Systematic review of mental health problems reported among healthcare workers during the COVID-19 pandemic in Iraq

Abstract

Abstract Background and Objective The COVID-19 pandemic presented substantial psychological challenges for healthcare workers worldwide, particularly in conflict-affected and resource-limited settings where existing stressors may have increased vulnerability. This review aimed to synthesise the evidence on mental health outcomes reported among healthcare workers (HCW) in Iraq during the COVID-19 pandemic in the federal provinces and the Kurdistan Region, and to examine variations by geographic location, professional speciality, and pandemic timing. Method A comprehensive systematic literature search was conducted in PubMed, Web of Science, Scopus, and Google Scholar as a supplementary source to identify peer-reviewed studies published between 2020 and 2024. Methodological quality and risk of bias were assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Due to the substantial clinical and methodological heterogeneity among the included studies, the findings were synthesised narratively rather than through formal meta-analysis. Results Sixteen cross-sectional studies were included, involving 7,156 HCWs and medical and nursing students. Across professional groups, including physicians, dentists, pharmacists, nurses, and healthcare students, studies reported substantial psychological distress, including depression, anxiety, stress, burnout, obsessive–compulsive symptoms, and post-traumatic stress symptoms. The reported prevalence of depression ranged from 11 to 39% in the Kurdistan Region and from 11.4 to 60% in the Iraqi federal provinces. The prevalence ranged from 22 to 90% in the Kurdistan Region and 14.1–42.9% in Iraqi federal provinces of Iraq, while stress prevalence ranged from 9.6 to 90.5% and 10.9 to 43.4%, respectively. OCD symptoms were reported only in studies conducted in Iraqi federal provinces, while PTSD symptoms were reported only in studies conducted in the Kurdistan region. The variability between studies reflected differences in diagnostic instruments, professional groups, study settings, and data collection. Conclusion This review identified substantial and heterogeneous psychological distress among healthcare workers in Iraq during the COVID-19 pandemic period. The findings highlight the need for context-specific mental health support and stronger institutional preparedness to protect healthcare workers during future public health crises.