• Users Online: 641
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
   Table of Contents      
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 131-136

Psychological Impact of COVID-19 Pandemic on Healthcare Workers Posted in the Obstetric Unit


1 Department of Obstetrics and Gynecology, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India
2 Department of Psychiatry, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India

Date of Submission17-Jul-2022
Date of Acceptance28-Jul-2022
Date of Web Publication23-Aug-2022

Correspondence Address:
DNB (OBGY) Sonal Prasad
Assistant Professor, C-8/452, Sector 8, Rohini, New Delhi, Delhi 110085
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_41_22

Rights and Permissions
  Abstract 


Objective: This study was done to determine the prevalence and predictors of depression, anxiety, and stress among doctors in COVID MCH unit in Delhi. Method: A cross-sectional study was conducted in India among 356 doctors to evaluate the mental health of doctors working in COVID-infected maternity wards over a period of 6 months using a predesigned, semistructured Depression, Anxiety, and Stress Scale (DASS-21) questionnaire which was developed on Google Forms. The predictors to stress, anxiety, and depression were subject to univariate logistic regression. Result: Out of the total 356 participants, 38.76% felt stressed, 56.46% were anxious, while 43.25% felt depressed. The mean DASS-21 score for stress, anxiety, and depression was 7.46, 4.12, and 4.29, respectively. Female gender was found to be a significant predictor of stress, anxiety, and depression. Staying with parents/children was a significant predictor for stress and living alone was found to be a significant predictor of depression. Fear of infecting their family members was the main concern among those tested positive. Conclusion: The present study has shown a significant psychological impact arising from this pandemic. Early screening targeting the medical workforce and the implementation of psychological interventions is essential for maintaining the functionality of the healthcare system.

Keywords: Anxiety, COVID-19 pandemic, depression, healthcare worker, mental health, stress


How to cite this article:
Chadha S, Prasad S, Tyagi D, Ansari A, Kahar GR. Psychological Impact of COVID-19 Pandemic on Healthcare Workers Posted in the Obstetric Unit. MAMC J Med Sci 2022;8:131-6

How to cite this URL:
Chadha S, Prasad S, Tyagi D, Ansari A, Kahar GR. Psychological Impact of COVID-19 Pandemic on Healthcare Workers Posted in the Obstetric Unit. MAMC J Med Sci [serial online] 2022 [cited 2022 Sep 26];8:131-6. Available from: https://www.mamcjms.in/text.asp?2022/8/2/131/354345




  Introduction Top


The entire world is challenged with a severe healthcare crisis, which is seen once in a century, that is, the COVID-19 pandemic. Doctors/healthcare workers have a pivotal role in providing care to infected persons. Working in a stressful, unforeseen, and unprecedented situation with difficult working conditions and long working hours while stretching their limits and risking their life with threatening infection poses healthcare workers at an imminent risk of psychological problems such as anxiety, stress, burnout, depression, and posttraumatic stress disorder in long run.[1] Healthcare workers are a nonhomogeneous occupational category which compromises of doctors, nurses, nursing orderly, and sanitation staff. Additionally, different specialities have different levels of duration and degree of exposure while managing the patients.[2] Obstetrical patients with COVID-19 infection become particularly challenging in this regard as not only is the patient load high in a country like India, social distancing is almost impossible in a public health facility.[3] Furthermore, obstetrics requires close manual monitoring to avoid significant morbidity and mortality in the patients. The conflict between self-safety, professional commitment, and poor infrastructure has resulted in exhaustion with psychological and physical consequences as seen in various obstetric facilities available to them. We conducted this study to find out the impact of COVID-19 pandemic on mental health of healthcare workers in the obstetric unit of a referral hospital in North India.


  Material and Methods Top


This was a survey-based, cross-sectional study conducted online in a referral center in North India over 6-month (Nov 2021 to May 2022) duration. A Google Forms (Alphabet Inc, CA)-based online questionnaire was prepared and circulated among doctors involved in care of COVID positive antenatal and postnatal patients in obstetric casualty, labor room, and wards. Those who were doing their internships were excluded. Informed consent was included in the Google Forms.

In addition to demographic characteristics and living conditions, the survey had questions pertaining to the validated Depression, Anxiety, and Stress Scale (DASS-21) instruments as well as miscellaneous psychosocial questions. A specific question confirming that the doctor works with COVID-19 patients in maternal child health (MCH) ward was added to avoid entries from doctors not posted in MCH unit with COVID-19 infected women. Only one response was permitted per person. Data were collected and analyzed.

Validated rated scales

DASS-21 is designed to measure the psychological states of depression, anxiety, and stress. It consists of three self-reported scales containing seven items each divided into subscales with similar queries.

The depression scale gauzes dysphoria, hopelessness, devaluation of life, self-deprecation, anhedonia, and inertia. The anxiety scale estimates autonomic arousal, situational anxiety, and subjective experience of anxious affect. The stress scale assesses difficulty in relaxing, nervous arousal, and easily being upset or agitated. Scores are calculated separately for depression, anxiety, and stress by adding the scores of appropriate related questions.

DASS demonstrates excellent internal consistency and discriminative and convergent validities with Cronbach alpha coefficient values of 0.81, 0.89, and 0.78 for subscales of depression, anxiety, and stress, respectively.

Scores >4, 3, and 7 are clinically concerning for depression, anxiety, and stress, respectively.

Study outcome

The primary outcome was to determine the prevalence and predictors of depression, anxiety, and stress among doctors in MCH unit. The secondary outcomes included 1) analysis of causes and coping mechanisms for stress, anxiety, and depression and 2) psychosocial impact on those healthcare workers who were tested positive for COVID-19 during their services.

Statistical analysis

Data were exported from Google Forms to Microsoft Excel spreadsheet and coded. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS, IBM SPSS Staistics, version 21.0, IBM Corp, Armonk, NY), version 20.0. Continuous variables were summarized as means within each group; categorical variables were described as percentages with frequency counts. An independent t test was used to determine significance of difference in continuous variables between groups. For categorical variables, chi-square test was used. A P-value < 0.05 was deemed significant.

The hypothesized factors/predictors to stress, anxiety, and depression such as age, gender, being a resident, living conditions, and presence of comorbidities were subject to univariate logistic regression.


  Results Top


The pro forma was circulated in obstetric healthcare units with COVID-19 patients. A total of 364 doctors responded, out of which eight entries were incomplete and so the remaining 356 entries were assessed. The sociodemographic distribution of the study population is shown in [Table 1]. The age range of the study population was 23 years. The mean age of the study population was 30.76 years.
Table 1 Sociodemographic distribution of healthcare workers

Click here to view


The distribution of psychological impact of working in COVID maternity ward is summarized in [Table 2]. Out of the total 356 participants, 38.76% (138) of the total population felt stressed, 56.46% (201) were anxious, while 43.25% (154) felt depressed.
Table 2 Distribution of psychological impact on the basis of severity

Click here to view


The mean DASS-21 score for stress was 7.46 (Interquartile range (IQR): 4–10). Out of the 138 doctors who felt stressed, 66 (47.82%) had mild stress while 38 (27.53%) had severe stress. Fear of contracting disease to one’s family (36.99%) and the stress of increased workload (21.01%) were reported as the greatest cause of stress among healthcare workers.

Among the participants, 201 had reported anxiety, out of which 44.27% (89) had mild and 39.80% (80) had moderate anxiety. The mean DASS-21 score for anxiety was 4.12 (IQR: 1–6). Breach of sanitation and outcome of the patient were the most commonly reported causes of anxiety accounting for 24.38% and 22.39% of cases, respectively. Other reported causes of anxiety included COVID-19 statistics (20.40%), inadequate social support (16.42%), and anxiety for future (16.42%).

The mean DASS-21 score for depression was 4.29 (IQR: 2–7). Depression was seen in 43.25% of the study population. However, only 24% of the population directly reported feeling depressed. About 33.76% had mild depression and 51.29% had moderate depression.

Only 12 (3.37%) opted for professional help for their mental issues. Out of 356, 49 (13.76%) felt the need for substance abuse and seven (1.96%) reported to have suicidal thoughts.

The coexisting factors which could have been additive to psychological impact are summarized in [Table 3].
Table 3 Coexisting factors additive to psychological impact

Click here to view


About 148 (41.57%) of the total 356 healthcare workers were tested positive for COVID-19. Out of these 148, 56 (37.83%) were asymptomatic. Among the 92 symptomatic cases, 84 (56.76%) were managed at home and eight (5.4%) required admission. Only one (0.68%) required intensive care unit (ICU) facility [Figure 1]. The psychological impact of testing COVID positive among doctors was also analyzed. Fear of infecting their family members was the main concern as reported by 115 (77.70%) doctors. Concern regarding cost of treatment, social stigma, and fear of death were other major concerns in healthcare accounting for 50.68%, 66.22%, and 30.40% of COVID positive healthcare workers, respectively.
Figure 1 Pie chart depicting COVID outcome of healthcare workers.

Click here to view


Various coping mechanisms adopted by doctors to handle the psychological impact were studied. It was found that seeking support of family and friends and pursuing a hobby were the most common methods of allaying anxiety adopted by 48.03% and 18.54% of the study population, respectively. Other coping mechanisms included exercise, meditation, and spiritual aid adopted by 12.36%, 12.36%, and 8.70% of participants each, respectively. According to 80.26% of the study population, their work colleagues were the strongest support system, while 70.47% mentioned their spouse as their strongest support system.

The univariate analysis was done to find out the predictors of stress, anxiety, and depression, and is summarized in [Table 4]. The analysis affirmed that female gender (odds ratio: 2.178, 95% confidence interval (CI): 1.231–3.860, P = 0.007) and staying with family (parents/children; odds ratio: 2.41, 95% CI: 1.064–3.584, P = 0.036) were significant predictors for stress among all hypothesized factors. The only significant predictor for anxiety was female gender (odds ratio: 2.002, 95% CI: 1.128–3.549, P = 0.015). When predictors of depressive symptoms were analyzed, it was found that female gender (odds ratio: 2.032, 95% CI: 1.012–4.001, P = 0.044) and living alone (odds ratio: 2.244, 95% CI: 1.108–4.720, P = 0.017) were significant predictors for the same.
Table 4 Univariate analysis for predictors of stress, anxiety, and depression

Click here to view



  Discussion Top


The emergence of the coronavirus has been a physical, mental, and emotional upheaval in the life of everyone, especially healthcare personnel. Millions of cases were diagnosed during the second wave with exponential rise in the number of cases everyday.[4] The healthcare professionals were under huge pressure as they dealt with various hurdles like overstretched working hours without leaves, limited personal protective equipment, being isolated from family, etc. Concerns regarding the mental health of various workers in healthcare setup are very pertinent as the psychological impact of the pandemic is expected not only in the short term but also is also expected to be lasting. This study aimed to estimate the magnitude of stress, anxiety, and depression associated among the healthcare workers and to assess the risk factors which are associated with them. As mental health issues are often neglected in India even among healthcare workers, the study results will help us in catering to the specific needs of the healthcare professionals with respect to their mental health.

In our study the prevalence of stress, anxiety, and depression was found to be 38.76%, 56.46%, and 43.25%, respectively. Similar observations were made by other studies done in India. A study by Kulkarni et al.[5] reported 52.8% exhaustion of the healthcare workers during the last wave of COVID-19 pandemic. Another study, done on dermatologists reported 73.9% stress and 30% insomnia, due to COVID-19 pandemic.[6] These are higher than studies done in Wuhan, the epicenter of the pandemic. Zhu et al.,[7] in a study done on 5062 people in China, found that the prevalence rates of stress, anxiety, and depression were 29.8%, 24.1%, and 13.5%, respectively. Another study from China reported that among 1257 healthcare workers, prevalence rates of severe distress, depressive symptoms requiring treatment, and anxiety were 10.5%, 14.8%, and 13.3%, respectively.[8] Likewise, a study by Chew et al.[9] reported lower prevalence of stress among healthcare workers in Singapore (4.7% among 277 HCW), Malaysia (14.3% among 175 HCW), and Indonesia (6.8% among 250 HCW). This increased prevalence of stress and anxiety in Indian healthcare workers can be explained by increased patient load in the country along with limited resources in terms of patient care and personal protective equipments.

In our study, the risk factors for stress, anxiety, and depression when analyzed demonstrated female gender as an important predictor. A study done by Lai et al.[10] also showed similar observations and found that females were at significantly higher risk of developing stress (OR: 1.45, P = 0.01), anxiety (OR: 1.69, P = 0.001), and depression (OR: 1.94, P = 0.003). Our study reaffirms the findings of various studies which report that females have a greater vulnerability to stress disorders.[11],[12] It has been reported that estrogens diminish the response of sympathoadrenal and HPA, resulting in poorer cortisol feedback and thus, delay in control of stress.[13] Consequent to the central action of estrogens, women are more sensitive to stress and have lower tolerance to negative emotions. Women have two to three times greater risk of developing posttraumatic stress disorder as compared to men.[14],[15] Women across cultures have multiple responsibilities of managing household and family along with their professional duties. It is well established that female gender is more prone to stress and depression in everyday life, so added impact of COVID-19 is bound to impact them more.

Our study also highlights the role of family on the psychological state of a doctor. Living with parents and children was a significant predictor of stress for doctors posted in COVID-19 wards. This is also reflected in the observation that the fear of contracting disease to one’s family and the stress of increased workload were reported as the greatest cause of stress among COVID-19 infected healthcare workers. We found that living alone and away from family was associated with significant risk of depression as family has been an important support system for them. In our study, spouses and parents combined together form the commonest source of support as reported by the participants. This rehighlights the strong family bonding in the Indian culture and healthcare workers are no different.

The coping mechanisms utilized by the health workers to alleviate the psychological impact have not been addressed much in the present literature. Our study found that most of the healthcare workers opted to seek help from family to allay stress and anxiety. Those staying away from family opted for other healthy options like pursuing a hobby or meditation/yoga.The adverse psychological impact of the pandemic can be highlighted by the observation that 49 (13.76%) participants felt the need for substance abuse and seven (1.96%) reported to have suicidal thoughts. This is really alarming as narcotics, sedatives, and anesthetic drugs are easily available to healthcare professionals and this can prove to be really dangerous. Moreover, despite the high prevalence of stress, anxiety, and depression among the healthcare workers, only 12 (3.37%) opted for professional help for their mental issues. This is despite the fact that helpline numbers for mental health support circulated frequently and support was available round the clock. This throws light to the low emphasis given to mental health by the healthcare workers and their hesitancy to seek help. In a study Grover et al.[16] reported that despite high prevalence levels of stress and approximately 17% of participants having suicidal thoughts, only 8.36% respondents reported of substance abuse. Another study conducted among internal medicine residents had shown only 9% prevalence of alcohol abuse despite a 76% burnout.[17]

Our study has certain limitations. Our study is based on a self-reported, questionnaire-based survey which is subject to recall bias. Although validated screening tools have been used, face to face interviews would have provided better assessment of the mental state. Yet another limitation is that India is a large country with massive diversities and differences might be present and thus, the findings may not be truly reflective of the entire nation.

The main strength of this study is that the psychological impact has been assessed while the trigger event was at its peak and uncertainty was very high.

Our study is a mere snapshot of the present psychological state of our healthcare workers. HCWs (a resource we are already short on) are the biggest asset with which we are fighting this invisible enemy. We can be protected physically by using masks and protective gear but the gradual and probably long-lasting damage to mental health is a matter of grave concern and must be identified and recognized − which was the main purpose of our study. It is our contention that psychological health promotion should be emphasized and adopting individualized method for stress alleviation must be encouraged amongst healthcare workers. As there is a taboo, stigma, and hesitancy associated with seeking mental support, we propose that there should be mandatory psychological screening and counseling whenever there is a stressful situation in healthcare setup.


  Conclusion Top


The psychological impact of COVID-19 pandemic on doctors can no longer be overlooked. It highlights the importance of psychological support and help/intervention required to ensure an efficient clinical workforce. Early screening and timely intervention targeting the healthcare workers is mandatory to protect and maintain the proper functioning of the healthcare system.

Acknowledgments

Authors would like to thank the patients of Dr Baba Saheb Ambedkar Medical College and Hospital, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. Available from: https://www.who.int/publications-detail/mental-health-and-psychosocial-considerations-during-the-covid-19-outbreak. [Accessed on May 25, 2021].  Back to cited text no. 1
    
2.
Lai J, Ma S, Wang Y et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.  Back to cited text no. 2
    
3.
The Federation of Obstetric and Gynaecological Societies of India. Good clinical practice recommendation on pregnancy with COVID-19 infection; version1. [Online]. March 28, 2020. [Accessed on April 5, 2020].  Back to cited text no. 3
    
4.
Ministry of Health and Family Welfare, Government of India. https://mohfw.gov.in. [Accessed on August 2, 2021].  Back to cited text no. 4
    
5.
Khasne RW, Dhakulkar BS, Mahajan HC, Kulkarni A. Burnout among healthcare workers during COVID-19 pandemic in India: results of a questionnaire-based survey. Indian J Crit Care Med 2020;24:664-71. doi: 10.5005/jp-journals- 10071-23518.  Back to cited text no. 5
    
6.
Bhargava S, Sarkar R, Kroumpouzos G. Mental distress in dermatologists during COVID-19 pandemic: assessment and risk factors in a global, cross-sectional study. Dermatol Ther 2020;33:e14161. doi: 10.1111/dth.14161  Back to cited text no. 6
    
7.
Zhu N, Zhang D, Wang W et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-33.  Back to cited text no. 7
    
8.
Liu Q, Luo D, Haase JE et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Global Health 2020;8:e790-8. doi: 10.1016/S2214-109X(20) 30204-7.  Back to cited text no. 8
    
9.
Chew NW, Ngiam JN, Tan BY et al. Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic. BJPsych Open 2020;6:e116.  Back to cited text no. 9
    
10.
Lai J, Ma S, Wang Y et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976. doi: 10.1001/jamanetworkopen.2020.3976  Back to cited text no. 10
    
11.
Bangasser DA, Wicks B. Sex-specific mechanisms for responding to stress. J Neurosci Res 2017;95:75-82. doi: 10.1002/jnr.23812  Back to cited text no. 11
    
12.
Novais A, Monteiro S, Roque S, Correia-Neves M, Sousa N. How age, sex and genotype shape the stress response. Neurobiol Stress 2017;6:44-56. doi: 10.1016/j.ynstr.2016.11.004  Back to cited text no. 12
    
13.
Verma R, Balhara YP, Gupta CS. Gender differences in stress response: role of developmental and biological determinants. Ind Psychiatry J 2011;20:4-10. doi: 10.4103/ 0972-6748. 98407  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005;62:617-27. doi: 10.1001/archpsyc.62.6.617  Back to cited text no. 14
    
15.
Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 2006;132:959-92. doi: 10.1037/ 0033-2909. 132.6.959  Back to cited text no. 15
    
16.
Grover S, Sahoo S, Bhalla A, Avasthi A. Psychological problems and burnout among medical professionals of a tertiary care hospital of North India: a cross-sectional study. Indian J Psychiatry 2018;60:175-88. doi: 10.4103/psychiatry.IndianJPsychiatry_254_17  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358-67. doi: 10.7326/0003-4819-136-5- 200203050-00008.  Back to cited text no. 17
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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
Material and Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed214    
    Printed14    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    

Recommend this journal