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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 1  |  Page : 47-53

A cross-sectional survey of psychosocial effects of COVID-19 on doctors working in a tertiary care hospital


Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

Date of Submission31-Mar-2021
Date of Decision17-May-2021
Date of Acceptance14-Jun-2021
Date of Web Publication18-Jul-2021

Correspondence Address:
Dr. Shankar Kumar
Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru - 560 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_6_21

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  Abstract 


Background: The novel coronavirus disease (COVID-19) outbreak has made great psychological impact on the medical fraternity. Concerns such as fear of infection and inadequate PPE can lead to psychological distress impairing functioning.
Aims: The aim of the study was to assess psychosocial effects among doctors working with COVID-19 patients and to study the association of these concerns with psychological distress.
Settings and Design: It was a cross-sectional study conducted among 150 doctors in a tertiary care hospital treating COVID-19 patients for a period of 2 months.
Materials and Methods: A pro forma containing sociodemographic details, concerns regarding COVID-19 and perceived needs that could reduce stress among the doctors, Depression Anxiety and Stress Scale 21 was sent using Google Forms to consenting doctors. Data were entered on SPSSv20. Data were analyzed using Chi-square test to compare concerns, univariate and multivariate logistic regression was done to predict stress using concerns.
Results: Out of 150 doctors, 53 (35.33%) were male and 97 (52.67%) were female. The main concerns were fear of infecting colleagues and family members (55.33%), not getting adequate support from the management (47.33%), fear of infecting themselves (22%), and fear of death (22.66%). Working as a team (76.67%), provision of adequate PPE (63.33%), positive attitude of colleagues (62.67%), recognition of work by the management (58.67%), provision of adequate training (56.67%), and family support (53.33%) were the main perceived needs of the doctors which could reduce stress. Those with “high stress” significantly had greater helplessness, loneliness, and feeling avoided by people and fear of death due to COVID-19 (P: 0.05, 0.001, 0.002, and 0.01, respectively).
Conclusions: The chief concerns among doctors working in COVID hospitals were regarding safety (infecting family members) and stigma and discrimination by the society. Factors which they perceived would reduce stress were working in a team, social support, and provision of safety measures by administration/management.

Keywords: COVID-19, emotions, fear, mental disorders


How to cite this article:
Kota S, Kumar S, Kayarpady A, Gopal A, Prashanth N R. A cross-sectional survey of psychosocial effects of COVID-19 on doctors working in a tertiary care hospital. Telangana J Psychiatry 2021;7:47-53

How to cite this URL:
Kota S, Kumar S, Kayarpady A, Gopal A, Prashanth N R. A cross-sectional survey of psychosocial effects of COVID-19 on doctors working in a tertiary care hospital. Telangana J Psychiatry [serial online] 2021 [cited 2021 Dec 2];7:47-53. Available from: http://www.:tjpipstsb.org/text.asp?2021/7/1/47/321774




  Introduction Top


The novel coronavirus disease (COVID-19), since its origin in December 2019 in the Hubei province of China, is spreading worldwide and was declared as a pandemic in March 2020. The outbreak has caused severe respiratory and other medical health problems. In addition to this, it has also caused great impact on mental health among general population, more so among medical professionals who work in COVID-19 care team.

In the fight against the 2019 novel coronavirus (2019-nCoV), it was described that medical workers in Wuhan faced enormous pressure including a high risk of infection and inadequate protection from contamination, overwork, frustration, discrimination, isolation, patients with negative emotions, a lack of contact with their families, and exhaustion.[1]

COVID-19, apart from affecting the health, safety, and well-being of individuals and communities, is causing distress and a wide variety of psychological reactions which can overwhelm health-care workers who are at the frontline of managing the pandemic. Factors associated with increased distress in health professionals include the perception of increased death from infection, living with family, being treated differently by people, and inability to do one's job because of precautionary measures.[2] Health-care professionals dealing with COVID-19 are under increased psychological pressure and experience high rates of psychiatric morbidity, resembling the situation seen during the SARS and H1N1 epidemics.[3],[4],[5] A very recent study among health-care professionals in a tertiary infectious disease hospital for COVID-19 in China revealed a high incidence of anxiety and stress disorders among frontline medical staff.[3],[6] There is a dearth of evidence from India regarding the concerns of health-care workers and the perceived needs that could help in decreasing psychological distress. This is important to study as it can help in devising management strategies to decrease stress* and improve the quality of life among health-care workers. Hence, the study was conducted with the following aims and objectives:

  1. To assess the psychosocial effects on personal and professional life of doctors working with COVID-19 patients
  2. To study the association of these psychosocial effects with psychological distress among the doctors working for COVID-19.


Note: *by stress, we mean distress throughout the article.


  Materials and Methods Top


Materials

It was a cross-sectional study conducted among doctors who worked with COVID-19 patients in a tertiary care teaching hospital in India for 2 months. The study setting was a government hospital, and the study sample consisted of predominantly junior doctors and postgraduates with 1–5 years of service. The hospital was converted into an exclusive COVID treatment facility during the time of assessment. Most of the postgraduates and junior doctors had minimal family responsibilities. The Institutional Ethical Clearance was obtained for the study. Snowball technique was used to contact frontline doctors treating COVID-19 patients. Using the formula 4pq/d2, the total number of participants required for the study was 150. The study was conducted using a survey link through Google Forms which was sent to doctors on Whatsapp platform. The first page of the study pro forma included an informed consent form which the study sample had to consent.

Inclusion criteria

  • Doctors who are involved in treating COVID-19 patients
  • Participants willing to give informed consent for the study.


Exclusion criteria

  • Doctors who are not frontline workers.


The tools which were used in the study were:

  • A semi-structured pro forma was designed for the study which contained the following details: sociodemographic data, past and family history of psychiatric illness and medical illness, concerns among the doctors, and perceived needs that could reduce stress. A specific questionnaire was designed to assess concerns and perceived needs based on original articles and reviews using search words “Concerns and stress among doctors/healthcare workers dealing with COVID-19.” It was administered to a small group of doctors working with COVID-19 patients and was again modified based on their feedback. [Annexure 1] shows the questionnaire containing the list of the concerns among doctors regarding COVID-19 and Annexure 2 shows the list of factors (perceived needs) that would reduce the stress among doctors. There were 12 questions regarding concerns. Questions 1, 2, 3, 6, 7, 9, and 10 [Annexure 1] had responses which had to be rated on a 1–5 Likert scale as “ Not at all, Little bit, Sometimes, Often, and Always.” The instructions for scoring were as follows:


  • Not at all: If it never occurred during the past month.

    Little bit: If it occurred on less than half of the occasions during the past month.

    Sometimes: If it occurred around half of the occasions during the past month.

    Often: If it occurred more than half of the occasions but not always during the past month.

    Always: If it occurred on all the occasions during the past month.

    The remaining questions 4, 5, 8, 11, 12 had responses as either “yes” or “no.”

  • There were 11 perceived needs or factors that could reduce the stress among doctors which had to be scored as “Yes/No” [Annexure 2]
  • Depression Anxiety Stress Scale 21: This scale contains 21 items which is used to assess the psychological symptoms. It is a screening tool which mainly assesses stress, anxiety, and depression.[7] It is a self-report tool and has good reliability and construct validity.[8]



Methods

The doctors fulfilling the inclusion criteria were enrolled into the study. The participants were informed about the objectives and potential benefits of the study, and an informed consent was taken to participate in the study which was included in the Google Forms after agreeing to which the participants were able to proceed. A semi-structured questionnaire containing sociodemographic data, past and family history of psychiatric illness and medical illness was filled up by each participant. We had a list of frontline doctors to whom the questionnaire was sent through Google Forms link, and confidentiality of the participants was ensured. An option for contacting the primary investigator for help was offered, and the contact details of primary investigator were provided.

Statistical analysis

The data collected were analyzed using SPSSv20 IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. We used Chi-square test for association of concerns with Student's t-test to compare means of anxiety and depression between those with and without severe stress. Univariate and multivariate logistic regression was used to predict stress using concern variables. P ≤0.05 was assumed for statistical significance.


  Results and Discussion Top


This was a cross-sectional study which examined the concerns and perceived needs likely to reduce stress among doctors working in a COVID-19 hospital.

One hundred and fifty doctors were included in the study. Out of 150, 53 (35.33%) were male and 97 (52.67%) were female. Fifty-eight (38.67%) doctors were married and 92 (61.33%) doctors were staying without family in our study. The mean working hours of the doctors were 121.56 h per month. In our study, 7% of population had a history of psychiatric illness and 10% of population had a family history of psychiatric illness, the rates of which are similar to the general population.[9] Most of the doctors who participated in our study were young, unmarried (80.67%) and were staying without family (61.33%). This could be explained by the fact that the study was conducted in a teaching hospital and most of our participants were postgraduates [Table 1].
Table 1: Sociodemographic characteristics of population

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In this study, we found that more than half of the population (55.33%) had fear of infecting colleagues and family members, 22% had fear of infecting themselves, 22.66% had fear of death due to COVID-19, and 14.67% felt helpless while treating COVID-19 patients [Table 2]. A study by Nickell et al. in 2004 which measured psychosocial effects of SARS on hospital population also reported around 65% of the study population reporting SARS-related concerns for their own or family's health.[2] These concerns are understandable as COVID-19 is associated with multiple short- and long-term uncertainties such as morbidity, mortality, lack of clear-cut treatments available, and rapidity of spread of the disease. Around 38% of doctors were not able to do their job satisfactorily because of PPE. This could be due to suffocation, dehydration, and fatigue that could reduce work efficiency. We also found that 24.67% felt loneliness during duty, 29.33% felt they are working overtime, and 47.33% felt not getting adequate support from the management/administration. Hence, this unprecedented situation necessitates the need for greater support from close ones and especially administration to decrease loneliness. Nearly 12% of doctors felt they were avoided by the people in the society. These findings in our study were consistent with many existing studies which have mentioned about such concerns and its association with stress.[10],[11],[12],[13],[14],[15],[16]
Table 2: Concerns regarding coronavirus disease 2019

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In spite of all these uncertainties and concerns, we found that doctors who worked in COVID-dedicated hospitals were proud to be a part of COVID-19 team (92%) and around 76.67% never regretted for joining medical profession. This could reflect positive coping strategies such as positive reframing and active coping among the doctors. Studies have also mentioned factors such as confidence in safety, risk perception, and confidence in skills are proven facilitators for willingness to work.[3],[17] The increasing knowledge about preventing and dealing with the disease, and the development of more specific procedural and treatment protocols, alongside educational activities, will contribute to improving the morale of health-care workers dealing with the pandemic.[3]

In this study, the most common factors or perceived needs that could help doctors reduce stress and improve their work efficiency were working as a team (76.67%) followed by provision of adequate PPE (63.33%), positive attitude of colleagues (62.67%), adequate nutrition (61.33%), any recognition of work by the management (58.67%), provision of adequate training (56.67%), family support (53.33%), financial compensation to family in case of disease related death at work (40.67%), psychiatry therapy made available at work (33.33%), and opportunities to ventilate (30.67%) [Table 3]. It is postulated that positive social support of high quality can significantly enhance resilience to stress and help protect against trauma-related psychopathology.[18] Working as a team thus could enhance social support and promote resilience. It is also studied that health-care professionals' motivation and morale is significantly improved when they perceive that their efforts are recognized and reciprocated by employers and authorities in these ways.[13],[19],[20] Thus, positive attitude of colleagues and recognition of work could help in mitigating stress. In addition to this, risk perception could be lowered by management's efforts in reducing self-infection/cross-contamination and in providing safe and efficient donning and doffing of PPE among health-care workers.[21]
Table 3: Factors likely to help in reducing stress

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Mean scores of stress, anxiety and depression in the study population were 10.66, 9.04 and 8.62 respectively. [Table 4]. We also found that those with “high stress” significantly had higher helplessness, loneliness, feeling avoided by people, and fear of death due to COVID-19. Those with “high stress” also had higher symptoms of anxiety and depression [Table 5] and [Table 6]. Multivariate logistic regression also identified loneliness during duty and stigma of being avoided by people were associated with higher odds of severe stress [Table 7]. These concerns could be associated with higher risk perception and poor coping among doctors treating COVID patients which could lead to psychological distress and these findings were similar to many existing studies.[14],[22],[23]
Table 4: Mean scores of stress, anxiety, and depression among coronavirus disease doctors

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Table 5: Comparisons of concerns between those with and without high stress

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Table 6: Comparisons of anxiety and depression between those with and without high stress

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Table 7: Univariate and multivariate logistic regression to predict stress using concern variables

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Strengths and Limitations

In addition to assessing concerns of doctors, we also made an attempt to identify perceived needs which would reduce stress. We also assessed stress and its association between concerns and psychological symptoms. As confidentiality was ensured, there was a sufficient response from the study population.

We also have limitations in our study. This study was cross sectional in nature, and since it was an online survey, subjectivity in answering could not be avoided. Although we assessed concerns and psychological symptoms, a systematic assessment of psychiatric disorders was not made. Socio-occupational functioning was not assessed in detail.

Implications of the study

Doctors treating COVID-19 patients face enormous stress which is associated with multiple concerns. It is important to identify and address the concerns and perceived needs of these doctors as it can help in mitigating psychological distress. Mental health professions should form an integral part of the treatment team and devise strategies to decrease psychological symptoms which could translate into better work efficiency and quality of life of these doctors.


  Conclusions Top


The chief concerns among doctors working in COVID hospitals were regarding safety (infecting family members) and stigma and discrimination by the society. They also experienced significant loneliness and helplessness all of which was associated with higher stress levels. Factors which they perceived would reduce stress were working in a team, social support, and provision of safety measures by administration/management.

Ethics

Ethical committee approval is taken from the Institution.

Acknowledgment

Dr. Chandrashekar H, Professor and Head of the Department, Department of Psychiatry, Bangalore Medical College and Research Institute for his intellectual inputs in designing the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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