Assessment of mental health and quality of life status in health care professionals during COVID-19 in a tertiary care hospital in Jammu, India

INTRODUCTION

In the end of 2019 when people were making resolutions for new year, who on the earth had idea that the world will change completely until cluster of pneumonia with unknown etiology was found in city of Wuhan, China. Disease was found to be caused by novel corona virus subsequently named as COVID-19 on 11 February 2020. WHO carried out virtual conference on 11 March and confirmed our fear, COVID-19 was declared pandemic.¹ This pandemic had brought a significant change in all walks of human life; economic, social, mental and political. COVID-19 has been challenging to people of all spheres of life, but it profoundly affected the life, lifestyle and quality of life of healthcare professionals (HCPs). They were confronted with a greater challenge on the line of duty and path of their mission which demanded high level of motivation and medical care for COVID-19 patients, be it in health institutions or among the community. They also reported experiencing high level of stress, anxiety and depression symptoms which usually have long term psychological implication.² The WHO also emphasized the extremely high burden on healthcare workers, and called for action to address the immediate needs and measures needed to save lives and prevent a serious impact on physical and mental health of healthcare workers.³ COVID-19 crisis placed additional pressure on healthcare professionals (HCPs) and on the healthcare system in general (owing to reasons like longer duty hours, involvement of high risk procedures, washing hands at regular intervals and being ostracized). The COVID-19 pandemic caused a substantial degree of panic, worry, fear and apprehension.⁴

Review of literature shows there is limited literature about mental health and quality of life among healthcare professionals during this pandemic. The present study was conducted to assess the mental health by estimating the prevalence and severity of mental health symptoms and its impact on quality of life during COVID-19 pandemic among HCPs working at GMC-H Jammu.

METHODS

The present research was a cross-sectional study with a purposive sampling technique. Data was collected from November 2020 to October 2021. The study was conducted among health care professionals (HCPs) working in a tertiary care hospital in Jammu city of UT of Jammu and Kashmir. For the study purposes HCPs were defined as those who deliver care services to the sick and ailing either directly as doctors/nurses or indirectly as aides, helpers, lab technicians etc.

Due permission was sought from institutional ethical committee (IEC) GMC Jammu (via order no: IEC/GMC/2021/672) before the start of the study. The inclusion criterion in this study were all the health care professionals working in a tertiary care hospital and were willing to participate. The following were the exclusion criteria for the current study: 1) the HCPs who were taking medicines for psychiatric ailments. 2) Those who had undergone surgery/ hospitalization in last six months. 3) Those who had mortality in the family in last six months.

The study was carried out once in a week with 5-6 interviews conducted on a daily basis and each interview lasting about 30 minutes. So, at the end of the study period a total of 250 HCPs were finally enrolled.

The instrument used in the study was a questionnaire consisting of 3 parts. The first part contains socio-demographic data and information about COVID-19. The second part consisted of depression, anxiety and stress scale-21 (DASS-21), designed to measure the emotional states of depression, anxiety and stress. The third part of the questionnaire was World Health Organization quality of life scale (WHOQOL-BREF). It comprises of 26 items which measure the four domains: physical health, psychological health, social relationships and environment.

The data thus collected was entered into Excel spread sheet. Tests of significance like chi square test, t-test and ANOVA were used. A statistically significant difference between groups was determined at 95% confidence level (p value <0.05).

RESULTS

Figure 1 shows age group and gender wise distribution of the respondents. The mean age of the study population was 41±9.66 years. Females constituted higher proportions than males (57.2% versus 42.8%). Majority of the respondents belonged to 41-50 years of age group in males and 31-40 age group in females.

Table 1 shows the distribution of HCPs on the basis of various socio-demographic characteristics. Overall, a total of 250 individuals were surveyed during the course of the study, out of which majority (74.8%) of the respondents were married, 23.20% of the subjects were unmarried and more than half of the participants (60.4%) hailed from urban background. almost 2/3^rd of study population was educated up to graduate and post graduate level (30% and 36% respectively). Only 11.2% of respondents were literate up to primary level. On the basis of job profile, most (43.6%) of the HCPs were doctors followed by paramedics (31.6%). Most (41.6%) of the HCPs were from para clinical and non-clinical departments, about 36% of the participants were from clinical department. Almost half of the participants had worked for <10 years in their respective departments and majority (88%) of the participants had no co-morbidity.

As evident from above Table 2, the overall prevalence of depression, anxiety and stress was 51.2%, 18% and 45.2% respectively among the study participants.

Figure 2 depicts, 29.2% of the study population had mild depression and 18.0% had moderate degree of depression where as 3.6% had severe depression. Only 0.4% of respondents had extremely severe degree of depression and 12.4% of the study subject had mild anxiety and 40% had moderate degree of anxiety. As evident from table, 30.8% study subject had mild stress and moderate level of stress was found in 10.4%. Only 4% respondent had extreme severe degree of stress.

Table 3 shows the association between different socio-demographic variables with depression, anxiety and stress among respondents. Depression was found to be more in age group 41-50 years (64.40%) while anxiety (23%) and stress (52.5%) were found to be more in age group ≤30 years, only depression was found to be significantly associated with age. Analysis of results showed that females reported higher levels of distress and gender and it was found to be associated with anxiety (p<0.05). Prevalence of depression, anxiety and stress was reported higher in participants hailing from urban areas and those with higher level of education. On the basis of job profile and current working department, depression was reported higher among nurses and those working in ICU (56.60%, 72%), higher level of anxiety was found in doctors and professionals working in Flu-OPD’s (27.52%, 42.85%). Stress was found to be more in paramedics staff and those working in isolation ward (77.21%, 63.63%). Although the prevalence of co-morbidity was lower, psychological distress was reported higher in participants with any existing health condition and this association was statistically significant in case of depression and anxiety.

*Statistically significant

*Statistically significant

Figure 3 shows the mean (SD) scores across various domains of quality of life (QOL). The result revealed that respondents have scored maximum mean scores (53.67%) in domain of social relationship.

Analysis of association of socio-demographic profile with various domains of quality of life among the health care workers showed that social relationship had significant association with all the sociodemographic characteristics. Job profile and duration of service were seen to have statistically significant association with psychological domain of quality of life (Table 4).

DISCUSSION

The mean age of the study population was 41±9.66 years and majority of the respondents were in 31–40-year age group. These findings are in agreement with those reported by Zhang et al.⁵

Regarding prevalence of psychiatric morbidities among the respondents it was 51.2%, 18% and 45.2% for depression, anxiety and stress respectively. These results are in consonance with those reported by young et al, Zhang et al and Rossi et al but were in contrast to the findings reported by Aly et al, Suryavanshi et al and Tan et al.^6-11 The probable difference reported by various authors is likely to be use of different tools in different geographical areas and population.

The results further revealed that female health care professionals suffered higher levels of psychiatric morbidities (depression, anxiety and stress) than their male counterparts and these findings were ably supported by Tomar et al.¹² The possible reason for higher levels of psychiatric morbidities in females could be due to increased physiological vulnerability and not able to handle higher levels of stress in an efficient manner.

During the present study, it was found that association of level of education with anxiety and stress was statistically significantly (p<0.05) and it was in line with the results reported by Xie et al.¹³ It was also found that doctors (half of the respondents) had higher levels of anxiety while stress levels were more in paramedics and depression was found to be high in nurses. All this could be related to COVID-19 related care, being in touch with them besides increased hours.

Prevalence of depression was found to the tune of 72% in the respondents working in ICU and results were statistically significant for association between anxiety and current working department. These results are in consonance with that reported by Tomar et al.¹²

The scoring in all domains of QOL was on higher side in male respondents and association of gender was to be statistically significant (p<0.05) with social relationship and health satisfaction. The results were in agreement to those reported by Hawalder et al.¹⁴ The results also revealed significant association between QOL and level of education. However, Zhang et al reported contrasting results while assessing QOL among local residents in Liaoning province of china.⁵

The scores of various domains of QOL were better in respondents who had no contact with COVID 19 positive patients and who themselves tested negative for COVID-19. Similar findings were reported by Shah et al.¹⁵ The results also elucidated better scores in all domains of QOL in respondents who were residing in urban areas and it was in consonance with those reported by Hawlader et al.¹⁴

CONCLUSION

Prevalence of depression, anxiety and stress was found to be 51.2%, 18% and 45.2% respectively among the health care professionals. Age and co-morbidity were significantly associated with depression while literacy level and job profile were statistically associated with anxiety and stress. Variable found to have statistical association with QOL were job profile, duration of service, current working department and thought of resignation from job due to COVID-19 pandemic. Authors recommend that health planners evolve strategies to combat mental health problems and improve QOL of HCPs by rationalizing work load, allowing adequate breaks and counselling sessions as and when required.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of GMC Jammu (via order no: IEC/GMC/2021/672)

REFERENCES

1. 1. Cucinotta D, Vanelli M. 2020. WHO declares COVID-19 a pandemic. Acta Bio Med Atenei Parmens. 2020;91(1):157.
2. 2. 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. Canadian J Psychiatr. 2007;52(4):233-40.
3. 3. WHO. Pneumonia of unknown cause- China. 2020. Available at: https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/. Accessed on 12 July 2024.
4. 4. Gupta S, Prasad AS, Dixit PK, Padmakumari P, Gupta S, Abhisheka K. Survey of prevalence of anxiety and depressive symptoms among 1124 healthcare workers during the coronavirus disease 2019 pandemic across India. Med J Armed Forces India. 2021;77:S404-12.
5. 5. 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(7):2381.
6. 6. Young KP, Kolcz DL, O’Sullivan DM, Ferrand J, Fried J, Robinson K. Health care workers’ mental health and quality of life during COVID-19: results from a mid-pandemic, national survey. Psychiatric Services, 2021;72(2):122-8.
7. 7. Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosomat. 2020;89(4):242-50.
8. 8. Rossi R, Socci V, Pacitti F, Di Lorenzo G, Di Marco A, Siracusano A, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Network Open. 2020;3(5):e2010185.
9. 9. Aly HM, Nemr NA, Kishk RM, Elsaid NMA. Stress, anxiety and depression among healthcare workers facing COVID-19 pandemic in Egypt: a cross-sectional online-based study. BMJ Open. 2021;11(4):e045281.
10. 10. Suryavanshi N, Kadam A, Dhumal G, Nimkar S, Mave V, Gupta A, et al. Mental health and quality of life among healthcare professionals during the COVID‐19 pandemic in India. Brain Behav. 2020;10(11):e01837.
11. 11. 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(4):317-20.
12. 12. Tomar BS, Suman S, Singh P, Raj P, Nathiya D. Mental health outcome and professional quality of life among healthcare workers during COVID-19 pandemic: a frontline-COVID survey. Hamdan Med J. 2020;13(4):196-202.
13. 13. Xie XM, Zhao YJ, An FR, Zhang QE, Yu HY, Yuan Z, et al. Workplace violence and its association with quality of life among mental health professionals in China during the COVID-19 pandemic. J Psychiatr Res. 2021;135:289-93.
14. 14. Hawlader MD, Rashid MU, Khan MA, Ara T, Nabi MH, Haque MM, et al. Quality of life of COVID-19 recovered patients in Bangladesh. PloS One. 2021;16(10):e0257421.
15. 15. Shah R, Ali FM, Nixon SJ, Ingram JR, Salek SM, Finlay AY. Measuring the impact of COVID-19 on the quality of life of the survivors, partners and family members: a cross-sectional international online survey. BMJ Open. 2021;11(5):e047680.