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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 197-202

A cross-sectional study to assess the psychosocial impact of COVID-19 pandemic on health-care workers at a tertiary care hospital in India


1 Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan, India
2 Department of Mathematics and Statistics, JECRC University, Jaipur, Rajasthan, India
3 Department of Medicine, RUHS College of Medical Sciences and Attached Hospitals, Jaipur, Rajasthan, India
4 Department of Psychiatry, UCLA School of Medicine, Los Angeles, CA, USA

Date of Submission06-Jul-2020
Date of Acceptance25-Aug-2020
Date of Web Publication26-Sep-2020

Correspondence Address:
Dr. Munesh Kumar
A-2, New Heera Bagh Flats, Near Kalyan Dharamshala, Jaipur - 302 004, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_89_20

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  Abstract 


Introduction: Corona virus disease 2019 (COVID-19) has been declared a notified disaster and public health emergency of international concern. Health-care workers (HCWs) who are involved in the care of these COVID patients are at additional risk of developing mental illness themselves due to direct exposure associated with the disease in them leading to this study.
Aim: This study aims to assess the psychosocial impact of COVID-19 pandemic on HCW using Screening Questionnaire for Disaster Mental Health (SQD).
Materials and Methods: A cross-sectional study was done on 112 HCW in SMS Hospital, Jaipur from June 1, 2020, to June 15, 2020. SQD was used to assess the magnitude of posttraumatic stress disorder and depression in these HCWs who were directly involved in care of COVID-19 patients at some point of time and had no previous history of mental illness.
Results: 5.67% HCW were suffering from severe posttraumatic stress disorder and similar 5.67% had severe depression due to COVID-19. Results analyzed by t-test found that, overall, HCWs were mildly affected by COVID-19 in terms of posttraumatic stress disorder (mean value 2.16; 95% confidence interval [CI] = 1.80–2.53, P = 0.000) and depression (mean value 1.27; 95% CI = 0.97–1.57, P = 0.000) as per SQD scale.
Conclusion: The study highlighted that the majority of the HCW were slightly affected by corona pandemic in terms of posttraumatic stress disorder and depression but as corona is still persisting, the need of constant vigilance for its psychosocial impact on them continues.
The following core competencies are addressed in this article: Medical knowledge, Professionalism, Practice-based learning and improvement, Systems-based practice.

Keywords: COVID-19, depression, health care workers, mental health, posttraumatic stress disorder


How to cite this article:
Bansal A, Jain S, Sharma L, Kumar M, Sharma A. A cross-sectional study to assess the psychosocial impact of COVID-19 pandemic on health-care workers at a tertiary care hospital in India. Int J Acad Med 2020;6:197-202

How to cite this URL:
Bansal A, Jain S, Sharma L, Kumar M, Sharma A. A cross-sectional study to assess the psychosocial impact of COVID-19 pandemic on health-care workers at a tertiary care hospital in India. Int J Acad Med [serial online] 2020 [cited 2020 Nov 30];6:197-202. Available from: https://www.ijam-web.org/text.asp?2020/6/3/197/296147




  Introduction Top


Corona virus disease 2019 (COVID-19) is a highly infectious pandemic which has affected millions of persons worldwide and the number is still increasing. An estimated average mortality rate of this disease is 3.4% globally.[1],[2] The World Health Organization declared it a public health emergency of international concern on January 30, 2020.[3] Considering the magnitude of the problem beyond the coping capacity of the community of affected area and substantial human suffering, COVID-19 has been acknowledged as a notified disaster by Government of India.[4] First case of COVID-19 was reported in SMS Hospital, Jaipur, on 29/2/2020. Within next 3 months, the total number of COVID patients increased to 1249 including 96 health-care workers (HCWs). Most of the affected HCWs were infected while dealing with patients in that duration. Further scrutiny of the list of affected HCW revealed that 88% of them were either doctors, residents, nursing, or paramedical staff. Only 12% were others including ancillary staff. One nursing staff died due to COVID-19 infection. It clarified that besides physical illness, HCW are at an additional risk of developing mental illness due to direct exposure with the disease. The previous study on HCW in an illness similar to COVID-19, almost more than a decade ago, suggested that HCW are at higher risk of developing anxiety, depression, and stress during these periods.[5] Many studies have been done to assess the magnitude of mental burden of corona on general public but there is paucity of evaluating the same with focus on HCW.[6],[7] Hence, this study was planned for HCW to evaluate the psychosocial impact of corona virus on their own mental health

Objective

The objective is to assess the psychosocial impact of COVID-19 pandemic on HCW using Screening Questionnaire for Disaster Mental Health (SQD).


  Materials and Methods Top


Study design and settings

A cross-sectional study was conducted from 1 to 15 June 2020 after ethical approval in SMS hospital, Jaipur, Rajasthan. SMS is a 2455-bedded tertiary care specialty and super specialty hospital which caters to a wide variety of population from all over Rajasthan and nearby states. On May 31, 2020, 900 beds were reserved for COVID patients. The bed occupancy rate on that date was 6.6% and 26% respectively for COVID and non-COVID patients. As the COVID-19 patients were identified and managed mainly by medicine, respiratory disease, ENT, anesthesia, ICU departments after confirmation from microbiology section, HCW working in these departments were most vulnerable for the psychosocial impact of virus besides physical illness. Hence, the data collection was confined to these specialties only.

Selection of study population

Total 118 HCWs were randomly selected from those who were directly involved in the diagnosis, treatment, and care of COVID-19 patients. Faculty, postgraduate students, nursing, and paramedical staff were considered for the inclusion in the study. Three HCW did not give consent and three HCW who gave the affirmative reply to mental illness were excluded in the initial phase only. Ancillary staff such as security guards, ward boys, ambulance drivers, helpers, porters, and food suppliers were not included in the study considering their highly diversified levels of risk involvement in patient care and different predisposing factors for mental illness.

Method and study tool

SQD was used in the study. The advantage of SQD is that it is less time consuming and answers are dichotomous, i.e., either “yes” or “no,” leaving no space for ambiguity.

Description of the Screening Questionnaire for Disaster Mental Health

SQD is a validated tool which was developed for rapid screening of posttraumatic stress disorder (PTSD) and depression. Cronbach's alpha value to show internal consistency of SQD used in the study was 0.86. It has total 12 items which were adopted from the posttraumatic symptom scale (PTSS-10), DSM-IV diagnostic criteria for PTSD and DSM-IV diagnostic criteria for major depressive episode (MDE). In SQD questionnaire, the responses are defined for two categories that are “YES” and “NO”. So for analyzing the data, number 0 is assigned for each “NO” response and number 1 for each “YES” response.

SQD-P subscale to measure PTSD uses 9 items [Q3–Q4, Q6–Q12 from total 12 items shown in [Table 1]. In SQD-P subscale, 3 items each of intrusion, avoidance, and hyper arousal type have been selected. Intrusive items identify newer symptoms due to event exposure, avoidance items recognize need of conscious evasion of stress causing factor and hyper arousal type items spot excessive expression of feelings. Intrusive items are: “recurrent and intrusive distressing recollections of the event;” “nightmares about the accident or disaster;” and “fears when approaching the place of the accident or situations that remind me of it.” Items related to avoidance are “efforts to avoid thoughts, feelings, or conversations associated with the trauma;” “tendencies to withdraw myself from others;” and “markedly diminished interest or participation in significant activities.” Hyper arousal items are “difficulty with sleep;” “irritable feelings;” and “tendencies to jump or startle at sudden noises or unexpected movements.” While interpreting the results in terms of severity of PTSD, values in range 0–3 represent slightly affected (means currently little possibility of PTSD). Similarly, 4–5 correspond to moderately affect and 6–9 stand for severely affected (possibly suffering from PTSD), respectively.
Table 1: Question wise responses given by participants (expressed in number and percentage)

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SQD-D subscale to measure depression has 6 items (Q1–3, Q5–6, Q10). In SQD-D subscale, 3 items [1],[2],[5] have been adopted from DSM-IV's diagnostic criteria for MDE. These are “depressed mood;” “decrease in appetite;” and “fatigue or loss of energy nearly every day.” Three items (Q3, 6, 10) are same as were used in SQD-P. Depression is categorized in terms of severity, using the cutoff point scores. According to SQD-D subscale, participants with a score of 0–4 are less likely to be depressed and 5–6 are more likely to be depressed. Many prior studies have reported that chances of depression coexisting with PTSD are very high.[8],[9]

This SQD questionnaire was explained to 112 HCW enrolled in the study in small groups and were requested to fill it. The collected data were analyzed statistically using the statistical software Minitab 16 (PA, USA).


  Results Top


Total 112 HCW participated in the study. Out of them, 106 HCW submitted the completed questionnaire and only these were included while computing the results. Among them 64 were males and 42 were females. Segregation of HCW showed that 19 were doctors, 53 were medical students, and 34 were nursing and technical staff. The mean age of the participants was 29.13 years.

The responses obtained to individual questions are shown in [Table 1].

The study reported that only 5.67% HCWs were suffering from severe posttraumatic stress disorder and also 5.67% were more likely to be depressed due to COVID-19 [Table 2]a and [Table 2]b.
Table2:

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As shown in Pie-Chart for SQD-P, it is clear that the category 2 had the highest percentage followed by category 1 [Figure 1]a. By category, here, we mean the number of items for whom “yes” answers were given by the participants, out of total nine items used in SQD-P subscale. Box plot shows that the consistency of the responses for SQD-P was in the range of 1–3 [Figure 1]b.
Figure 1: Summary for subscale SQD-P depicting category and consistency of responses. (a) Pie chart for SQD-P. (b) Boxplot for SQD-P. SQD = Screening Questionnaire for Disaster Mental Health

Click here to view


Similar analysis was done for SQD-D. Pie-Chart depicts that the category 0 had the highest percentage succeeded by category 1 [Figure 2]a. It means that maximum participants gave “no” answers for all the six items of SQD-D subscale followed by one “yes” answer. The Box plot shows that the consistency of the responses was in the range of 0–2 [Figure 2]b.
Figure 2: Summary for subscale SQD-D depicting categories and consistency of responses. (a) Pie chart for SQD-P. (b) Boxplot for SQD-P. SQD = Screening Questionnaire for Disaster Mental Health

Click here to view


Statistical analysis

T-test for single mean used for SQD-P found P = 0.000 which was <0.05 [Table 3]. 0.05 was considered as “level of significance” in our study. Hence, we rejected our null hypothesis, according to which there was no psychosocial effect of COVID infection on HCW and accepted the alternative hypothesis of HCW were definitely affected by this pandemic in terms of PTSD. The mean value was 2.16 with 95% confidence interval [CI] between 1.80 and 2.53. Since both upper and lower values of CI fell in the range of 0–3 which denotes mild category as per SQD-P scale, hence, it was concluded that HCW were only mildly affected by COVID-19 in terms of PTSD. Similarly, single T test for mean in SQD-D subscale also found P value to be 0.000, indicating that overall HCW were less likely to depressed due to COVID-19 [Table 4].
Table 3: One-sample t-test for Screening Questionnaire for Disaster Mental Health-P

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Table 4: One-sample t-test for Screening Questionnaire for Disaster Mental Health-D

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  Discussion Top


Our study using SQD scale found that 84.90% HCWs were slightly stressed and 94.33% were slightly depressed due to COVID-19. These results are in accordance with another study done by Zhang et al. using impact of event scale (IES) reflecting a mild stressful impact due to the pandemic.[7] The mean SQD scores for stress and depression among HCW in our study were 2.16 and 1.27, respectively. These were lower than the study done by Tan et al. in Singapore using depression, anxiety, and stress scale 21 and IES-R scores during COVID outbreak. Both the scales included intrusion, avoidance, and hyper arousal parameters based items for assessing the mental burden of the pandemic.[10] A systematic review and meta-analysis done by Pappa et al. highlighted that the prevalence rate of depression was 22.8% with female predominance of affective symptoms.[11] These reports are contrary to our findings where males and females were equally affected by depression and males were marginally more affected in terms of stress disorder.

Sleep difficulties were reported by 21.49% of participants in our study against 12.5% and 38.9% by two another studies, respectively.[6],[11] However, the same study found more than 80% of the Indian general population was preoccupied with the thoughts of COVID-19 while it was only 16.82% in the present study focused on HCW.[6] A study by Lai et al. found that females, nurses and frontline workers exposed to COVID-19 in Wuhan, China, were suffering more from depression (50.4%), anxiety (44.6%), insomnia (34.0%), and distress (71.5%) which are totally different to our findings where HCWs were only slightly affected and female HCWs were even lesser affected with PTSD than males.[12]

Strength of study

It was done when the burden of COVID-19 was high. SQD scale used in study is a convenient, reliable, validated tool for rapid screening of PTSD and depression without ambiguity of outcome.

Limitations of study

The follow-up of participants for mental status was not possible as only one time response was collected from respondents in this questionnaire based study. It was a monocentric study with limited study population so the stratification of the results by type of health-care worker was not possible without compromising with the power of the study.


  Conclusion Top


The study highlights that majority of HCW directly engaged in the diagnosis, treatment, and care for patients with COVID-19 were slightly affected by corona pandemic with little possibility of PTSD and depression though being at highest risk for psychological distress during the outbreak. However, as the pandemic is still persisting, the need of constant vigilance for its psychosocial impact on HCW continues.

Acknowledgments

The author(s) would like to acknowledge all the HCW who participated in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Research quality and ethics statement

The study was conducted in duly compliance with the established international publishing and reporting recommendations by EQUATOR network for enhancing quality and transparency in health research. The approval of the ethics committee was obtained through letter No. IT/02/2020 dated March 4, 2020.



 
  References Top

1.
Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA 2020;323:1439-40.  Back to cited text no. 1
    
2.
WHO Corona Virus Disease 2019 (COVID-19) Situation Report – 77. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200406-sitrep-77-covid-19.pdf?sfvrsn=21d1e632_2. [Last accessed on 2020 Jun 20].  Back to cited text no. 2
    
3.
Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int. J Surg. 2020;76:71-6.  Back to cited text no. 3
    
4.
5.
Graham RL, Donaldson EF, Baric RS. A decade after SARS: Strategies for controlling emerging coronaviruses. Nat Rev Microbiol 2013;11:836-48.  Back to cited text no. 5
    
6.
Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian Journal of Psychiatry. 2020;8:102083.  Back to cited text no. 6
    
7.
Zhang Y, Ma ZF. Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning Province, China: A cross-sectional study. Int J Environ Res Public Health 2020;17:2381.  Back to cited text no. 7
    
8.
Fujii S, Kato H, Maeda K. A simple interview-format screening measure for disaster mental health: An instrument newly developed after the 1995 Great Hanshin Earthquake in Japan – The Screening Questionnaire for Disaster Mental Health (SQD). Kobe J Med Sci 2008;53:375-85.  Back to cited text no. 8
    
9.
Wagle S, Amnatsatsue K, Adhikari B, Kerdmongkol P, Van Der Putten M, Silpasuwan P. Health-related quality of life after the 2015 Gorkha earthquakes, among older adults living in Lalitpur District of Central Nepal. Disaster Med Public Health Prep 2020;12:1-0.  Back to cited text no. 9
    
10.
Tan BY, Chew NW, Lee GK, Jing M, Goh Y, Yeo LL, et al. Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Ann Intern Med 2020;173:317-20.  Back to cited text no. 10
    
11.
Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:901-7.  Back to cited text no. 11
    
12.
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. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

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



 

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