Mental Health Status of Health Workers during the COVID-19 Pandemic in Setting of DHQ Hospital Jhelum, Punjab, Pakistan: A Cross-sectional Study

Hamida Sarwar1, Kousar Perveen1, Rida Mazhar2, Muhammad Afzal1, Syed Amir Gilani3

1Lahore School of Nursing, The University of Lahore, Pakistan

2District Head Quarter Hospital, Jhelum, Pakistan

3The Faculty of Allied Health Sciences (FAHS), The University of Lahore, Pakistan

Abstract | COVID-19 pandemic has been shown to have significant effects on the mental health of people all across the globe, generally, and healthcare workers, particularly. This report is a cross-sectional study comprising statistical data and mental health measurements from HCW including doctors, nurses, and paramedics from DHQ Hospital Jhelum, Punjab Pakistan during the period April 24, 2020, to May 09, 2020. Healthcare professionals in hospitals equipped with Flu filter clinics and COVID-19 isolation wards were eligible. After obtaining informed consent and assuring confidentiality, statistical data, and mental health measurements from 73. The instrument used for this study was focused on depression, anxiety, distress, and insomnia using the Chinese genre of authorized measurement tools. Removed reference statistical evaluation was performed by using SPSS version 2.6. The data was analyzed to assess the severity of symptoms of depression, anxiety, distress, and insomnia; and then conferred as numbers and percentages. A significant proportion of doctors, nurses, and paramedics reported symptoms of anxiety (38.3%), depression (58.9%), insomnia (45.2%), and distress (61.64%). Overall data collected showed that the ratio of symptoms was comparatively high among nurses than doctors.

Novelty Statement | During COVID-19 pandemic, mental health problems, in general, and mental health status of healthcare workers in developing countries, in particular, is not a widely studied subject. This study tries to bridge this gap in research.

Article History

Received: July 08, 2020

Revised: July 27, 2020

Accepted: September 07, 2020

Published: December 18, 2020

Authors’ Contributions

HS and SAG did literature review. KP, RM, MA, SAG and HS collected the data. KP, SAG and HS and wrote the article. RM, HS and MA did statistical analysis.

Keywords

Covid-19, Healthcare workers, Pandemic, Mental health, DHQ hospital

Corresponding Author: Hamida Sarwar

[email protected]

To cite this article: Sarwar, H., Perveen, K., Mazhar, R., Afzal, M. and Gilani, S.A., 2020. Mental health status of health workers during the COVID-19 pandemic in setting of DHQ Hospital Jhelum, Punjab, Pakistan: A cross-sectional study. Punjab Univ. J. Zool., 35(2): 217-222. https://dx.doi.org/10.17582/journal.pujz/2020.35.2.217.222

Introduction

In the last twenty years, three different forms of coronavirus have caused three different epidemics, namely MERS and SARS caused by MERS-CoV and recently in 2019 SARS-CoV2 (Bonilla-Aldana et al., 2020). The mortality rates of SARS and MERS were 10% and 37% respectively, while the mortality rate of COVID-19 is 2.3% (Petrosillo et al., 2020).

However, on the whole, COVID-19 has caused a greater impact on the lives of humans across the globe because it soon turned into a pandemic that spanned all across the globe (Li et al., 2020). Although COVID-19 is less deadly than SARS and MERS, COVID-19 has spread more widely (Petrosillo et al., 2020). Doctors, nurses, and paramedical staff have been widely declared “frontline warriors in the fight against the COVID-19 pandemic” (Health workers are the frontline soldiers against COVID-19. Let’s protect them | Africa Renewal, 2020).

According to the recommendations by WHO and CDC, healthcare workers must wear personal protective equipment and adhere to disinfection protocols at all times when coming in contact with a suspected case of COVID-19 (Coronavirus Disease 2019 (COVID-19), 2020). Such working conditions not only cause physical pressure but also high levels of psychological pressure (Santos et al., 2020).

Since the first case of COVID-19 in Pakistan was detected in February 2020, the healthcare workers in Pakistan have faced additional psychological pressures due to inadequate availability of personal protection equipment, sleep disturbances, helplessness, concern regarding contagion exposure to family and friends, exhaustion due to the shortage of healthcare staff and lack of contact with family resulting in loss of social support (Rana et al., 2020). These stressors may result in a wide range of mental health issues that can be severely detrimental to the performance of these healthcare workers in the clinical as well as the non-clinical setting against the ongoing pandemic (Torales et al., 2020).

Additionally, an increasing number of HCWs are becoming infected with SARS-Cov2 every day: As of 24th April 2020, at least 253 healthcare workers have been infected by the virus in Pakistan so far. Resultantly, these infected medical workers need to be isolated themselves causing a further shortage of doctors and nurses and increasing the physical and psychological pressure on healthcare workers. Mental health problems that result from such psychological stressors can weaken the strategies of COVID-19 control and may result in higher morbidity and mental health problems globally (Rossi et al., 2020).

Aim of study

This study was carried out to assess the presence of symptoms in HCW due to a novel coronavirus pandemic.

 

Materials and Methods

This report is a cross-sectional study comprising statistical data and mental health assessments from 73 HCW including doctors, nurses, and paramedics from DHQ Hospital Jhelum, Punjab Pakistan during the period April 24, 2020, to May 09, 2020.

Confirmed cases of COVID-19 were 20,941 in Pakistan with 7,646 in Punjab province. Out of the 250 were admitted in DHQ hospital Jhelum 220 of them have been cured and discharged from the hospital, 1 patient is dead and the rest are admitted to the hospital. Approval was granted from the Medical Superintendent of the hospital before the commencement of this study. Written consent was provided by all the participants and allowed to amend the survey at any time, they wished. They were assured confidentiality of the information the provided.

Healthcare workers including doctors, nurses, and paramedics working in COVID-19 isolation wards were part of this survey. The sample size of respondents was calculated using formula S=(Z-score) 2p (1-p)/ (margin of error) 2 in which Z score is 1.96; p is 0.5 and the margin of error was 0.05. So for the infinity population sample size was calculated as 384.16. The population of 73 formula was adjusted as Adjusted S= (S)/1+ [(S-1)/population] so the sample size was, therefore, 61.13 (Cochran).

The instrument used for this study was focused on depression, anxiety, distress, and insomnia using the Chinese genre of authenticated measurement tools (Lai et al., 2020).

Statistical analysis was done using statistical package for the social sciences (SPSS) software version 2.6. The data was analyzed for the severity of symptoms of distress, depression, insomnia, and anxiety. Frequencies of risk factors including anxiety, insomnia, depression, and distress were represented by bar charts and tables.

 

Results and Discussion

Demographic characteristics

The occupational and demographic data were represented by the respondents themselves. A total of 73 participants including 25 doctors (34.2%), 39 nurses (53.4%), 9 paramedics (12.3%) participated in the study. Out of the 58 were female (79.5%) and 15 were male (20.5%). Participants aged between 18-25 were 18, 26-30 were 30, 31-40 were 10 and more than 40 years were 15.

Table 1 shows the frequency and the percentage of all participants according to age. There were 73 58 were females 15 were males which was the 20.5 percent of the total.

 

Table 1: Frequency and percentage of study population according to gender.

Gender	Frequency	Percentage
Male	15	20.5%
Female	58	79.5%
Total	73	100%

 

Table 2 shows the categories of Health care workers included in study to assess the mental health status during COVID-19. There were 39 Nurses with the Huge percentage of 53.4%. There were 9 Paramedics and 25 Doctors.

 

Table 2: History of occupation of all participants.

Occupation
Categories		Frequency	Percentage
1.	Doctors	25	34.2%
2.	Nurses	39	53.4%
3.	Paramedics	9	12%
Total		73	100%

 

Figure 1 shows the distribution of participants according to the age groups, the most of the participant were between the age of 26 to 30 years of age with the highest percentage of 41 %. Participants aged between 18-25 were 18, 31-40 were 10 and more than 40 years were 15.

 

 

Outcome and analysis

A significant proportion of doctors, nurses, and paramedics reported symptoms of anxiety (38.3%), depression (58.9%), insomnia (45.2%), and distress (61.64%). Overall data collected showed that the ratio of symptoms was comparatively high among nurses than doctors. The analysis showed that being a Female and average professional title, nurses were suffering from severe symptoms of depression, anxiety, distress, and insomnia. The score of insomnia in the participants is shown in Figure 2. Analysis scores of the participants are represented in Tables 4, 5 and 6.

Figure 2 shows the prevalence of Insomnia in all the HCWs accordingly. The most vulnerable group experiencing the symptoms of Insomnia was nurses with the large number of 39 out of 73.

Table 3 shows that the study population of the study was comprised of the young age group of the individuals, the p-value was 17.24 with the significant value of .696, the degree of freedom was 21.

 

Table 3: Statistics of age and gender of all study population.

Age and gender
	Value	df	Asymptotic significance (2-sided)
Pearson chi-square	17.240a	21	.696
Likelihood ratio	20.039	21	.519
Linear by linear association	.497	1	.481
N of valid cases	73

 

a: 41 cells (93.2%) have expected count less than 5. The minimum expected count is .21.

 

Table 4 shows the score of anxiety among the health care workers which show significant symptoms of anxiety. The most exposed group was the females suffering from the anxiety.

Table 4 shows the score of depression among the participants due to the exposure to covid-19 patients. It shows that the positive symptoms adhere in all the groups of health care workers included in the study population.

Table 6 shows the scores of distress in healthcare workers. The most significant group here is nurses due to the average title and burden of work with average income.

SARS CoV-2 has been announced as a global health threat by WHO. While the majority of studies are being conducted worldwide to determine the pathogenesis, epidemiology, prevention, and treatment of the disease, there’s a dire need to determine the mental health aspects of the ongoing pandemic as well (COVID Publications). Sound mental health is pivotal to decreasing the overall burden of disease in the society as well as in assuring the quality of life for clinical as well as non-clinical personnel (Short et al., 2018). In the past few years, the importance of standardizing mental health assessment has been much debated upon (Druss, 2018). However, due to the nascent nature of the COVID-19 pandemic and the insidious onset of mental health problems, Mental health issues emerging from the pandemic have not been a top priority by researchers from all across the globe, in general, and in developing countries like Pakistan, in particular, where mental health issues are still stigmatized and rarely mainstreamed (Sohail, 2017). Therefore, this cross-sectional study was conducted in the setting of District Head Quarter Hospital Jhelum to assess the mental health issues emerging from the Coronavirus pandemic in healthcare staff. This study showed that the highest percentage of health-care works experienced symptoms of anxiety, distress, depression, and insomnia. The nursing staff experienced more psychological stress than doctors. After nurse’s symptoms were prominent in doctors than paramedics due to much more exposure to COVID-19 patients, lack of personal protective measures, less psychological support, and fear of becoming the source of exposing their family members.

This study was confined to DHQ hospital Jhelum and conducted only in one hospital. It can be conducted in different hospitals geographically and in order to get more widely applicable results both nationally and internationally. This study was unable to distinguish pre-existing mental health symptoms, that might have been present before the pandemic, from new mental health symptoms that had solely resulted from the COVID-19 pandemic.

Table 4: Scores of anxiety measurements in HCWs.

Table 5: Scores of depression measurements in participants.

Table 6: Scores of distress in healthcare workers.

 

Conclusions and Recommendations

Health care workers are suffering more from anxiety, depression, insomnia, and distress in the current situation of the COVID-19 pandemic. This study also showed somehow that the ratio of symptoms was comparatively high among nurses than doctors.

 

Conflict of interest

The authors have declared no conflict of interest.

 

References

Coronavirus Disease 2019 (COVID-19), 2020. Centers for disease control and prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html.

Health Workers are the Frontline Soldiers Against COVID-19. Let’s Protect Them | Africa Renewal, 2020. UN. Org. https://www.un.org/africarenewal/web-features/coronavirus/health-workers-are-frontline-soldiers-against-covid-19-let%E2%80%99s-protect-them.

Timeline of WHO’S Response to COVID-19, 2020. WHO International. https://www.who.int/news-room/detail/29-06-2020-covidtimeline.

Bonilla-Aldana, Katterine, D., Holguin-Rivera, Y., Cortes-Bonilla, I., Cardona-Trujillo, M.C., García-Barco, A., Bedoya-Arias, H.A., Rabaan, A.A., Sah, R. and Rodriguez-Morales, A.J., 2020. Coronavirus infections reported by promed, February 2000–January 2020. Travel Med. Infect. Dis., 35: 101575. https://doi.org/10.1016/j.tmaid.2020.101575

Druss, B.G., 2018. Mental health quality improvement goes global. World Psychiatry, 17: 44-45. https://doi.org/10.1002/wps.20487

Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N. and Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z. and Hu, S., 2020. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open, 3: e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976

Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y. and Ren, R., Leung, K., Lau, E., Wong, J., Xing, X., Xiang, N., Wu, Y., Li, C., Chen, Q., Li, D., Liu, T., Zhao, J., Liu, M., Tu, W., Chen, C., Jin, L., Yang, R., Wang, Q., Zhou, S., Wang, R., Liu, H., Luo, Y., Liu, Y., Shao, G., Li, H., Tao, Z., Yang, Y., Deng, Z., Liu, B., Ma, Z., Zhang, Y., Shi, G., Lam, T., Wu, J., Gao, G., Cowling, B., Yang, B., Leung, G. and Feng, Z., 2020. Early transmission dynamics in Wuhan, China, of novel coronavirus, infected pneumonia. N. Engl. J. Med., 382: 1199-1207.

Petrosillo, N., Viceconte, G., Ergonul, O., Ippolito, G. and Petersen, E., 2020. COVID-19, SARS and MERS: Are they closely related? Clin. Microbiol. Infect., 26: 729-734. https://doi.org/10.1016/j.cmi.2020.03.026

Rana, W., Mukhtar, S. and Mukhtar, S., 2020. Mental health of medical workers in Pakistan during the pandemic COVID-19 Outbreak. Asian J. Psychiatry, 51: 102080. https://doi.org/10.1016/j.ajp.2020.102080

Rossi, R., Socci, V., Pacitti, F., Lorenzo, G.D., Marco, A.D., Siracusano, A. and Rossi, A., 2020. Mental health outcomes among frontline and second-line health care workers during the Coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Network Open, 3: e2010185. https://doi.org/10.1001/jamanetworkopen.2020.10185

Santos, Dos, W.A., Beretta, L.D.L., Leite, B.S.L, da Silva, M.A.P., Cordeiro, G.P. and França, E.M., 2020. O Impacto da Pandemia Da COVID-19 Na Saúde Mental Dos Profissionais De Saúde: Revisão Integrativa. Res. Soc. Dev., 9: 190985470. https://doi.org/10.33448/rsd-v9i8.5470

Short, B., Marr, C. and Wright, M., 2018. A new paradigm for mental-health quality and safety: Are we ready? Austral. Psychiatry, 27: 44-49. https://doi.org/10.1177/1039856218797423

Sohail, S.A., Syed, A.A. and Rahman, A., 2017. Mental health in Pakistan: Yesterday, today and tomorrow. Int. Cult. Psychol., pp. 17-37. https://doi.org/10.1007/978-1-4899-7999-5_2

Torales, J., O’Higgins, M., Castaldelli-Maia, J.M. and Ventriglio, A., 2020. The outbreak of COVID-19 coronavirus and its impact on global mental health. Int. J. Soc. Psychiatry, 66: 317-320. https://doi.org/10.1177/0020764020915212