Strategies for the Psychological Support of the Healthcare Workforce during the COVID-19 Pandemic: The ERNST Study
2. Materials and Methods
4.1. Strengths and Study Limitations
4.2. Implications for Policy, Practice, and Research
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
- Initiatives to improve working conditions:
- Economic reinforcements, such as payments and salary increases.
- Vacation facilities or regulated rest shifts.
- Training in the correct use of personal protective equipment.
- Specific cleaning protocols for the centers.
- Periodic testing of professionals for the early detection of infection.
- Interruption of professional and student training.
- Diagnostic tests for the family members of healthcare professionals.
- Other measures for the protection of patients and professionals in health centers (for example, triage and change of mask for everyone who enters the center).
- Hotels for healthcare professionals (or other accommodation options to avoid the risk of contagion to family members and loved ones).
- Modification of leave and vacation dates.
- Initiatives for psycho-emotional reinforcement and support:
- Support hotline for healthcare professionals.
- Peer support programs.
- Specific programs developed by the Occupational Risk Prevention Service/Mental Health Service/Employee Assistance.
- Measures to strengthen work morale.
- Social recognition.
- Web repositories of good practices to build resilience and protect the well-being of healthcare professionals.
- Use of scales or other resources for the self-assessment of stress levels.
- Emotional or psychological assistance to the families of healthcare professionals with COVID-19.
- Initiatives to strengthen staff, teams, and the organization:
- Increasing the supply of new jobs for healthcare professionals.
- Hiring of personnel reinforcements.
- Definition of “reserve” or “containment” teams of healthcare professionals to avoid massive contagion and guarantee the availability of minimum human resources.
- Suspension of leaves and vacations.
- Modification of leave and vacation dates.
- Protocols and clinical practice guidelines approved and established at the state level by the Ministry of Health and other national entities (shared action criteria among regions and health institutions in the country).
- Establishment of mechanisms to listen to the proposals of healthcare professionals (e.g., working groups with professional associations, trade unions, and scientific societies).
- Definition and establishment by the Occupational Health Department of clear instructions on how to act in case of close contact with people who are positive for COVID-19, hospitalization, and discharge of COVID-19 patients.
- Definition of the indicators for the contingency plans.
- Periodic evaluation of the effectiveness and usefulness of the measures and actions implemented.
- Availability of regular and updated information on the evolution of the pandemic at national, regional, and local levels to healthcare professionals (including data on infected and deceased healthcare professionals).
- Distance learning systems (e.g., healthcare professionals in home isolation who advise and train new personnel, training in the use of personal protective equipment, and new protocols and practices)
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|Sex (n, %)|
|Age (mean, [min–max])||47.0 [24–68]|
|Professional profile (n, %)|
|Nurse 1||5 (8.9%)|
|Physician 1||18 (32.1%)|
|Psychologist 1||2 (3.6%)|
|Other healthcare professionals||1 (1.8%)|
|Researchers on public health or related disciplines||13 (23.2%)|
|Professor in the health area||15 (26.8%)|
|Other legal, social, or technical profession||2 (3.6%)|
|Type of work organization (n, %)|
|Healthcare organization||21 (37.5%)|
|Higher education and associated organizations||27 (48.2%)|
| Government/intergovernmental organizations except|
higher education and healthcare organization
|Private non-profit without market revenues, NGO||2 (3.6%)|
|Country||Number of HCWs Infected with COVID-19||Number of HCWs who Died from COVID-19||Date of Data Obtainment||Data Source|
|Argentina 1||79,806||472||March 2021||Ministerio de Sanidad de Argentina|
|Azerbaijan 2||No data||45||July–August 2020||Erdem and Lucey |
|Belgium 3||No data||No data|
|Bosnia and Herzegovina 3||2019||8||April 2021||Provided by the collaborator|
|Brazil 1||48,234 nurses||556 nurses||February 2021||Provided by the collaborator|
|Bulgaria 3||12670||No data||April 2021||Provided by the collaborator|
|Chile 1||52,241||102||January 2021||Epidemiological report from the Ministry of Health |
|Colombia 1||3655||31||July–August 2020||Erdem and Lucey |
|Croatia 3||2551 physicians||2 physicians||February 2021||Croatian Medical Chamber |
|Czech Republic 3||1119||2||July–August 2020||Erdem and Lucey |
|Denmark 3||2380||15||March 2021||Statens Serum Institut |
|Ecuador 1||No data||No data|
|Estonia 3||No data||No data|
|Finland 3||2000||No data||January 2021||Provided by the collaborator|
|France 3||81,032||16||May 2021||French public health |
|Germany 3||104,387||148||March 2021||Provided by the collaborator|
|Ireland 3||16,381||9||April 2021||Provided by the collaborator|
|Israel 4||No data||No data|
|Italy 3||138,129||333||July 2021||Ministry of Health from Italy|
|Japan 1||No data||No data|
|Lithuania 3||No data||No data|
|Malta 3||No data||No data|
|Mexico 1||No data||No data|
|Netherlands 3||No data||No data|
|Peru 1||13,073 physicians a + 7780 nurses b||400 physicians a + 90 nurses b||a March 2021|
b January 2021
|Provided by the collaborator|
|Poland 3||91,949||187||February 2021||Provided by the collaborator|
|Portugal 3||3681||1||July–August 2020||Erdem and Lucey |
|Romania 3||20,504||94||Provided by the collaborator|
|Serbia 3||No data||No data|
|Slovakia 3||No data||40||September 2021||Institute of Health Analysis (Ministry of Health)|
|Spain 3||128,590 c||112 d||c February 2021|
d March 2021
|c Ministerio de Sanidad de España |
d Consejo General de Colegios Oficiales de Médicos 
|Sweden 3||No data||No data|
|Switzerland 3||No data||No data|
|Turkey 3||>120,000||383||January 2021||Provided by the collaborator|
|United States 1||114,529||574||July–August 2020||Erdem and Lucey |
|Country||Initiatives at National Level||Incidence|
(per 100,000 Inhabitants)
(per 100,000 Inhabitants)
|Per Capita Income (EUR )|
|Argentina||Emotional support with online inquiries and helpline by a net of psychologists (Argentine Society of Intensive Care, only to their partners).||6589.6||2.1||140.9||EUR 7463|
|Azerbaijan||Support hotline for healthcare workers, peer support programs, measures to strengthen work morale, social recognition, and self-assessment of stress level.||3143.6||1.4||44.6||EUR 4263|
|Belgium||Website, webinars, and research (example: www.dezorgsamen.be, accessed on 15 September 2021)||8558.6||2.4||208.8||EUR 39,110|
|Bosnia and Herzegovina||Support hotline for healthcare workers.||6081.3||4.3||262.0||EUR 5266|
|Brazil||No support interventions, but there is social recognition.||6895.0||2.8||190.5||EUR 6013|
|Chile||No support interventions, but there is social recognition.||6302.8||2.2||138.2||EUR 11,582|
|Croatia||For the prevention of “burn-out syndrome”: 24 h hotline for psychological help for healthcare workers (Croatian Institute for Public Health).||8220.2||2.2||176.8||EUR 12,170|
|Czech Republic||Healthcare insurance company partially covers psychotherapy.||15,241.8||1.8||273.8||EUR 19,970|
|Estonia||No support interventions, but there is social recognition and the use of scales and other resources for the self-assessment of stress levels.||5438.5||0.9||48.0||EUR 20,440|
|Finland||Support hotline for healthcare workers.||1574.2||1.0||16.5||EUR 42,940|
|France||National hotline for psychological support (regional medico-psychological emergency unit).||8732.6||1.8||160.5||EUR 34,040|
|Ireland||Psychological support via professional organizations.||5013.9||2.0||98.5||EUR 73,590|
|Israel||A 24 h hotline for support by psychologists and social workers (Ministry of Health).||8799.7||0.7||64.5||EUR 38,942|
|Italy||INAIL (National Institute of Workers’ Compensation—Insurance) with the psychologist council activated on a 24 h support telephone line. Taskforce for developing guidelines for the local implementation of psychological support from the HCW webpage.||6700.2||3.0||201.2||EUR 27,780|
|Japan||Telephone-based consultation initiative for nurses on the frontlines (Japan Nurses’ Association).||339.1||1.9||6.4||EUR 35,059|
|Lithuania||Psychologist consultation for healthcare workers (Ministry of Health).||9306.7||1.6||147.1||EUR 17,510|
|Malta||Psychology Department Mater Dei Hospital website in Facebook.||4535.6||1.4||62.3||EUR 25,310|
|Mexico||(1) Government initiatives: Webpage with some support resources, including mindfulness audio, some videos, a list of emotional support initiatives, and a mental-health-risks questionnaire.|
(2) University initiatives: Community-exclusive call centers and a telepsychiatry clinic.
(3) Civil societies: Telepsychiatry for health professionals, and a list of emotional support networks
|Netherlands||Websites for information consultation. For example, the Trimbos Institute. Impact Kenniscentrum.||8987.6||1.1||101.6||EUR 45,870|
|Peru||Phone number by the government for support.|
Webinars for health workers by psychologists and psychiatrists.
Friend call for psychological support. Rapid-response teams. Psychosocial support.
|Poland||No support interventions, but there is social recognition.||7423.2||2.4||180.2||EUR 13,600|
|Portugal||Psychological counseling from the national health service to support the psychological concerns and challenges of patients and health professionals (who are providing health care).||8236.3||2.0||167.0||EUR 19,660|
|Serbia||No support interventions, but there is social recognition.||7969.7||0.9||74.0||EUR 6710|
|Slovakia||Psycho-social support teams during the 1st pandemic wave (Ministry of Health). Online application to monitor the stages of depression and anxiety via a questionnaire and to provide recommendations.||7017.9||3.1||216.2||EUR 16,770|
|Spain||Telephone support from the Ministry of Health.||7538.9||2.2||167.3||EUR 23,690|
|Turkey||RUHSAD (mental health support system) app to offer psychosocial counseling (over the telephone or online systems) and mental health support services.||5732.9||0.8||48.0||EUR 7520|
|United States||Web repositories of good practices to build resilience and protect the well-being of healthcare professionals, and the use of scales or other resources for the self-assessment of stress levels.||9739.4||1.8||173.3||EUR 55,806|
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López-Pineda, A.; Carrillo, I.; Mula, A.; Guerra-Paiva, S.; Strametz, R.; Tella, S.; Vanhaecht, K.; Panella, M.; Knezevic, B.; Ungureanu, M.-I.; et al. Strategies for the Psychological Support of the Healthcare Workforce during the COVID-19 Pandemic: The ERNST Study. Int. J. Environ. Res. Public Health 2022, 19, 5529. https://doi.org/10.3390/ijerph19095529
López-Pineda A, Carrillo I, Mula A, Guerra-Paiva S, Strametz R, Tella S, Vanhaecht K, Panella M, Knezevic B, Ungureanu M-I, et al. Strategies for the Psychological Support of the Healthcare Workforce during the COVID-19 Pandemic: The ERNST Study. International Journal of Environmental Research and Public Health. 2022; 19(9):5529. https://doi.org/10.3390/ijerph19095529Chicago/Turabian Style
López-Pineda, Adriana, Irene Carrillo, Aurora Mula, Sofia Guerra-Paiva, Reinhard Strametz, Susanna Tella, Kris Vanhaecht, Massimiliano Panella, Bojana Knezevic, Marius-Ionut Ungureanu, and et al. 2022. "Strategies for the Psychological Support of the Healthcare Workforce during the COVID-19 Pandemic: The ERNST Study" International Journal of Environmental Research and Public Health 19, no. 9: 5529. https://doi.org/10.3390/ijerph19095529