|Year : 2021 | Volume
| Issue : 2 | Page : 153-157
Mental health problems in health-care workers working in COVID-19 quarantine centers
Parth Singh Meena, Charan Singh Jilowa, Anubhuti Sharma, Mahendra Jain, Neelam Nainwani, Manisha Singh Palawat, Parashar Ashish
Department of Psychiatry, JLN Medical College, Ajmer, Rajasthan, India
|Date of Submission||11-Jun-2021|
|Date of Decision||05-Jul-2021|
|Date of Acceptance||21-Jul-2021|
|Date of Web Publication||28-Oct-2021|
Dr. Parth Singh Meena
Department of Psychiatry, JLN Medical College, Ajmer, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: The coronavirus disease-19 (COVID-19) pandemic in India has put health-care workers (HCWs) under intense pressure and has led to immense psychological stress due to factors including a high risk of infection, inadequate protection from contamination, overwork, cutting-off with families, and exhaustion. The unprecedented stressful conditions are causing mental health problems such as stress, anxiety, depression, disturbed sleep, irritability, fear, and panic. The present study was carried out to investigate the mental health problems among HCWs working in close proximity with COVID-19 patients in quarantine centers and to explore the relevant influencing factors for the development of psychological interventions for them. Subject and Methods: HCWs working in COVID-19 quarantine centers in Ajmer were interviewed for exploring mental health problems in a cross-sectional study carried out at JLN Medical College, Ajmer, India. Depressive symptoms, anxiety, and stress among HCWs were assessed using the Depression Anxiety Stress Scale and Perceived Stress Scale (PSS). Relevant data were analyzed, and comparisons between different groups were performed using the two independent sample t-tests. All statistical analyses were performed using the SPSS software version 22.0 for Windows. Results: 53.57% (n = 30) of participants were suffering from depressive symptoms, 64.28% (n = 36) were suffering from anxiety symptoms, and 78.6% (n = 47) were suffering from stress. HCWs living in joint families were more affected by depression (P = 0.02). Both anxiety and stress were more commonly reported by HCWs of age <30, females, nurses and those living in joint families, but difference was statistically insignificant. Conclusion: The present study demonstrated that a considerable number of HCWs were suffering from mental health problems such as depression, anxiety, and stress. It is important to have periodic mental health assessment of HCWs dealing with COVID-19 patients.
Keywords: Anxiety, coronavirus disease-19, depression, health-care workers, pandemic
|How to cite this article:|
Meena PS, Jilowa CS, Sharma A, Jain M, Nainwani N, Palawat MS, Ashish P. Mental health problems in health-care workers working in COVID-19 quarantine centers. Ann Indian Psychiatry 2021;5:153-7
|How to cite this URL:|
Meena PS, Jilowa CS, Sharma A, Jain M, Nainwani N, Palawat MS, Ashish P. Mental health problems in health-care workers working in COVID-19 quarantine centers. Ann Indian Psychiatry [serial online] 2021 [cited 2023 Apr 1];5:153-7. Available from: https://www.anip.co.in/text.asp?2021/5/2/153/329434
| Introduction|| |
The coronavirus disease-19 (COVID-19) epidemic started when, patients with pneumonia of unknown cause were emerged in Wuhan, China, in December 2020. Later, on the World Health Organization (WHO) confirmed that the infective agent causing this unusual type of respiratory illness is a novel virus named severe acute respiratory syndrome coronavirus 2, and this type of pneumonia is called the COVID-19. The COVID-19 epidemic spread rapidly globally and on March 11, 2020, WHO declared it a pandemic. Due to high infectivity, the COVID-19 pandemic not only raised health-care concerns but also led to unprecedented psychological distress, particularly among health-care workers (HCWs). Doctors and paramedics have showed their commitment and compassion in the war against COVID-19 pandemic as first-line soldiers against the war risking their own lives in the course of their duties.
The war-like situation caused by the COVID-19 pandemic in India has put HCWs under intense pressure, including a high risk of infection, inadequate protection from contamination, overwork, frustration, discrimination, isolation, cutting-off with families, and exhaustion. The severe situation is causing mental health problems such as stress, anxiety, depressive symptoms, disturbed sleep, anger, fear, and panic. Maintaining the mental health of HCWs is important not only for combating and controlling COVID-19 but also for performing routine tasks.
Most studies on the epidemic situation of COVID-2019 have focused on epidemiological investigation, prevention and control, diagnosis, and treatment. Many others have investigated the mental health problems in general public developed during the pandemic, but fewer studies have focused on mental health problems of medical workers during the pandemic. The purpose of the present study was to investigate the psychiatric morbidities among HCWs and to explore the relevant influencing factors for the development of psychological interventions for them so that they can adjust to public health emergencies.
| Subject and Methods|| |
It was a cross-sectional, observational study. Psychiatrists from JLN Medical College and associated Hospital, Ajmer, were given the task of visiting Quarantine centers and Shelter Homes to screen the inhabitants for psychiatric problems and to provide them required mental health care. The psychiatrists also interviewed the HCWs posted there and encouraged them to participate in the present study. The duration of the study was 3 months, from August 2020 to October 2020. A total of 56 HCWs including medical officers and nurses were included in the study after obtaining written informed consent. Approval for the study was obtained by the Institutional Ethical Committee.
Sociodemographic profile according to literature review and expert consultation, self-made general information and demographic questionnaires, including gender, age, nursing age, education, professional qualifications, and marital status.
An unstructured pro forma having five questions regarding attitude and behavior of public toward HCWs was also given along with sociodemographic profile.
The depression anxiety stress scale
Depression Anxiety Stress Scale (DASS-21) is a quantitative measure of distress along the three axes of depression, anxiety, and stress. Each of the three DASS-21 scales contains seven items, divided into subscales with similar content. The depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia, and inertia. The anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The stress scale is sensitive to the levels of chronic nonspecific arousal. It assesses difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/over-reactive and impatient. Scores for depression, anxiety, and stress are calculated by adding the scores for the relevant items.
The perceived stress scale
Perceived stress scale (PSS) is the most widely used psychological tool for measuring the perception of stress. It is a measure of the degree to which situations in one's life are appraised as stressful. The questions in the PSS ask about feelings and thoughts during the last month. The respondents are asked how often they felt a certain way. PSS scores are obtained by reversing responses (e.g. 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items.
Counting data were expressed by frequency and percentage, and the measurement data were expressed by mean ± standard deviation. The comparisons between the two groups were performed using the two independent-sample t-tests. All statistical analyses were performed with the IBM Statistical Product and Service Solutions (SPSS) version 22 for Windows, IBM New York, USA, with two-tailed P < 0.05 to be considered statistically significant.
| Results|| |
The mean age of the HCWs was 34.07 (±4.69) years. 79.6% of HCWs were of age more than 30 years. The mean age of female HCWs was significantly higher than their male counterparts (P = 0.0006). 60.71% (n = 34) HCWs were male while 39.29% (n = 21) were females. Fifty percentage (n = 28) of the participants were doctors and equal number of nurses participated in the study. 85.7% (n = 24) of the doctors were males, whereas majority of nurses (64.3%) were females [Table 2]. All of the HCWs reported that they were doing their duty for the greater good of the society but 64.2% (n = 36) of the participants felt they have been ostracized by friends, neighbor, and the society for working in the quarantine centers/shelter homes.
Mean score on DASS-21 of was 9.71 ± 7.11 and 53.57% (n = 30) of participants were suffering from depression (30.3% [n = 17] mild, 16% [n = 9] moderate, 7% [n = 4] severe depression). Mean anxiety score was 8.45 ± 7.24 and 64.28% (n = 36) were suffering from anxiety symptoms (32.1% [n = 18] mild, 19.6% [n = 11) moderate, 10.7% [n = 6] severe and 1.7 [n = 1] extremely severe). 11.27 ± 8.69 was the mean score on Stress sub-scale and 78.6% (n = 47) were suffering from stress (33.9% [n = 19] mild, 25% [n = 14] moderate, 19.6% [n = 11] severe and 5.3% [n = 3] extremely severe) [Table 1] [Chart 1]. Depression was apparently more prevalent in HCWs with age <30 (P = 0.19), in females (P = 0.28) and in nurses (P = 0.42), but the difference was not significant; HCWs living in joint families were more affected by depression (P = 0.02). Both anxiety and stress were more commonly reported by HCWs of age <30, females, nurses and those living in joint families, but difference was statistically insignificant [Table 2].
PSS-10 mean score of the sample was 18.23 ± 9.36. 51.8% (n = 29) HCWs had score between 0 and 13 indicative of low stress, 25% (n = 14) had scores between 14 and 26 indicating moderate stress and 23.2% (n = 13) HCWs indicating high levels of stress [Table 3]. No significant difference was found in the prevalence of perceived stress among HCWs divided on the basis of age (P = 0.16), gender (P = 0.78), occupation (P = 0.41), and family type (P = 0.22).
| Discussion|| |
The current study shows that HCWs are facing a significant degree of anxiety, stress, and depression due to the COVID-19 pandemic.
All the HCWs interviewed believed that they are putting themselves in danger for the greater good of the society at large but almost two-third (64.2%) of the HCWs felt rejected and orchestrated by neighbors, friends, and relatives for working in close proximity of corona-infected patients.
More than half (53.57%) of the HCWs were suffering from depression, whereas almost two thirds (64.28%) of the health workers were suffering from anxiety. The most prevalent psychopathology amongst the HCWs was stress which was perceived by 78.6% % of the HCWs [Table 1], [Chart 1]. Almost half (48.21%) of the respondents were suffering from moderate to severe stress [Table 4] [Chart 2].
In the first paper on the mental health of HCWs in Wuhan, China, the authors found that among 994 medical and nursing staff, 36.9% had subthreshold psychiatric problems, 34.4% had mild problems, 22.4% had moderate problems, and 6.2% had severe mental health problems in the immediate aftermath of the viral epidemic. Zhou et al., assessed 606 frontline hospital staff and 1099 general population were recruited. The prevalence of depression, anxiety, somatization symptoms, insomnia, and suicide risk in frontline medical staffs was 57.6%, 45.4%, 12.0%, 32.0%, and 13.0%, respectively. Similar results were found by Cai et al. that being HCWs were independently associated with more severe scores of depression, anxiety, and insomnia. Lai et al. conducted a study from 34 hospitals in China, their results showed that a significant proportion of 1257 participants reported symptoms of depression (50.4%), anxiety (44.6%), insomnia (34.0%), and distress (71.5%). Another study of HCWs at a Children Hospital revealed that contact with COVID-19 patients was associated with higher risk of sleep-related problems. Lu et al., 2020 found that the risk of anxiety and depression in HCWs who were in direct contact with COVID-19 patients was almost twice than in nonmedical staff with low risk of contact with COVID-19. Chatterjee et al. conducted an online survey on 152 doctors in West Bengal, India in March-April 2020. 34.9% of the respondents were depressed, whereas 39.5% and 32.9% were having anxiety and stress, respectively. Unpredictability and inaccurate information about its mode of transmission, unpredictable course, high infectiousness, rapidity of transmission, and lack of definitive and specific treatment protocols or vaccine were the characteristics of COVID-19 epidemic which were responsible for the mental health issues. Widespread global connectivity and extensive media coverage were leading to the catastrophic reactions secondary to the outbreak.
In the current study, depression, anxiety, and stress were found to be more prevalent in HCWs of age <30 years, although not significantly [Table 2] and [Table 3] . A recent Chinese study which included the general population as well as HCWs found that younger people had significantly higher anxiety and depression scores. In the present study, the authors found that depressive symptoms were more common in female HCWS, nurses, and HCWs living in joint families, although the scores were significantly higher only in HCWs living in joint families [Table 2].
In two Chinese studies, nurses were found to be at greater risk of developing mental health problems as compared to doctors. Another study revealed that nurses had greater anxiety than doctors and other hospital staff and had significantly higher financial worries. A factor analysis study conducted on 140 HCWs of a tertiary care hospital in West Bengal, India, revealed that doctors had the highest level of anxiety among the health-care workers. Both doctors and nurses perceived a greater level of irritability than the other HCWs. Lower age, female gender, and residence in urban localities were associated with higher anxiety. Female gender, being single, and comorbid medical conditions were associated with sense of hopelessness.
It is generally considered that living in joint family is a protective factor against stressful conditions and mental illnesses., Review of studies analyzing the role of the family in relation to mental health have found that the nuclear family structure is more likely to be associated with psychiatric disorders than the joint family. Conversely, the current study has depicted that HCWs living in joint families were having significantly more prevalence of depression [Table 2].
In a review aimed at providing an overview of the research findings on mental health issues faced by HCW due to COVID-19, Spoorthy et al., in a review giving an overview about mental health problems in HCWs found that among sociodemographic variables being female and being <30 years old was associated with higher anxiety, depression, and distress, although the difference was not statistically significant. Cai et al. found that HCWs aged between 31 and 40 years were more concerned about infecting their families, whereas mortality in patients caused more stress in HCWs more than 50 years of age important. Older staff reported increased stress due to exhaustion due to prolonged work hours caused increased stress in older HCWs while younger HCWs were more stressed about their safety.
Epidemics may lead to emergence of severe and variable psychological effects on people. Preexisting mental health problems may and on the other hand new mental health issues may arise. People may develop a fear of getting sick or dying predisposing them to severe anxiety, helplessness, and hopelessness and they often blame sick people or those coming in close contact with ill people. Depression, anxiety, panic attacks, illness anxiety disorder, somatic symptoms disorder, posttraumatic stress disorder, and psychosis may emerge in vulnerable people during the epidemics.,,
| Conclusion|| |
The findings of the study add up to the growing literature on the mental health problems of HCWs involved in the care of COVID-19 patients. The study demonstrated that a considerable number of HCWs were suffering from mental health problems such as depression, anxiety, and stress. It is important to have periodic mental health assessment of HCWs dealing with COVID-19 patients for evaluating stress, depression, and anxiety in them. They should be encouraged to come forward and share their mental health issues with the health authorities. Setting up teams of mental health professionals to deal with mental health issues and providing psychological support to both patients and HCW is highly advisable.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;6736:30183-5.
Xiang Y, Yang Y, Li W, Zhang L, Zhang Q, Teris C, et al
. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020;7:228-9.
Catton H. Global challenges in health and health care for nurses and midwives everywhere. Int Nurs Rev 2020;67:4-6.
Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al
. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7:e14.
Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, et al
. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun 2020;87:11-7.
Zhou Y, Wang W, Sun Y, Qian W, Liu Z, Wang R, et al
. The prevalence and risk factors of psychological disturbances of frontline medical staff in china under the COVID-19 epidemic: Workload should be concerned. J Affect Disord 2020;277:510-4.
Cai H, Tu B, Ma J, Chen L, Fu L, Jiang Y, et al
. Psychological impact and coping strategies of frontline medical staff in Hunan between January and March 2020 during the outbreak of coronavirus disease 2019 (COVID19) in Hubei, China. Med Sci Monit 2020;26:e924171-1-16.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al
. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.
Wang S, Xie L, Xu Y, Yu S, Yao B, Xiang D. Sleep disturbances among medical workers during the outbreak of COVID-2019. Occup Med (Lond) 2020;70:364-9.
Lu W, Wang H, Lin Y, Li L. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Res 2020;288:112936.
Chatterjee SS, Bhattacharyya R, Bhattacharyya S, Gupta S, Das S, Banerjee BB. Attitude, practice, behavior, and mental health impact of COVID-19 on doctors. Indian J Psychiatry 2020;62:257-65. [Full text]
Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of coronavirus disease 2019 (COVID-19) beyond paranoia and panic. Ann Acad Med Singap 2020;49:155-60.
Tang L, Bie B, Park SE, Zhi D. Social media and outbreaks of emerging infectious diseases: A systematic review of literature. Am J Infect Control 2018;46:962-72.
Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based crosssectional survey. Psychiatry Res 2020;288:1-6.
Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: A factor analysis. Front Psychol 2021;12:611314.
Sethi BB, Chaturvedi PK. A review and role of family studies and mental health. Indian J Soc Psychiatry 1985;1:216-30.
Leff J, Wig NN, Bedi H, Menon DK, Kuipers L, Korten A, et al
. Relatives' expressed emotion and the course of schizophrenia in Chandigarh. A two-year follow-up of a first-contact sample. Br J Psychiatry 1990;156:351-6.
Bharat S. Research on family structure and problems: Review, implications and suggestions. In: Bharat S, editor. Research on Families with Problems in India: Issues and Implications. Vol. 1. Bombay: Tata Institute of Social Sciences; 1991. p. 33-67.
Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian J Psychiatry 2020;51:102119.
Hall RC, Hall RC, Chapman MJ. The 1995 Kikwit Ebola outbreak: Lessons hospitals and physicians can apply to future viral epidemics. Gen Hosp Psychiatry 2008;30:446-52.
Müller N. Infectious diseases and mental health. In: Sartorius N, Holt RI, Maj M, editors. Key Issues in Mental Health. Basel: S. KARGER AG; 2014. p. 99.
Sim K, Chan YH, Chong PN, Chua HC, Soon SW. Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease. J Psychosom Res 2010;68:195-202.
[Table 1], [Table 2], [Table 3], [Table 4]