A study from Bangladesh, one of the poorest countries in the world, reveals a high prevalence of anxiety and depressive symptoms among frontline physicians. These findings indicate the need for policies to mitigate the psychological impact of COVID-19 on these high-risk workers by appropriate physical and emotional support.
The study was published on the pre-print server medRxiv*.
The sudden and rapid emergence and spread of the COVID-19 pandemic has led to a heightened perception of infection risk and increased emotional stress on health workers the world over. Earlier studies have shown that, in 34 Chinese hospitals, frontline workers had depressive symptoms and signs of anxiety while dealing with COVID-19.
Exhausted Physicians. Image Credit: FamVeld/Shutterstock.com
COVID-19 Situation in Bangladesh
The Bangladesh outbreak was reported to have begun on March 8, 2020, and the first COVID-19-related death occurred on March 18. Within seven months from the beginning of the outbreak, there were almost 3 million cases.
About 7,800 physicians were included, and 88 of them died. This is in keeping with the death of 278 physicians the world over within the first five months of the pandemic.
The situation in Bangladesh is worrying because of the poverty of the region, with a severe resource crunch and a lack of support for doctors working with these patients. Many of them live in extended families, within crowded quarters, and simply cannot quarantine after they return home. Thus, not only do they face exposure to potential infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but they carry the emotional impact of potentially taking it home to their family.
The current cross-sectional study aims to explore the level of anxiety and depression, and the associated risk factors, in this segment of the population in Bangladesh, during the current pandemic. The researchers used convenience sampling to identify participants in their online survey, in view of the risk involved in collecting data within the hospitals.
The questionnaire used had three parts, one covering the demographics of the participant population, the second relating to the pandemic, and the third covering the Hospital Anxiety and Depression Scale (HADS).
The study had 412 participants, with about 56% being female. About 93% of invitees took part in the survey. Most participants were between 25 and 34 years, and about 57% were unmarried. Just under half had an income of 40,000 BDT per month, about 365 GBP, or more.
The researchers found that female participants were more likely to have anxiety, at ~75% vs 58% in males. The risk was 2.5 times higher in females. With depression, the difference was smaller, at ~54% and 42% in females and males, respectively. The risk of anxiety was greater in those with symptoms suspicious of COVID-19 vs those without, at 78% vs 66%. The odds of depression in the former group were 63% higher.
Another risk factor that contributed to anxiety was inadequate training about COVID-19, cited by 72% of anxious respondents vs ~61% of those who felt they had been properly trained.
Anxiety was higher if the participant was not ready to deal with COVID-19 patients, at ~75%, but even among those who were ready for this situation, anxiety was reported in 60%. In these groups, depression was reported in ~57% and 40% of physicians, respectively.
Those who were worried about contracting the infection suffered anxiety, in ~82% of cases, but this was reported in less than a third of physicians who were not very worried about this possibility.
Other risk factors included excessive tendencies to check on the latest updates on the disease, addiction to social media, being so busy that they had less than 2 hours of leisure a day, earning too little to support one’s family, experiencing difficulties with commuting to, or from work with police or other regulatory officials.
People with a tendency to become upset easily, or who disliked human contact, were also more likely to become anxious or depressed. In the latter category, the adjusted odds for anxiety and depression were well above 2.7 times higher than for those who were comfortable with human contact.
Risk Factors for Mental Distress
Overall, about 68% and 49% of physicians in the study met the HADS cut-offs for anxiety and depression, respectively. The risk factors for these conditions included the lack of financial incentive, the need to spend out of pocket for personal protective equipment, perceived inadequacy of training, feelings of not being able to control their management of COVID-19 patients, fear of infection, fear of trouble or humiliation related to commuting to or from work, and lack of leisure time, along with disturbed or inadequate sleep, inability to support one’s family, and poor socialization skills.
Such findings are in agreement with earlier studies using the same or other research scales, though at higher levels. This could be explained by the marked shortage of physicians in Bangladesh, with most of them being in urban areas, along with documented higher rates of infection and mortality among healthcare workers. Coupled with the very long working hours, an extreme deficit in PPE, and the poor recompensation for emotional and physical burdens, this contributes to a high prevalence of psychological distress.
The markedly higher impact among females is in keeping with the observed gender gap for mental distress during the current pandemic. Both biological and hormonal mechanisms may underlie this phenomenon. Interestingly, there was no increase in depression or anxiety related to age, comorbidity, or mental state before the pandemic.
Sleep and leisure were inversely linked to mental distress, with the risk of depression being fourfold among those who had less than 2 hours of leisure a day compared to those who had 4-6 hours.
Implications and Conclusion
Despite the obvious potential for biases in this study, it points to the need for policymakers and health authorities to support their frontline staff in the battle against this pandemic, especially in resource-poor locations. In such situations, support from outside is often lacking, while financial stress is likely to increase, especially when physicians have to provide their own PPE.
Given the vulnerability of the physicians and other health care staff in this extraordinary condition whilst they are shouldering the overwhelming weight of the epidemic, fighting social stigma and putting their lives at risk to help the affected, health authorities should addressing their psychological needs and formulate effective strategies, SOPs, and appropriate interventions.”
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.