|Ahead of print publication
Psychological impact of COVID-19 on female health professionals
Priya Bansal1, Supriya Agarwal2
1 Department of Medicine, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
2 Acting Consultant Psychiatrist, Adult Community Mental Health Team, Deavon Partnership Trust and RDE, UK
|Date of Submission||29-May-2021|
|Date of Decision||16-Nov-2021|
|Date of Acceptance||24-Nov-2021|
|Date of Web Publication||15-Mar-2022|
R-4/44, Raj Nagar, Ghaziabad - 201 002, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: The World Health Organization in January 2020 declared an outbreak of novel coronavirus disease, COVID-19, an international public health emergency. The suddenness of this calamity with no end in sight caused a great deal of stress, anxiety, and depression throughout the world. Aim: The aim of this study was to assess the psychological impact during the developing COVID-19 situation among female health professionals. Methods: This was an observation-based cross-sectional study conducted for a total of 3-month duration between August and October 2020. A structured questionnaire to assess the psychological impact was sent via the (email) electronic mail system, and responses were obtained from 343 female doctors. Results: The mean ± standard deviation values for age were found to be 39 ± 8 years. Insomnia, stress, and anxiety were seen in a majority of the respondents. Conclusions: The present study has shown severe psychological impact associated with the pandemic on female health-care workers and highlights the major factors associated.
Keywords: Anxiety, depression, insomnia, psychological impact, stress, survey, female health professionals
| Introduction|| |
The COVID-19 disease was declared a pandemic by the World Health Organization in March 2020. Frontline workers, especially health-care professionals, have suffered from psychological side effects such as depression, insomnia, anxiety, and stress in the wake of this calamity. These may be attributed to extremely long working hours, increased workload, information bombardment on social media, and high rates of infection among the handling staff. There is a need to address this impact even as we prepare to enter the third year of living with this disease.
There is evidence that gender has a role to play in response to stress. Each gender has a different psychological framework, and it is important to explore the impact of a formidable threat such as the COVID-19 pandemic in each gender. The impact of the pandemic on female health professionals due to changed work and home dynamics is not yet well known. This survey aims to study the mental health burden of female health-care workers (HCWs), which can help formulate preventive and supportive measure by policy-makers to alleviate the same.
| Methods|| |
This observational cross-sectional study was conducted over a 3-month period from August to October 2020. A structured questionnaire in English language, intended to reach female doctors posted for COVID-19 duties in various hospitals across the country, was distributed via electronic mail system and various social media platforms. Responses were obtained from 343 female HCWs.
The questionnaire comprised the following study variables – age range, categorized into (i) between 20 and 30 years, (ii) between 30 and 40 years, (iii) between 40 and 50 years, (iv) between 50 and 60 years, and (v) above 60 years; specialty; presence of stress; anxiety; insomnia; and factors contributing to the above. We also tried to learn about any available support systems, their coping measures, and if the pandemic came up with any positives as well. The questionnaire concluded with suggestions to authorities that may help the mental health of the HCWs. Ethical approval and permission were obtained from concerned authorities. The data collection was anonymized at the outset, and informed consent was taken by the respondents before taking the survey. Participation was on a voluntary basis, and there were no incentives. Data confidentiality and anonymity were guaranteed.
The collected data were analyzed by Microsoft Excel and SPSS version 26.0 (SPSS Inc., Illinois, USA) using appropriate statistical methods such as percentages and averages. Mean and standard deviation was calculated for continuous variables.
| Results|| |
The survey included 343 female health professionals across the country. The mean age was 39 ± 8 years. The age distribution is shown in [Table 1].
The distribution specialty-wise is described in [Table 2].
The number of married women was 289. Only 27 women gave a history of prior mental health disorder.
Ninety-nine percent of the female professionals felt that the COVID-19 pandemic had impacted their life in some way of the other [Figure 1]. Fifty percent confessed that their life was worse compared to pre-COVID times due to increased workload at both home and at work-front. This was compounded by an inability to interact with peers due to social isolation or to pursue recreational activities. The respondents missed having no fear at work, the availability of house helps, and having a better personal space prior to the pandemic as children and spouse went for their school and work.
Insomnia was seen in 55% of the respondents with complaints of both increased sleep latency and frequent awakenings [Figure 2].
Only 11% of the women did not complain of any stress [Figure 3]. Thirty-seven percent complained of feeling stressed at all times due to the fear that a family member might catch COVID-19, or due to financial insecurity, social stigma related to the job, or having to see children idling away at home. Less than 1% of the respondents complained of marital disharmony.
Eighty-seven percent of the respondents complained of anxiety [Figure 4]. The most common causes of anxiety were - inability to cope with kids' online classes, information bombardment with COVID-19 statistics, and the uncertainty of the future. Participants also complained of anxiety due to inability to meet their parents or visit family due to the fear of exposing them to infection.
While a majority of the women complained of mild-to-moderate stress on a scale of 0–5 [Figure 5], depression was absent or mild in most of the respondents [Figure 6] (0 – no change, 1–2 – mild, 3–4 – moderate, and 5 – severely difficult and functionally disabling). Most of the respondents lamented the inability to plan a much-awaited vacation; some also complained that they were unable to plan family or apply for change of workplace.
The change in dynamics of living associated with the pandemic also brought along some positives. The respondents appreciated the improved hygiene practices in the society, having more family time, and that the environment became healthier with less pollution. At least 50% of the married women claimed to have their spouse as their biggest support system to help cope with the stress and pressure at work. Most of the women were able to make time for yoga, meditation, an exercise routine, or a hobby to allay their anxiety and fears.
The solutions suggested by the participants to help them beat the psychological impact of the pandemic include the provisions of health insurance or a financial bonus by the policymakers, a crèche facility, and regular psychological counseling at workplace. Most benefitted from staggered duty rosters which provided both physical and mental relief.
| Discussion|| |
This cross-sectional survey enrolled 343 respondents and revealed a high prevalence of mental health symptoms among female HCWs treating patients with COVID-19. Most participants were aged 31–40 years, were married, and worked as general practitioners.
In a study from Singapore, from among 470 participants, 68 (14.5%) participants screened positive for anxiety, 42 (8.9%) for depression, 31 (6.6%) for stress, and 36 (7.7%) for clinical concern of post-traumatic stress disorder. In another study done among both the health-care and non health-care working professionals in India, anxiety was seen in 55.65%, 48.54%, 52.34%, and 56% of physicians, nursing staff, technicians, and non health-care study population. Depression was evidently reported from 32.1%, 53.72%, 42.7%, and 35%, and insomnia was found to afflict 47%, 38.2%, 39.4%, and 43% of the above mentioned categories. On analyzing the psychological parameters of depression, insomnia, and anxiety between health-care and non health-care professional workers, significance was obtained (P = 0.05, 0.03, and 0.02, respectively). A survey conducted among Romanian medical residents obtained an average burnout for medical residents of 76%, about 2 months after the outbreak of the pandemic. Burnout was considered as fulfilling one of the three criteria: an elevated level of emotional exhaustion (≥27), and/or a high score for depersonalization (≥10), and/or a low personal accomplishment score (≤33). Unlike our study, the above studies did not assess in particular the prevalence of the impact in female professionals.
A study of 1257 HCWs in 34 hospitals in China indicated that being a woman was associated with severe depression, anxiety, and distress (e.g., severe depression among women: odds ratio, 1.94; 95% confidence interval, 1.26–2.98; P = 0.003). In a study of the psychological impact on hospital workers in South Korea, most of the participants were women and nurses, who accounted for the largest proportion of the hospital's workforce. They had high Impact of Event Scale-Revised scores. Their risk of contracting the disease was high because they were intensively involved in providing care to patients. A study from Oman accrued 1139 HCWs from different parts of the country, out of which 911 (80%) were female. The study showed that 368 (32.3%), 388 (34.1%), 271 (23.8%), and 211 (18.5%) respondents reported symptoms of depression, anxiety, stress, and insomnia respectively, while working during the pandemic period. A study by Gupta et al. also suggested that male HCWs had significantly minimal anxiety scores (219/368, 59.5%) than female HCWs. Moreover, there was a significant association between the female gender as well as inadequate availability of personal protective equipment and higher anxiety levels (P = 0.01 for both). A study from Spain revealed that females who are working in the frontline, with the uncertainty of a possible infection, the perception of inadequate protection measures, and having experienced the death of a close person by COVID-19, showed a heightened risk of experiencing psychological distress. A study by Conti et al. from Italy also reiterated that female care workers experienced higher levels of anxiety and somatization symptoms, and stated that they needed psychological care more than men (P < 0.001).
The reasons for the high prevalence of mental health symptoms among female health professionals include social isolation, increase in burden on the domestic field, and increase in fear of disease exposure at work. While most women had the support of their spouses and were able to make more time for their families, it is proposed that psychological counseling and psychiatric care should be provided to female health professionals to address exhaustion and prevent burnout at the work front.
Our study had several limitations. The responses may be judged as inauthentic as the questionnaire was self-reported. There are no comparative studies from pre-COVID times which makes it difficult to ascertain if other factors are accountable for the mental health of female health professionals. Our study lacks a longitudinal follow-up. A long-term follow-up to assess the psychological implications with a decline in the number of cases, lifting of travel restrictions, and availability of vaccination are worth further investigation.
| Conclusions|| |
This survey is unique as it specifically targets a very vulnerable population – the female health professionals facing the heat of this pandemic. It reports high rates of symptoms of anxiety, insomnia, and stress among female HCWs as an aftermath of this pandemic. It is imperative to protect the health of all front-line workers, especially women, to tackle this pandemic successfully on all fronts. Proactive measures should be undertaken by hospital authorities and government policymakers to promote mental well-being of female health professionals, to secure them a healthy work–life balance and a better quality of life. They form the backbone of our society.
The authors wish to thank all the respondents for their participation in this survey. We also wish to acknowledge their ongoing efforts in helping the society live through this pandemic.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Verma R, Balhara YP, Gupta CS. Gender differences in stress response: Role of developmental and biological determinants. Ind Psychiatry J 2011;20:4-10.
] [Full text]
Tan BY, Chew NW, Lee GK, Jing M, Goh Y, Yeo LL, et al.
Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Ann Intern Med 2020;173:317-20.
Raj R, Koyalada S, Kumar A, Kumari S, Pani P, Nishant, et al.
Psychological impact of the COVID-19 pandemic on healthcare workers in India: An observational study. J Family Med Prim Care 2020;9:5921-6. [Full text]
Dimitriu MC, Pantea-Stoian A, Smaranda AC, Nica AA, Carap AC, Constantin VD, et al.
Burnout syndrome in Romanian medical residents in time of the COVID-19 pandemic. Med Hypotheses 2020;144:109972.
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.
Jo SH, Koo BH, Seo WS, Yun SH, Kim HG. The psychological impact of the coronavirus disease pandemic on hospital workers in Daegu, South Korea. Compr Psychiatry 2020;103:152213.
Alshekaili M, Hassan W, Al Said N, Al Sulaimani F, Jayapal SK, Al-Mawali A, et al.
Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: Frontline versus non-frontline healthcare workers. BMJ Open 2020;10:e042030.
Gupta B, Sharma V, Kumar N, Mahajan A. Anxiety and sleep disturbances among health care workers during the COVID-19 pandemic in India: Cross-sectional online survey. JMIR Public Health Surveill 2020;6:e24206.
Erquicia J, Valls L, Barja A, Gil S, Miquel J, Leal-Blanquet J, et al.
Emotional impact of the Covid-19 pandemic on healthcare workers in one of the most important infection outbreaks in Europe. Med Clin (Engl Ed) 2020;155:434-40.
Conti C, Fontanesi L, Lanzara R, Rosa I, Porcelli P. Fragile heroes. The psychological impact of the COVID-19 pandemic on health-care workers in Italy. PLoS One 2020;15:e0242538.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2]