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Depression and anxiety associated with COVID- 19 pandemic among healthcare professionals in India- A systematic review and meta-analysis
Abstract and Figures
Background
As India is fighting against the second wave of COVID-19, Healthcare professionals are the front-line warriors on that battlefield which puts them under psychological pressure, this systematic review aims to critically look into and amalgamate the evidence on impact of COVID-19 on psychological health of healthcare professionals in India and to seek the attention of policymakers.
Methods
A systematic literature search was performed using the following databases PubMed, SCOPUS, Web of Science, Cochrane Library, ScienceDirect. Additionally, random search in Google, Google Scholar and ResearchGate was also performed until February 2021. The methodological quality of studies was assessed using Downs and Black for reporting quality. Meta-analysis was performed using revMAN. The review protocol is registered in PROSPERO and is available online.
Result
Prevalence of depression was found to be present in 41.90% of 5796 participants in five studies (95% Confidence Interval [CI]: 29.17 to 54.64), and prevalence of anxiety was found to be 42.87% common in 10 studies with a total sample size of 3059 people (95% Confidence Interval [CI]: 30.26 to 55.49), Stress was found to be prevalent (58.04%) in 12 studies with 4209 participants, (95% CI: 44.81–71.28), Prevalence of sleeping problem in 3 studies with 416 participants recorded a prevalence rate of 31.94 (95% CI: 21.38–42.49)
Conclusion
The COVID-19 pandemic has had a significant impact on people's mental and physical health, particularly among health-care workers. Authorities should develop programmes to help health-care workers improve their mental health.
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Context:
The recent spread of SARS-CoV-2 pandemic has resulted in a number of mental health issues among healthcare workers and dentists are no exception to this due to their nature of work. Hence, the aim of this study was to evaluate the level of perceived stress (PS) among Chhattisgarh dentists and identify the sources of stress before and during the COVID-19 crisis.
Materials and methods:
An online questionnaire-based survey was done to assess the level of PS using perceived stress scale (PSS) and sources of stress among dentists of Chhattisgarh state of India before the onset of COVID-19 in the state and immediately after the nationwide lockdown was announced owing to COVID-19 outbreak. Based on the type of work, the dental practitioners were categorized into three groups--dental practitioners (group A), dental academicians (group B), and dentists who are practitioners as well as academicians (group C). Frequency, percentages, and mean values were calculated and compared among different participant characteristics using Student's t test, paired t test, and one-way ANOVA.
Results:
During phase I, mean PSS for dentists was 18.61 ± 6.87 which increased to 20.72 ± 1.95 in phase II. Group C dentists recorded higher mean PSS during phase I, while group A dentists reported higher mean PSS during phase II. No family time due to long working hours (90%) was the major stressor among the three groups of dentists during phase I and concern about getting infected (83.3%) was identified as the most frequent stressor during phase II followed by stress over financial implications.
Conclusion:
Chhattisgarh dentists are reeling under psychological stress, which could be highly deteriorating to their mental health. Hence, concerned authorities should come forward and support the dentists by providing adequate guidelines, policies, and monetary support to them.
Purpose: To assess the magnitude of mental health problems among ophthalmologists in India post lockdown during COVID pandemic.
Method: Cross-sectional survey conducted online on registered practising ophthalmologists of India, post lockdown at the start of elective surgeries (20th to 25th May, 2020). The degree of symptoms of depression, anxiety and stress was assessed by DASS −21 questionnaire. DASS - Subscales: DASS- D (depression), DASS- A (anxiety) and DASS-S (stress) and grading of severity (mild, moderate, severe) were analysed.
Results: A total of 144 ophthalmologists aged 29–72 years responded to online survey. Of all participants, 94 (64.2%) of ophthalmologists suffered from mental health problems. Seventy six (52.7%) ophthalmologists had depression and anxiety whereas 20 (14%) reported stress. Women ophthalmologists scored highest total DASS mean score and DASS-stress mean score (p = .04 and p = .03). Results of DASS-D and DASS-A showed female preponderance (men vs women 42.5% vs 61.5%, p = .02; 42.5% vs 60%, p = .04). Severity of symptoms revealed that ophthalmologists above 40 years of age with more than 10 years’ experienced severe stress (p = .005). Comprehensive ophthalmologists presented with severe stress and ophthalmologists practicing speciality with severe anxiety. Pearson’s correlation analysis showed positive correlation between total DASS-21 score with each of the three subscales scores (DASS D, r-0.88: p < .001; DASS-A, r = 0.96: p = <0.001; DASS-S, r = 0.95: p < .001).
Conclusion: Screening by Dass-21 scale has brought noticeable transient mental health issue among ophthalmologist to the fore. Few with high risk may require professional mental care to alleviate it.
Objectives
To describe the initial dilemmas, mental stress, adaptive measures implemented and how the healthcare team collectively coped while providing healthcare services in a large slum in India, during the COVID-19 pandemic.
Setting
Community Health Division, Bangalore Baptist Hospital, Bangalore.
Study design
We used mixed methods research with a quantitative (QUAN) paradigm nested in the primary qualitative (QUAL) design. QUAL methods included ethnography research methods, in-depth interviews and focus group discussions.
Participants
A healthcare team of doctors, nurses, paramedical and support staff. Out of 87 staff, 42 participated in the QUAL methods and 64 participated in the QUAN survey.
Results
Being cognizant of the extreme vulnerability of the slums, the health team struggled with conflicting thoughts of self-preservation and their moral obligation to the marginalised section of society. Majority (75%) of the staff experienced fear at some point in time. Distracting themselves with hobbies (20.3%) and spending more time with family (39.1%) were cited as a means of emotional regulation by the participants in the QUAN survey. In the QUAL interviews, fear of death, the guilt of disease transmission to their loved ones, anxiety about probable violence and stigma in the slums and exhaustion emerged as the major themes causing stress among healthcare professionals. With positive cognitive reappraisal, the health team collectively designed and implemented adaptive interventions to ensure continuity of care. They dealt with the new demands by positive reframing, peer support, distancing, information seeking, response efficacy, self-efficacy, existential goal pursuit, value adherence and religious coping.
Conclusion
The novel threat of the COVID-19 pandemic threw insurmountable challenges potentiating disastrous consequences; slums becoming a threat to themselves, threat to the health providers and a threat for all. Perhaps, a lesson we could learn from this pandemic is to incorporate ‘slum health’ within universal healthcare.
Background: The COVID-19 pandemic is found to affect the mental health of the population. Undergraduate medical students are especially prone to mental health disorders and hence could be more vulnerable to the impact of the pandemic. Methods: A prospective longitudinal study was conducted on 217 undergraduate medical students in a medical college at Chennai, India. Depression, anxiety,
and stress levels were recorded using Depression Anxiety Stress Scale 21 Items (DASS21) before and during the COVID-19 outbreak in India in December 2019 and June 2020, respectively. In the follow-up survey, in addition to DASS21, the Pittsburgh Sleep Quality Index to assess sleep quality and a self-administered questionnaire to assess the impact of COVID-19 related stressors were used. The selfadministered
questionnaire assessed the status of COVID-19 testing, interactions
with COVID-19 patients, self-perceived levels of concerns and worries related to academics (COVID-19-AA (academic apprehensions)) and those pertaining to the self and family/friends (COVID-19-GA (general apprehensions)). Cross-sectional and longitudinal comparison of overall scores of depression, anxiety, and stress and scores stratified by gender, year of study, place of residence and monthly family
income were performed. Predictors for depression, anxiety, and stress during COVID-19 were investigated using adjusted binary logistic regression analysis and results were expressed as adjusted odds ratio with 95% confidence interval (CI). A P value < 0.05 was considered statistically significant. Results: The average scores of depression, anxiety, and stress during the baseline survey were 7.55 ± 7.86, 4.6 ± 6.19 and 7.31 ± 7.34 with the prevalence (95% Cl) of 33.2% [27–39.9%], 21.2% [16–27.2%] and 20.7% [15.5–26.7%]; in follow-up
survey, the mean scores were 8.16 ± 8.9, 6.11 ± 7.13 and 9.31 ± 8.18 with the prevalence being 35.5% [29.1–42.2%], 33.2% [27–39.9%] and 24.9% [19.3–31.2%] for depression, anxiety, and stress respectively. There was a significant increase in both the prevalence and levels of anxiety and stress (P < 0.001), with depression remaining unchanged during COVID-19, irrespective of gender, year of study, place of residence and family’s monthly income. Poor sleep quality, higher levels of baseline depression, anxiety, and stress, higher COVID-19-GA, COVID-19 patients in family/friends and direct interactions with COVID-19 patients were found to be significant predictors of negative mental health in undergraduate medical students. COVID-19-AA was not significantly associated with depression, anxiety, and stress. Conclusion: The COVID-19 pandemic appears to negatively affect the mental health of the undergraduate medical students with the prevalence and levels of anxiety and stress being increased, and depression symptoms remaining unaltered. Addressing and mitigating the negative effect of COVID-19 on the mental health of this population is crucial.
The pandemic has taken a toll on the mental health of people especially health care workers like physicians, nurses and paramedical staff who have to work for long hours, in shifts and under immense stressful situations. There is ample literature available on the effect of stress on psychological wellbeing. The aim of this research paper is to find out the mediation effect of subjective happiness on the relationship between perceived stress and psychological wellbeing of health care workers who are engaged in COVID-19 hospital duties. The sample included 231 physicians and healthcare workers engaged in duties in two major COVID-19 medical college hospitals of Northern India. The results prove that there is a significant effect of perceived stress on psychological well- being with subjective happiness playing a mediating role. Perceived stress decreases subjective happiness which in turn affects psychological wellbeing of physicians and health care workers during COVID-19. Higher the level of subjective happiness, lesser will be the impact or there will be delayed impact of perceived stress on psychological wellbeing. Psychological Well Being (PWB) Scale (Ryff, 1989), Subjective Happiness Scale (Lyubomirsky & Lepper, 1999) and Perceived Stress Scale (Cohen, 1994) were used to examine the mediation of subjective happiness on the relationship between perceived stress and psychological wellbeing.
Introducción:
La COVID-19 se propaga por vías respiratorias y aerosoles. La pandemia originada por esta enfermedad causa pánico, miedo y estrés en todos los estratos de la sociedad. Al igual que todas las demás profesiones médicas, los dentistas, particularmente los endodoncistas, que están muy expuestos a los aerosoles, pueden mostrar estrés.
Objetivo:
Encuestar a los endodoncistas indios para comprender mejor sus niveles de estrés psicológico durante el confinamiento de la India durante la pandemia de la COVID-19.
Métodos:
Del 8 de abril al 16 de abril de 2020 se realizó una encuesta cerrada en las redes sociales de endodoncia. Se utilizó la técnica de muestreo de bola de nieve. Asimismo, se recolectaron datos demográficos básicos, entorno de práctica y otras informaciones relevantes. El estrés psicológico y la angustia percibida se calcularon a través del índice de angustia peritraumática COVID-19 y la escala de estrés percibido. El análisis de regresión multinomial se realizó para estimar la tasa de riesgo relativo y p ≤ 0,05 se consideró significativo.
Resultados:
Este estudio tuvo 586 endodoncistas indios que completaron esta encuesta. De estos, 311 (53,07 %) eran hombres, 325 (55 %) en el grupo de edad de 25-35 años, 64 % en áreas urbanas, 13,14 % en prácticas individuales y un cuarto de ellos eran residentes. Las mujeres endodoncistas tenían un alto estrés percibido (RRR = 2,46, p = 0,01) en comparación con los hombres, medido por PSS. Los endodoncistas más jóvenes < 25 años (RRR = 9,75; p = 0,002) y 25-35 años (RRR = 4.60; p = 0,004) en comparación con el grupo de edad > 45 años tenían más angustia. Los consultores exclusivos tuvieron RRR = 2,90, p = 0,02, para la angustia leve a moderada en comparación con la normal. Se consideran los factores que impulsan este fenómeno.
Conclusiones:
Durante el cierre debido a la COVID-19, los endodoncistas indios 1-en-2 tuvieron angustia, según lo medido por CPDI y 4 de cada 5 percibieron estrés, según lo indicado por PSS. Nuestro modelo identificó ciertos factores que impulsan el (des)estrés, lo que ayudaría a los formuladores de políticas a iniciar una respuesta adecuada.
Background. – Health care workers are under a substantial level of psychological impact due to the risk of exposure, workload and moral dilemmas as the nation is on upsurge of COVID-19 cases. Since there are limited research available on this issue from India, we have decided to conduct an online survey to evaluate mental health outcome and professional quality of life among healthcare worker during COVID-19 pandemic.
Methods. – From 25th May to 10th June 2020, a web-based (FRONT-LINE COVID) survey was conducted. Impact of event revised (IES-R), Connor-Davidson Resilience scale (CD-RISC) and Professional Quality of life (ProQOL) and Feeling related questions were administered among Healthcare workers from different departments of hospital.
Results. – Among the respondents,218 (52.1%) belongs from the low-risk unit and 200 (47.9%) from the ‘high-risk unit’ including a higher proportion of nurses 191 (45.7%), female 282(67.5%), aged 31-40 years (48.3%), and married 220 (52.6%). Overall female nurses (P=>0.001), doctors (P=0.02) those were working in an emergency unit (P= <0.001) were at greater risk of psychological distress. Middle-aged (31- 40 years) had a higher level of resilience (p=0.02) contrast to this; working in COVID-19 unit was associated with a lower scale of resilience (p=0.009). Resilience and QoL were an important predictor for psychological distress.
Conclusion. – Results implicate interventions for stress management and social support among medical staff working in the pandemic.
