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VOLUME 25 , ISSUE 5 ( May, 2021 ) > List of Articles


Impact of COVID-19 Pandemic on the Emotional Well-being of Healthcare Workers: A Multinational Cross-sectional Survey

Seema Tekwani

Citation Information : Tekwani S. Impact of COVID-19 Pandemic on the Emotional Well-being of Healthcare Workers: A Multinational Cross-sectional Survey. Indian J Crit Care Med 2021; 25 (5):499-506.

DOI: 10.5005/jp-journals-10071-23806

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Coronavirus disease-2019 (COVID-19) in the last few months has disrupted the healthcare system globally. The objective of this study is to assess the impact of the COVID-19 pandemic on the psychological and emotional well-being of healthcare workers (HCWs). Materials and methods: We conducted an online, cross-sectional, multinational survey, assessing the anxiety (using Generalized Anxiety Disorder [GAD-2] and GAD-7), depression (using Center for Epidemiologic Studies Depression), and insomnia (using Insomnia Severity Index), among HCWs across India, the Middle East, and North America. We used univariate and bivariate logistic regression to identify risk factors for psychological distress. Results: The prevalence of clinically significant anxiety, depression, and insomnia were 41.4, 48.0, and 31.3%, respectively. On bivariate logistic regression, lack of social or emotional support to HCWs was independently associated with anxiety [odds ratio (OR), 3.81 (2.84–3.90)], depression [OR, 6.29 (4.50–8.79)], and insomnia [OR, 3.79 (2.81–5.110)]. Female gender and self-COVID-19 were independent risk factors for anxiety [OR, 3.71 (1.53–9.03) and 1.71 (1.23–2.38)] and depression [OR, 1.72 (1.27–2.31) and 1.62 (1.14–2.30)], respectively. Frontliners were independently associated with insomnia [OR, 1.68 (1.23–2.29)]. Conclusion: COVID-19 pandemic has a high prevalence of anxiety, depression, and insomnia among HCWs. Female gender, frontliners, self-COVID-19, and absence of social or emotional support are the independent risk factors for psychological distress.

  1. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168(10):1245–1251. PMCID: PMC154178 PMID: 12743065
  2. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3(3):e203976. DOI: 10.1001/jamanetworkopen.2020.3976.
  3. Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public – a systematic review and meta-analysis. Psychiatry Res 2020;291:113190. DOI: 10.1016/j.psychres.2020.113190.
  4. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007;146(5):317–325. DOI: 10.7326/0003-4819-146-5-200703060-00004.
  5. Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166(10):1092–1097. DOI: 10.1001/archinte.166.10.1092.
  6. Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care 2008;46(3):266–274. DOI: 10.1097/MLR.0b013e318160d093.
  7. Sapra A, Bhandari P, Sharma S, Chanpura T, Lopp L. Using generalized anxiety disorder-2 (GAD-2) and GAD-7 in a primary care setting. Cureus 2020;12(5):e8224. DOI: 10.7759/cureus.8224.
  8. Plummer F, Manea L, Trepel D, Mcmillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry 2016;39:24–31. DOI: 10.1016/j.genhosppsych.2015.11.005.
  9. García-Campayo J, Zamorano E, Ruiz MA, Pérez-Páramo M, López-Gómez V, Rejas J. The assessment of generalized anxiety disorder: psychometric validation of the Spanish version of the self-administered GAD-2 scale in daily medical practice. Health Qual Life Outcomes 2012;10:114. DOI: 10.1186/1477-7525-10-114.
  10. Lewinsohn PM, Seeley JR, Roberts RE, Allen NB. Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychol Aging 1997;12(2):277–287. DOI: 10.1037//0882-7974.12.2.277.
  11. Pinquart M, Sörensen S. Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging 2003;18(2):250–267. DOI: 10.1037/0882-7974.18.2.250.
  12. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 2011;34(5):601–608. DOI: 10.1093/sleep/34.5.601.
  13. Gagnon C, Bélanger L, Ivers H, Morin CM. Validation of the Insomnia Severity Index in primary care. J Am Board Fam Med 2013;26(6):701–710. DOI: 10.3122/jabfm.2013.06.130064.
  14. Que J, Shi L, Deng J, Liu J, Zhang L, Wu S, et al. Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China. Gen Psychiatr 2020;33(3):e100259. DOI: 10.1136/gpsych-2020-100259.
  15. Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang T, et al. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun 2020;87:49–50. DOI: 10.1016/j.bbi.2020.04.031.
  16. Du J, Dong L, Wang T, Yuan C, Fu R, Zhang L, et al. Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan. Gen Hosp Psychiatry 2020;67:144–145. DOI: 10.1016/j.genhosppsych.2020.03.011.
  17. Azoulay E, Cariou A, Bruneel F, Demoule A, Kouatchet A, Reuter D, et al. Symptoms of anxiety, depression and peritraumatic dissociation in critical care clinicians managing COVID-19 patients: a cross-sectional study. Am J Respir Crit Care Med 2020;202(10). DOI: 10.1164/rccm.202006-2568OC.
  18. Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun 2020;89:531–542. S0889-1591(20)30954-5. DOI: 10.1016/j.bbi.2020.05.048.
  19. Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun 2020;88:559–565. DOI: 10.1016/j.bbi.2020.04.049.
  20. Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic – a review. Asian J Psychiatr 2020;51:102119. DOI: 10.1016/j.ajp.2020.102119.
  21. Hou T, Zhang T, Cai W, Song X, Chen A, Deng G, et al. Social support and mental health among health care workers during coronavirus disease 2019 outbreak: a moderated mediation model. PLoS One 2020;15(5):e0233831. DOI: 10.1371/journal.pone.0233831.
  22. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7(3):e14. DOI: 10.1016/S2215-0366(20)30047-X.
  23. Xiao X, Zhu X, Fu S, Hu Y, Li X, Xiao J. Psychological impact of healthcare workers in China during COVID-19 pneumonia epidemic: a multi-center cross-sectional survey investigation. J Affect Disord 2020;274:405–410. DOI: 10.1016/j.jad.2020.05.081.
  24. Singh R, Subedi M. COVID-19 and stigma: social discrimination towards frontline healthcare providers and COVID-19 recovered patients in Nepal. Asian J Psychiatr 2020;53:102222. DOI: 10.1016/j.ajp.2020.102222.
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