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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 134-137

Posttraumatic stress symptoms in health-care workers treating COVID-19 crisis: A cross-sectional descriptive study


Department of Psychiatry, Kakatiya Medical College, Warangal, Telangana, India

Date of Submission29-Nov-2021
Date of Decision01-Dec-2021
Date of Acceptance02-Dec-2021
Date of Web Publication12-Jan-2022

Correspondence Address:
Dr. Gireesh Kumar Miryala
Kakathiya Medical College, Warangal, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjp.tjp_42_21

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  Abstract 


Background: Severe acute respiratory syndrome (SARS-COVID 19) pandemic had much impact on both physical and psychological aspects. In order to assess the posttraumatic stress disorder (PTSD) symptoms among the health-care workers (HCWs), the study has been made.
Methodology: A cross-sectional study was conducted among 96 HCWs. The sociodemographic characteristics such as age, gender, department, and designation were collected using a standardized questionnaire. Posttraumatic stress symptoms were assessed using a self-administered PTSD checklist.
Results: The mean severity score of PTSD symptoms was 38.5 (12.9). There was a positive correlation between age and the severity score assessed using the PTSD checklist. There was also significant difference between the departments and total score with the P = 0.02.
Conclusion: It denotes that the HCWs were in moderate level of stress in the pandemic. It also shows that, among postgraduate students as their years of experience increased, PTSD score also increased.

Keywords: Healthcare workers, posttraumatic stress disorder, stress


How to cite this article:
Reddy GS, Kumar B P, Puttala S, Miryala GK. Posttraumatic stress symptoms in health-care workers treating COVID-19 crisis: A cross-sectional descriptive study. Telangana J Psychiatry 2021;7:134-7

How to cite this URL:
Reddy GS, Kumar B P, Puttala S, Miryala GK. Posttraumatic stress symptoms in health-care workers treating COVID-19 crisis: A cross-sectional descriptive study. Telangana J Psychiatry [serial online] 2021 [cited 2022 Aug 9];7:134-7. Available from: https://tjpipstsb.org/text.asp?2021/7/2/134/335646




  Introduction Top


Severe acute respiratory syndrome (SARS-COVID-19) is an infectious disease caused by virus belonging to coronavirus family. The outbreak of SARS-COVID19 was initially noticed in Wuhan city of China in mid-December 2019, and it was declared as “Public Health Emergency of International Concern” on January 30, 2020. Subsequently, COVID-19 was declared as pandemic on March 11, 2020 by the WHO.[1]

In India, the pandemic was reported in Kerala on January 30, 2020 and it is in an increasing trend since then. In India, according to records, as per May 27, 2020, the total number of confirmed cases were 1,31,868 and total deaths were 3867. The pandemic crisis hit India to a great extent through human transmission, and hence Government of India has proposed many guidelines according to the WHO.[2] As there is no effective medical intervention related to SARS-COVID-19, educating people and counseling them regarding the preventive measures is an effective strategy to control the pandemic.[3]

Where the global pandemic is concerned with the direct impact of SARS COVID-19 among the victims, the pandemic casualty has made dramatic change on the psychosocial effects on community. Considering the psychosocial impact during the pandemic, health-care workers (HCWs) are the most affected.[4] HCWs have not only faced stress physically but also psychologically.[5] These aspects can trigger psychopathologies such as acute stress disorder and posttraumatic stress disorders (PTSDs).[6] HCWs have been challenged with unprecedented demands, both professionally and personally with efforts to manage the patients without patients without definitive treatment protocols during the initial outbreak.[7] In view of this, the study was made to assess the PTSD symptoms among the HCWs.

Aims and objectives

Among the health care dealing with the COVID-19 pandemic, (1) to assess the PTSD symptoms among the HCWs.


  Methodology Top


This was a cross-sectional descriptive study. The study was conducted among the HCWs, in tertiary health care centers of Telangana between May and June 2021. All the HCWs consenting and total 96 participants were included in the study. Written consent from the participants was obtained after explaining the purpose and procedure of the study in detail. The participants were interviewed using a pretested questionnaire consisting of questions on sociodemographic characteristics such as age, gender, designation, and department they were working. Posttraumatic stress symptoms were assessed using PTSD checklist-civilian version; it comprises 17 items that correspond to the key symptoms of PTSD. It is self-administered questionnaire with 5-point Likert scale responses. The number of professionals to be interviewed per day was based on the availability of study participants. Each participant was given a unique id number to keep their identity confidential. Data were collected and entered in Microsoft Excel analyzed using IBM SPSS software version 20, Kakatiya Medical College, Warangal, Telangana. Continuous variables such as age were categorized and analyzed for the descriptive analysis. For outcome variable, the 17 items were added up for the severity score ranging between 17 and 85 (17–29 denotes little to no severity, 28–29 denotes some PTSD symptoms, 30–44 denotes moderate to moderately high severity of PTSD symptoms, and 45–85 denotes high severity). Association between the outcome variables and independent variables was tested for statistical significance using independent sample t-test and one way Analysis of variance test. Correlation was assessed between the two continuous variables.


  Results Top


Among 96 participants, who were included in the study, the mean age of the study population was 27.5 (3.8) years. The participants were equally proportionate between the genders. All of the study participants were the postgraduate students, of which 42.7% of them were in 1st year of postgraduation, 27.1% of them were in 2nd year of postgraduation, and 29.2% were in their 3rd year of postgraduation. Around 50% of the participants were from anesthesiology department. The rest of them were proportionate between general medicine and pulmonology [Table 1].
Table 1: Sociodemographic characteristics of the study population (n=96)

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The mean score of the PTSD checklist was 38.5 (12.9) where the mean severity score of postgraduate student was 37.5 (12.1), 35.8 (10.5), and 43.1 (15.1) among 1st year, 2nd year, and 3rd year, respectively. It also shows that there is no significant difference between the groups and within the groups among the designation and total severity score.

The mean score of the PSTD score was 41.0 (15.2), 32.3 (10.1), and 40.3 (11.9) among the participants who were in the department of general medicine, pulmonology, and anesthesiology, respectively.

While comparing the gender to total severity score, male and female population had scores of 38.8 and 38.2 respectively. The severity score between the gender does not show any difference [Table 2].
Table 2: Stratified score of the mean severity score of posttraumatic stress disorder among various sociodemographic characteristics (n=96)

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Correlation to age, gender, designation, and department with total score indicates that there is no significant correlation between age and total severity score. While comparing with help of spearman correlation, it denotes that there was a significant correlation between the total severity score and the various departments [Table 3].
Table 3: Correlation between the various characteristics and posttraumatic stress disorder score (n=96

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  Discussion Top


The hospital-based study was conducted among the HCWs in order to assess their PTSD symptoms during this pandemic situation. The PTSD symptoms were assessed using PTSD checklist in this study. The current study reports that the mean score of the PTSD symptoms was 38.5 (12.9) which denotes that the study participants were in moderate-to-high severity of PTSD symptoms. Comparing the findings with other sociodemographic details, it is found that, as the age increased the level of severity score also increased. A study (Raj et al.), where 300 HCWs were included and assessed for psychological impact, it demonstrated significant high levels of depression, anxiety, and insomnia.[4]

When the study was compared with the study conducted in Singapore by Benjamin et al., where 470 HCWs were included showed 36 participants (7.7%) of the total group had symptoms of PTSD. Thus, it indicates that HCWs are at a risk of 1.85 times of getting psychological issues compared with non-HCWs.[8]

Attempt was made to find the severity score with other characteristics such as gender, designation, and department. It denotes that gender does not have much impact toward the total severity score in this study. The mean score of both male and female was 38 which is also similar to our total mean PTSD score. While considering the designation with years of postgraduation, it denotes that HCWs who are in 3rd year of postgraduation were at a high level of stress compared with others with the mean and standard deviation of the score of 43.1 (15.1). It also indicates that the person who were in 2nd year and 1st year were with similar score such as 37.5 (12.1) and 35.8 (10.5), respectively.

A systemic review (by Cabarkapa et al.) that included 55 studies suggested that HCWs had higher psychological implications and had increased risk of acquiring trauma or stress-related disorders, depression, and anxiety.[9] Another systemic review (by Danet) that included various studies from different countries on psychological impact on HCWs implicated high levels of stress, depression, anxiety, and insomnia in cases of direct contact with infected patients.[10]

A study (by Chatterjee et al.) that was conducted during early phase of COVID 19 in India that included 140 HCWs suggested that doctors had higher levels of psychopathologies, stress, and insomnia among HCWs.[11] A study (By Bashar et al.) shows health-care professionals dealing with COVID 19 were under high psychological pressure and experience higher rates of psychiatric morbidity, resembling situation of SARS and H1N1 epidemic.[12]

When comparing the mean score with the various departments it denoted that, participants who were from general medicine and anesthesiology has similar mean score such as 41.0 (15.2) and 40.4 (11.9), respectively. With the post hoc test, it shows a significant difference between the department such as general medicine and the pulmonology.

It also implies that there is no significant difference between the mean scores of genders and various departments. In correlation between the other socio demographic characteristics, stress increased as the age increased and the correlation also shows that there was a significant difference among the scores in various departments and various level of designation.

Implication of the study

This study during the pandemic reveals the psychological impact of the HCWs, hence it could help understand and motivate HCWs to obtain the future goals.

Strength

  1. As the study was conducted during the pandemic, recall bias has been eliminated
  2. Postgraduates of departments who have had immense work pressure and were subjected to witnessing utmost deaths (compared to previous noncovid duties) were included in the study.


Limitations

  1. As the study consisted of postgraduate students, other HCWs such as nurses and ground level workers were not taken into consideration
  2. As the sample included only postgraduate students of General Medicine, Pulmonology and Anesthesiology departments, rest of postgraduates of other departments were excluded.



  Conclusion Top


It indicates that the HCWs were at a moderate level of stress in the pandemic. It also shows that, among postgraduate students as their years of experience increased PTSD symptoms score also increased. It also denotes that the participants who were in the department of general medicine and anesthesiology had higher level of stress. Age and level of stress were also positively correlated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int. [Last accessed on 2021 Jul 08].  Back to cited text no. 1
    
2.
Coronavirus Disease (COVID-19) Situation Reports. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. [Last accessed on 2021 Jul 08].  Back to cited text no. 2
    
3.
India Country Overview | World Health Organization. Available from: https://www.who.int/countries/kaz. [Last accessed on 2021 Jul 08].  Back to cited text no. 3
    
4.
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.  Back to cited text no. 4
  [Full text]  
5.
Si MY, Su XY, Jiang Y, Wang WJ, Gu XF, Ma L, et al. Psychological impact of COVID-19 on medical care workers in China. Infect Dis Poverty 2020;9:113.  Back to cited text no. 5
    
6.
Selvaraj P, Muthukanagaraj P, Saluja B, Jeyaraman M, Anudeep TC, Gulati A, et al. Psychological impact of COVID-19 pandemic on health-care professionals in India – A multicentric cross-sectional study. Indian J Med Sci, doi 10.25259IJMS_193_2020.   Back to cited text no. 6
    
7.
Asnakew S, Amha H, Kassew T. Mental health adverse effects of COVID-19 pandemic on health care workers in north west Ethiopia: A multicenter cross-sectional study. Neuropsychiatr Dis Treat 2021;17:1375-84.  Back to cited text no. 7
    
8.
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.  Back to cited text no. 8
    
9.
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. 9
    
10.
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. 10
    
11.
Chatterjee SS, Chakrabarty M, Banerjee D, Grover S, Chatterjee SS, Dan U. Stress, sleep and psychological impact in healthcare workers during the early phase of COVID-19 in India: A factor analysis. Front Psychol 2021;12:611314.  Back to cited text no. 11
    
12.
Bashar MA, Bammidi R. Psychological impact of COVID-19 pandemic on health care professionals and workers. Ind Psychiatry J 2020;29:176-9.  Back to cited text no. 12
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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