|Year : 2022 | Volume
| Issue : 2 | Page : 93-97
Anxiety and depressive symptoms in health-care workers managing COVID-19 patients: A cross-sectional study
Joel Sabu, K Priya Nayak, Joshua S Chacko, Aiswarya Roy Karintholil
Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka, India
|Date of Submission||17-Jul-2022|
|Date of Acceptance||16-Nov-2022|
|Date of Web Publication||10-Jan-2023|
Dr. K Priya Nayak
Father Muller Medical College, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Health-care professionals managing the pandemic are at higher risk of developing psychological distress and posttraumatic stress symptoms. The study highlights the importance of evaluating mental health among health-care workers to improve efficiency at work and also proves to be a major step to prevent suicide among health-care workers. Materials and Methods: The authors conducted a cross-sectional questionnaire-based clinical study, using the Depression, Anxiety, and Stress Scale-21 to assess stress, anxiety, and depressive symptoms among doctors and nurses managing COVID-19 patients in Karnataka. Results: Of 233 participants, 3 (1.3%), 27 (11.6%), 15 (6.4%), and 159 (68.2%) participants were suffering from mild, moderate, severe, and extremely severe anxiety respectively; 17 (7.3%), 32 (13.7%), 21 (9%), and 131 (56.2%) are suffering from mild, moderate, severe, extremely severe depressive symptoms, respectively; 15 (6.4%), 19 (8.2%), 26 (11.2%), and 114 (48.9%) are suffering from mild, moderate, severe, and extremely severe stress, respectively. The study also showed that health-care workers who had faced an epidemic in the past were able to cope up with the change in a scenario as compared to those who had not in the past. Conclusion: The study shows the prevalence of stress, anxiety, and depressive symptoms in doctors and nurses. It also shows that people who had exposure to a pandemic in the past were able to cope up better with the situation.
Keywords: Anxiety disorder, COVID-19, depressive disorder, health-care workers
|How to cite this article:|
Sabu J, Nayak K P, Chacko JS, Karintholil AR. Anxiety and depressive symptoms in health-care workers managing COVID-19 patients: A cross-sectional study. Muller J Med Sci Res 2022;13:93-7
|How to cite this URL:|
Sabu J, Nayak K P, Chacko JS, Karintholil AR. Anxiety and depressive symptoms in health-care workers managing COVID-19 patients: A cross-sectional study. Muller J Med Sci Res [serial online] 2022 [cited 2023 May 28];13:93-7. Available from: https://www.mjmsr.net/text.asp?2022/13/2/93/367405
| Introduction|| |
The novel coronavirus has spread rapidly all over the world and affected more than 55 crore people. It has caused a drastic effect on the health, wealth, and lives of people around the world.,, As of July 17, 2022, there have been 557,917,904 confirmed cases of COVID-19, including 6,358,899 deaths, reported to the WHO. The prevalence of psychiatric symptoms in the general population has increased after the lockdown. A study conducted by Panigrahi et al. revealed a total of 151 COVID-related suicide (CRS) reports. CRS was more frequently reported among males, 122 (80.8%), those whose COVID status was unknown, 72 (48.0%), and those in quarantine/isolation, 74 (49.0%).
An online study conducted in China on the mental health status of the medical staff using the WHO 20-Item Self-Reporting Questionnaire, Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale showed that the prevalence of psychological distress, anxious symptoms, and depressive symptoms was 744 (15.9%), 749 (16.0%), and 1618 (34.6%), respectively. Another study using Zung Self-Rating Depression Scale (SDS) and Zung SAS was conducted at the Fifth Affiliated Hospital of Sun Yat-sen University, and the results showed SDS and SAS scores as 30.05 ± 8.16 and 28.09 ± 4.98 (<30 years of age) and 29.06 ± 7.87 and 27.63 ± 6.34 (>30 years of age). A study conducted by Yan LV and Zhun Zhang among 8028 doctors from 8 provinces in China showed the overall anxiety among medical staff was 2786 (34.7%) with 1991 (24.8%) with mild anxiety symptoms. A study in India on the mental health impact of COVID on doctors concluded that 34.9% and 39.5% had depressive and anxiety symptoms, respectively. A meta-analysis done by Pappa et al. analyzed 13 studies with a combined total of 33,062 participants. A prevalence rate of 23.2% was obtained on assessing anxiety in 12 studies and a prevalence of 22.8% on analysis of depression in 10 studies. A subgroup analysis revealed a higher rate of affective symptoms exhibited by female health-care professionals and nurses as compared to male and medical staff, respectively. Finally, 38.9% of insomnia was estimated across 5 studies. A study conducted by Sunil R in 313 clinical and nonclinical health-care workers, in India, revealed that 7.3% of health-care workers were having moderate insomnia, 3.8% had severe insomnia, and 20.8% were having subthreshold insomnia. 6.7% of respondents showed severe anxiety and depression, 8.0 and 32.3% of the respondents had moderate and mild anxiety-depression, respectively, 6.4% had high perceived stress, and 47.6 and 46.0% of the respondents had moderate and low stress, respectively.
Many factors could have increased the prevalence of illness. It could be either a preexisting psychiatric disorder or precipitation of psychiatric disorders due to the various stressors. In addition, the risk of exposure to the virus, worry about infecting the family members, lack of availability of personal protective equipment, long duty hours, pessimistic comments from the patients, and also assault on health-care workers increased the risk of psychiatric symptoms among health-care workers. Quarantine and lack of family support further increased the risk. All these factors not only impact the mental well-being of health-care workers but also may negatively affect the efficiency at work.
There are many studies conducted globally that assess the prevalence of psychiatric illness among the general population. However, there are not many studies conducted among health-care workers in South India. Hence, identifying psychiatric symptoms among these individuals is of utmost importance. The study highlights the importance of evaluation of mental health among health-care workers to improve efficiency at work but also proves to be a major step to prevent suicide among health-care workers. The main purpose of the study is to assess stress, anxiety, and depressive symptoms in health-care workers managing COVID-19 patients in Karnataka, India; Compare whether those who had an exposure to a pandemic in the past were able to cope up with change in scenario with respect to those who hadn't.
| Materials and Methods|| |
Source of data
Doctors and nurses in tertiary health centers, who were managing the patients with COVID-19 from Karnataka, constituted a sample for the study. The study design used was a cross-sectional study. A semi-structured questionnaire was used for sociodemographic and clinical variables. The Depression, Anxiety, and Stress Scale-21 was used to assess stress, anxiety, and depressive symptoms. The scale used has commendable psychometric properties. As per the scale used, a score of 0–9 (depression), 0–7 (anxiety), and 0–14 (stress) is normal; 10–13 (mild depression), 8–9 (mild anxiety), 15–18 (mild stress), 14–20 (moderate depression), 10–14 (moderate anxiety), 19–25 (moderate stress), 21–27 (severe depression), 15–19 (severe anxiety), 26– 33 (severe stress), 28 + (extremely severe depression), 20 + (extremely severe anxiety), 34 + (extremely severe stress), respectively. The study was conducted for 1 month. The study was approved by an Institutional Ethics Committee in Karnataka, and informed consent was obtained from all the participants.
Collection of data and analysis
A total of 500 participants were approached for the study, of which 233 participants were included in the study (sample size was achieved using the sample size calculator for margin of error as 0.0452, p as 0.145, and z as 1.96). The formula was used for calculating sample size: Cochran's formula, X = (Zα/2)2 × p × (1 − p)/(MOE)2. Those who are above the age of 20 years and below the age of 70 years and those who gave informed consent (a mandatory field for informed consent was included in the questionnaire which was sent through an E-mail) were included in the study, and those who are on treatment for psychiatric symptoms were excluded from the study. The questionnaire was sent to the participants through an E-mail, and the data collected were entered into an Excel sheet. The collected data were analyzed qualitatively by frequency distribution and quantitatively by percentage, mean, Chi-square test, and standard deviation using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.).
| Results|| |
In the observational descriptive cross-sectional questionnaire-based clinical study, of 233 participants, 140 were doctors and 93 were nurses. The details of demographic characteristics are presented in [Table 1]. Large proportions of female medical staff were seen in the study. The leading age band was 20–25 years old, accounting for 132 (56.7%) in the groups.
|Table 1: Demographic characteristics of 233 participants enrolled in the study|
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Comparison of anxiety, stress, and depressive symptoms
Of 233 participants, 3 (1.3%), 27 (11.6%), 15 (6.4%), and 159 (68.2%) participants were suffering from mild, moderate, severe, and extremely severe anxiety, respectively.
17 (7.3%), 32 (13.7%), 21 (9%), and 131 (56.2%) are suffering from mild, moderate, severe, extremely severe depressive symptoms, respectively.
15 (6.4%), 19 (8.2%), 26 (11.2%), and 114 (48.9%) are suffering from mild, moderate, severe, and extremely severe stress, respectively.
Comparison of doctors and nurses with varied severity of anxiety, stress, and depression
[Figure 1], [Figure 2], [Figure 3] show the comparison of numbers of doctors and nurses with various degrees of stress, anxiety, and depression, respectively.
Comparison of psychiatric symptoms among those who faced an epidemic in the past with those who were new to the scenario
Of 33 participants,104(44.6%),145(62.23%),118(15.64%) wo had not faced an epidemic in the past as compared to 10(4.29%),14(6%),13(5.57%) who faced an epidemic in the past, showed symptoms of severe stress, severe anxiety and severe depression respectively.
Significance of anxiety, stress, and depression in the study based on Chi-square test
Based on the results from the Chi-square test (as shown in [Table 2]), we concluded that anxiety, stress, and depression were highly significant to the professional field as P = 0.000.
| Discussion|| |
The number of studies conducted on the mental health status of doctors and nurses managing COVID-19 patients is limited. The current study included 233 participants, of which 3 (1.3%), 27 (11.6%), 15 (6.4%), and 159 (68.2%) participants were suffering from mild, moderate, severe, and extremely severe anxiety symptoms, respectively; 17 (7.3%), 32 (13.7%), 21 (9%), and 131 (56.2%) are suffering from mild, moderate, severe, extremely severe depressive symptoms, respectively. 15 (6.4%), 19 (8.2%), 26 (11.2%), and 114 (48.9%) are suffering from mild, moderate, severe, and extremely severe stress, respectively; Of 233 participants,104(44.6%),145(62.23%),118(15.64%) wo had not faced an epidemic in the past as compared to 10(4.29%),14(6%),13(5.57%) who faced an epidemic in the past, showed symptoms of severe stress, severe anxiety and severe depression respectively. Based on the results from the Chi-square test, we concluded that anxiety, stress, and depression were highly significant to the professional field as P = 0.000.
Anxiety and depressive symptoms were more prevalent in doctors as compared to nurses in contrast to the study done by Mathur et al. The current study emphasizes the need to take measures to enhance the mental health of doctors and nurses managing the pandemic as a large proportion of them are suffering from one of the other symptoms of stress, anxiety, and depression. The study also found that health-care workers who had faced an epidemic in the past were able to cope up with the change in a scenario as compared to those who had not in the past. The study also highlights the importance of the evaluation of mental health among health-care workers. This not only improves efficiency at work but also proves to be a major step to prevent suicide among health-care workers.
There are a few limitations to the present study. The study cannot be generalized as it was mostly conducted on health-care workers of South India. Personality traits of these health-care workers were not taken into consideration, which could have impacted the results. The prevalence of comorbid medical conditions was not included during the assessment. The study has only included direct health-care workers, and a large proportion of indirect health-care workers were not included in the present study.
| Conclusion|| |
The COVID 19 Pandemic has not only caused several medical complications it has also impacted mental health. The prevalence of depressive and anxiety disorders has significantly increased post-pandemic and the study reflects and highlights the impact on the health care workers. Early identification of these psychiatric symptoms is of utmost importance to ensure proper treatment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Du Toit A. Outbreak of a novel coronavirus. Nat Rev Microbiol 2020;18:123.
Carlos WG, Dela Cruz CS, Cao B, Pasnick S, Jamil S. Novel Wuhan (2019-nCoV) coronavirus. Am J Respir Crit Care Med 2020;201:P7-8.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al.
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
WHO Coronavirus (COVID-19) Dashboard World Health Organization. World Health Organization; 2022. Available from: https://covid19.who.int/
. [Last accessed on 2022 Jul 17].
Panigrahi M, Pattnaik JI, Padhy SK, Menon V, Patra S, Rina K, et al.
COVID-19 and suicides in India: A pilot study of reports in the media and scientific literature. Asian J Psychiatr 2021;57:102560.
Liu Z, Han B, Jiang R, Huang Y, Ma C, Wen J, et al
., Mental Health Status of Doctors and Nurses During COVID-19 Epidemic in China (3/4/2020). SSRN Available from: https://ssrn.com/abstract=3551329
. [Last accessed on 2020 Sep 16].
Liang Y, Chen M, Zheng X, Liu J. Screening for Chinese medical staff mental health by SDS and SAS during the outbreak of COVID-19. J Psychosom Res 2020;133:110102.
Lv Y, Zhang Z, Zeng W, Li J, Wang X, Hailong Luo GQ. Anxiety and Depression Survey of Chinese Medical Staff Before and During COVID-19 Defense (3/7/2020). SSRN Available from: https://ssrn.com/abstract=3551350
. [Last accessed on 2020 Sep 16].
Mathur S, Sharma D, Solanki RK, Goyal MK. Stress-related disorders in health-care workers in COVID-19 pandemic: A cross-sectional study from India. Indian J Med Spec 2020;11:180-4. Available from: http://www.ijms.in/text.asp?2020/11/4/180/302078
. [Last accessed on 2020 Sep 16].
Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:901-7.
Sunil R, Bhatt MT, Bhumika TV, Thomas N, Puranik A, Chaudhuri S, et al.
Weathering the storm: Psychological impact of COVID-19 pandemic on clinical and nonclinical healthcare workers in India. Indian J Crit Care Med 2021;25:16-20.
Coker AO, Coker OO, Sanni D. Psychometric properties of the 21-item depression anxiety stress scale (DASS-21). Afr Res Rev 2018;12:135-42. [doi: 10.4314/afrrev.v12i2.13].
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]