Prevalence and predictors of depression, anxiety and stress among frontline healthcare workers at COVID-19 isolation sites in Gaborone, Botswana

Prevalence and Factors Associated with Common Mental Disorders and Posttraumatic Stress Disorder Among Healthcare Workers in a Reference Center for Infectious Diseases During the COVID-19 Pandemic: A Survey-Based Cross-Sectional Study

A cross-sectional survey conducted between July and September 2020 and August and September 2021 estimated the prevalence and predictors of common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) among healthcare workers (HCWs) at an infectious disease referral center during the COVID-19 pandemic. CMDs were assessed using the General Health Questionnaire (GHQ-12), and PTSD using the Impact of Event Scale-Revised (IES-R). Multivariate logistic regressions identified predictors of CMD and PTSD. The study included 371 HCWs in 2020 and 167 in 2021. The CMD prevalence was 34.3% (95% confidence interval (CI): 29.5-39.4) in 2020 and 30.5% (95% CI: 23.7-38.1) in 2021. The PTSD prevalence was 25.4% (95% CI: 21.0-30.2) in 2020 and 32.7% (95% CI: 25.6-40.5) in 2021. Factors increasing CMD odds included lower education (adjusted odds ratio (AOR) = 3.71, 95% CI: 1.60-8.61), lack of physical activity (AOR = 2.23, 95% CI: 1.33-3.73), and experiencing COVID-19 symptoms (AOR = 1.64, 95% CI: 1.02-2.64) in 2020; chronic diseases (AOR = 3.14, 95% CI: 1.34-7.35) and SARS-CoV-2 testing (AOR = 3.39, 95% CI: 1.13-10.17) raised CMD odds in 2021. Frontline HCWs had lower CMD odds in 2020 (AOR = 0.60, 95% CI: 0.36-1.00) and 2021 (AOR = 0.33, 95% CI: 0.14-0.75). PTSD was associated with having COVID-19 symptoms (AOR = 2.06, 95% CI: 1.23-3.45), living with high-risk individuals (AOR = 1.75, 95% CI: 1.03-2.95), and losing loved ones (AOR = 1.86, 95% CI: 1.09-3.17) in 2020. Chronic diseases increased PTSD odds in 2020 (AOR = 2.20, 95% CI: 1.25-3.86) and 2021 (AOR = 2.30, 95% CI: 1.03-5.13), while age decreased them in 2020 (AOR = 0.95, 95% CI: 0.93-0.98) and 2021 (AOR = 0.95, 95% CI: 0.91-0.99). Younger HCWs with chronic conditions living with high-risk individuals were particularly affected. These findings highlight the urgent need for targeted emotional support and stress management programs for HCWs.

Experiences of Registered Nurses Providing Care to COVID-19 Patients at Sir Ketumile Masire Teaching Hospital and Sekgoma Memorial Isolation Centre

Introduction

The negative effects of COVID-19 on registered nurses (RNs) across the globe are slowly being reported. However, documentation in developing countries like Botswana is limited despite the perilous roles and responsibilities they played in patient care during the pandemic. Understanding the experiences of RNs working in COVID-19 isolation areas offers a body of knowledge that can improve current healthcare systems and assist in better preparing for future public health crises.

Aim

To explore and describe the experiences of RNs who worked in selected COVID-19 isolation centres in Botswana.

Methods

An exploratory, descriptive, phenomenological research design was used. RNs were purposefully sampled, and data were collected using phenomenological, in-depth, individual interviews. Giorgi's method of qualitative data analysis was used to analyse the data.

Results

Nineteen RNs aged 23-47 years were interviewed. Three themes emerged with subthemes: participants expressed professional challenges in providing care and treatment, participants made personal sacrifices and felt isolated, and participants shared positive experiences (silver lining) of providing care during the COVID-19 era.

Conclusion

The participants experienced both personal and system challenges but grew professionally and demonstrated resilience. The results pointed to a need for RNs to be supported when providing care during pandemics primarily to enhance their well-being.

Prevalence and Risk Factors Associated with Depressive Symptoms Among Healthcare Professionals at a Tertiary Care Hospital in Mogadishu, Somalia: A Cross-Sectional Study

Background

Depression, a prevalent mental health issue, can significantly impact healthcare workers (HCWs), leading to decreased productivity, increased turnover, and high medical errors. However, there is a dearth of information regarding depression among healthcare professionals in Somalia. Therefore, this study aimed to assess the magnitude and risk factors associated with depressive symptoms among healthcare professionals in Mogadishu, Somalia.

Methods

A hospital-based cross-sectional study was conducted among HCWs at Erdogan Hospital, in the capital city of Somalia. Data was collected using questionnaires on socio demographic, work-related characteristics and Patient Health Questionnaire-9 (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to identify variables associated with depressive symptoms. A p-values of 0.05 as a cutoff for a significant association.

Results

The prevalence of depressive symptoms among healthcare professionals was 48.9% (95% CI: 45.4-56.9%). In multivariable analysis, being female (AOR = 2.05; 95% CI: 1.17-3.60), being a nurse (AOR = 3.11; 95% CI: 1.14-8.48), unmarried (AOR = 1.83; 95% CI: 1.04-3.21), having insufficient sleep (AOR = 2.61; 95% CI: 1.45-4.70), a family history of mental illness (AOR = 3.31; 95% CI: 1.49-7.36), lack of physical activity (AOR = 2.59; 95% CI: 1.19-5.62), and having low social support (AOR = 3.06; 95% CI: 1.17-7.98) were all associated with increased odds of experiencing depressive symptoms.

Conclusion

The study showed that nearly half of healthcare professionals experienced depressive symptoms. The study underscores the importance of efficient screening methods for identifying psychological symptoms in healthcare professionals, which is essential for enhancing their mental health and patient care. Therefore, we recommend that healthcare institutions and policymakers develop and implement screening measures to identify and improve the mental health well-being of HCWs, as well as provide high-quality patient care.

Emotional Responses of Hospital Staff to the DASS-21 Survey During Mass COVID-19 Testing After the Relaxation of Prevention and Control Measures in Zhejiang, China, and Their Change Trajectory

Aim

To investigate the emotional response of hospital staff to the Depression Anxiety Stress Scale-21 (DASS-21) over the COVID-19 pandemic and after the relaxation of prevention and control measures in Zhejiang Province, China, and identify influencing factors.

Design

Multicenter online cross-sectional design.

Methods

From January 10, 2023, to January 20, 2023, 1054 hospital employees in Zhejiang, China, were recruited using WeChat. Data was gathered via online, self-administered surveys. T-tests and one-way analyses of variance, Pearson's correlation analysis, and multiple linear stepwise regression analyses were used to examine the data.

Results

More than 90% of hospital employees were infected with COVID-19. Through regression analysis, the following variables were found to be independent predictors of emotional response to DASS-21: resilience (-13.346, P < 0.0001), sleep (14.689, P < 0.0001), friend support (-4.278, P < 0.0001), education level (2.699, P = 0.007), and marriage (-2.214, P = 0.027). The emotional responses were not as severe as predicted, but they were still well above the Chinese norm. A longitudinal comparison of DASS-21 emotional responses with similar studies showed a parabolic downward trend over time.

Conclusion

Our results identified education level, marriage, friend support, resilience, and sleep as independent predictors of emotional responses to the DASS-21 among hospital workers in this outbreak. Improving the mental resilience and sleep status of staff is a key target. Unmarried medical personnel with higher education should be given greater attention and support by management. In addition, there is still room for further improvement in the government and societal responses to similar outbreaks. The study also found a parabolic downward trend in DASS-21 emotional responses among hospital workers during the COVID-19 outbreak over time.

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems.

METHODS

Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale.

RESULTS

A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder.

CONCLUSIONS

The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

Respected but stigmatized: Healthcare workers caring for COVID-19 patients

BACKGROUND

Healthcare workers (HCWs) caring for Corona Virus Disease 2019 (COVID-19) patients are at increased risk of being stigmatized, which compromises their individual mental well-being and the quality of care they deliver. Stigma-reduction interventions may (partly) prevent this. However, there is a lack of in-depth understanding of the experiences and underlying causes of COVID-19 stigma among HCWs, which is needed to design such interventions. We conducted in-depth semi-structured interviews to assess COVID-19 stigma among COVID-19 HCWs in Ireland, Nigeria, The Netherlands, Pakistan, and The Philippines.

METHODS

We used a purposive and snowball sampling to recruit a total of 53 HCWs for online interviews (13 in Ireland; 15 in Nigeria; 6 in The Netherlands; 6 in Pakistan; and 13 in The Philippines (2021). After verbatim transcribing interviews, we used a thematic approach for data analysis.

RESULTS

In all countries, stigmatization of COVID-19 HCWs is driven by fear of infection and the perception of HCWs being carriers of the disease amplified by them wearing of scrubs and personal protective equipment. There were differences between countries in the way stigma manifested in self- anticipated and experienced stigma like scolding, discrimination, avoidance, (self-) isolation, and exclusion in public, in the community, at work, and in the household. The stigma resulted in feelings of depression, loneliness, isolation, and the desire to quit one's job.

DISCUSSION

COVID-19 HCWs from all countries experienced all forms of stigmatization related to their work as a COVID-19 frontliner. This affected their mental well-being, which in turn affects job performance and quality of care, there is a high need to develop stigma reduction tools for HCWs.