The gap of psychological perspective in high-containment lab training: an Exploratory Systematic Review and Meta-Analysis

Laboratory personnel work in high-containment laboratories (HCL), research laboratories, diagnostic laboratories, and hospitals, and their performance directly impacts public health outcomes2-4. We depend on this workforce more than we often acknowledge, yet they have received limited scientific attention as a distinct occupational group.5-7. Understanding and supporting their well-being is likely to increase performance and potentially reduce human error, which in turn could improve research quality8-10. The mental health burden observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic highlighted the vulnerability of this workforce under sustained pressure 11,12. This period underscored a simple point: laboratory personnel are human, and the scientific community owes them evidence-based support, not just admiration from a distance. In all probability, the post-COVID data of laboratory personnel under pressure may be a great starting point for acquiring accumulated evidence, and it may allow addressing known human vulnerabilities rather than waiting for ideal data, while risks will continue to persist in the “new era of infectious diseases”13-16. More specifically, HCLs operate at biosafety level three (BSL-3) and biosafety level four (BSL-4). In parts of Europe, biological agents are additionally classified by risk group and associated containment levels (e.g., RG-3/RG-4 and CL-3/CL-4), where BSL refers to the technical laboratory containment standard, while HCL/CL denotes the institutional and cross-country governance level under which such laboratories operate; these frameworks broadly correspond to work conducted under BSL-3 and BSL-4 conditions. Although risk group classification is not identical to biosafety level designation, all these laboratories aim to prevent exposure and protect the public against high-consequence pathogens17-19. According to the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), BSL-3 laboratories work with pathogens that can cause serious or potentially lethal disease through inhalation, while BSL-4 laboratories work with dangerous and often fatal pathogens for which vaccines or effective treatments are generally not available 20-25. Despite the importance of HCLs, scientific literature (excluding procedural and governing documents) still lacks a systematic account of how the training of personnel operates in practice, particularly on these levels, which challenges are encountered, and which solutions are proposed, as they are highly dependent on context: the pathogen researched and the country of origin, often without harmonization26-29. Psychological data that explicitly focuses on laboratory personnel are limited, sometimes not publicly available, and even scarcer for HCL personnel, for obvious biosecurity reasons29-31. However, human factors (HF) drive both success and, unfortunately, many failures in biosafety and biosecurity, yet training frameworks rarely integrate psychological and behavioral evidence or awareness19,32. Across biosafety levels, laboratory work shares core features that shape mental load and behavior, sustained attention, strict procedures, high consequences of potential error, and prolonged work under pressure; and thankfully, attempts are made to deeply understand HF30,33-35. Furthermore, the boundaries of laboratory levels are not fixed36. The same individuals often move between containment levels, perform preparatory, cleaning, or downstream tasks, or enter HCL work after experience in lower-level laboratories. This overlap became especially pronounced at the beginning of the SARS-CoV-2 pandemic, when restrictions, staffing limits, and disrupted workflows forced laboratory personnel to work often under suboptimal conditions37. These circumstances intensified cognitive and emotional demands and may have resulted in somewhat mirrored key stressors38-40.