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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 4  |  Page : 362-365

Impact of COVID-19 on mental health of health-care providers in Maharashtra: A cross-sectional study


Department of Community Medicine, Mimer Medical College, Talegaon Dabhade, Maharashtra, India

Date of Submission17-May-2022
Date of Decision22-Jul-2022
Date of Acceptance24-Jul-2022
Date of Web Publication30-Jan-2023

Correspondence Address:
Dr. Maya Vikas Kshirsagar
Lalit F-706, Nanded City - 411 041, Pune
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_93_22

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  Abstract 


Background: As COVID-19 is spreading rapidly, it is emotionally challenging for everyone. It has been observed that health-care workers come to play a major role and give their efforts to a greater extent in such situations. The studies have reported adverse psychological reactions to the 2003 severe acute respiratory syndrome outbreak among health-care workers. Hence, the study was planned to assess depression, anxiety, and stress among health-care professionals during the corona pandemic. Materials and Methods: A cross-sectional, observational study was carried out on health-care professionals working in the state of Maharashtra who were involved in the management of COVID-19 patients. Institutional ethical permission was taken before the study. The questionnaire was created to collect the data which having background information and the Depression, Anxiety, and Stress Scale-21. Data were entered into Microsoft Excel sheets and appropriate statistical analysis was done. Results: A total of 200 participants were included in the study. It was observed in our study that 51% of participants had depression, 38% had stress, and 49% had anxiety. Depression, anxiety, and stress were more among female health-care professionals than male professionals and it was statistically significant. It was found in our study that depression, anxiety, and stress were more in urban professionals than in rural health-care professionals, and the difference was statistically significant. Conclusion: As our study demonstrated a higher burden of depression, stress, and anxiety, early screening of health-care professionals and implementation of psychological interventions are essential for protecting and maintaining the functionality of the health-care system.

Keywords: Anxiety, COVID-19, depression, stress


How to cite this article:
Kshirsagar MV, Vaidya SR, Ashturkar MD. Impact of COVID-19 on mental health of health-care providers in Maharashtra: A cross-sectional study. Ann Indian Psychiatry 2022;6:362-5

How to cite this URL:
Kshirsagar MV, Vaidya SR, Ashturkar MD. Impact of COVID-19 on mental health of health-care providers in Maharashtra: A cross-sectional study. Ann Indian Psychiatry [serial online] 2022 [cited 2023 Mar 26];6:362-5. Available from: https://www.anip.co.in/text.asp?2022/6/4/362/368785




  Introduction Top


Since the end of December 2019, the Chinese city of Wuhan has reported novel pneumonia caused by coronavirus disease 2019 (COVID-19), which is spreading domestically and internationally.[1],[2] The virus has been named severe acute respiratory syndrome coronavirus (SARS-CoV) and the disease COVID-19. Emerging viral diseases are frequent public health threats as a result of their potential to develop into epidemics and pandemics, and COVID-19 has become one of the major catastrophes in the century.[3] In the past week of March 2020, the World Health Organization (WHO) declared it a Public Health Emergency of International Concern (PHEIC), which is the sixth PHEIC under the International Health Regulations after H1N1 influenza (2009), Polio (2014), Ebola in West Africa (2014), Zika (2016), and Ebola in the Democratic Republic of the Congo (2019). On February 11, 2020, the WHO has officially declared COVID-19 as a "pandemic" from the previous status of global health emergency.[4]

As the disease is spreading rapidly, the COVID-19 outbreak is emotionally challenging for everyone. It has been observed that health-care workers come to play a major role and give their efforts to a greater extent every day in such situations. Facing this critical situation, health-care workers on the front line who are directly involved in the diagnosis, treatment, and care of patients with COVID-19 are at risk of developing psychological distress and other mental health symptoms. The ever-increasing number of confirmed and suspected cases, overwhelming workload, widespread media coverage, lack of specific drugs, feelings of being inadequately supported, etc., may all contribute to the mental burden of these health-care workers. The studies have reported adverse psychological reactions to the 2003 SARS outbreak among health-care workers.[2],[5],[6],[7] Similar concerns about the mental health, psychological adjustment, and recovery of health-care workers treating and caring for patients with COVID-19 are now arising. It affects their work output which in the pipeline, affects the health-care delivery to the whole nation.[8]

A study from Wuhan and China revealed 50.4% of depression, 44.6% of anxiety, 34.0% of insomnia, and 71.5% of distress among 1257 health-care workers.[2] There are very few studies carried out on the Indian population. Hence, the study was planned to assess the depression, anxiety, and stress among health-care workers during the corona pandemic.

Aim and objectives

  1. To study the impact of COVID-19 on the mental health of health-care providers
  2. To identify some of the predictors on the mental health effect of health-care providers.



  Materials and Methods Top


A cross-sectional, observational study was carried out on health-care workers working in the state of Maharashtra. The health-care professionals involved in the management of COVID-19 patients were included in the study. The depression among the health-care providers in previous studies was approximately 34.9%.[9] Considering allowable error 20% of prevalence, 95% confidence interval (α = 0.05), and sample size was 200. Institutional ethical permission was taken before the study. An online semi-structured questionnaire in Google forms was developed, with a consent form attached to it. The link of the questionnaire in Google Forms was sent through E-mail and WhatsApp to the health-care professionals.

The questionnaire was formed based on two parts: the first part was for background data which included age, gender, place of practice, qualification, specialties, and duration in health-care sectors. In the second part, the Depression, Anxiety, and Stress Scale (DASS)-21 was applied. The DASS-21 is based on three subscales of depression, stress, and anxiety, and each subscale consists of seven questions. The rating of DASS subitems such as depression, anxiety, and stress can be rated as normal, mild, moderate, and extremely severe. Each item is scored on a self-rated Likert scale from 0 (did not apply to me all) to 3.[10] Both English and non-English versions have high internal consistency (Cronbach's alpha scores >0.7). The DASS scale has a shorter version and longer version (comprising 21 and 42 items, respectively). In DASS-21, the final score of each item is multiplied by two to obtain the final score.[11]

Data were entered into Microsoft Excel sheets. The Chi-square test was applied and statistical significance was determined at P < 0.05.


  Results Top


A total of 200 health-care professionals who were participated in the study.

It was observed that the maximum participants in the study, i.e. 63 (61.5%) were in the age group between 41 and 50 years, followed by 61 (30.5%) were <30 years of age. There were 47 (23.5%) participants in the age group between 31 and 40 years, whereas 29 (14.5%) were >50 years of age [Table 1].
Table 1: Age wise distribution

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In the present study, 110 (55%) were male health-care professionals, whereas 90 (45%) were female health-care professionals [Figure 1].
Figure 1: Gender-wise distribution

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[Table 2] shows the practice area of health-care professionals participated in the study. It was observed that 149 (74.5%) were working in an urban area and 51 (25.5%) were working in rural areas of Maharashtra. Among the health-care providers, maximum, i.e. 158 (79%) were working as private practitioners and 42 (21%) were working in government health-care facilities. Among the health-care professionals, 146 (73%) were graduates, 47 (23.5%) were postgraduates, and 7 (3.5%) were superspeciality professionals in our study.
Table 2: Practice area of health care professionals

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In the present study, depression was observed in 102 (51%) participants, stress in 98 (49%) participants, and anxiety in 76 (38%) participants [Figure 2]. Among the depression, it was found that 38 (19%) had moderate depression, followed by 33 (16.5%) had mild depression, 20 (10%) had extremely severe depression, and 11 (5.5%) health-care professionals had severe depression. It was observed that 27 (13.5%) participants had mild stress, 25 (12.5%) had severe stress, 21 (10.5%) had moderate stress, whereas 3 (1.5%) had extremely severe stress in our study. It was found that moderate anxiety was seen among 44 (22%) participants, extremely severe anxiety in 26 (13%), severe anxiety in 20 (10%), and mild anxiety in 8 (4%) health-care professionals. The various leisure activities used by the participants were watching television/social media, spending time with family and friends, doing yoga/meditation/exercise, some spent time on singing/reading, etc.
Figure 2: Depression, anxiety, and stress among health-care professionals

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It was observed in the study that female health-care professionals had more depression, anxiety, and stress as compared to male professionals, and it was found statistically significant [Table 3]. Depression, anxiety, and stress were more among the health-care providers working in urban areas as compared to rural areas, and this was statistically significant.
Table 3: Association of depression, anxiety and stress with gender and practice area

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  Discussion Top


The present study was carried out to see the impact of COVID-19 on mental health among health-care professionals in Maharashtra. In our study, maximum participants in the study, i.e., 61.5% were in the age group between 41 and 50 years followed by 30.5% were <30 years of age. In a review carried out to see the mental health problems faced by health-care workers during the COVID-19 pandemic, the mean age of medical staff participants ranged between 26 and 40 years of age.[12] It was observed that 74.5% of professionals were working in an urban area and 25.5% were working in the rural areas of Maharashtra. Among the health-care providers, maximum, i.e. 79% were working as private practitioners and 21% were working in government health-care facilities. In another study carried out by Selvaraj et al., 52% of participants were working in government health setup, whereas 48% were working in private setup.[13]

Depression was observed in 51% of participants, stress in 49% of participants, and anxiety in 38% health-care professionals. In a study carried out by Chatterjee et al.,[11] 34.9% of participants were depressed, 39.5% had anxiety, whereas 32.9% of participants were having stress. A study carried out in Hubei showed the prevalence of depression at 50.4% among frontline health-care workers. It was also observed that during the swine flu that health-care professionals experienced anxiety in India. It was also revealed from the literature that a large proportion of health-care workers were suffered from various mental health problems.[14],[15],[16]

It was found in our study that, 10% had extremely severe depression and 5.5% of health-care professionals had severe depression. Another study carried out in West Bengal showed that 5.9% had severe and 3.9% of doctors had very severe depression. It was observed that 12.5% had severe stress, whereas 1.5% had extremely severe stress in our study. Similar observations were found in other studies which showed 7.2% severe anxiety and 2% very severe anxiety among doctors.[11] It was observed in the study that female health-care professionals had more depression, anxiety, and stress as compared to male professionals. The study conducted in China[14] also showed a higher prevalence of depression in female health-care workers. A higher proportion of mental health problems were observed during the COVID-19 pandemic in different countries.


  Conclusion Top


A higher prevalence of mental health problems was observed among health-care professionals while managing the pandemic situations as frontline workers. Early screening of health-care professionals and the implementation of psychological interventions are essential for protecting and maintaining the functionality of the health-care system. More research will help to outline the intervention measures for health-care workers to cope with difficult situations during pandemics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207.  Back to cited text no. 1
    
2.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, 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.
World Health Organization. Novel Coronavirus (2019-n COV) Situation Report-1. Geneva: World Health Organization; 2020. Available from: https://www.who.int/. [Last accessed on 2021 Sep 18].  Back to cited text no. 3
    
4.
NHCPRC. National Health Commission of the People's Republic of China: Coronavirus Disease (COVID 19); 2020. Available from: http://www.nhc.gov.cn. [Last accessed on 2021 Oct 15].  Back to cited text no. 4
    
5.
Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168:1245-51.  Back to cited text no. 5
    
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Bai Y, Lin CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv 2004;55:1055-7.  Back to cited text no. 6
    
7.
Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry 2007;52:233-40.  Back to cited text no. 7
    
8.
Chatterjee SS, Malathesh BC, Mukherjee A. Impact of COVID-19 pandemic on pre-existing mental health problems. Asian J Psychiatry 2020;51:102071.  Back to cited text no. 8
    
9.
Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33:335-43.  Back to cited text no. 9
    
10.
Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol Assess 1998;10:176-81.  Back to cited text no. 10
    
11.
Chatterjee SS, Bhattacharyya R, Bhattacharyya S, Gupta S, Das S, Banerjee BB. Attitude, practice, behavior, and mental health impact of COVID-19 on doctors. Indian J Psychiatry 2020;62:257-65.  Back to cited text no. 11
  [Full text]  
12.
Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian J Psychiatr 2020;51:102119.  Back to cited text no. 12
    
13.
Selvaraj P, Muthukanagaraj P, Saluja B, Jeyaraman M, Anudeep TC, Gulati A, et al. Psychological impact of COVID-19 pandemic on health-care professionals in India – A multicentric cross- sectional study. Indian J Med Sci 2020:72:141-7.  Back to cited text no. 13
    
14.
Guo WP, Min Q, Gu WW. Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: A cross-sectional study. Health Qual Life Outcomes 2021;19:103.  Back to cited text no. 14
    
15.
Maunder R. The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: Lessons learned. Philos Trans R Soc Lond B Biol Sci 2004;359:1117-25.  Back to cited text no. 15
    
16.
McAlonan GM, Lee AM, Cheug V. Immediate and sustained psychological Impact of an emerging infectious disease outbreak on health care workers. Can J Psychiatry 2007;52:241-7.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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