BACKGROUND: Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout . The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health .

METHODS: We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806] ) to November 17 , 2020 . Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers .

RESULTS: From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review . Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries . Psychological symptoms of anxiety (14.3-92.3 %), stress (11.9-93.7 %), depression (17-80.5 %), post-traumatic stress disorder (13.2-75.2 %) and burnout (14.7-76 %) were commonly reported among physicians, regardless of infectious disease outbreak or country . Younger, female (vs. male), single (vs. married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms . INTERPRETATION: Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist . Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19.