• Users Online: 64
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 42-46

Mental health problems during COVID-19 outbreak in social health-care workers in Karimnagar


Department of Psychiatry, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India

Date of Submission08-Apr-2021
Date of Decision19-Apr-2021
Date of Acceptance10-May-2021
Date of Web Publication18-Jul-2021

Correspondence Address:
Dr. Vishnu Vardhan Mavillapalli
Room No. 212, E Block, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar - 505 415, Telangana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_10_21

Rights and Permissions
  Abstract 


Introduction: The COVID-19 outbreak has created unpredictable stress physically and mentally in all sections of population. There is no exception for health-care workers being in frontline during this crisis period. Due to the virus rapid transmission and the pattern of clinical presentation, uncertainty, is created in the form of health emergency all over. There is a need to address mental health issues during this pandemic outbreak of COVID-19 in those who are in frontline.
Subjects and Methods: It is an observational cross-sectional study performed in social health-care workers (accredited social health activist [ASHA]) to know the psychological disturbances during COVID-19 outbreak. This study has been done in primary health centers located in and around Karimnagar City, Telangana. The scale used to perform this study is Depression, Anxiety, and Stress Scale of 21 questions.
Results: Out of 181 ASHA workers interviewed, majority of ASHA workers were at normal emotional states of depression (81.8%) and stress (91.2%), but about half (91, 50.3%) of them had moderate level of anxiety and 16 (9%) had severe anxiety level. Only 12 (6.6%) and 4 (2.2%) had moderate depression level, and stress level, respectively. Out of 91 ASHA workers who had moderate level of anxiety, only one had moderate level of depression and out of 16 who had severe level of anxiety, all of them had normal level of depression and stress.
Conclusion: Frontline health care workers experience psychological disturbances during pandemics like COVID-19 to a certain degree. Administrators should be aware that the mental health support of health care workers is an important part of the COVID- 19 response. Educational interventions, to ensure understanding and use of infectious control measures. Psychological support, like counselling services and development of support systems among colleagues.

Keywords: Accredited social health activist workers, COVID-19, health-care workers, mental health problems


How to cite this article:
Rachakatla SK, Porandla K, Krishna P S, Kumar N D, Mavillapalli VV, Pusukuri S, Sultana A. Mental health problems during COVID-19 outbreak in social health-care workers in Karimnagar. Telangana J Psychiatry 2021;7:42-6

How to cite this URL:
Rachakatla SK, Porandla K, Krishna P S, Kumar N D, Mavillapalli VV, Pusukuri S, Sultana A. Mental health problems during COVID-19 outbreak in social health-care workers in Karimnagar. Telangana J Psychiatry [serial online] 2021 [cited 2021 Dec 2];7:42-6. Available from: http://www.:tjpipstsb.org/text.asp?2021/7/1/42/321761




  Introduction Top


An accredited social health activist (ASHA) is a community health worker instituted by the government of India's Ministry of Health and Family Welfare (MoHFW) as a part of the National Rural Health Mission. ASHAs are local women trained to act as health educators and promoters in their communities. The Indian MoHFW describes them as health activist(s) in the community who will create awareness on health and its social determinants and mobilize the community toward local health planning and increased utilization and accountability of the existing health services.[1]

On January 30, 2020, the World Health Organization (WHO) announced the novel coronavirus and declared it a Public Health Emergency of International Concern (PHEIC), which is the sixth PHEIC under the International Health Regulations.[2] The novel coronavirus disease has rapidly spread, threatening the lives of millions of people, and has aroused attention all over making it a public health emergency worldwide. In late December 2019, the first case of COVID 19 was registered in Wuhan city, China, and by early January, it started spreading all over the world. On February 11, 2020, the novel coronavirus was officially named by the WHO as COVID-19. The pandemic not only brought a high mortality rate from the viral infection but also created mental catastrophe in the world.[3] Information so far suggests that most COVID-19 illness is mild and severe illness occurs in up to 16% of cases.[4] The uncertainty and unpredictability of COVID-19 through its clinical presentation, fast transmission pattern, and underprepared health facilities caused constant high levels of stress leading to mental health issues such as fear of contagion, anxiety, and stigma toward the disease of all people ranging from healthy to individuals at risk to care workers.[5] With the advent of COVID-19 in India, health workers have been under physical and psychological pressure including high risk of infection, inadequate equipment for safety from contagion, isolation, exhaustion, and lack of contact with family. During a crisis, similar to the COVID-19 pandemic, shortages of drug and life-saving equipment may occur.[6],[7] The severity of the disease had problems that not only affected health-care workers decision-making ability but also in long-term, it might have detrimental effects on their overall well-being. The unremitting stress experienced by health-care workers could trigger mental health issues such as anxiety, fear, panic attacks, stigma and avoidance of contact, depressive tendencies, sleep disturbances, helplessness, interpersonal social isolation from family, and concern regarding contagion exposure to their friends and family.[5] Similarly, Chong et al. reported a 75.3% overall prevalence of psychiatric manifestations (anxiety, depression, and sleep disturbances) in a population of health-care workers employed in a tertiary hospital during the severe acute respiratory syndrome coronavirus 1 outbreak. The frequency was even higher during the subsiding/control phase (80.6%) compared with the early phase (71.3%) of the epidemic. Hence, there is a need to impede health-care workers to seek counseling and psychotherapeutic interventions.[8] Institutional agencies and supervisors should be able to recognize the detrimental effects of the pandemic on health-care workers and should be willing to decrease working hours, apply flexible schedules, and clearly assign roles and responsibilities to equally distribute the workload.[9]

The first confirmed COVID-19 case in India was reported on January 30, 2020,[10] and by early March, the first case was reported in Telangana, COVID-19 started spreading rapidly thereafter all over Telangana, creating chaos in health-care system and people.[11] With the surge in the cases of COVID-19 in the country and the influx of migrant population from hotspot areas, one of the major challenges in the country was to cater to the health-care needs and arrest the spread in its rural population. ASHAs have played a critical role in supporting the health-care system in the management of COVID-19 during this crisis period.[12]

The purpose of this study is to identify depressive symptoms and anxiety symptoms and stress-related problems in the mid of this pandemic in health-care workers who are highly vulnerable to psychological distress.


  Subjects and Methods Top


The study was done in the early outbreak of COVID 19 in April and May in Karimnagar town, located in north Telangana; the sample was collected from six urban health centers and surroundings primary healthcare centre (PHCs) attached to the town which were Kothapally PHC, Manakondur PHC, and Thimmapur PHC. A total of 181 ASHA workers were included in the study, among them 35 workers are from Karimnagar, 65 from Kothapally, 60 from Thimmapur, and 21 from Manakondur PHC. They were explained regarding the purpose of the study, consent was obtained, and assured of confidentiality. Prior to the study, permission was obtained from district medical health officer and head of the department psychiatry and ethical committee of the college. In this study, each health-care worker was given a copy of semi-structured pro forma of sociodemographic data and Depression, Anxiety and Stress Scale-21 Items (DASS-21) Scale which has been translated into regional language for convenience; the sample was collected from those who attended to their respective PHC on the day of study.

Scale

The DASS-21 is a set of three self-report scales designed to measure the emotional states 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 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 summing the scores for the relevant items.[13]


  Results Top


Overall, 181 ASHA workers were interviewed. They work in different villages of Karimnagar district. Out of 181 ASHA workers, 174 (96%) were married and the other 7 (4%) were either widowed or divorced. Among them, 55% (99) were educated up to SSC and only 15% (27) had educational degree [Table 1].
Table 1: Demographic characteristics of accredited social health activist workers (n=181

Click here to view


Majority of ASHA workers were at within normal score limits of depression (81.8%) and stress (91.2%), but about half of them had moderate level of anxiety and 16 (9%) had severe anxiety level. Only 12 (6.6%) and 4 (2.2%) had moderate depression level and stress level, respectively [Table 2].
Table 2: Severity labels of scores for depression, anxiety, and stress of accredited social health activist workers (n=181)

Click here to view


Out of 91 ASHA workers who had moderate level of anxiety, only one had moderate level of depression and out of 16 who had severe level of anxiety, all of them had normal level of depression and stress (not shown in Table).

Percentages are rounded to nearest decimals.

Levels of anxiety and stress were not significantly different between married and widowed workers, but widowed/divorced ASHA workers had high level of depression (P < 0.01). ASHA workers with intermediate and degree education had higher scores of depression compared to those with SSC or education level below than SSC, whereas they were more anxious comparatively [Table 3].
Table 3: Association of marital and educational status with severity of scores for depression, anxiety, and stress of accredited social health activist workers (n=181)

Click here to view



  Discussion Top


By March 2020, the WHO declared COVID-19 a pandemic, pointing to over 110 countries and territories around the world suffering from this infectious disease.[14] The mental health effects of COVID-19 pandemic on health workers confront serious challenges. Health-care workers face threat to their life's working during these tough times and also news of death of their colleagues demoralizes them. The fear of becoming infected by COVID-19, lack of social support system, and high workload tend to increase mental health problems.[15]

Out of 181 ASHA workers, 55% (99) educated up to SSC and 15% (27) educated till degree, marital status: 174 (96%) were married and 7 (4%) were widowed. Majority of ASHA workers were at normal emotional states of depression (81.8%) and stress (91.2%), but about half of them had moderate level of anxiety and 16 (9%) had severe anxiety level. Only 12 (6.6%) and 4 (2.2%) had moderate depression level and stress level, respectively. Out of 91 ASHA workers who had moderate level of anxiety, only one had moderate level of depression and out of 16 who had severe level of anxiety, all of them had normal level of depression and stress.

The reason behind most of the health-care workers facing anxiety symptoms is because of lack of awareness about the pandemic, lack of equipment, and fear of getting infected. Medical health-care workers had a higher prevalence of anxiety even after adjustment for possible confounders. Reasons for this may include reduced accessibility to formal psychological support, less first-hand medical information on the outbreak, less intensive training on personal protective equipment, and infection control measures. As the pandemic continues, important clinical and policy strategies are needed to support health-care workers. Our study identified ASHA workers as a vulnerable group susceptible to psychological distress.

This study was performed early in the outbreak and only in Karimnagar, which may limit the generalizability of the findings. Follow-up studies could help assess for progression or even a potential rebound effect of psychological manifestations once the imminent threat of COVID-19 subsides. Our study highlights that health-care personnel are at highest risk for psychological distress during the COVID-19 outbreak. Early psychological interventions targeting this vulnerable group may be beneficial. Psychological crisis intervention plays a crucial role in health-care professionals to provide better services for the control of pandemic. National health commission along with mental health association has setup guidelines through print and electronic media to educate about the pattern of disease transmission, how to prevent the transmission of disease, and the importance of social distancing, personal hygiene, and self-discipline which would decrease distress in health-care social workers. Therefore, social health-care workers are no exception to mental health issues as they have the duty of community-level surveillance and care for the general population during this pandemic. They may face excessive workload, isolation, and are highly vulnerable to experience physical exhaustion, fear, depression, anxiety, and sleep problems. This study involves to identify social health-care workers who are at risk of mental health problems enable them for psychological intervention to promote social stability during this crisis period.

All social health workers should be made aware of some principles which promote emotional, physical, relational, and spiritual/religious wellness. These include the following:

  1. Ensure breaks and adequate sleep
  2. Keep in touch with relatives/friends
  3. Carry out some activities and hobbies unrelated to work
  4. Exercise regularly and have a healthy diet
  5. Practice relaxation exercises like yoga
  6. Religious activities (if you are a religious person)
  7. Make time for yourself and your family
  8. Focus on the long-term, ensure as much as training for their staff to fulfill roles
  9. Mix and match, ensure that juniors with limited experience work with their senior colleagues.


Ensure staff rotation from jobs of higher stress to lower stress and vice versa. Duty/shift breaks/holidays to be agreed upon within the team and ensured as far as possible. Ensure good quality communication along with accurate information updates. Have regular team meetings even if its brief, it helps to develop a “bond” and also to sort out issues that may emerge because of working in stressful situations. Team meetings may also be used to discuss common mental health issues that arise out of working under difficult circumstances (stress, burnout, anxiety, fear, etc.) and simple steps for psychological “self-care.”

If any of the team member is experiencing mental health difficulties, provide for a “buddy.” The “buddy” can be a senior colleague/workmate, who may be expected to talk and listen and provide common sense suggestions for mental health care. They can also be asked to report back if things deteriorate. “Buddy” should be made aware that all matters discussed are strictly confidential and to be shared on a need-to-know basis. All staff should be made to know of nearest specialist mental health service and access to its services.

Finally, refer any member who appears to have uncontrollable distress for assessment and intervention to the nearest specialist mental health service. The following are certain indications for mental health assessment:

  • Expressing suicidal ideas
  • Violent/aggressive behavior
  • Uncontrolled use of alcohol/drugs
  • Crying or expressing uncontrollable distress
  • Unexplained bizarre behavior like talking or smiling to self
  • Significant deterioration in occupational functioning.[16]



  Conclusion Top


Almost all frontline personnel in pandemics like COVID-19 are likely to experience psychological disturbances to a certain degree. Steps need to be taken proactively to ensure that it remains in control. Personnel should practise “self-care.” Health authorities should consider setting up multidisciplinary mental health teams at regional and national levels for dealing with mental health issues and providing psychological support to both patients and health-care workers. Team leaders should employ steps to minimize mental health difficulties. Administrators should be aware that the mental health support of personnel is an important part of the COVID-19 response. Most importantly, personnel requiring help should be identified and offered appropriate intervention to prevent negative consequences. Educational interventions should target health-care workers to ensure understanding and use of infectious control measures. Psychological support could include counseling services and development of support systems among colleagues.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ministry of Health and Family Welfare (MoHFW). About Accredited Social Health Activist (ASHA): National Health Mission. Available from: https://nhm.gov.in/index1.php?lang=1&level=1&sublinkid=150 &lid=226. [Last accessed on 2021 Apr 01].  Back to cited text no. 1
    
2.
-nCoV Outbreak is An Emergency of International Concern. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/international-health-regulations/news/news/2020 /2/2019-ncov-outbreak-is-an-emergency-of-international-concern. [Last accessed on 2021 Apr 01].  Back to cited text no. 2
    
3.
Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 2020;26:e923549.  Back to cited text no. 3
    
4.
Giannis D, Geropoulos G, Matenoglou E, Moris D. Impact of coronavirus disease 2019 on healthcare workers: Beyond the risk of exposure. Postgrad Med J 2021;97:326-8.  Back to cited text no. 4
    
5.
Dalal PK, Roy D, Choudhary P, Kar SK, Tripathi A. Emerging mental health issues during the COVID-19 pandemic: An Indian perspective. Indian J Psychiatry 2020;62:S354-64.  Back to cited text no. 5
    
6.
Fox ER, Sweet BV, Jensen V. Drug shortages: A complex health care crisis. Mayo Clin Proc 2014;89:361-73.  Back to cited text no. 6
    
7.
Cadogan CA, Hughes CM. On the frontline against COVID-19: Community pharmacists' contribution during a public health crisis. Res Social Adm Pharm 2021;17:2032-5.  Back to cited text no. 7
    
8.
Chong MY, Wang WC, Hsieh WC, Lee CY, Chiu NM, Yeh WC, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry 2004;185:127-33.  Back to cited text no. 8
    
9.
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.  Back to cited text no. 9
    
10.
Sahu KK, Mishra AK, Lal A, Sahu SA. India fights back: COVID-19 pandemic. Heart Lung 2020;49:446-8.  Back to cited text no. 10
    
11.
One Year Since First Case Recorded in Telangana; 2021. Available from: https://telanganatoday.com/one-year-since-first-case-recorded- in-telangana. [Last accessed on 2021 Apr 01].  Back to cited text no. 11
    
12.
COVID-19 BOOK OF FIVE: Response and Containment Measures for ANM, ASHA, AWW. Ministry of Health and family Welfare; 2020.  Back to cited text no. 12
    
13.
Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2nd ed. Sydney: Psychology Foundation; 1995.  Back to cited text no. 13
    
14.
Montemurro N. The emotional impact of COVID-19: From medical staff to common people. Brain Behav Immun 2020;87:23-4.  Back to cited text no. 14
    
15.
Zhu Z, Xu S, Wang H, Liu Z, Wu J, Li G, et al. COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. EClinicalMedicine. 2020;24.  Back to cited text no. 15
    
16.
Mental Health in the Times of COVID-19 Pandemic: Guidance for General Medical and Specialised Mental Health Care Settings. 1st ed. Bengaluru: Department of Psychiatry, National Institute of Mental Health and Neurosciences; 2020.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Subjects and Methods
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed208    
    Printed2    
    Emailed0    
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]