|Year : 2021 | Volume
| Issue : 2 | Page : 122-127
Stress and anxiety among medical interns and doctors deputed in COVID duties: A cross-sectional study
N Gyan Nihal, Prashanth Challuri, Mallepalli Pramod Kumar Reddy, Ravulapati Sateesh Babu
Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India
|Date of Submission||21-Jun-2021|
|Date of Decision||21-Jul-2021|
|Date of Acceptance||19-Oct-2021|
|Date of Web Publication||12-Jan-2022|
Dr. N Gyan Nihal
Department of Psychiatry, Mamata Medical College, Khammam, Telangana
Source of Support: None, Conflict of Interest: None
Background: In addition to the psychological aspects of the outbreak in the society, doctors and medical interns are subjected to additional stress due to direct involvement in the treatment of patients and increased risk of infection, fear of transmission to their closed ones, feeling stigmatized and rejected, and working under extreme pressure. On the flip side, physical and emotional burnout over time is caused by the increasing number of cases and disease-related fatalities, work overload for an extended period of time, and lack of Personal Protective Equipment (PPE). Stress and anxiety should also be focused among medical interns and doctors.
Aims and Objectives: The aim of this study is to assess stress and anxiety among medical interns and doctors posted in COVID-19 duties.
Materials and Methods: This cross-sectional study consisted a sample size of 373 participants comprised of doctors and medical interns posted in COVID duties across India. The samples were drawn using the convenience sampling method. Perceived stress scale-10 and generalized anxiety disorder– 7 scale were the tools used to collect the data for this study.
Results: Majority of the sample were under moderate stress (62.47%) and mild anxiety (34.58%). The mean score of stress and anxiety in the study was 21.14 (standard deviation [SD] = 7.452) and 8.44 (SD = 5.550), respectively, and found to be statistically significant.
Conclusions: Our study confirms that medical interns and doctors face moderate stress and mild anxiety while attending COVID duties and treating COVID-positive patients. The mental well-being of doctors and medical interns should be protected while fighting with a disaster that has a major impact on society globally.
Keywords: Anxiety, COVID-19, doctors, medical interns, stress
|How to cite this article:|
Nihal N G, Challuri P, Reddy MP, Babu RS. Stress and anxiety among medical interns and doctors deputed in COVID duties: A cross-sectional study. Telangana J Psychiatry 2021;7:122-7
|How to cite this URL:|
Nihal N G, Challuri P, Reddy MP, Babu RS. Stress and anxiety among medical interns and doctors deputed in COVID duties: A cross-sectional study. Telangana J Psychiatry [serial online] 2021 [cited 2022 Jan 17];7:122-7. Available from: http://www.:tjpipstsb.org/text.asp?2021/7/2/122/335638
| Introduction|| |
The world is currently under the control of a highly contagious mystery virus, the severe acute respiratory syndrome of coronavirus 2, which led to coronavirus disease in 2019 (COVID-19). The planet is being rattled with exponential deaths, the economy collapsed, and the health-care system disrupted. Initial quarantine was sloppy and unprepared which lead to an uncontrolled spread of the virus in India. Our health-care system is now overwhelmed as the virus spreads like wildfire. The soldiers in this war are the health-care workers who stand on the frontline and the doctors residents form the foundation of every health-care system.
Coronavirus disease 2019 (COVID-19) pandemic is currently a major global emergency for public health. By September 5, 2020, there were 2,61,71,112 confirmed cases and 865,154 people had lost their lives globally. In our country, there have been 3,936,747 confirmed cases of COVID-19 with 68,472 deaths.
A detailed list of 196 doctors who had lost their lives due to the novel coronavirus was submitted by Indian Medical Association (IMA), warned that these deaths were alarming. Majority of deaths were from Tamil Nadu with 43 deaths followed by Maharashtra (23 deaths), Gujarat (23 deaths), Bihar (19 deaths), Karnataka (15 deaths), Andhra Pradesh (12 deaths), and Delhi (12 deaths). According to IMA, of the 196 doctors expired due to COVID-19, 170 of them were above 50 years of age, with general practitioners comprising around 40% of the deaths.
Reports of physician deaths due to COVID not only signify the severity of the disease but also add to greater burden and distress, disproportionately on physicians.
Mental health professionals working with the airways, such as dentists, otorhinolaryngologists, and anesthesiologists, are particularly at risk for infection with COVID-19. In the study, this group accounted for 12% of all doctor deaths from COVID-19. Psychiatrists account for three per cent of physician deaths (6 deaths out of 198).
Issues relevant to mental health in doctors are not only the patient, but even the doctors are isolated and anxious about going home and potential of being sources of infection for their families, fear of becoming infected and isolated, fear of coming into contact and having to be quarantined, placing family members as well as other staff at risk of quarantine, fear of missing out and worry of how others will perform in their stead, the problems faced by households due to lockdown will get accentuated if the doctor needs isolation/quarantine and the fear of not using personal protective equipment (PPE) properly because of inadequate practice. People in the community stigmatize and fear that doctors may transmit the disease by working in COVID hospital.
Medical staff from all over India working with COVID-19 patients appealed to the Union Ministry of Health for aid stating that they are being harassed, and many of them were told by their landlords to immediately leave their rented accommodation because of fear that they might spread the disease.
Herein, we sought to evaluate the measures of stress and anxiety among doctors providing care for individuals affected by COVID-19.
| Materials and Methods|| |
This was a cross-sectional study conducted on 373 participants comprised of doctors and medical interns posted in COVID duties across India selected by convenient sampling. A semi-structured online questionnaire was developed, with a consent form attached to it. It started from August 1 to ended on August 24, 2020. The questionnaire link was sent to the investigators through WhatsApp and other social media. Upon receiving and clicking the link, participants were directed to the information about the study and informed consent. Once they accepted to take the survey, they filled up the demographic details such as age, sex, marital status, designation, accommodation, posted in ward or intensive care unit (ICU), any comorbidities. Then, a set of several questions appeared sequentially, which the participants were to answer. Participants who were not posted in COVID duties, with a history of psychiatric illness, health-care professionals other than medical interns, and doctors and participants not willing to give consent were excluded from this study.
Stress was assessed with 10-item questionnaire perceived stress scale (PSS). The PSS-10 asks participants about their feelings and thoughts over the last month using a five-point Likert scale (0 = never, 1 = almost never, 2 = once in a while, 3 = often, and 4 = very often). Internal reliability was good (α = 0.78). Scores ranging from 0 to 13 would be considered low stress, 14–26 would be considered moderate stress, and 27–40 would be considered high perceived stress.
The symptoms of anxiety were assessed with 7-item questionnaire, generalized anxiety disorder (GAD-7) scale. Participants rated their symptoms during the last 2 weeks on a 4-point scale (0 = not at all to 3 = almost every day). Ratings were summed with higher scores indicating increased anxiety. Internal reliability was good (α = 0.89). 5–9, 10–14, and ≥15 interpreted as mild, moderate, and severe levels of anxiety, respectively.
It was done using the SPSS software for the statistical analysis version 26 (IBM Corp., IBM SPSS Statistics for Windows, Armonk, NY, USA). Descriptive statistics were used for the demographic and clinical variables. Student t-test was done to verify the differences between the two categorical variables. One-way analysis of variance was done to verify the differences between more than two variables. Means for scales were calculated. P value was set at significance of <0.05.
| Results|| |
Majority of the sample were from the age group below 30 years (20–24 years and 25–29), unmarried (80.16%), females (53%), hostellers (54.96%). With regard to the designation, interns and junior residents majorly participated (about 73%) in this study. Maximum participants were posted in COVID wards (82.57%). Around 6% of the sample had comorbidities such as hypertension, diabetes, and chronic obstructive pulmonary diseases (COPD) [Table 1].
Significant high scores of stress were seen in the age group above 40 years (M = 29.1; standard deviation [SD] = 3.478), participants residing with their family (M = 22.23; SD = 7.512), posted in COVID ICU (M = 22.91; SD = 5.989) and with comorbidities (M = 26.24; SD = 6.685). High scores were observed in females, married and in associate professors/professors but found to be not significant [Table 2] and [Figure 1].
|Table 2: Stress among various variables based on Perceived Stress Scale scores|
Click here to view
Significant high scores of anxiety were seen in the age group above 40 years (M = 15.2; SD = 1.686), participants residing with their family (M = 9.66; SD = 5.725), professors/associate professors by designation (M = 12; SD = 5.598), and with comorbidities (M = 11.52; SD = 4.676). High scores were observed in females, married and in COVID ICU but found to be not significant [Table 3] and [Figure 1].
|Table 3: Anxiety among various variables based on generalized anxiety disorder scores|
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Stress and anxiety
Majority of the sample were under moderate stress (62.47%), 24.3% were under severe stress and 13.40% under mild stress. With regard to anxiety, majority of the sample were under mild anxiety (34.58%), 23.86% were under moderate anxiety, and 15.82% were under severe anxiety. The mean score of stress and anxiety in the study was 21.14 (SD = 7.452) and 8.44 (SD = 5.550), respectively, and found to be statistically significant [Table 4].
| Discussion|| |
Our study showed that severe stress and severe anxiety in the age group above 40 years as the severity and fatality of the COVID are higher in the elderly.
Our study showed moderate stress in participants with regard to accommodation though stress was higher in participants residing with family and moderate anxiety significantly.
Anxiety was higher in professors followed by assistant professors, interns, medical officers, senior resident, and junior residents. This could be due to age and associated comorbidities causing anxiety in professors. Stress was not significant with regard to the designation.
Stress was significantly higher in participants posted in ICU rather than wards. Anxiety was had also followed the same pattern but was not significant. This could be due to a high workload, long-term fatigue, risk of infection, and frustration with the death of their patients. They not only face anxiety but also misunderstanding from patients and their families. ICU is a high-stress environment where decisions about end-of-life care are made.
Participants with comorbidities such as hypertension, diabetes, and COPD had significantly higher stress than those without it although it was under moderate stress category but moderate anxiety was seen in participants with comorbidities, whereas mild anxiety was seen in subjects without comorbidities and found to be significant. People of any age who have underlying medical conditions, such as hypertension and diabetes, have shown worse prognosis. People with COPD or any respiratory illnesses are also at risk for severe illness from coronavirus.
Acute shortage of PPE, N95 masks, and training programs that are crucial to protect from COVID-19. Densely populated outpatient departments and the lack of staff to ensure physical distancing are disturbing in many places. Other shortcomings include lack of effective leadership, communication gap, and inadequate infection control practices. This led to a state of helplessness, frustration, fear, panic, and anxiety, resulting in low morale among resident doctors.
Our study confirms the concerns about psychological well-being of medical interns and doctors and indicates 13.4% had mild stress, 62.4% had moderate stress, and 24.13% had severe stress, whereas 34.5% had mild anxiety, 23.86% had moderate anxiety, and 15.82% had severe anxiety.
Our study confirms that stress and anxiety were significantly correlated with each other.
Lai, et al. study earlier this year reported that out of 493 doctors, 59.4% were considered normal and 29%, 6.9%, and 4.7% were considered mild, moderate, and severe anxiety, respectively, among doctors treating COVID-19 patients in China.
Wilson et al. study on doctors and nurses involved in triage, screening, diagnosing, and treatment of COVID-19 patients had reported the prevalence of mild, moderate, and severe stress as 17.4%, 78.9%, and 3.7%, respectively, assessed with PSS-10, whereas the prevalence of mild, moderate, and severe anxiety as 48.6, 13.7, and 4%, respectively, assessed with GAD-7 among doctors treating COVID patients. The questionnaires used in their study were similar to our study, but their study did not involve medical interns. Their study suggested that the COVID-19 has not affected the psychological well-being of the health-care professionals in India.
Our study suggests higher stress and anxiety compared to previous studies. This may be due to the period of the study. Although the government denies community transmission, experts claim there are several cases currently where the source of infection cannot be traced-proof that “full-blown” community transmission is happening in India. West Bengal and Kerala accepted community transmission in their states. As the cases are on a hike which causes burden on medical interns and doctors demanding extra hours to work from them, no quarantine period, reusing PPE and increased susceptibility to COVID which again results in increased stress and anxiety.
Assessment of stress and anxiety in our study was based on the self-report tools. Both scales used in this study (PSS-10 and GAD-7) are on generalized context, no COVID-19 specific scale or items used to attribute the study findings on COVID-19. Furthermore, our study was conducted during a critical period of the COVID-19 pandemic in India when cases were still rising. Although the responses were taken from various colleges across the country, the sample size is still small with the number of medical interns and doctors posted in COVID duties across the country and responses maximum received were from Andhra Pradesh and Telangana. The findings may not represent the overall medical interns and doctors posted in COVID duties during the time of this study. This also being a cross-sectional study and convenience sampling method.
Despite the limitations, this is the first study to analyze stress and anxiety among medical interns and doctors exclusively in COVID duties providing care for individuals affected by COVID-19 to the best of our knowledge.
| Conclusions|| |
Our study suggests that medical interns and doctors face moderate stress and mild anxiety while attending COVID duties and factors such as age, accommodation, posting, and comorbidities might play a significant role in stress and anxiety.
It is necessary to implement strategies to mitigate psychological distress and provide psychosocial support to medical interns and doctors who are posted in COVID duties. Further research is needed to assess the long-term impact of such an outbreak on mental health of medical interns and doctors posted in COVID duties as well as effectiveness of interventions to improve their psychological well-being.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]