Jung's archetype, 'The Wounded Healer', mental illness in the medical profession and the role of the health humanities in psychiatry

Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors across Several Hospitals after Second Wave: Have We Acclimatized? A Cross-sectional Survey

Background

Coronavirus disease-2019 (COVID-19) pandemic has been a cause of significant mental health disturbances in medical health personnel. However, 18 months into the pandemic, healthcare workers (HCWs) have become accustomed to the heightened stress and anxiety that comes with caring for COVID patients. Through this study, we aim to measure depression, anxiety, stress, and insomnia in doctors with the help of validated scales.

Materials and methods

This was a cross-sectional study with an online survey design conducted among doctors from major hospitals in New Delhi. The questionnaire included participant demographics, including designation, specialty, marital status, and living arrangements. This was followed by questions from the validated depression, anxiety, stress scale (DASS-21), and insomnia severity index (ISI). Depression, anxiety, stress, and insomnia scores were calculated for each participant, and the data were analyzed statistically.

Results

The mean scores of the whole study population showed no depression, moderate anxiety, mild stress, and subthreshold insomnia. Female doctors exhibited more psychological issues (mild depression and stress, moderate anxiety, but only subthreshold insomnia) as compared to males (mild anxiety, but no depression, stress, and insomnia). Junior doctors also had higher depression, anxiety, and stress scores than senior doctors. Similarly, single doctors, those living alone, and those not having kids had higher DASS and insomnia scores.

Discussion

HCWs have been under tremendous mental stress during this pandemic which is influenced by multiple factors. Female sex, junior doctors, working on the frontline, not being in a relationship, and living alone may be some of the factors recognized in our study and corroborated by many authors, which may increase the chances of depression, anxiety, and stress in them. HCWs need regular counseling, time off for rejuvenation, and social support to overcome this hurdle.

How to cite this article

Kohli S, Diwan S, Kumar A, Kohli S, Aggarwal S, Sood A, et al. Depression, Anxiety, Stress, and Insomnia amongst COVID Warriors across Several Hospitals after Second Wave: Have We Acclimatized? A Cross-sectional Survey. Indian J Crit Care Med 2022;26(7):825-832.

Social sciences and medical humanities: the new focus of psychiatry

The clinical practice of psychiatry should incorporate a biopsychosocial model of illness, acknowledging both cultural and social influences on the patient’s experience. Medical humanities include a number of academic disciplines that complement the clinical practice of psychiatry. The medical profession, including psychiatry, has a social responsibility to study the psychosocial context within which people become ill and have to be treated. Although the biopsychosocial model of illness has strong theoretical foundations, its application in clinical practice is limited. A new approach would be to restructure medical student teaching to include medical humanities in the first year, and to share such education with other professions.

Stigma and mental health challenges in medical students

Despite the perception that medical students and doctors should be 'invincible', mental health challenges are common in this population. Medical students and doctors have low levels of help seeking for their own psychiatric problems often only presenting to mental health services once a crisis arises. Fear of exposure to stigmatisation is a crucial factor contributing to symptom concealment and is a barrier to accessing mental health services. Autobiographical narratives of the 'Wounded Healer' are gaining popularity among medical students and doctors with mental health challenges both as an effective form of adjunctive therapy and as a means to campaign against stigma. Indeed, the results of a randomised controlled trial to assess the efficacy of Coming Out Proud with mental illness revealed immediate positive effects on stigma stress-related variables. We provide an autobiographical narrative from a medical student who has first-hand experience with mental health challenges.

Should Ramadan be prescribed after Christmas? Obesity in the healthcare profession and the health benefits of fasting

Obesity is an important risk factor for cardiovascular morbidity and mortality. In the UK, one in four people are considered overweight or obese and that number is expected to rise to one in three by 2020. Employees of the National Health Service (NHS) are no exception with up to half of healthcare workers considered overweight or obese. Religious periods such as Christmas and Ramadan are associated with weight changes. Weight gain has been reported during the Christmas period albeit not as much as was traditionally believed according to the results of recent research. Conversely, weight loss has been reported in Muslims who fast during the Islamic month of Ramadan; however, this amount tends to be modest and weight gradually returns to pre-Ramadan status according to a meta-analysis of the literature. We report a case of an NHS healthcare worker - which is the first of its kind that illustrates the role that fasting and other factors have played a role in causing dramatic oscillations in his weight.