (2020).	3	Irã	14 (50)	40.58±4.44.	BAI (NI).	T: 2 (14,3%)
Naser et al.⁴⁹49 Naser AY, Dahmash EZ, Al-Rousan R, Alwafi H, Alrawashdeh HM, Ghoul I, Abidine A, Bokhary MA, Al-Hadithi HT, Ali D, Abuthawabeh R, Abdelwahab GM, Alhartani YJ, Al Muhaisen H, Dagash A, Alyami HS. Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: A cross-sectional study. Brain Behav 2020; 10(8):e01730. (2020).	4	Jordânia	1163 (56,1)	18 a >50.	GAD-7 (≥5).	T: 823 (70,8%)/ L: 442 (38,0%)/ M: 250 (21,5%)/ G: 131 (11,3%).
Que et al.⁵⁰50 Que J, Le Shi JD, Liu J, Zhang L, Wu S, Gong Y, Huang W, Yuan K, Yan W, Sun Y, Ran M. Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China. Gen Psychiatry 2020; 33(3):e100259. (2020).	5	China	2285 (69,1)	31.06±6.9.	GAD-7 (L:5-9; M:10-14; G≥15).	T: 46,0%/ L: 787 (34,44%)/ M-G: 265 (11,60%).
Rossi et al.⁵¹51 Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, Rossi A. Mental Health Outcomes Among Frontline and Second-Line Health Care Workers During the Coronavirus Disease 2019 (COVID-19) Pandemic in Italy. JAMA Net Open 2020; 3(5):e2010185. (2020).	4	Itália	1379 (77,2)	39.0±16.0.	GAD-7 (G≥15).	T: 273 (19,8%).
Shechter et al.⁵²52 Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, Birk JL, Brodie D, Cannone DE, Chang B, Claassen J. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2020; 66:1-8. (2020).	3	Estados Unidos	657 (70,9)	18-24: 1,5%; 25-34:46,8%; 35-44:20,9%; 45-54:12,0%; 55-64: 8,9%; 65-74: 0,4%; ≥75: 0,3%); NI: 5 (0,7%).	GAD-2 (≥3).	T: 33,0%.
Tan et al.⁵³53 Tan BY, Chew NW, Lee GK, Jing M, Goh Y, Yeo LL, Zhang K, Chin HK, Ahmad A, Khan FA, Shanmugam GN, Chan BPL, Sunny S, Chandra B, Ong JJY, Paliwal PR, Wong LYH, Sagayanathan R, Chen JT, Ng AYY, Teoh HL, Ho CS, Ho RC, Sharma VK. Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Ann Intern Med 2020; 173(4):317-320. (2020).	4	Singapura	470 (68,3)	31 (28-36).	DASS-21 (>7).	T: 68 (14,5%).
Temsah et al.⁵⁴54 Temsah MH, Al-Sohime F, Alamro N, Al-Eyadhy A, Al-Hasan K, Jamal A, Al-Maglouth I, Aljamaan F, Al Amri M, Barry M, Al-Subaie S. The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country. J Infect Public Health 2020; 13(6):877-882. (2020).	5	Arábia Saudita	582 (75,1)	≤30: 30,6%; 31-39: 38,3%; 40-49: 22,9%; ≥50: 8,2%.	GAD-7 (L<5; M (ponto de corte):5-9; M alta: 10-14; muito alta: 10-14.	T: 185 (31,8%)/ M: (>5 com ansiedade): 121 (20,8%)/ M alta: 47 (8,1%)/ muito alta: 17 (2,9%).
Vanni et al.⁵⁵55 Vanni G, Materazzo M, Santori F, Pellicciaro M, Costesta M, Orsaria P, Cattadori F, Pistolese CA, Perretta T, Chiocchi M, Meucci R. The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric Survey. In Vivo 2020; 34(3 Supl.):1685-1694. (2020).	4	Itália	46 (65,2)	47 (40-54).	DASS-21 (N:0-7; L:8-9; M:10-14; G:15-19).	T: 18 (39,1%)/ L-M: 12 (26,1%)/ G-EG: 6 (13,0%).
Wang et al.⁵⁶56 Wang S, Xie L, Xu Y, Yu S, Yao B, Xiang D. Sleep disturbances among medical workers during the outbreak of COVID-2019. Occup Med (Lond) 2020; 70(5):364-369. (2020).	5	China	123 (90)	33.75±8.41.	SAS (≥50).	T: 9 (7%).
Xiao et al.⁵⁷57 Xiao X, Zhu X, Fu S, Hu Y, Li X, Xiao J. Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: A multi-center cross-sectional survey investigation. J Affect Disord 2020; 274:405-410. (2020).	5	China	958 (68,2)	NI.	HAD (≥8).	T: 518 (54,1%).
Yang et al.⁵⁸58 Yang S, Kwak SG, Ko EJ, Chang MC. The mental health burden of the covid-19 pandemic on physical therapists. Int J Environ Res Public Health 2020; 17(10):3723. (2020).	5	Coreia do Sul	65 (47,7)	20-29: 21; 30-39: 20: 40-49: 16; >50: 8.	GAD-7 (≥5).	T: 21 (32,3%).
Zandifar et al.⁵⁹59 Zandifar A, Badrfam R, Khonsari NM, Assareh M, Karim H, Azimzadeh M, Sepehr MN, Tajbakhsh R, Rahimi F, Ghanipour N, Agoushi A, Gelsefid SH, Etemadi F, Qorbani M. COVID-19 and medical staff's mental health in educational hospitals in Alborz Province, Iran. Psychiatry Clin Neurosci 2020; 74(9):499-501. (2020).	2	Irã	N: 894 (SF: 619; SM: 254)	>30: 293; 30-40: 364; >40: 205.	DASS-21 (NI).	T: 51,2%.
Zhang et al.⁶⁰60 Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, Du H, Li R, Kang L, Su M, Zhang J, Liu Z, Zhang B. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel coronavirus disease outbreak. Front Psychiatry 2020; 11:306. (2020).	4	China	1.563 (82,7)	18 a 60.	GAD-7 (≥5).	T: 699 (44,7%)/ L: 497 (31,8%)/ M: 119 (7,6%)/ G: 83 (5,3%).
Zhang et al.⁶¹61 Zhang SX, Liu J, Jahanshahi AA, Nawaser K, Yousefi A, Li J, Sun S. At the height of the storm: Healthcare staff's health conditions and job satisfaction and their associated predictors during the epidemic peak of COVID-19. Brain Behav Immun 2020; 87:144-146. (2020).	2	Irã	304 (58,6)	35.1±9.1.	PHQ-4/GAD-2 (NI).	T: 28,0%.
Zhang et al.⁶²62 Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, Min BQ, Tian Q, Leng HX, Du JL, Chang H. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom 2020; 89(4):242-250. (2020).	4	China	2.182 (64,2)	<18 a >60.	GAD-2 (≥3)	T: 228 (10,4%)
Zhao e Huang⁶³63 Zhao N, Huang Y. Chinese mental health burden during COVID-19 outbreak: a web-based cross-sectional survey. Asian J Psychiatr 2020; 51:102052. (2020).	4	China	2.250 (NI)	NI	GAD-7 (≥9).	T: 802 (35,6%).
Zhu et al.⁶⁴64 Zhu Z, Xu S, Wang H, Liu Z, Wu J, Li G, Miao J, Zhang C, Yang Y, Sun W, Zhu S. COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. EClinicalMedicine 2020; 24:100443. (2020).	4	China	5.062 (85,0)	19 a 49	GAD-7 (≥8).	T: 1218 (24,1%).
Zhu et al.⁶⁵65 Zhu J, Sun L, Zhang L, Wang H, Fan A, Yang B, Li W, Xiao S. Prevalence and Influencing Factors of Anxiety and Depression Symptoms in the First-Line Medical Staff Fighting Against COVID-19 in Gansu. Front Psychiatry 2020; 11:386. (2020).	5	China	165 (83,0)	34.16±8.06.	SAS (≥50).	T: 33 (20,0%).

Instrumento	Critérios	Pontos de corte
7-item Generalized Anxiety Disorder (GAD-7) scale	Este instrumento apresenta sete itens relacionados a sintomas de ansiedade ocorridos nos últimos sete dias, com quatro opções de resposta: 0 - de modo algum, 1 - vários dias, 2 - mais da metade dos dias e 3 - quase todos os dias. Desse modo, a pontuação pode variar de 0 a 21.	Sem ansiedade: 0 a 4 pontos; ansiedade leve: 5 a 9, moderada: 10 a 14, e grave: (15 a 21).
Depression, anxiety and stress scales (DASS-21)	Este instrumento é um conjunto de três subescalas, cada uma com 7 itens, que avaliam depressão, ansiedade e estresse, conforme os sintomas referidos na última semana antes da avaliação. A escala é do tipo Likert, com quatro opções de resposta variando de 0 (Não se aplicou de maneira alguma) a 3 (aplicou-se muito, ou na maioria do tempo). Deste modo, a pontuação total é o somatório das respostas de cada item, multiplicado por 2	O ponto de corte é >7, sendo de 8-9 (leve), 10-14 (moderada), 15-19 (grave) e 20-42 (extremamente grave).
Zung Self-rating Anxiety Scale (SAS)	A SAS, que avalia a frequência de sintomas de ansiedade nos últimos dias, é composta por 20 itens com quatro opções de resposta: 1 - pouco ou um pouco do tempo; 2 - algumas vezes; 3 - boa parte do tempo; e, 4 - na maioria ou todo o tempo. Cinco itens do instrumento (5, 9, 13, 17 e 19) recebem pontuação invertida. Deste modo, a pontuação total varia de 20 a 80	<50 pontos - normal; 50 a 60 pontos - ansiedade leve, 61 a 70 pontos - ansiedade moderada; e, >70 pontos - ansiedade grave.
Generalized Anxiety Disorder 2-item (GAD-2)	Esse instrumento tem dois itens sobre a frequência dos sintomas de ansiedade nos últimos sete dias com quatro opções de resposta: 0 - de modo algum, 1 - vários dias, 2 - mais da metade dos dias e 3 - quase todos os dias. O escore total varia de 0 a 6.	Ansiedade: Escore ≥3.
Patient Health Questionnaire-4 (PHQ-4)	Este instrumento é composto pelas subescalas Patient Health Questionnaire-2 (PHQ-2), utilizada para o diagnóstico da depressão, e a GAD-2 para a ansiedade	Ansiedade: ≥3
Beck Anxiety Inventory (BAI)	O instrumento composto por 21 itens avalia sintomas de ansiedade na última semana e tem quatro opções de resposta variando de 0 (absolutamente não) a 3 (gravemente, dificilmente pude suportar). A pontuação total varia de 0 a 63.	Ansiedade: >8.
Hospital Anxiety and Depression Scale (HAD)	Cada uma das subescalas do instrumento (HAD-A para ansiedade e HAD-D para depressão) tem sete questões referentes aos sintomas dos últimos sete dias. Para cada pergunta pode ser atribuída pontuação de 0 a 3, com um máximo de até 21 pontos.	Ansiedade: escore >8.
Hamilton Anxiety Scale (HAMA)	Esta escala tem 14 itens, com cinco opções de resposta, variando de 0 (nunca) a 4 (muito grave).	Sem ansiedade: 0-6; Ansiedade: ≥7. Ansiedade grave ≥14.

Análises de subgrupos	Número de estudos	Prevalência geral (IC95%)	Teste estatístico (Valor de p)
Critério diagnóstico			Chi² = 283,47, df = 6 (P <0,0001)
GAD-7	16	41 (44-49)
GAD-2	3	24 (7-40)
SAS	6	21 (11-31)
DASS-21	6	35 (19-51)
HAMA	1	25 (23-27)
BAI	1	21 (14-28)
HAD	2	54 (51-57)
Continente			Chi² = 1,75, df = 2 (P = 0,42)
Ásia	26	34 (28-40)
Europa	4	34 (15-53)
América	3	43 (31-55)
Categoria profissional			Chi² = 1,01, df = 2 (P = 0,60)
Iniciante	4	30 (17-43)
Intermediário	4	39 (24-54)
Sênior	4	30 (21-39)
Qualidade metodológica			Chi² = 0,16, df = 1 (P = 0,69)
Boa qualidade	26	34 (28-40)
Baixa qualidade	9	37 (26-47)

[1] Colaboradores

Concepção, planejamento, coleta, análise, interpretação dos dados e redação do trabalho: DFO Silva, RN Cobucci e FB Andrade. Interpretação dos resultados e redação ou revisão do manuscrito: VP Soares-Rachetti e SCVC Lima. Todos os autores aprovaram a versão final encaminhada.

Brasil

Brasil

Prevalence of anxiety among health professionals in times of COVID-19: a systematic review with meta-analysis

Abstract