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Psychological impact of COVID-19 on health-care workers in southern India

 Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Date of Submission16-Oct-2021
Date of Decision28-Jan-2022
Date of Acceptance21-Feb-2022
Date of Web Publication19-Jan-2023

Correspondence Address:
Parveen Sultana Shaik,
Department of Public Health Dentistry, Sibar Institute of Dental Sciences, Takkellapadu, Guntur - 522 509, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aip.aip_126_21


Background: The study aims to uncover some of the relevant concerns, with a specific emphasis on psychological and mental status evaluation, as well as a few suggested coping mechanisms. Materials and Methods: A cross-sectional, observational study conducted on medical, dental, and nursing from all over India. The questionnaire, which consisted of 19 questions, was designed to determine the health-care professionals' awareness of the WHO guidelines. Collected data were computed with SPSS version 25 and analyzed using descriptive statistics, independent t-test and Chi-square test, Pearson correlation, and one-way ANOVA. Results: Medical (4.23 ± 0.645) health-care personnel have higher mean stress levels than nursing (3.16 ± 0.458) and dental (2.2 ± 0.953) health-care workers (HCWs) (P = 0.0001). In terms of work experience, 6–10 years (3.35 ± 1.13) have higher stress levels than 1–5 years and >10 years (P = 0.005). Conclusion: This study uncovered a high pervasiveness of discerning stress among HCWs during the COVID-19 pandemic, which afflicted all workers despite the demographic status.

Keywords: Coping strategies, COVID-19, health-care professionals, stress

How to cite this URL:
Shaik PS, Halder N, Thota S, Nachu S, Bhavani VD, M. Pavani NP. Psychological impact of COVID-19 on health-care workers in southern India. Ann Indian Psychiatry [Epub ahead of print] [cited 2023 Feb 3]. Available from: https://www.anip.co.in/preprintarticle.asp?id=368089

  Introduction Top

The novel coronavirus 19 had started its unceremonious journey from Wuhan in Mainland China around November–December 2019, slithering its way into most of the countries of the world such as a Fiendish Snake. By now, it is a pandemic in its true sense, disregarding all the national boundaries, reporting (while penning down this article) over a whopping 170 million affected cases and 3.5 million untimely deaths worldwide. Our society has faced similar bio disasters in the past also, including severe acute respiratory syndrome (SARS) in China, parts of Asia and Canada in 2003, Ebola in West Africa in 2014, and the Middle East respiratory syndrome in 2016.[1] It was established that when juxtaposed to the general public, workers in the health-care fields who are already in constant risk of COVID-19 infection because of their relatively direct exposure are additionally stressed particularly due to meager protective facilities, uncurbed workload, ascertain opinion in the form of stigmatization, ostracization by neighbors or landlords, reduced or frozen salaries, dealing with uncooperative patients who are not adhering to safety instructions, physical and psychological violence toward fellow associates of the health-care community. In fact, it has been observed that during the catastrophes of SARS outbreak and the initial COVID outbreak in the Wuhan area, the front-line health-care workers (HCWs), mostly women (76.7%), nurses (60.8%) reported symptoms of depression (50.4%), anxiety (44.6%), insomnia (34.0%), and mental distress (71.5%).[2]

Sweeping infectious disease epidemics or pandemics façade copious challenges to individuals of all age groups and cultures alike but the emotional stress experienced by frontline HCWs is difficult to encompass in its entirety and even less is known about its implications on their mental health and well-being.[3] Sometimes, even doctors have health comorbidities such as the general population but their dire need of the hour forces them to push themselves to the brim, to give a new lease of life, and become the beacon of hope to thousands of helpless patients. Dealing with a severe health disaster associated with a high degree of uncertainty is an unchartered journey into the unknown at various levels thereby resulting in an overall negative experience.

Unintentionally, HCWs experience emotional exhaustion and are strained with unmanaged stress and physical fatigue, which may lead to medical fallacy, lack of compassion for treating patients, decreased productivity, and higher turnover rates which in turn have substantial implications on their comprehensive personal health, job performance, and mental well-being.[4] Are the "Gods with white coats" along with other health caregivers taken too much granted for everywhere? Is it not the time for us to awake and acknowledge the fact that HCWs are not completely invincible but highly and equally vulnerable? What is the "quick fix solution" in this scenario which can prevent them to feel completely overwhelmed with work and stretched to the fullest?.

There is only a handful of literature available on the health ramification of HCWs providing care to COVID-19 patients. No precise guide is available to date to lead the practitioners and the leaders on the various interventions which can be applied and their consequent efficacy in the long run because COVID-19 issues are more complex and "Byzantine" than just simple occupational jeopardy and most likely to linger on like a ripple effect even when the shockwaves of the crisis ebb down.[5] Hence, there is an increasingly pressing requirement to address this impact on an individual's mental state so that definitive proactive measures can be undertaken both at present times as well as in future epidemics and pandemics. Here is our study, which seeks to unearth some of the pertinent issues, with a particular emphasis on psychological and mental status evaluation, as well as a few proposed coping techniques.

  Materials and Methods Top

This was a cross-sectional, observational study conducted in English on medical, dental, and nursing from all over India. An online structured questionnaire was created, along with a consent form. It began on September 14, 2020, and concluded on September 24, 2020. The link to the questionnaire was emailed to the investigators' contacts through email and WhatsApp. Participants were automatically routed to brief information about the study and informed consent form after receiving and clicking the link. Once a consenting individual decides to participate, they are asked to provide demographic information before being asked to respond to a carefully constructed series of questions.


The entire survey was divided into three sections.

  • Brief information on study + Informed consent
  • Epidemiological data (Basic details)
  • Questionnaire.

The questionnaire, which consisted of 19 questions, was designed to determine the health-care professionals' awareness of the WHO guidelines, whether they were able to follow the guidelines formulated by experts, whether they suffered from any comorbid conditions, what were the red flags for their emotional paranoia, and measurement of their stress (if any) using a 5-point Likert scale, what could be the possible reasons for their perceived stress (if any), how did they cope up with the stressful conditions (if any) using COPE scale, and finally, what do the participants think that the respected authorities should have done to lessen down the stressful impact (if any). The research protocol for the study was approved by the Institutional Review Board (40/IRB/SIBAR/2020).

On piloting, it was unearthed that it takes downright 5 min to complete each form. Those forms with complete responses were accepted and finally analyzed. While collecting data, complete confidentiality and anonymity were maintained. It was assured that the interpretation of this study will be utilized for the sole purpose of our study and will not be disclosed for commercial purposes. The participants were given the option to opt out of the study if they did not want to submit the data midway through this survey. A total of 336 responses were recorded. Collected data were checked for completeness and consistency.

Sample size

The sample size was derived using the formula Z2PQ/d2 where Z = standard normal deviate – set at 1.96 at 95% confidence level, P = proportion of the study population (P = 50%), q = 1 – p, and d = degree of accuracy desired at 0.05. The study population was determined to be 500, yet we had a response rate of 67%.

Statistical analysis

All collected data were reviewed for completeness and consistency before being analyzed with IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. We computed descriptive statistics, independent t-test, and Chi-square test for variations between subcategories, Pearson correlation and one-way ANOVA were used to determine the relationship between the variables. P ≤ 0.05 was set as the level of statistical significance.

  Results Top

The demographic characteristics of study participants are shown in [Table 1]. The majority of the subjects are men (57.6%), and the majority of participants have 1–5 years of work experience (65.1%). [Table 2] demonstrates that medical (45.7%) and nursing (38.7%) HCWs use alcohol to cope with situations slightly more than dental (27.8%) HCWs (P = 0.01). Medical (1.6%) health-care participants cited negative feelings to preserve emotional balance, followed by nursing (0.9%) and dental (0.2%) HCWs (P = 0.03). In comparison to medical and dental health-care professionals, nursing (18%) HCWs try to devise a strategy to address the condition (P = 0.002).
Table 1: Distribution of study participants according to their demographic characteristics

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Table 2: Depicting cope up strategies among various health-care workers

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[Table 3] reveals that medical (4.23 ± 0.645) health-care personnel have higher mean stress levels than nursing (3.16 ± 0.458) and dental (2.2 ± 0.953) HCWs (P = 0.0001). In terms of work experience, 6–10 years (3.35 ± 1.13) have higher stress levels than 1–5 years and >10 years (P = 0.005).
Table 3: Illustrating the stress levels of various groups of health-care workers and their work experience

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[Figure 1] depicts the response rate among HCWs. Andhra Pradesh has the greatest response rate, followed by Tamil Nadu and West Bengal, whereas Bihar, Madhya Pradesh, Punjab, and Rajasthan have the lowest. [Figure 2] illustrates that the majority of HCWs feel uncertainty about the disease, and that a lack of health-care infrastructure is the source of their reported stress. [Figure 3] indicates that the majority of HCWs believed that the health authorities should build early support systems such as adequate supply of protective materials, family care services in their absence, and pretraining to reduce stress symptoms among health-care professionals.
Figure 1: State-wise distribution of health-care workers participated in the study

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Figure 2: Depicts reasons for perceived stress among various health-care professionals

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Figure 3: Role of health-care workers in stress management

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  Discussion Top

The unexpected discovery of COVID-19, followed by its sudden widespread transmission and declaration of a pandemic, has exacerbated worry and stress levels in communities worldwide, leading to mental health issues in individuals. We discovered that the COVID-19 pandemic has a considerable influence on HCWs in this investigation.

According to the study by Tam et al.,[6] fear of uncertainty or infection was at the top of the list of psychological obstacles they faced. Providing medical care during a global pandemic instills fear and raises stress levels, revealing that becoming infected was the most upsetting for more than 70% of those polled which is consistent with the findings of the present study (41.5%).

This study discovered a considerable prevalence of perceived stress of 86.9% among HCWs, which is consistent with the findings published by Mohamed et al. (2021).[7]

According to our findings, females perceived stress as more intense than males, which is consistent with the findings of Özçevik Subasi et al.,[8] Cai et al.,[9] and Babore et al.[10] This could be attributable to gender differences in psychological reactions and risk perception in public health circumstances.

In the current study, medical professionals report more stress from fatigue than dental and nursing professionals; this could be attributed to exhaustive work shifts, decreased hours of rest, excessive workload, autonomy, and lack of support from superiors. These findings contradict with those of a study conducted by Rose et al.,[11] which found that nurses experienced more stress from exhaustion than other health-care staff.

In the current study, the majority of respondents (65.1%) with 1–5 years of work experience reported more stress than those with more than 6 years of experience, which is similar with studies conducted by Alina et al. (2021)[12] and Elbay et al.[13]

In our study, 72.6% of respondents were optimistic about the shift and used active functional coping in the form of receiving emotional support from others, whereas 38.3% coped with this scenario by expressing their negative feelings, which is consistent with the findings of Rishi et al.[14]

Ministries of health, public health authorities, and enacting partners must all acknowledge the importance of a preventative strategy for preventing the emergence of psychological manifestations. Psychosocial support and effective measures must be widely available in a variety of modalities and levels, as well as tailored to the individual qualities of HCWs, to empower them in the crucial role they play in the fight against epidemics. It is also vital to ensure that HCWs are properly trained in the provision of care for COVID-19 patients, and that clear guidance/operational procedures exist for transmission training.

  Conclusion Top

The coronavirus 19 pandemic (COVID-19) has had a tremendous impact on India. The resulting uncertainty has put the general public's and health-care professionals' psychological resiliency to the test. While the primary focus is on laboratory testing, illness cure research, and disease prevention, all individuals are dealing with a slew of psychological issues as they adjust to new lifestyles and disease fears. This study uncovered a high pervasiveness of discerning stress among HCWs during the COVID-19 pandemic, which afflicted all workers despite demographic status.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Cabarkapa S, Nadjidai SE, Murgier J, Ng CH. The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain Behav Immun Health 2020;8:100144.  Back to cited text no. 1
Bai Y, Lin CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv 2004;55:1055-7.  Back to cited text no. 2
Lancee WJ, Maunder RG, Goldbloom DS; Coauthors for the Impact of SARS Study. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv 2008;59:91-5.  Back to cited text no. 3
Urdaneta F, Stacey M, Sorbello M. The adverse impact of COVID-19 on health care providers: Time to start measuring. Anesth Analg 2020;131:e187-9.  Back to cited text no. 4
Shaukat N, Ali DM, Razzak J. Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review. Int J Emerg Med 2020;13:1-8.  Back to cited text no. 5
Tam CW, Pang EP, Lam LC, Chiu HF. Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: Stress and psychological impact among frontline healthcare workers. Psychol Med 2004;34:1197-204.  Back to cited text no. 6
Aly HM, Nemr NA, Kishk RM, Elsaid NM. Stress, anxiety and depression among healthcare workers facing COVID-19 pandemic in Egypt: A cross-sectional online-based study. BMJ Open 2021;11:e045281.  Back to cited text no. 7
Özçevik Subaşi D, Akça Sümengen A, Şimşek E, Ocakçı AF. Healthcare workers' anxieties and coping strategies during the COVID-19 pandemic in Turkey. Perspect Psychiatr Care 2021;57:1820-8.  Back to cited text no. 8
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 (COVID-19) in Hubei, China. Med Sci Monit 2020;26:e924171.  Back to cited text no. 9
Babore A, Lombardi L, Viceconti ML, Pignataro S, Marino V, Crudele M, et al. Psychological effects of the COVID-2019 pandemic: Perceived stress and coping strategies among healthcare professionals. Psychiatry Res 2020;293:113366.  Back to cited text no. 10
Rose S, Hartnett J, Pillai S. Healthcare worker's emotions, perceived stressors and coping mechanisms during the COVID-19 pandemic. PLoS One 2021;16:e0254252.  Back to cited text no. 11
Danet Danet A. Psychological impact of COVID-19 pandemic in Western frontline healthcare professionals. A systematic review. Med Clin (Barc) 2021;156:449-58.  Back to cited text no. 12
Elbay RY, Kurtulmuş A, Arpacıoğlu S, Karadere E. Depression, anxiety, stress levels of physicians and associated factors in COVID-19 pandemics. Psychiatry Res 2020;290:113130.  Back to cited text no. 13
Rishi P, Acharya S, Das S, Sood A. Varying psychological impacts of COVID-19 and functional/dysfunctional coping strategies: A mixed-method approach. J Health Manage 2021;23:226-39.  Back to cited text no. 14


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3]


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