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Online Survey to Assess Psychological Problems Among Frontline Healthcare Workers During the First Wave of SARS-CoV-2 (COVID-19) Pandemic and Their Psychosocial Determinants: an Indian Perspective

Published online by Cambridge University Press:  09 September 2021

Shashank Purwar
Affiliation:
Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
Rahat Jahan
Affiliation:
Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
Disha Gautam
Affiliation:
Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
Snehil Gupta*
Affiliation:
Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, India
Abhijit R. Rozatkar
Affiliation:
Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, India
Mohit Kumar
Affiliation:
Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, India
Devendra Basera
Affiliation:
Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, India
*
Corresponding author: Snehil Gupta, Email: snehil2161@gmail.com.
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Abstract

Type
Letter to the Editor
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

Frontline healthcare workers (HCWs) are at risk of developing psychological problems during the COVID 19 pandemic which are determined by certain bio-psycho-social factors.Reference Gupta and Sahoo1 However, literature concerning this risk is scarce from India, particularly from Central India, which has higher population density and poorer health infrastructure than other parts of the country. Having such literature may act as a guide to policymakers and hospital administrations in order to take appropriate preventive and therapeutic measures with which to ameliorate the psychological concerns of the HCWs. Hence, this study aimed at assessing the magnitude of psychological problems among frontline HCWs as well as their psychosocial determinants amidst the first wave of the COVID-19 pandemic. An online survey was conducted from April, 2020 till July, 2020 involving the HCWs: specialists, junior doctors, nursing staff, and supporting staff (housekeepers and security personals), in a tertiary care hospital from central India to assess their level of psychological problems such as depression, anxiety, and stress scale-21 (DASS-21); as well as to take note of event-related stress symptoms (Impact of Event Scale-Revised-22 [IES-R]). Psycho-social determinants including attitudinal factors such as perceived stigma, sense of controllability over the patients’ conditions, etc., were also considered.

Methods

Descriptive statistics and Chi-square-, Pearson’s correlation coefficient and ordinal logistic regression (LR) (relationship between the socio-demographic, professional profiles of the HCWs, attitude towards COVID19 and their psychological problems) were used for the analysis.

Results

Out of the 315 participants, a sizeable portion had moderate to very severe depression (28.5%), anxiety (31%), stress (18.4%), event-related stress (21.9%), and negative attitudes (about a third) towards the COVID-19 pandemic. Being female (vs male, LR: 2.5- 5.5, P ≤ 0.002), married (vs unmarried, LR: 2.5, P ≤ 0.005 on a measure of stress), working as junior doctors, or supporting staff (vs. nursing staff, LR: 11.08, P < 0.0001), and a higher level of perceived stigma (vs lesser stigma, LR: 6.03 to 14.06, P < 0.0001) and lesser reliance on PPE (vs greater reliance, LR: 5.11, P = 0.003 on a measure of anxiety), and belief of uncontrollability over the patients’ condition (vs greater controllability, LR: 3.01 to 5.41, P ≤ 0.007) had a higher likelihood to experience psychological problems (Table 1).

Table 1. Strength of association of socio-demographic and occupational variables with various psychological outcome measures (ordinal regression analysis)

Exp. (B): likelihood ratio - represents that this variable did not achieve the threshold P = 0.2 in the univariate logistic regression analysis to be included in multivariate regression model; ref. - reference category.

These findings are in line with previous literature. Reference Gupta and Sahoo1,Reference Gupta, Prasad and Dixit2 The findings of this study underscore the need for hospital-level mental health support systems for frontline HCWs. Reference Şahin, Aker, Şahin and Karabekiroğlu3,Reference Yıldırım and Worry4 This includes a system of early identification of mental health concerns, peer support systems, tele-counseling services, Reference Gupta, Kumar and Rozatkar5 and COVID support systems for HCWs who acquired the infection (or who are in quarantine). Also, the association between perceived stigma and poor psychological outcomes reflects the need to ensure social security for HCWs, as well as the necessity behind recognizing and rewarding their efforts while spreading awareness among the public. Reference Gupta, Prasad and Dixit2 Furthermore, the importance of having hospital-level support system, effective communication between the HCWs and hospital administration, and having mental health professionals in the hospital infection-control committee cannot be overemphasized. There is an urgent need for tailored support services in order to create a conducive work environment, thereby improving productivity and quality of life. Lastly, HCWs need to be trained in soft skills, such as communication skills, so that they can deal with COVID-19 patients (in possible upcoming waves), and address the vaccination hesitancy among the general public. Future research could build on these findings.

Supplementary Material

To view supplementary material for this article, please visit https://doi.org/10.1017/dmp.2021.290

Conflict of interest

None of the authors has any association with any commercial entity or agency which could be construed as a potential conflict of interest with regard to the current research work.

References

Gupta, S, Sahoo, S. Pandemic and mental health of the front-line healthcare workers: A review and implications in the Indian context amidst COVID-19. Gen Psychiatr. 2020;33(5):e100284.CrossRefGoogle ScholarPubMed
Gupta, S, Prasad, AS, Dixit, PK, et al. Survey of prevalence of anxiety and depressive symptoms among 1124 healthcare workers during the coronavirus disease 2019 pandemic across India. Med J Armed Forces India. 2021;77(2):s404-s412.CrossRefGoogle ScholarPubMed
Şahin, MK, Aker, S, Şahin, G, Karabekiroğlu, A. Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. J Community Health. 2020;45(6):1168-1177.CrossRefGoogle ScholarPubMed
Yıldırım, M, Worry, Özaslan A., severity, controllability, and preventive behaviours of covid-19 and their associations with mental health of Turkish healthcare workers working at a pandemic hospital. Int J Ment Health Addict. 2021:1-15.Google Scholar
Gupta, S, Kumar, M, Rozatkar, AR, et al. Feasibility and effectiveness of telecounseling on the psychological problems of frontline healthcare workers amidst COVID-19: A randomized controlled trial from Central India. Indian J Psychol Med. 2021;43(4):343-350.CrossRefGoogle ScholarPubMed
Figure 0

Table 1. Strength of association of socio-demographic and occupational variables with various psychological outcome measures (ordinal regression analysis)

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