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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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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 ( 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,
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:
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
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)
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
31.60 ± 6.03 years
21–61 years
31 years
630 (43.2%)
828 (56.79%)
Senior residents
PG students/JRs
456 (31.27%)
492 (33.74%)
510 (34.97%)
798 (54.73%)
348 (23.86%)
180 (12.34%)
132 (9.05%)
1176 (80.65%)
282 (19.34%)
Tested COVID positive
963 (66.05%)
495 (33.95%)
Marital status
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
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”
Strongly agree
Neither agree nor 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”
Strongly agree
Neither agree nor disagree
Strongly disagree
810 (55.55%)
534 (36.62%)
30 (2.05%)
72 (4.93%)
12 (0.82%)
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022)
“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
Strongly agree
Neither agree nor 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”
Strongly agree
Neither agree nor 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
Marital status
Living arrangement
Living alone
Living with someone
Having kids
Tested positive
Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors
Indian Journal of Crical Care Medicine, Volume 26 Issue 7 (July 2022)
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
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
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
Signicant association was found between
the prevalence of physical symptoms
and psychological outcomes (including
depression, anxiety, and stress).
Rossi etal.16
1379 HCWs in Italy Global Psychotrauma Screen (GPS)
10-item Perceived Stress Scale
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
1257 HCWs in 34 hospitals in
9-item Patient Health Questionnaire
7-item Generalized Anxiety Disorder
Scale (GAD-7)
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
Signicant risk factors were female gender,
nurses, and those involved in the direct
care of COVID-19 patients.
Que etal.20
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%,
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
Sahil Diwan
Ajay Kumar
Sanchaita Kohli
Shipra Aggarwal
Aakar Sood
Harish Chander Sachdeva
G Usha
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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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ResearchGate has not been able to resolve any citations for this publication.
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Background: The coronavirus disease-2019 (COVID-19) pandemic has led to a significant disruption in healthcare delivery and poses a unique long-term stressor among frontline nurses. Hence, the investigators planned to explore the adverse mental health outcomes and the resilience of frontline nurses caring for COVID-19 patients admitted in intensive care units (ICUs). Materials and methods: A cross-sectional online survey using Google form consisted of questionnaires on perceived stress scale (PSS-10), generalized anxiety disorder scale (GAD-7), Fear Scale for Healthcare Professionals regarding the COVID-19 pandemic, insomnia severity index, and the Connor-Davidson Resilience Scale-10 (CD-RISC) were administered among the nurses working in COVID ICUs of a tertiary care center in North India. Results: A considerable number of subjects in the study reported symptoms of distress (68.5%), anxiety (54.7%), fear (44%), and insomnia (31%). Resilience among the frontline nurses demonstrated a moderate to a high level with a mean percentage score of 77.5 (31.23 ± 4.68). A negative correlation was found between resilience and adverse mental outcomes; hence, resilience is a reliable tool to mitigate the adverse psychological consequences of the COVID-19 pandemic. Conclusion: Emphasizing the well-being of the nurses caring for critical COVID-19 patients during the pandemic is necessary to enable them to provide high-quality nursing care. How to cite this article: Jose S, Cyriac MC, Dhandapani M, Mehra A, Sharma N. Mental Health Outcomes of Perceived Stress, Anxiety, Fear and Insomnia, and the Resilience among Frontline Nurses Caring for Critical COVID-19 Patients in Intensive Care Units. Indian J Crit Care Med 2022;26(2):174-178.
Full-text available
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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Background: Coronavirus disease-2019 (COVID-19) in the last few months has disrupted the healthcare system globally. The objective of this study is to assess the impact of the COVID-19 pandemic on the psychological and emotional well-being of healthcare workers (HCWs). Materials and methods: We conducted an online, cross-sectional, multinational survey, assessing the anxiety (using Generalized Anxiety Disorder [GAD-2] and GAD-7), depression (using Center for Epidemiologic Studies Depression), and insomnia (using Insomnia Severity Index), among HCWs across India, the Middle East, and North America. We used univariate and bivariate logistic regression to identify risk factors for psychological distress. Results: The prevalence of clinically significant anxiety, depression, and insomnia were 41.4, 48.0, and 31.3%, respectively. On bivariate logistic regression, lack of social or emotional support to HCWs was independently associated with anxiety [odds ratio (OR), 3.81 (2.84-3.90)], depression [OR, 6.29 (4.50-8.79)], and insomnia [OR, 3.79 (2.81-5.110)]. Female gender and self-COVID-19 were independent risk factors for anxiety [OR, 3.71 (1.53-9.03) and 1.71 (1.23-2.38)] and depression [OR, 1.72 (1.27-2.31) and 1.62 (1.14-2.30)], respectively. Frontliners were independently associated with insomnia [OR, 1.68 (1.23-2.29)]. Conclusion: COVID-19 pandemic has a high prevalence of anxiety, depression, and insomnia among HCWs. Female gender, frontliners, self-COVID-19, and absence of social or emotional support are the independent risk factors for psychological distress. How to cite this article: Jagiasi BG, Chanchalani G, Nasa P, Tekwani S. Impact of COVID-19 Pandemic on the Emotional Well-being of Healthcare Workers: A Multinational Cross-sectional Survey. Indian J Crit Care Med 2021;25(5):499-506.
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The COVID-19 pandemic’s first wave required considerable adaptation efforts on the part of healthcare workers. The literature on resilient healthcare describes how the collective regulation strategies implemented by frontline employees make essential contributions to institutions’ abilities to cope with major crises. The present mixed-methodology study was thus conducted among a large sample of employees in a variety of Swiss healthcare institutions and focused on problematic real-world situations experienced by them and their managers during the pandemic’s first wave. It highlighted the anticipatory and adaptive strategies implemented by institutions, teams and individuals. The most frequently cited problematic situations involved organisational changes, interpersonal conflicts and workloads. In addition to the numerous top-down measures implemented by institutions, respondents also identified personal or team regulation strategies such as increasing staff flexibility, prioritising tasks, interprofessional collaboration, peer support or creating new communication channels to families. The present findings underlined the importance of taking greater account of healthcare support staff and strengthening managerial capacity to support interprofessional teams including those support staff.
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Purpose of review: We aim to provide quantitative evidence on the psychological impact of epidemic/pandemic outbreaks (i.e., SARS, MERS, COVID-19, ebola, and influenza A) on healthcare workers (HCWs). Recent findings: Forty-four studies are included in this review. Between 11 and 73.4% of HCWs, mainly including physicians, nurses, and auxiliary staff, reported post-traumatic stress symptoms during outbreaks, with symptoms lasting after 1-3 years in 10-40%. Depressive symptoms are reported in 27.5-50.7%, insomnia symptoms in 34-36.1%, and severe anxiety symptoms in 45%. General psychiatric symptoms during outbreaks have a range comprised between 17.3 and 75.3%; high levels of stress related to working are reported in 18.1 to 80.1%. Several individual and work-related features can be considered risk or protective factors, such as personality characteristics, the level of exposure to affected patients, and organizational support. Empirical evidence underlines the need to address the detrimental effects of epidemic/pandemic outbreaks on HCWs' mental health. Recommendations should include the assessment and promotion of coping strategies and resilience, special attention to frontline HCWs, provision of adequate protective supplies, and organization of online support services.
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Background Healthcare workers fighting against the coronavirus disease 2019 (COVID-19) pandemic are under tremendous pressure, which puts them at an increased risk of developing psychological problems. Aims This study aimed to investigate the prevalence of psychological problems in different healthcare workers (ie, physicians, medical residents, nurses, technicians and public health professionals) during the COVID-19 pandemic in China and explore factors that are associated with the onset of psychological problems in this population during this public health crisis. Methods A cross-sectional, web-based survey was conducted in February 2020 among healthcare workers during the COVID-19 pandemic. Psychological problems were assessed using the Generalized Anxiety Disorder Scale, Patient Health Questionnaire and Insomnia Severity Index. Logistic regression analyses were used to explore the factors that were associated with psychological problems. Results The prevalence of symptoms of anxiety, depression, insomnia and the overall psychological problems in healthcare workers during the COVID-19 pandemic in China was 46.04%, 44.37%, 28.75% and 56.59%, respectively. The prevalence of the overall psychological problems in physicians, medical residents, nurses, technicians and public health professionals was 60.35%, 50.82%, 62.02%, 57.54% and 62.40%, respectively. Compared with healthcare workers who did not participate in front-line work, front-line healthcare workers had a higher risk of anxiety, insomnia and overall psychological problems. In addition, attention to negative or neutral information about the pandemic, receiving negative feedback from families and friends who joined front-line work, and unwillingness to join front-line work if given a free choice were three major factors for these psychological problems. Conclusions Psychological problems are pervasive among healthcare workers during the COVID-19 pandemic. Receiving negative information and participating in front-line work appear to be important risk factors for psychological problems. The psychological health of different healthcare workers should be protected during the COVID-19 pandemic with timely interventions and proper information feedback.
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Background The pandemic of Corona Virus (COVID-19) hit India recently; and the associated uncertainty is increasingly testing psychological resilience of the masses. When the global focus has mostly been on testing, finding a cure and preventing transmission; people are going through a myriad of psychological problems in adjusting to the current lifestyles and fear of the disease. Since there is a severe dearth of researches on this issue, we decided to conduct an online survey to evaluate its psychological impact. Methods From 26th to 29th March an online survey (FEEL-COVID) was conducted using principles of snowballing, and by invitation through text messages to participate. The survey collected data on socio-demographic and clinical variables related to COVID-19 (based on the current knowledge); along with measuring psychological impact with the help of Impact of Event–revised (IES-R) scale. Results There were a total of 1106 responses from around 64 cities in the country. Out of these 453 responses had at least one item missing; and were excluded from the analysis. The mean age of the respondents was around 41 years with a male female ratio of 3:1 and around 22% respondents were health care professionals. Overall approximately one third of respondents had significant psychological impact (IES-R score > 24). Higher psychological impact was predicted with younger age, female gender and comorbid physical illness. Presence of physical symptoms and contact history predicted higher psychological impact, but did not reach statistical significance. Conclusion During the initial stages of COVID-19 in India, almost one-third respondents had a significant psychological impact. This indicates a need for more systematic and longitudinal assessment of psychological needs of the population, which can help the government in formulating holistic interventions for affected individuals.
The coronavirus disease 2019 (COVID-19) pandemic has caused enormous psychological impact worldwide. We conducted a systematic review and meta-analysis on the psychological and mental impact of COVID-19 among healthcare workers, the general population, and patients with higher COVID-19 risk published between 1 Nov 2019 to 25 May 2020. We conducted literature researching used Embase, PubMed, Google scholar and WHO COVID-19 databases. Among the initial search of 9207 studies, 62 studies with 162,639 participants from 17 countries were included in the review. The pooled prevalence of anxiety and depression was 33% (95% confidence interval: 28%-38%) and 28% (23%-32%), respectively. The prevalence of anxiety and depression was the highest among patients with pre-existing conditions and COVID-19 infection (56% [39%-73%] and 55% [48%-62%]), and it was similar between healthcare workers and the general public. Studies from China, Italy, Turkey, Spain and Iran reported higher-than-pooled prevalence among healthcare workers and the general public. Common risk factors included being women, being nurses, having lower socioeconomic status, having high risks of contracting COVID-19, and social isolation. Protective factors included having sufficient medical resources, up-to-date and accurate information, and taking precautionary measures. In conclusion, psychological interventions targeting high-risk populations with heavy psychological distress are in urgent need.
Background During the COVID-19 pandemic general medical complications have received the most attention, whereas only few studies address the potential direct effect on mental health of SARS-CoV-2 and the neurotropic potential. Furthermore, the indirect effects of the pandemic on general mental health are of increasing concern, particularly since the SARS-CoV-1 epidemic (2002-2003) was associated with psychiatric complications. Methods We systematically searched the database Pubmed including studies measuring psychiatric symptoms or morbidities associated with COVID-19 among infected patients and among none infected groups the latter divided in psychiatric patients, health care workers and non-health care workers. Results A total of 43 studies were included. Out of these, only two studies evaluated patients with confirmed COVID-19 infection, whereas 41 evaluated the indirect effect of the pandemic (2 on patients with preexisting psychiatric disorders, 20 on medical health care workers, and 19 on the general public). 18 of the studies were case-control studies/compared to norm, while 25 of the studies had no control groups. The two studies investigating COVID-19 patients found a high level of post-traumatic stress symptoms (PTSS) (96.2%) and significantly higher level of depressive symptoms (p=0.016). Patients with preexisting psychiatric disorders reported worsening of psychiatric symptoms. Studies investigating health care workers found increased depression/depressive symptoms, anxiety, psychological distress and poor sleep quality. Studies of the general public revealed lower psychological well-being and higher scores of anxiety and depression compared to before COVID-19, while no difference when comparing these symptoms in the initial phase of the outbreak to four weeks later. A variety of factors were associated with higher risk of psychiatric symptoms and/or low psychological well-being including female gender, poor-self-related health and relatives with COVID-19. Conclusion Research evaluating the direct neuropsychiatric consequences and the indirect effects on mental health is highly needed to improve treatment, mental health care planning and for preventive measures during potential subsequent pandemics.