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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 1  |  Page : 7-11

Evaluation of the impact of the COVID-19 pandemic on the mental health of the health-care professionals across India


1 Consultant Paediatric Gastroenterologist, Apollo Childrens Hospital, Chennai, Tamil Nadu, India
2 Psychologist, Apollo Hospitals, Chennai, Tamil Nadu, India
3 Student Clinical Psychologist, PSG College of Sciences, Coimbatore, Tamil Nadu, India

Date of Submission22-Nov-2020
Date of Decision09-Feb-2021
Date of Acceptance09-Feb-2021
Date of Web Publication22-Mar-2021

Correspondence Address:
Dhanasekhar Kesavelu
Consultant Paediatric Gastroenterologist, Apollo Childrens Hospital, Chennai,Tamilnadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_126_20

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  Abstract 


Introduction: The unprecedented pandemic of COVID-19 has put a huge strain on the global health system and stress on the mental health of health-care professionals. We ventured to perform a virtual analysis of the mental health of our colleagues via an online assessment and sent a questionnaire-based survey. Materials and Methods: A 31-question-based survey was sent to health-care professionals including medical and paramedical staff. This Survey was then sent as an online questionnaire using google forms®. Questions were based on three categories, namely their general health, interpersonal support, and resilience. The General Health Questionnaire, Interpersonal Support Evaluation List-12, and Brief Resilience Scale were used to formulate the questionnaire. Results: The results did not show or highlight any area of significant concern currently, although a repeat survey will be very crucial to assess the impact of the pandemic on the mental health of health-care professionals postpandemic and how it has affected their general health, resilience, and an assessment of the support system. Conclusion: The Covid 19 pandemic as expected is taking a toll on the Health Care Workers and this requires ongoing evaluation and intervention.

Keywords: COVID-19, health-care professionals, mental health, pandemic, questionnaire, survey


How to cite this article:
Kesavelu D, Inuganti AR, Karthikeyan N. Evaluation of the impact of the COVID-19 pandemic on the mental health of the health-care professionals across India. Apollo Med 2021;18:7-11

How to cite this URL:
Kesavelu D, Inuganti AR, Karthikeyan N. Evaluation of the impact of the COVID-19 pandemic on the mental health of the health-care professionals across India. Apollo Med [serial online] 2021 [cited 2021 Oct 20];18:7-11. Available from: https://www.apollomedicine.org/text.asp?2021/18/1/7/311627




  Introduction Top


On January 30, 2020, as of March 4, 2021 we have 11,156,923 confirmed cases of COVID-19 with 157,435 deaths deaths. As we continue to struggle with this pandemic which has crippled many of the advanced healthcare systems of other countries it is imperative that we ensure our healthcare professionals are provided all of the care and support possible for the challenges ahead. So we decided to focus on evaluating the impact this pandemic has on their mental health of our health-care workers in scenario is crucial, so we can prepare and support them for the battle ahead and for the days to come. We recognize that their mental health is imperative to ensure that their ability to function in this pandemic is protected, especially as death toll and numbers impacted across the world continue to rise. The healthcare professionals are learning fast to adapt to the demands of this pandemic, a virus that continues to claim many lives and has been stretching some of the most advanced health care systems to the limit. This Virus had resulted in the lockdown or stay at home order to 1.3 billion people in India and much more internationally.[1]


  Materials and Methods Top


The purpose of this study is to analyze the mental health of health-care professionals in real time. The tools utilized for the purpose were put together in a simple survey format to ensure ease of use; the survey consisted of 31 questions. This survey questionnaire was designed in Google Forms and made accessible online for self-administration. An informed consent script briefly explaining the objective of the study was provided at the beginning of the survey. The respondents who continued and participated in the survey were assumed to have consented.

This survey was then sent to all health-care professionals using social media platforms. Each respondent was evaluated considering three important components:

  1. Their general health
  2. Interpersonal support
  3. Resilience.


The three components listed above we decided were essential to evaluate their ability to deal with the demands of this pandemic. Their general health, evaluating for per existing stressors, their current social support systems as it is important for stress management and finally we evaluated their resilience or their ability to bounce back from challenges.

To evaluate the general health, we used the General Health Questionnaire (GHQ) created by Goldberg and Blackwell[2] in 1970's, which is a tool that has been widely used to assess psychological distress. The GHQ-12 comprises 12 questions regarding the general level of happiness, symptoms of depression and anxiety symptoms, perceived stress, and sleep disturbance in real time. Each item has a four-point response scale.

The GHQ-12 includes the following 12 questions:

  1. Have you recently been able to concentrate on whatever you are doing?
  2. Have you recently lost much sleep due to some worry?
  3. Have you recently felt constantly under strain?
  4. Have you recently felt that you could not overcome your difficulties?
  5. Have you recently been feeling unhappy and depressed?
  6. Have you recently been losing confidence in yourself?
  7. Have you recently been thinking of yourself as a worthless person?
  8. Have you recently felt that you are playing a useful role in life?
  9. Have you recently felt capable of making decisions about things?
  10. Have you recently been able to enjoy your normal day-to-day activities?
  11. Have you recently been able to face up to your problems?
  12. Have you recently been feeling reasonably happy, all things considered?


Then, we decided that we needed to measure their perceived social support as research indicates a strong link between this and mental health. The Interpersonal Support Evaluation List-12[3] (ISEL-12; Cohen, Mermelstein, Kamarck, and Hoberman, 1985) is broadly employed as a short-form measure of the traditional ISEL, which measures perceived social support. This questionnaire has three different subscales designed to measure three dimensions of perceived social support which are Appraisal Support or Advice, Belonging Support or Empathy, and Tangible Support or Observable Help. Each dimension is measured by four items each on a four-point scale ranging from “definitely true” to “definitely false.”

The questions for the Appraisal Support Subscale are items 1, 5, 7, and 9:

  • 1 – If I wanted to go on a trip for a day (for example, to the country or mountains), I would have a hard time finding someone to go with me
  • 5 – If I decide one afternoon that I would like to go to a movie that evening, I could easily find someone to go with me
  • 7 – I do not often get invited to do things with others
  • 9 – If I wanted to have lunch with someone, I could easily find someone to join me.


The Belonging Support Subscale items are made up of 3, 8, 10, and 12:

  • 3 – If I were sick, I could easily find someone to help me with my daily chores
  • 8 – If I had to go out of town for a few weeks, it would be difficult to find someone who would look after my house or apartment (the plants, pets, garden, etc.)
  • 10 – If I were stranded 10 miles from home, there is someone I could call who could come and get me
  • 12 – If I needed some help in moving to a new house or apartment, I would have a hard time finding someone to help me.


The rest of the items create the Tangible Support Subscale:

  • 2 – I feel that there is no one I can share my most private worries and fears with
  • 4 – There is someone I can turn to for advice about handling problems with my family
  • 6 – When I need suggestions on how to deal with a personal problem, I know someone I can turn to
  • 11 – If a family crisis arose, it would be difficult to find someone who could give me good advice about how to handle it.


Finally, we decided to measure resilience or the ability to bounce back given the nature of this pandemic and extensive loss it was causing.[4] We felt this was an essential ability. This instrument was developed in 2008 by Smith et al.; it was called the Brief Resilience Scale (BRS)[5] that is a very brief six-item questionnaire [Table 1]. The six questions on it are as follows: (1) I tend to bounce back quickly after hard times. (2) I have a hard time making it through stressful events. (3) It does not take me long to recover from a stressful event. (4) It is hard for me to snap back when something bad happens. (5) I usually come through difficult times with little trouble. (6) I tend to take a long time to get over the setbacks in my life. Patients were asked to indicate the degree with which they agree with the statements on a five-point scale ranging from strongly agree to strongly disagree.
Table 1: General Health questionnaire

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Using these three instruments, a 31-question survey was developed that was administered to 112 health-care workers across the country; the criteria were that they had to have experience working with the COVID-19 epidemic and had to be health-care professionals working in India. The survey was administered from April 15, 2020, to May 15, 2020.


  Results Top


We had 128 responses for the survey. The first 8 questions on the survey related to basic demographic details or information to ensure they met the criteria, such as they had to health-care workers with experience in COVID-19 cases in India. Of the 110 respondents, 51.6% were male and 48.4% female, and 60.9% were doctors while the rest were other medical staff such as nurses, pharmacists, human resources, hospital staff, front office staff, and nonmedical staff. Most of the respondents were from the Chennai district in Tamil Nadu as the study originated from there. About 84.4% did not work in government facilities while the rest worked in the private health-care system.

The next 12 responses are related to the questions related to General Heath or GHQ-12.

The responses for the GHQ which measures the general level of happiness, anxiety, and depression in respondents did indicate certain specific areas of concern at this time. The responses for the GHQ which measure the general level of happiness, anxiety and depression in the respondents had a scores that require further exploration. The highest score was when 30.3% responded that often lose sleep over worry, 21.2% state they often feel unhappy and depressed. This seems to be area where further supportive services are offered, especially for those whose responses are consistently concerning.

The following 12 questions were related to the perceived social support the health care workers experienced. We measured this using the ISEL-12 (Cohen, Mermelstein, Kamarck, and Hoberman, 1985) is broadly employed as a short-form measure of the traditional ISEL, which measures perceived social support [Table 2].
Table 2: The interpersonal support evaluation list

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This questionnaire has three different subscales designed to measure three dimensions of perceived social support which are Appraisal Support or Advice, Belonging Support or Empathy, and Tangible Support or Observable Help. Each dimension is measured by four items each on a four-point scale ranging from “definitely true” to “definitely false.”

The questions for the Appraisal Support Subscale are items 1, 5, 7, and 9 [Table 3].
Table 3: Appraisal Support Subscale

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When we look at the results of the appraisal support scale we observed that 35.4% responded that they did not get invited to do things with others we need to clarify this further, is this a consistent feeling they have or is it because of the current concerns of others because of their work with Covid 19 patients.

The Belonging Support Subscale items are made up of 3, 8, 10, and 12 [Table 4].
Table 4: The Belonging Support Subscale

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While the majority of the responses on the belonging support score were in the acceptable range, a significant score was when 30/7% responded that they would have difficulty finding someone to take care of their home for a few weeks. We need to explore this more and evaluate if the responses were impacted by the limitations caused by the current Pandemic situation or is more consistent with their experience of their social support system.

Line I On the tangible scale it was a little concerning that 18.9% felt they had no one to give them advice on how to handle a family crisis [Table 5], about 20% (11.8% probably true and 7.9% definitely true) felt they did not have a support system to share their private worries and fears with. These respondents need to be further counseled on how to build their support system and explore for difficulties they may be experiencing in these areas.
Table 5: The Tangible Support Subscale

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The final six were from the BRS, as shown in [Table 6].
Table 6: Brief Resilience Scale

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The three concerning responses on the resilience scale are when 29.9% said they had a hard time managing stressful events, 9.4% said they have a hard time bouncing back, and 28.3% state it is hard to snap back when something bad happens. We would need to explore situations that caused these responses with the survey respondents and help them explore other ways they can better prepare themselves for such events.


  Discussion Top


The results did not indicate any significant area of concern on any of the scales at this time it would be beneficial to repeat this study every 4–6 weeks to monitor impact on their mental health. In addition, we must create support groups to help the staff deal with the aftermath of this pandemic in addition to ensuring the availability of access to mental health workers supporting and encouraging the use of these services. The medical community in particular often has difficulty recognizing and meeting their own medical needs, especially their mental health is often underplayed by their wish to remain at the service of others and disregard their own needs. Education is required to help them recognize the needs for this to change.


  Conclusion Top


An interesting study in this area is entitiled “Burnout among Healthcare Workers during COVID-19 Pandemic in India: Results of a Questionnaire-based Survey” Ruchira W Khasne, Bhagyashree S Dhakulkar, Hitendra C Mahajan, Atul P Kulkarni.[6] This study administered a questionnaire-based survey the Copenhagen Burnout Inventory was carried out among HCWs looking after COVID-19 patients. This study found that there was a significant prevalence of burnout during the COVID-19 pandemic among HCWs, in particular, doctors and support staff. Female respondents had higher prevalence. We suggest that the management should be proactive and supportive in improving working conditions and providing assurance to the HCWs. The long-term effects of the current pandemic need to be assessed later.

Another interesting study is the Psychological impact of COVID-19 pandemic on health-care professionals in India-A multicentric cross-sectional study. The aim of the study was to assess the presence of psychological distress, depression, anxiety, stress, and insomnia experienced by the Indian healthcare workers. Here the DASS-21 questionnaire and the Insomnia Severity Index were utilized. This study indicated that among 55% of medical officers in the study reported having moderate levels of depression. With respect to anxiety, it was found that among men as many as 52% reported experiencing severe anxiety and 24% had moderate levels of anxiety whereas females reported as high as 68% and 48% of moderate and severe anxiety, respectively. In this study, around 30% and 44% of male doctors reported mild and moderate levels of stress, respectively, whereas 70% and 56% of female doctors reported mild and moderate levels of stress, respectively. It was also observed that among female doctors the rates of moderate insomnia were especially high (65%), whereas a high level of male participants reported sub-threshold insomnia (52%).

A third study that also focused in this area was entitled 'Mental Health and quality of life among healthcare professionals during the COVID-19 pandemic in India. This study was carried out by M Suryavanshi N, Kadam A, Dhumal G, et al. Brain Behav. 2020;10:e01837. They utilized the Patient Health Questionnaire (PHQ-9) to assess the severity of symptoms of depression, the Generalized Anxiety Disorder (GAD-7) questionnaire, Quality of life and Stressors or the factors they perceive as contributing to their mental stress was also evaluated. This study demonstrated a high burden of depression and anxiety among young, unmarried HCPs serving COVID-19 patients in the highly impacted regions of India. They also found moderate to severe depression and anxiety among HCPs that negatively impacted their overall quality of life during COVID pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO. Coronavirus Disease 2019 (COVID-19). 2019; WHO; 2020. Available from: https: www.who.int/docs/default-source/coronaviruse/situation-reports/20200415. [Last accessed on 2021 Mar 05].  Back to cited text no. 1
    
2.
Goldberg DP, Blackwell B. Psychiatric illness in general practice. A detailed study using a new method of case identification. Br Med J 1970;1:439-43.  Back to cited text no. 2
    
3.
Cohen S, Mermelstein R, Kamarck T, Hoberman HM. Measuring the functional components of social support. In Sarason IG, Sarason BR, editors. Social Support: Theory, Research, and Applications. The Hague, Netherlands: Martinus Niijhoff; 1985.  Back to cited text no. 3
    
4.
Qin M, Vlachantoni A, Evandrou M, Falkingham J. General Health Questionnaire-12 reliability, factor structure, and external validity among older adults in India. Indian J Psychiatry 2018;60:56-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: Assessing the ability to bounce back. Int J Behav Med 2008;15:194-200.  Back to cited text no. 5
    
6.
Khasne RW, Dhakulkar BS, Mahajan HC, Kulkarni AP. Abstract Background: Burnout, a state of physical and emotional exhaustion, in healthcare workers (HCWs) is a major concern. Indian J Crit Care Med 2020;24:664-71.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


This article has been cited by
1 Editorial
Raju Vaishya,SatishKumar Agarwal
Apollo Medicine. 2021; 18(1): 1
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