State of Mental Health of Caregivers on the Frontline during the Covid 19 Pandemic in Medical College and Tertiary Care Centers of Maharashtra
© 2021 Mrudula Joshi, et al, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Healthcare workers have been under immense pressure during COVID 19 pandemic. The novelty of the disease, absence of vaccine, transmission pattern of infection, unpredictable and uncertain nature of infection, unprepared healthcare services were additional factors contributing to the stress of high number of infected cases. These factors can cause significant disturbance in state of mental health of caregivers on the frontline who have direct exposure to infected patients as well as suspected with infected and quarantined individuals. The aim of the study was to evaluate the prevalence of Depression, Anxiety, Stress and Post-Traumatic Stress Symptoms experienced by healthcare workers on frontline in Mumbai and Thane, Maharashtra, India in the midst of outbreak which are the most affected cities of the Nation.
Introduction
On 31 December 2019, a novel viral pneumonia was announced
by the World Health Organization. By the 23 rd March 2020, this
novel coronavirus (COVID-19) quickly spread across the globe,
infecting more than 294,110 people in 187 countries and kill-
ing 12,944 individuals. WHO declared the COVID 19 a global
pandemic on 11 th March 2020, India reported its 1 st case on 30 th
January 2020 in Kerala. Though the spread of disease started in
Maharashtra, the first confirmed case of COVID-19 was on the
9 th March 2020. As dated on 1 st August 2020 India has confirmed
17,51,919 cases to be positive out of which 5,67,636 are active
cases, and 37,403 are deceased. Maharashtra being the most
affected state of the country has recorded 4,31,719 COVID 19
cases, where 1,49,214 are under treatment, 2,66,883are recovered
and 15,316 are deceased. Mumbai, Pune and Thane are 3 cities
of Maharashtra which are affected the most.
Along with the high number of cases, many other factors such as
the novelty of the disease, absence of vaccine, transmission pat-
tern of infection, unpredictable and uncertain nature of infection,
unprepared healthcare services put immense pressure on health
care workers on the frontline. Fear of contagion of disease as a
result of direct exposure to COVID 19 positive patients or sus-
pected individuals can cause many other psychological problems
such as fear, anxiety, facing marginalization or stigma can lead
to develop depressive tendencies. Concerns regarding exposure
of contagion to their family and friends can lead to avoidance of
contact thus leading to social isolation, helplessness. Incessant
stress can cause other psychological problems such as anxiety,
distress, trauma, sleep disturbances which further can affect the
decision-making abilities of health care workers.
Objective of the Study
We examined Depression, Anxiety, Stress and Post-traumatic stress symptoms experienced by healthcare workers in Mumbai and Thane, Maharashtra, India in the midst of outbreak.
Methods and Findings
From 15 th June 2020 to 30 th June 2020 healthcare workers from tertiary care hospitals who were caring for patients with COVID 19 in Mumbai and Thane were invited to participate in the study. The questionnaires were self-administered and were distributed to participants via web-based app - Google forms. In addition to Demographic information mentioned in table 1, standardized and validated questionnaires were used to assess the severity of Anxiety, Depression, Stress and Post-Traumatic Stress Disorder experienced by participants. Following questionnaires were used
- Center for Epidemiologic Studies Depression Scale (CES-D): The Center for Epidemiological Studies-Depression (CES-D), is a 20-item self-report measure which assesses symptoms associated with depression over the past week.
- Generalized Anxiety Disorder Scale - 7 (GAD - 7): The Generalized Anxiety Disorder Scale-7 (GAD-7) is a 7-item, self-rated scale as a screening tool and severity indicator for Generalized Anxiety Disorder.
- Perceived Stress Scale (PSS): The Perceived Stress Scale (PSS) is psychological instrument for measuring the percep- tion of stress. Items were designed to tap PSS measures how unpredictable, uncontrollable, and overloaded respondents find their lives
- Impact of Events Scale Revised (IES -R): The IES-R is a 22-item self-report that assesses subjective distress caused by traumatic events. Out of all invited participants, 30 partici- pated in study and 26 of them met inclusion criteria. From 26 participants 17 (65.38%) experienced Depression out of which 5 participants (19.23 %) suffered through Severe Majors Depressive Disorder. 16 (61.53%) Experienced Anxiety out of which 5 participants suffered through Severe Generalized Anxiety Disorder (19.23%). 14 (53.84%) experienced Post Traumatic Stress Symptoms out of which 10 met probable diagnosis of Post- Traumatic Stress Disorder (38.46%) and 20 (76.92%) experienced stress and Burnout.
| Characteristics | n= 26 | |
|---|---|---|
| Sex | Number | Average |
| Male | 7 | 26.92% |
| Female | 19 | 73.07% |
| Median age | 28.5 | |
| Living Arrangement | ||
| Alone | 5 | 19.23% |
| with family | 11 | 42.30% |
| with room mates | 10 | 38.46% |
| Occupation | ||
| Doctor | 26 | 100% |
| Other medical conditions | ||
| Hypertension | 1 | 3.84% |
| No medical conditions | 25 | 96.15% |
| Prevalence | n | % |
|---|---|---|
| Depression | 17 | 65.38% |
| Anxiety | 16 | 61.53% |
| Stress | 14 | 53.84% |
| PTSD | 20 | 76.92% |
| Questionnaire | Mean | SD |
|---|---|---|
| Center for Epidemiologic Studies Depression Scale (CES-D) |
8.653846 | 6.387126 |
| Generalized Anxiety Disorder Scale - 7 (GAD - 7) |
19.30769 | 11.27748 |
| Perceived Stress Scale (PSS) | 19.03846 | 8.069319 |
| Impact of Events Scale Revised (IES -R) | 30.57692 | 19.77211 |
Discussion
73.07% participants were female doctors where median age of the participants was 28.5 years old. 96.15 participants did not have any medical condition. Participants who had history of psychiat- ric illness were excluded from study. Prevalence of Depression, Anxiety, Stress and PTSD were 65.38%, 61.53%, 53.84%, 76.92% respectively. Overall mean scores of Depression, Anxiety, Stress and PTSD was that of similar to those in published research dur- ing COVID 19 pandemic and published from previous disease outbreaks, such as the severe acute respiratory syndrome (SARS). Mustafa et al. reported prevalence of Depression, Anxiety, In- somnia and Distress symptoms to be as 77.6 %, 60.2 %, 50.4%, and 76.4% (Mustafa Kürşat şahin, 2020). In study conducted by Ruchira et al. it was found that 52.8% of participants had pandemic related burnout. This is similar to our findings in current study.
Limitations
Participation from only one tertiary care hospital is limitation of the current study. Participation of HCWs from other tertiary care centers could strengthen the findings.
Future Directions
Having a longitudinal follow up of participants after timely intervals till Pandemic can give deeper understanding State of Mental Health of caregivers on the frontline during the COVID 19 pandemic.
References
1. Retrieved from https://www.covid19india.org/
2. Benjamin Y Q, Tan M N K (2020) Psychological Impact
of the COVID-19 Pandemic on Health. Annals of Internal
Medicine 173: 317-320.
3. Imran Ijaz Haider, F T (May-2020) Impact of the COVID-19
Pandemic on Adult Mental Health. Pak J Med Sci, COVID19-
S4 36: S90-S94.
4. Kaul R (2020) At least 500 Covid doctors have lost their lives,
says IMA, Hindustan times https://www.hindustantimes.com/
india-news/at-least-500-covid-doctors-have-lost-their-lives-
says-ima/story-ZNOr9Q2XoSpxEstJTGgYOP.html.
5. Mian-yoon chong, W c W c (2004) Psychological impact of
severe acute respiratory. British journal of psychiatry 185:
127-133.
6. Mustafa Kürşat şahin, S A (2020) Prevalence of Depression,
Anxiety, Distress and Insomnia and Related. Journal of Com-
munity Health 45: 1168-1177.
7. Narasimhan, T E (2020) India’s first coronavirus case: Kerala
student in Wuhan tested positive Businees Standard https://
www.business-standard.com/article/current-affairs/india-s-
first-coronavirus-case-kerala-student-in-wuhan-tested-posi-
tive-120013001782_1.html.
8. Ruchira W Khasne, B S (2020) Burnout among Healthcare
Workers during COVID-19 Pandemic in India: Results of a
Questionnaire-based Survey. Indian Journal of Critical Care
Medicine 24: 664 - 671.
9. Waleed Rana, S M (2020) Mental health of medical workers
in Pakistan during the pandemic COVID-19 outbreak. Asian
Journal of Psychiatry V- 51.
10. Worldometer (2020) Retrieved from https://www.worldom-
eters.info: https://www.worldometers.info/coronavirus/