Mental health assessment of frontline COVID-19 dermatologists: A Pan-Indian multicentric cross-sectional study

Impact of COVID-19 Pandemic on Dermatology Teaching Program in India: A Survey on the Faculty and Residents' Perspective

Background

Impact of COVID-19 pandemic has been immense. An innocent casualty of this disaster is medical education and training. Dermatology, which primarily deals with out-patient services, medical and surgical interventions, and in-patient services, was one of the worst hit. The National Medical Commission of India has implemented competency-based medical education (CBME) in Dermatology, Venereology, and Leprosy since 2019. The new curriculum relies on acquiring practical and procedural skills, training skills in research methodology, professionalism, attitude, and communication.

Objectives

The study was undertaken to understand the implications of the COVID-19 pandemic on postgraduate dermatology CBME training in India.

Materials and Methods

A questionnaire-based survey was carried out on postgraduate dermatology teachers and residents in India after obtaining ethics committee approval. An online semi-structured English questionnaire was administered by Google Forms. The calculated sample size was 366 dermatology faculty and 341 postgraduate students. Validity (Content validity ratio (CVR) ≥0.56) and reliability (Cronbach's alpha coefficient 0.7249) of the questionnaire were determined.

Results

Among the 764 responses received, 51.4% reported that their institutes were converted to exclusive COVID hospitals. Domains of dermatology education affected were procedural training (n = 655), bedside clinical teaching (n = 613), outpatient department-based clinical teaching (n = 487), bedside laboratory procedures (n = 463), research activities (n = 453), histopathology (n = 412), and theory classes (n = 302). To keep up with the teaching-learning process, online platforms were mostly utilized: Zoom Meeting (n = 379), Google Meet (n = 287), and WhatsApp Interaction (n = 224). Teaching during ward rounds was significantly more affected in exclusively COVID institutes than non-exclusive COVID institutes (P < 0.001). Psychomotor skill development suffered a major jolt with 26.7% of respondents reporting a standstill (P < 0.001). Communication skills among students suffered due to social distancing, mask, and poor attendance of patients. According to 23.84% of respondents, formative assessment was discontinued.

Conclusion

Online seminars, journal clubs, and assessments have been incorporated during the pandemic. Online modalities should be used as a supplementary method as psychomotor skills, communication skills, research work, and bedside clinics may not be replaced by the e-learning.

Prevalence of Stress and Insomnia among Health Care Workers in India during COVID-19 Pandemic: A Systematic Review and Meta-analysis

Background

Health care workers (HCWs) are prone to stress and insomnia because of pandemic situations. Assessment of the actual burden of this stress and insomnia is essential to form preventive strategies. The study's objective was to find out the pooled prevalence of stress and insomnia among HCWs in India during the coronavirus disease (COVID-19) pandemic.

Material and Methods

We conducted a systematic review and meta-analysis to determine the prevalence of stress and insomnia among HCWs during the COVID-19 pandemic in India. Cross-sectional studies conducted in India regarding stress and insomnia among HCWs were searched from PubMed, Scopus, Embase, and Google Scholar. These studies were published after the declaration of the COVID-19 pandemic till August 31, 2021. Articles were searched independently by both authors. Data were extracted in an Excel sheet and analyzed using the 'Meta' package of the 'R' software version 4.1.0.

Result

A total of 23 and 16 studies were included in the final pooled analysis of stress and insomnia, respectively, following preferred reporting items for systematic review and meta-analysis guidelines. A random-effects model was used to determine the pooled prevalence of stress and insomnia. This study is registered in Prospero. The registration number is CRD42021253917. The total numbers of HCWs from India included were 8125 and 4974, respectively, for finding out the pooled prevalence of stress and insomnia. The pooled prevalence of stress and insomnia among HCWs is 43% [95% confidence interval (CI) 30-56%] and 35% (95% CI 28-44%), respectively. Two out of five and one in three Indian HCWs have stress and insomnia, respectively, during the COVID-19 pandemic.

Conclusion

Human resource development should be prioritized to decrease the workload among HCWs. The findings from this study will be useful in preparing policy guidelines on mental health screening of HCWs during the pandemic.

Dermatology and Venereology Consultation Pattern from Inpatient and Emergency Department in Tertiary Hospital Setting Before and During COVID-19 Pandemic

Background/Purpose

COVID-19 pandemic has compromised healthcare services in dermatology and venereology. Given such circumstances, studies investigating the consultation pattern of related fields in hospitals were relatively scarce. The present study aimed to delineate such matter from tertiary hospital viewpoint.

Methods

Details concerning referred patients from the emergency room, inpatient wards, intensive care unit, and nursery to the Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo Hospital were retrospectively collected from electronic health records. Cases admitted in the 17 months span before and during COVID-19 global outbreak were included. The obtained data were presented descriptively, and Chi-squared test was performed upon attributes of interest at a significance level of 0.05.

Results

A slight increase of total consultation was found in the COVID-19 era with an initial reduction at the beginning (April-May 2020). One-time consultation was the most inquired to our department in both periods of which dermatitis was the most prevalent case and Gram staining was the most common examination. Topical antibiotics and emollient were the most prescribed medications before and during the outbreak, respectively. The conformity of initial-final decision, appropriateness of initial-final diagnosis, and consult response time were significantly different (p < 0.05) between the two groups.

Conclusion

There were changes of the number of consultation requests in the pandemic era with statistically significant change of decision conformity, diagnoses, appropriateness, and consult response time. Although some changes appeared, the most prevalent diagnoses remained.

COVID-19 and Healthcare Worker: What We Need to Know

COVID-19 pandemic has challenged and overwhelmed most healthcare institutions and healthcare workers, across the world. Despite being unprepared for this pandemic, frontline workers have worked relentlessly to provide the much-needed care to these patients. Doctors from different branches of medicine, including dermatologists, came forward and played a substantial role in mitigating the impact of this pandemic on the general population. Sadly, in the process, these healthcare workers faced many personal, social, psychological, economic, and health-related issues. The psychological burden and health-related issues received due attention in the main-stream news as well as scientific research papers. With most frontline workers isolated from their families, social media became the new platform to reduce the sense of isolation and share their anxiety, insomnia, and fatigue. This article is aimed at highlighting various challenges faced by healthcare workers during the ongoing COVID-19 pandemic.

An Observational Survey to Appraise the Influence of COVID-19 Pandemic on Dermatology Training Programs in India: Residents' Standpoint

Background:

Given the all-encompassing foothold of COVID-19, it is plausible that the pandemic would have a long-lasting impact on medical training programs, including dermatology. We conducted a survey amongst the residents of dermatology (across India) to assess the impact of COVID-19 pandemic on their teaching and education programs.

Materials and Methods:

An online semi-structured English questionnaire was prepared on the Google-forms platform and the link was circulated among the residents. The questionnaire comprised of five sections (demographic details, impact on clinical training, procedural training, academic curriculum, and research activities). Appropriate statistical tests were carried out to analyze the data obtained.

Results:

Three-hundred and seventy-eight responses were taken into consideration. A majority of the respondents (63.5%) were engaged in both COVID-19-related duties and departmental work (out-patient and in-patient duty). Around two-thirds of the trainees (65.1%) claimed a reduction in patient footfall (greater than 50% compared to pre-COVID times). Sixty-nine percent reported a decline of more than 50% in in-patient admission; 47.6% felt that the discontinuity in patient care had severely affected their residency training; 50.8% highlighted that no procedures were being performed in their department; 54.5% opined that academic activities were relatively unhampered as regular seminars were being conducted through online web-based applications; and 65.1% of the trainees were not able to devote any time to their thesis-related work.

Conclusion:

Since the after-effects of this pandemic will last long, it is advisable that residents and faculties adapt themselves to web-based learning programs in the academic curriculum so that the training of the future consultants does not get jeopardized. Our survey, being the first of its kind in dermatology, will throw some light on the perspective of residents and the way forward to combat the untoward consequences on their training programs.

Women in healthcare experiencing occupational stress and burnout during COVID-19: a rapid review

Context

COVID-19 has had an unprecedent impact on physicians, nurses and other health professionals around the world, and a serious healthcare burnout crisis is emerging as a result of this pandemic.

Objectives

We aim to identify the causes of occupational stress and burnout in women in medicine, nursing and other health professions during the COVID-19 pandemic and interventions that can support female health professionals deal with this crisis through a rapid review.

Methods

We searched MEDLINE, Embase, CINAHL, PsycINFO and ERIC from December 2019 to 30 September 2020. The review protocol was registered in PROSPERO and is available online. We selected all empirical studies that discussed stress and burnout in women healthcare workers during the COVID-19 pandemic.

Results

The literature search identified 6148 citations. A review of abstracts led to the retrieval of 721 full-text articles for assessment, of which 47 articles were included for review. Our findings show that concerns of safety (65%), staff and resource adequacy (43%), workload and compensation (37%) and job roles and security (41%) appeared as common triggers of stress in the literature.

Conclusions and relevance

The current literature primarily focuses on self-focused initiatives such as wellness activities, coping strategies, reliance of family, friends and work colleagues to organisational-led initiatives such as access to psychological support and training. Very limited evidence exists about the organisational interventions such as work modification, financial security and systems improvement.

Prevalence of anxiety and depression in South Asia during COVID-19: A systematic review and meta-analysis

INTRODUCTION

The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic.

METHOD

We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression.

RESULTS

A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7-48.1, I 2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9-39.4, I 2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups.

CONCLUSION

South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia.

Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review

BACKGROUND

Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout. The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health.

METHODS

We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 17, 2020. Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers.

RESULTS

From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review. Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries. Psychological symptoms of anxiety (14.3-92.3%), stress (11.9-93.7%), depression (17-80.5%), post-traumatic stress disorder (13.2-75.2%) and burnout (14.7-76%) were commonly reported among physicians, regardless of infectious disease outbreak or country. Younger, female (vs. male), single (vs. married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms.

INTERPRETATION

Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist. Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19.

Depression and anxiety associated with COVID- 19 pandemic among healthcare professionals in India- A systematic review and meta-analysis

BACKGROUND

As India is fighting against the second wave of COVID-19, Healthcare professionals are the front-line warriors on that battlefield which puts them under psychological pressure, this systematic review aims to critically look into and amalgamate the evidence on impact of COVID-19 on psychological health of healthcare professionals in India and to seek the attention of policymakers.

METHODS

A systematic literature search was performed using the following databases PubMed, SCOPUS, Web of Science, Cochrane Library, ScienceDirect. Additionally, random search in Google, Google Scholar and ResearchGate was also performed until February 2021. The methodological quality of studies was assessed using Downs and Black for reporting quality. Meta-analysis was performed using revMAN. The review protocol is registered in PROSPERO and is available online.

RESULT

Prevalence of depression was found to be present in 41.90% of 5796 participants in five studies (95% Confidence Interval [CI]: 29.17 to 54.64), and prevalence of anxiety was found to be 42.87% common in 10 studies with a total sample size of 3059 people (95% Confidence Interval [CI]: 30.26 to 55.49), Stress was found to be prevalent (58.04%) in 12 studies with 4209 participants, (95% CI: 44.81-71.28), Prevalence of sleeping problem in 3 studies with 416 participants recorded a prevalence rate of 31.94 (95% CI: 21.38-42.49).

CONCLUSION

The COVID-19 pandemic has had a significant impact on people's mental and physical health, particularly among health-care workers. Authorities should develop programmes to help health-care workers improve their mental health.

Mental health research in the lower-middle-income countries of Africa and Asia during the COVID-19 pandemic: A scoping review

BACKGROUND

Lower middle - income countries of Africa and Asia have accommodated a large portion of the world's population, where mental health research has been under-prioritized. This study aimed to review all published research on mental health issues related to the COVID-19 pandemic in lower middle - income countries of the Afro-Asian region.

METHODS

A search was conducted in the PubMed and PubMed Central databases using the terms "mental health," "psychiatric disorders," "COVID-19", "coronavirus," "Asia," "Africa," "Lower Middle-income countries." All articles published in the English language until 3rd July 2020 were included.

RESULT

A total of 133 papers were found in lower-middle-income countries of Africa (n = 11) and Asia (n = 122), which discussed various aspects of mental health in the context of COVID-19. Most of the studies are cross-sectional studies that addressed mental morbidities, psychological reactions, stress, coping among the general population, and focused groups (healthcare workers, students, elderly, patients). Researchers attempted to develop and validate tools that measure certain psychological constructs (fear, anxiety) concerning COVID-19. Online surveys were the primary modality of researching this COVID-19 pandemic.

CONCLUSION

COVID-19 related mental health research is scarce in lower-middle-income countries of Africa and Asia. Available researches suggest that mental health challenges during this COVID-19 pandemic are enormous and need attention. There is a need for policy and recommendations to deal with the mental health challenges in lower middle - income countries of Africa and Asia.