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Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors across Several Hospitals after Second Wave: Have We Acclimatized? A Cross-sectional Survey

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ORIGINAL ARTICLE
Depression, Anxiety, Stress, and Insomnia amongst COVID
Warriors across Several Hospitals after Second Wave: Have
We Acclimatized? A Cross-sectional Survey
Santvana Kohli1, Sahil Diwan2, Ajay Kumar3, Sanchaita Kohli4, Shipra Aggarwal5, Aakar Sood6,
Harish Chander Sachdeva7, G Usha8
Ab s t r A c t
Background: Coronavirus disease-2019 (COVID-19) pandemic has been a cause of signicant mental health disturbances in medical health
personnel. However, 18 months into the pandemic, healthcare workers (HCWs) have become accustomed to the heightened stress and anxiety
that comes with caring for COVID patients. Through this study, we aim to measure depression, anxiety, stress, and insomnia in doctors with
the help of validated scales.
Materials and methods: This was a cross-sectional study with an online survey design conducted among doctors from major hospitals in New
Delhi. The questionnaire included participant demographics, including designation, specialty, marital status, and living arrangements. This was
followed by questions from the validated depression, anxiety, stress scale (DASS-21), and insomnia severity index (ISI). Depression, anxiety,
stress, and insomnia scores were calculated for each participant, and the data were analyzed statistically.
Results: The mean scores of the whole study population showed no depression, moderate anxiety, mild stress, and subthreshold insomnia. Female
doctors exhibited more psychological issues (mild depression and stress, moderate anxiety, but only subthreshold insomnia) as compared to
males (mild anxiety, but no depression, stress, and insomnia). Junior doctors also had higher depression, anxiety, and stress scores than senior
doctors. Similarly, single doctors, those living alone, and those not having kids had higher DASS and insomnia scores.
Discussion: HCWs have been under tremendous mental stress during this pandemic which is inuenced by multiple factors. Female sex,
junior doctors, working on the frontline, not being in a relationship, and living alone may be some of the factors recognized in our study and
corroborated by many authors, which may increase the chances of depression, anxiety, and stress in them. HCWs need regular counseling, time
o for rejuvenation, and social support to overcome this hurdle.
Keywords: Anxiety, COVID-19, DASS, Depression, Insomnia, Insomnia severity index, Mental Health, Pandemic, Stress.
Indian Journal of Critical Care Medicine (2022): 10.5005/jp-journals-10071-24238
In t r o d u c t I o n
“A good half of every treatment that probes at all deep ly consists in the
doctor’s examining himself… It is his own hurt that gives a measure
of his power to heal.” Much before Carl Jung made this modest
statement, the idea of “ the wounded healer” was known to societ y
via excerpts from Greek mythology. The untoward bearing of an
inrmity and its th erapy on the physician him or herself is a tangible
element of the healing process, and it would be prudent to accept
that no one would want to be treated by a doctor who is not in an
optimal state of mental and physical health.1
Unfortunately, the reported prevalence of mental illness
among doctors is extremely discouraging and remarkably higher
than the general population.2 ,3 Physician depression and suicide
have been a public health crisis worldwide,4,5 and the inception of
the global COVID-19 pandemic in March 2020 has unequivocally
fueled this raging re.6 –8 Eighteen months into the pandemic,
many of these apprehensions have been allayed by the extensive
research and analyses conduc ted on the novel coronavirus and the
distinct guidelines introduced by the government, hospitals, and
clinics. HCWs have now adapted to the new work environment,
devised appropriate and convenient work shifts and protocols,
are accustomed to caring for COVID-19 patients, and become
more familiar with the disease course to be better prepared for
any adverse events.9
Apropos this, it was found most intriguing to assess the
physician’s mental health late into the pandemic, after the
psychological coping mechanisms have been set in place.
The present study, therefore, aims to evaluate the depression,
anxiety, stress, and insomnia levels in doctors across various
© The Author(s). 2022 Open Access This article is distributed unde r the terms of the Creative Commons Attributi on 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrest ricted use, distribution, and non- commercial reproduction in any mediu m, provided you give appropriate credit to
the original author(s) and the source, provi de a link to the Creative Commons license, and indicate if changes we re made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the da ta made available in this article, unless othe rwise stated.
1–3,5,8Department of Anesthesia and Critical Care Medicine, Vardhman
Mahavir Medical College and Safdarjung Hospital, New Delhi, India
4,6Department of Maxillofacial Surgery, CK Birla Hospital, New Delhi,
India
7Department of Anesthesia and Intensive Care, Vardhman Mahavir
Medical College and Safdarjung Hospital, New Delhi, India
Corresponding Author: Shipra Aggarwal, Department of Anesthesia
and Critical Care Medicine, Vardhman Mahavir Medical College and
Safdarjung Hospital, New Delhi, India, Phone: +91 9811420866, e-mail:
shipra.mamc@gmail.com
How to cite this article: Kohli S, Diwan S, Kumar A, Kohli S, Aggarwal S,
Sood A, et al. Depression, Anxiety, Stress, and Insomnia amongst
COVID Warriors across Several Hospitals after Second Wave: Have
We Acclimatized? A Cross-sectional Survey. Indian J Crit Care Med
2022;26(7):825–832.
Source of support: Nil
Conict of interest: None
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022)
826
hospitals at the current stage in the timeline, after the second
COVID wave.
MAt e r I A l s A n d M e t h o d s
A cross-sectional observational study with a survey design was
conducted by the Depar tment of Anesthesia at the senior author’s
institute between the period of 1st June to 31st July, 2021 as
approved by the institutional ethical committee (vide letter S.No.
IEC/*** */***/Project/2020- 08/CC-48). Included in the stu dy were all
doctors working in COVID and non-COVID wards and intensive care
units (ICU) of major teaching hospitals in New Delhi, with access to
the internet, a reasonable understanding of the English language,
and who were willing to participate in the study. Doctors with a
known prior history of any psychiatric illness were excluded from
the st ud y.
Questionnaire Design
A customized questionnaire was designe d comprising the following
clusters of questions:
Demographic details including age, sex, marital status, having a
child, living conditions, etc.
Medical history – History of diabetes, hypertension, asthma,
migraine, psychiatric illnesses, and other comorbidities.
Work details and COVID exposure risk, including professional
designation, specialt y, whether tested p ositive for COVID at any
point of time.
Status of mental health – Questions were designed based on
validated scales for evaluating depression, anxiety, stress
(DASS-21), and insomnia ISI.
Depression, anxiety, and stress were assessed using DASS-21,10
which is a validated tool for psychological screening among
patients. It is a self-reported 21-item questionnaire developed
by the University of New South Wales, Australia, which provides
independent measures of depression, stress, and anxiety. The
scores for each of the three compo nents are calculated by summing
up the scores for the relevant items and multiplying by two to
calculate the nal score. A cut-o score >9 represents the presence
of depression in the subject, which is further graded as “mild”
(score = 10–13), “moderate” (score = 14–20), “severe” (score = 21–47 ),
and “extremely severe” (score = 28–42). Similarly, a cut-o score of
>7 and >14 denote positive screen a nxiety and stress, respecti vely.
The anxiety subscale score is assessed as “mild” (8–9), “moderate”
(10–14), “severe” (15–19), and extremely severe” (20–42), whereas
the stress subscale score is divided into “mild” (15–18), “moderate”
(19–25), “severe” (26–33), and “extremely severe” stress (34–42).
Insomnia Severity Index (ISI)11 is a 7-item self-repo rt questionnaire
assessing the nature, severity, and impact of insomnia.6 The
dimensions evaluated are problems with sleep onset, sleep
maintenance, and early morning awakening, sleep dissatisfaction,
interference of sleep difficulties with daytime functioning,
noticeability of sleep problems by others, and distress caused by
the sleep diculties. A 5 -point Likert scale is used to rate each item
(e.g., 0 = no problem; 4 = very severe problem), yielding a total score
ranging from 0 to 28. The total score is then interpreted as follows:
absence of insomnia (0–7), subthreshold insomnia (8–14), moderate
insomnia (15–21), and severe insomnia (22–28).
Online Survey
Recruitment of subjects was done using the snowball sampling
technique. All subjects were contacted via e-mail or online
messaging services, wherein detailed information was provided
regarding the objectives and nature of the study, along with the
consent form and a link to access the survey questionnaire. The
questionnaire took approximately 10 minutes to complete.
The survey was anonymous and conducted through an online
survey platform (Survey Monkey). Complete condentiality of all
collected data was maintaine d throughout the course of the study.
The period of data coll ection was from 1st June to 31st July 2021. All
data were collected and compiled by a single investigator.
Analysis of Data
Statistical analysis was performed with the help of SPSS for
Windows, version 17.0 (SPSS, Chicago, Illinois). Continuous variables
were presented as mean ± SD, and categorical variables were
presented as absolute numbers and percentages. Data were
checked for normality before statistical analysis.
Categorical variables wer e analyzed using either the Chi-square
test or Fisher’s exact test for the comparison of the prevalence
of depression, anxiety, stress, and insomnia amongst physicians
posted in COVID and non- COVID wards and ICUs. The compar ison of
normally distributed continuous variables between the groups (as
per anxiety or depression) was performed using ANOVA, and further
multiple comparison tests were used to assess the dierences
between the individual groups.
re s u lt s
A total of 1683 responses were collected on the online survey
platform during the study period. Out of these, only 1458 (86.6%)
were complete and were included in the nal analysis (Tabl e 1). Of
the responses obtained, 630 (43.2%) were from males, and the rest
(56.8%) were from female doctors. The age of respondents ranged
from 21 to 61 years, with a median of 31 years.
Amongst the doctors, nearly 35% were post-graduate
students and non-academic junior residents (PGs and JRs), while
the remaining were senior residents (SRs) (33.74%) and faculty
(31.27%). More than half of the responses (54.73%) were obtained
from doctors of anesthesia sub-specialty, while surgical branches
(general surgery, orthopedics, neurosurgery, urology, pediatric
surgery, and cardiac surgery) comprised of 23.86% and medical
branches (internal medicine, pediatrics, cardiology, neurology,
and nephrology) comprised of 12.34% of the total responses.
Para-clinical specialties (supportive branches like microbiology,
laboratory medicine, pathology, and radiology) accounted for
9.05% of all responses.
The vast majority of doctors (80.65%) reported no comorbidities.
Over half of the study population (50.61%) were married, and the
remaining were either single (40.32%) or engaged/committed
(6.58%). Regarding living arrangements, 18.93% reported living
alone, 19.75% live with a atmate, and a sizeable por tion lives with
a family (37.44% in a nuclear family and 21.39% in a joint family).
Close to 2.5% of responder s did not want to reveal their relationship
status or living arrangements. Nearly two-thirds of the doctors
(64.97%) did not have kids. Approximately, 66% of the doctors
reported having tested COVID-19 positive at least once since the
onset of the pandemic.
Responding to the statement “I am worried about being
infected by COVID during my duty , 84.36% agree d/strongly agreed
with it. Most of the responders (92.17%) agreed/strongly agreed
with the statement “I am worried about carrying the infection
back to my family”. However, the response to the statement
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022) 827
Table 1: Demographic data
Sample size (n) 1458
Age
Mean
Range
Median
31.60 ± 6.03 years
21–61 years
31 years
Sex
Males
Females
630 (43.2%)
828 (56.79%)
Designation
Faculty
Senior residents
PG students/JRs
456 (31.27%)
492 (33.74%)
510 (34.97%)
Specialty
Anesthesia
Surgical
Medical
Non-clinical
798 (54.73%)
348 (23.86%)
180 (12.34%)
132 (9.05%)
Comorbidities
No
Yes
1176 (80.65%)
282 (19.34%)
Tested COVID positive
Yes
No
963 (66.05%)
495 (33.95%)
Marital status
Married
Engaged/committed
Single
Do not wish to reveal
738 (50.61%)
96 (6.58%)
588 (40.32%)
36 (2.46%)
Living arrangement
Live alone
Live with atmate
Live with a nuclear family
Live with joint family
Do not wish to reveal
276 (18.93%)
288 (19.75%)
546 (37.44%)
312 (21.39%)
36 (2.46%)
Whether have kids
Yes
No
Do not wish to reveal
504 (34.54%)
948 (64.97%)
6 (0.41%)
“I am worried about being infected by COVID during my duty”
Response
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
552 (37.86%)
678 (46.5%)
144 (9.87%)
78 (5.34%)
6 (0.41%)
“I am worried about carrying the infection back to my family”
Response
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
810 (55.55%)
534 (36.62%)
30 (2.05%)
72 (4.93%)
12 (0.82%)
(Contd...)
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022)
828
“I feel pressured fro m family to abstain from COVID duties” was less
unanimous. Although 32.92% agreed with the statement, 46.08%
did not feel any pressure from the family, highlighting the family
support. Around 65% of the participants reported that they were
“satised with basic facilities and accommo dation provided during
working hours”, which may go a long way in allaying stress and
anxiety at the workplace.
Depression Parameters
When analyzing questions that measure depression in the
responders, it was found that the mean depression score in
the whole population was 9.96 ± 2.74 (no depression), with no
correlation with age (r = 0.14). On further evaluation, females
showed a high mean depression score of 11.2 (mild depression)
as compared to males (8.34, no depression). This dierence was
statistically signicant (p = 0.03). Similarly, JRs and PGs showed
higher depression scores (11.15) as compared to faculty (8.55,
p = 0.048) and SRs (10.04, p = 0.1). The dierence in scores was
not signicant when analyzed specialty-wise (Ta ble 2). Likewise,
depression score was comparable amongst participants with or
without comorbidities, whether married, single or committed, and
whether living alone or with someone. However, doctors having
kids had signicantly lower depression scores (8.19) than those
without (10.88, p = 0.038), although the scores were comparable
amongst doctors of both genders with kids.
Anxiety Parameters
Upon evaluation of anxiety questions, the mean score in the
study population was 10.33 ± 2.05 (moderate anxiety), without
any correlation with age (r = 0.19). Sex-wise analysis revealed
mild anxiety in males an d moderate in females, with a statistically
signicant dierence in scores (11.21 vs 9.18, p = 0.04). Similar
findings were observed amongst PGs and JRs (score 12.58,
moderate anxiet y), SRs (10.92, moderate anxiety), and faculty (8.26,
mild anxiety). The diere nce in scores was signicant between JRs
and faculty (p = 0.03), but not between JRs and SRs (p = 0.055),
or SRs and faculty (p = 0.065). Although doctors of all specialties
had mild–moderate anxiety, their scores were compared
statistically. Similarly, doctors with or without comorbidities had
similar anxiety scores. However, anxiety was signicantly lower
in participants who were either married (9.42) or had kids (8.16)
than in those who were single (11.95) or did not have kids (11.46).
There was no signicant gender-based dierence in doctors who
were married or had kid s. Scores were comparable in doctors with
dierent living arrangements, or whether they tested positive or
not (Tabl e 2).
Stress Parameters
When looking at th e questions reecting stress in the par ticipating
doctors, the mean stress score of the whole study population
was 16.06 ± 3.16, reecting mild stress. No correlation was found
between the age o f doctors and the stress scores (r = 0.12). Females
had higher stress scores as compared to males (16.46 vs 12.22),
and this was statistically signicant (p = 0.027). The stress score
was higher in PGs and JRs (16.22) than in SRs (14.02) and faculty
(12.81), but these differences were not statistically significant.
Likewise, the stress score of doc tors divided specialty-wise is g iven
in Ta b le 2 , and the dierence between them was not signicant
(p >0.05). Doctors with como rbid conditions also had slightly higher
scores (16.14 vs 14.20, p = 0.12). There was also an insignicant
dierence in scores amongst responders who were married vs
unmarried or who lived alone vs living with family/atmate. On
the other hand, participants who had kids had signicantly lower
scores (12.76) vs those who did not (15.78, p = 0.035), although
scores were comparable amongst male or female doctors with kids.
Doctors who tes ted positive at any point during the pandemic also
had signicantly higher stress (16.92 vs 14.16, p = 0.038) than those
who were never positive.
Insomnia Parameters
Regarding insomnia questions, the mean score for all participants
was 8.79 ± 2.42, which suggests some amount of subthreshold
insomnia. Upon further analysis, the scoring in males (8.43) and
in females (9.05) also showed subthreshold insomnia, but the
difference was not statistically significant. Some scores were
low enough to suggest no insomnia (e.g., Faculty, committed
participants, surgical branches, having kids, and never testing
positive), but the dierence in each categor y was never statistically
signicant (p >0.05).
dI s c u s s I o n
Several studies have suggested that doctors and other medical
personnel routinely experience work-related psychological stress
and burn-out,2,3 often resulting in substance and alcohol abuse,
Table 1: (Contd...)
Sample size (n) 1458
“I feel pressured from family to abstain from COVID duties
Response
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
204 (13.99%)
276 (18.93%)
306 (20.98%)
450 (30.86%)
222 (15.22%)
“I am satised with basic facilities and accommodation provided to me during working hours”
Response
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
204 (13.99%)
744 (51.02%)
180 (12.34%)
282 (19.34%)
48 (3.29%)
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022) 829
antidepressants, and smoking. In general, medical professionals
are taught early in their training to mask their pain and to maintain
a stoic stance about illness, a nd this perpetuates the denial of their
own health vulnerabilities.12 Suicide rates globally are reported to
be much higher among doctors than among other professional
groups or the general population.4
Across the globe, the COVID-19 pandemic has been an
extremely testing situation for everyone. Despite being at the
forefront, HCWs are not immune to the physical, mental, and
emotional consequences of this disease. Several studies have
shown high rates of depression, stress, and anxiety in HCWs caring
for COVID-19 patients.6–8 This has been attributed not only to the
drastically escalated workload and change in the work conditions,
but also due to fear of health of sel f and loved ones, apprehensions
about the proper use of personal protective equipment (PPE), the
ever-changing course, sequelae, and treatment protocols of this
novel disease, and the attached social stigma.13
There are demographic, socio-economical, and occupational
factors that play a part in influencing psychological stress in
HCWs.7,8,1420 Female gender is more likely to be anxious, stressed,
and depressed as compared to their male counterparts,14 20 and
this could be explained because of personality and hormonal
dierences. Similar results were observed in our study with a high
rate of mild depression, moderate anxiety, and stress in females
as compared to males. The incidence of insomnia, however, was
comparable between both genders. Hierarchy in the healthcare
system showed that signicant anxiety and stress were seen in
junior doctors (JRs and PGs) as compared to senior doctors (SRs
and faculty).1416 This could be explained due to more exposure
of junior doctors to COVID-19 patients, lack of experience, and
less support from family (as they tend to be single more often and
have no kids). Single doctors and those living alone were more
prone to psychologica l issues than married counterparts and those
living with family. This could be easily explained by the support
and the opportunity to communicate feelings with spouse/loved
ones.7,18,19 Similarly, in our study, doctors living alone or single
showed a higher level of anxiety and stress which was statistically
signicant. Likewise, having kids s eems to be a stress buster, as was
observed in our study.
HCWs with previous COVID-19 infection and preexisting
comorbidities were more prone to anxiety, depression, stress, and
insomnia than their healthy counterparts.14,15 However, no such
results were seen in our study e xcept a high incidence of stress which
was statistically signicant and was seen in patients with previous
COVID-19 infectio ns. Previous studies showed that frontline workers
(those working in casualty and ICU) experienced and displayed
more mental health issues than non-frontline workers.1620 The
reasons suggested were fear of infection by family and colleagues,
lack of social support, and lack of protective measures. No such
dierence had been seen between frontline workers (anesthesia
Table 2: Depression, anxiety, stress, and insomnia parameters
Parameters Mean depression scores Mean anxiety scores Mean stress scores Mean insomnia scores
Whole population (± SD) 9.96 ± 2.74 10.33 ± 2.05 16.06 ± 3.16 8.79 ± 2.42
Sex
Males
Females
8.34
11.2
9.18
11.21
12.22
15.46
8.43
9.05
Designation
JRs/PGs
SRs
Faculty
11.15
10.04
8.55
12.58
10.92
8.26
16.22
14.02
12.81
9.41
9.28
7.56
Specialty
Anesthesia
Surgical
Medical
Paraclinical
9.95
10.68
8.4
10.27
11.17
10.63
8.93
9.27
16.21
15.44
13.73
15.00
9.22
7.62
9.40
8.40
Comorbidities
Yes
No
10.0
9.95
10.80
10.22
16.14
14.20
9.78
8.55
Marital status
Married
Committed
Single
9.12
9.58
10.87
9.42
10.20
11.95
14.69
14.94
15.39
8.23
7.86
9.89
Living arrangement
Living alone
Living with someone
10.25
9.76
11.04
9.88
14.17
14.08
9.88
8.03
Having kids
Yes
No
8.19
10.88
8.16
11.46
12.76
15.78
7.25
9.25
Tested positive
Yes
No
11.17
9.03
10.36
10.00
16.92
14.16
9.02
7.57
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022)
830
sub-specialty) and non-frontline workers (surgical, medical, and
para-clinical branches) in our study. Depression, anxiety, stress,
and insomnia scores were comparable between the two groups.
This can possibly be explained by the observation that repeated
COVID duties during 18 months of the pandemic have resulted
in the acclimatization of all HCWs to the scenario. They are now
more used to the COVID restrictions, working in PPE, long duty
hours, and staying away from family or taking extra precautions
around them. The intensit y of psychological illness has also become
mild–moderate as compared to severe psychological stress and
fear of death at the beginning of the pandemic. Tabl e 3 shows
various previous studies conducted on the psychological impact
of the COVID pandemic on HCWs, and the risk f actors identied for
mental health issues.
lI M I tAt I o n s
Our study has several limitatio ns. First, only doctors were included
in our study, and not all HCWs. Secondly, doctors included
belonged only to major hospitals of New Delhi and the National
Capital Region (NCR). We were unable to extend the study to
regions outside NCR , which may be less or more aected by COVID,
thus causing a dierent psychological im pact than reported. Third,
because of the snowballing technique used, we were unable to
ensure that the participating do ctors were posted in COVID wards
Table 3: Previous studies on the psychological impact of the COVID-19 pandemic on HCWs
Author, Year Country/Region Scales/Scores used Results
Varshney etal.14
2020
653 HCWs in 64 cities in India IES-R Approximately one-third of the
participants had a signicant psychological
impact (IES-R score >24).
Risk factors identied were young age,
female gender, and existing
comorbid conditions.
Chew etal.15
2020
906 HCWs in 5 major hospitals in
Singapore and India
DASS-21 and IES-R 5.3% of the HCWs screened positive for
moderate to very severe depression, 8.7%
for moderate to severe anxiety, 2.2%
for moderate to severe stress, and 3.8%
for moderate to severe psychological
distress.
Signicant association was found between
the prevalence of physical symptoms
and psychological outcomes (including
depression, anxiety, and stress).
Rossi etal.16
2020
1379 HCWs in Italy Global Psychotrauma Screen (GPS)
PHQ-9
GAD-7
ISI
10-item Perceived Stress Scale
(PSS-10)
Out of the total, 40.38% HCWs screened
positive for post-traumatic stress
symptoms, 24.73% for depression, 19.80%
for anxiety, 8.27% for insomnia, and
21.90% for stress.
Young age, female sex, frontline worker,
having a colleague who is infected/
deceased due to COVID, and being
exposed to the infection were identied as
risk factors for psychological disturbances.
Lai etal.18
2020
1257 HCWs in 34 hospitals in
China
9-item Patient Health Questionnaire
(PHQ-9)
7-item Generalized Anxiety Disorder
Scale (GAD-7)
ISI
Impact of Event Scale-Revised (IES-R)
A signicant proportion of HCWs reported
symptoms of distress (71.5%), depression
(50.4%), anxiety (44.6%), and insomnia
(34.0%).
Signicant risk factors were female gender,
nurses, and those involved in the direct
care of COVID-19 patients.
Que etal.20
2020
2285 HCWs in 28 regions of China GAD-7, PHQ-9, and ISI The prevalence of anxiety, depression,
insomnia, and the overall psychological
problems in HCWs was reported as
46.04%, 44.37%, 28.75%, and 56.59%,
respectively.
Receiving negative information and
working in direct contact with COVID
patients were recognized as important risk
factors for psychological issues.
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022) 831
while answering the questionnaire, although the questionnaire
did conrm that they have cared for COVID patients at som e point.
Lastly and most importantly, we did not compare the mental
health disturbances in the early days of the pandemic with the
current scenario. This would present a better comparison and a
clearer picture of the psychological impact of COVID after the
second wave in India.
co n c lu s I o n
To conclude, COVID-19 has caused a signicant psychological
impact amongst HCWs due to longer working hours, trying
working conditions, fear of health and safety of self and
loved ones, and ever-changing guidelines and social stigma
surrounding the novel disease. However like all warriors, HCWs
have acclimatized to the situation 18 months into the pandemic
and their mental health has stabilized. Females, young er doctors,
front-line workers, and lack of family support remain the risk
factors for psychological issues. Appropriate preventive measures
(Tab le 4 ) should be taken in the form of counseling sessions,
communication, and psychotherapy for all the HCWs, as the
wounded healers must emerge victorious and mentally healthy
from this pandemic.
or c I d
Santvana Kohli https://orcid.org/0000-0003-1410-6933
Sahil Diwan https://orcid.org/0000-0002-6489-802X
Ajay Kumar https://orcid.org/0000-0001-5643-7955
Sanchaita Kohli https://orcid.org/0000-0002-3869-4197
Shipra Aggarwal https://orcid.org/0000-0003-2709-1486
Aakar Sood https://orcid.org/0000-0002-5329-2428
Harish Chander Sachdeva https://orcid.org/0000-0003-4476-0506
G Usha https://orcid.org/0000-0001-5472-5769
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Table 4: Recommendations for psychological support of HCWs during pandemic11
Proper food, drink, rest, and transport facilities at work
Provide reasonable shift hours with adequate breaks
Designing rotates so that the same teams can work together
Focused workload management and dened role expectations
Proactively addressing suggestions, grievances, and issue resolution via a two-way dialogue
Regular praise and acknowledgment of duties under trying circumstances
Clear guidelines with rationale regarding patient care, with regular updates
Encourage morale-building team exercises and recreational activities
Making clear that sta safety is the foremost priority
Providing adequate and good quality equipment and safety gear like PPE, masks, and goggles
Ensuring that formal and informal psychological support is provided to sta
Providing adequate quarantine period and making sure support is provided during the quarantine
Ensuring adequate support in case sta or their family is exposed/infected
Planning for adequate replacement teams if HCWs get infected
Adequate support system in place for all HCWs, including doctors, nursing sta, technical sta, cleaning sta, and porters
HCWs, healthcare workers; PPE, personal protective equipment
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022)
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