ABSTRACT
Importance: The COVID-19 pandemic’s effect on the prevalence of anxiety symptoms among healthcare workers remains unclear. Hence, an investigation into their prevalence and the changes before and during the pandemic is needed. Objective: To provide a comprehensive summary of the prevalence of anxiety symptoms among healthcare workers internationally and to compare this before and during the COVID-19 pandemic. Data Sources: A literature search was conducted using Medline, PubMed databases, and Embase for observational studies from their establishment in January 1963, January 1963, and January 1989, respectively, to August 2022. Study Selection: A standardized search strategy was applied to the databases with keywords assembled into three categories, including “healthcare workers”, “anxiety symptoms”, and “miscellaneous”. The inclusion criteria were: (I) evaluation of the prevalence of anxiety symptoms among healthcare workers employed in hospitals; (II) measured through validation tools or questionnaires; (III) published in English. The exclusion criteria were: (I) no overall prevalence of anxiety provided; (II) case series, case reports, intervention research, and commentaries. Data Extraction and Synthesis: The protocol was developed based on the PRISMA guidelines. The pooled prevalence and 95% confidence interval (CI) were estimated using a random effects model. Main Outcome(s) and Measure(s): The articles were analyzed according to subgroups divided based on the time of the studies conducted, participant occupations, locations, screening instruments, and publication years. Results: A total of 358 cross-sectional articles with 373 estimates from 65 countries were included. The overall prevalence of anxiety symptoms among healthcare workers was 41.4% (95% CI, 39.3-43.4). The prevalence of anxiety symptoms before and during the COVID-19 pandemic were 40.7% (95% CI: 34.1-47.3) and 41.2% (95% CI: 39.1-43.3), respectively. Compared with studies before the pandemic, a higher prevalence of anxiety symptoms was identified among nurses, residents, and physicians during the pandemic. Conclusions and Relevance: A considerable proportion of healthcare workers have experienced anxiety symptoms, with their global prevalence increasing during the COVID-19 pandemic. Further research is needed to determine effective prevention and treatment strategies, particularly during the COVID-19 pandemic. Systematic review registration: CRD42022370819.