Factors associated with psychological resilience in healthcare workers during infectious disease outbreaks and pandemics – a Systematic review and critique of analytical approaches

In recent years, an increasing interest in understanding and increasing healthcare workers’ (HCWs) psychological resilience has been observed due to the intense nature of their working environment. This systematic review aimed to synthesise evidence on factors associated with the psychological resilience of HCWs working during infectious disease outbreaks. A systematic search was conducted across the following databases: The Cochrane Library, MEDLINE, PsychInfo, Embase, CINAHL, and Scopus on the 12th of December 2021 and was updated on the 19th of January 2024. Studies were included in the systematic review if they were conducted a) within an HCW population, b) during a pandemic/epidemic, c) psychological resilience was the outcome variable, d) being published between 2000 and the present and e) the study design was a retrospective/prospective cohort, case–control, or cross-sectional. The risk of bias was assessed using the Newcastle–Ottawa Scale. A narrative synthesis of the data was carried out where factors associated with psychological resilience were grouped into conceptually meaningful categories. Evidence was further tabulated by listing factors associated with higher or lower psychological resilience, and non-statistically significant associations. A total of 65 studies involving 36,056 HCWs were included. Most studies were cross-sectional, with 43% ( n = 28/65) conducted in the Middle East, primarily during the COVID-19 pandemic. Only one study included data from the MERS outbreak. Due to substantial heterogeneity across studies, a qualitative synthesis of findings is presented. Consistent findings indicated that a supportive workplace, enhanced coping skills, and improved mental and general health were linked to improved psychological resilience among HCWs. Additionally, burnout, higher fear of COVID-19, and the intention to resign were associated with lower psychological resilience. Multiple methodological and analytical limitations were identified, and 91% ( n = 59/65) of the studies were rated as ‘poor quality’ with the certainty of the evidence considered to be low. Despite identifying several factors associated with HCWs’ psychological resilience, the overall evidence was limited by low methodological quality and poor generalisability. The limited reporting of rurality and lack of studies specifically conducted in regional and rural healthcare settings prevented meaningful comparisons. Future research should investigate a broader range of factors using methodologically rigorous study designs and greater representation of regional and rural healthcare populations. PROSPERO: International prospective register of systematic reviews (CRD42022292992).