Dr. Archana Mishra is an Associate Professor in Vardhman
Mahavir Medical College and
Safdarjung Hospital, New Delhi.
Her fields of interests are Gynae Oncology and minimally invasive surgery including robotic
surgery. She has many awards
and publications to her credit. At
present she is Organizing Secretary of prestigious conference
IFCPC 2021
Background The COVID-19 pandemic had not only burdened healthcare systems all over the world but had also affected mental health of frontline Health Care Workers. Purpose Purpose of our study was to compare the psychological morbidity of health care workers posted in Covid labour room with their counter parts in Non Covid labour room.
Material and Methods Present study was a cross-sectional study conducted on HCW of Covid and Non Covid labour in a span of 6 months.
Results Insomnia in Covid labour room was found to be in 57% HCW as compared to none in non Covid labour room (mean score 7.47 ± 2.74 vs 1.82 ± 1.25, P Value < .0001). Depression was prevalent in 92% of participants in Covid labour room as compared to 12.5% in Non Covid labour room; however, severe depression was found in 6% participants (mean score 17.32 ± 4.88 vs 2.12 ± 1.65, P Value < .0001). Prevalence of anxiety in present study was 90% in Covid labour room and 6% in non Covid labour room (mean score 11.47 ± 4.57 vs 1.94 ± 1.43, P Value < .0001). Psychological morbidity as tested by Symptom Check List-k-9 was positive in 21.8% participants in Covid Labour room as compared to 1% in Non Covid labour room (mean score 5.57 ± 2.58 vs 2.22 ± 1.89, P Value < .0001).
Conclusion Study revealed significantly high psychological morbidity, insomnia, anxiety and depression in the health care workers in Covid labour room than Non Covid labour room.
Keywords : Psychological morbidity, Health care workers, Covid labour room, Anxiety, Depression, Insomnia
World health organization designated COVID-19 [SARSCoV2] outbreak a public health emergency in January 2020
which later on was declared as a pandemic in the month of
March same year [1]. COVID-19 pandemic has put health
care workers all over the world in an unprecedented situation. A few researchers had addressed the psychological
impact of pandemic over health care workers [2]. Most of
the studies are only from one country that is China. There
is paucity of literature from other countries. Most of the
studies have focused on anaesthesia and medicine specialty
only and very less data is available from obstetrics. Working
in labour room is psychologically demanding due to need
of immediate attention, quick crucial decisions regarding
maternal and fetal wellbeing and emergency situations like
postpartum haemorrhage. Obstetricians and labour room
staff posted in covid labour room face more challenges due
to prolonged direct exposure during monitoring of labour
and delivery, exposure to potentially fatal contamination,
physical exhaustion due to long working hours with personal protective equipment and working in an unadjusted
environment. During pandemic our labour room workforce
was divided in two halves to cater to covid labour room and
non covid labour room. Purpose of our study was to evaluate
the psychological morbidity of Health care workers posted
in covid labour room and compare it with their counterparts
posted in non covid labour room. Our study also evaluated
the reasons contributing to higher psychological morbidity
in the staff posted in covid labour room.
Present study was a cross-sectional study conducted in the department of Obstetrics and Gynaecology of a tertiary care centre of New Delhi in a span of 6 months from August 2020 to January 2021. Institutional ethics committee approved the study [IEC/VMMC/SJH/Projects/2020-08/CC-5].
Inclusion Criteria
Health care workers posted in covid labour room and non
covid labour room including doctors, nurses and other frontline healthcare workers.
Exclusion Criteria
HCW including doctors, nursing staff and other frontline health care workers posted inside the labour rooms were contacted and informed in detail about the study. After recruitment HCW were asked to self-administer the pre-structured proforma in the middle of their posting in their respective labour rooms. Confidentiality of the data was maintained. HCW undergoing psychological stress were offered telephonic/on site counselling by a co-investigator from psychiatry department.
Measurement Tools
Using the questionnaire, we collected demographic data and
administered the SCL-K 9 for severity of global symptoms
of psychological distress, insomnia scale, depressive symptom scale and anxiety symptom scale.
SCL-K-9 was used to measure psychological distress of participants. A total score more than or equal to 7 was taken as positive [3].
The Insomnia Severity Index (ISI) was used to measure the severity of insomnia. Each item was rated on a 0–4 scale, and the total score ranged from 0 to 28. Higher score suggested more severe insomnia symptoms. A total score of≥8 was considered as having symptoms of insomnia.
The Patient Health Questionnaire 9-item depression module (PHQ-9) was used to measure depressive symptoms. Each of the nine items were scored on a scale from 0 to 3. The total score suggested different levels of depressive symptoms: minimal/no depression (0–4), mild depression (5–9), moderate depression (10–14) or severe depression (15–21).
The Generalized Anxiety Disorder (GAD-7) scale was used to assess anxiety. The total score can be categorized into four severity groups: minimal/no anxiety (0–4), mild anxiety (5–9), moderate anxiety (10–14) or severe anxiety (15–21).
Statistical Analysis:
The presentation of the Categorical variables was done in
the form of number and percentage (%). On the other hand,
the presentation of the continuous variables was done as
mean ± SD and median values. The data normality was
checked by using Kolmogorov–Smirnov test. The cases in
which the data were not normal, we used non parametric tests. The following statistical tests were applied for the
results:
The data entry was done in the Microsoft EXCEL spreadsheet and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software version 21.0
For statistical significance, p value of less than 0.05 was
considered as significant.
Results were available for 400 participants, 200 in each group of covid labour room and non covid labour room. All our participants were females. Table 1 reveals base line characteristics of participants. Table 2 describes comparison of social characteristics between covid and non covid labour room. Table 3 compares psychological morbidity scores between covid and non covid labour room. Table 4 shows comparison of perceived stressors between covid and non covid labour room.
Insomnia was found to be in 57% of health care workers in covid labour room as compared to none in non covid labour room. Depression was prevalent in 92% of participants in covid labour room as compared to 12.5% in non covid labour room; however, severe depression was found only in 6% participants. Prevalence of anxiety in present study was 90% in HCW in covid labour room and 6% in HCW in non covid labour room. Psychological morbidity as tested by Symptom Check List -9 was positive in 21.8% participants in covid labour room as compared to 1% in non covid labour room.
Present study is one of the very few studies which assessed and compared psychological morbidity (anxiety, insomnia, depression and symptoms of psychological distress) in age, sex and profession matched healthcare workers posted in covid versus non covid labour room. There are many more
studies on psychological aspect of HCW but direct comparison with other studies should be made with caution due to difference in assessment tools, survey methods, sociocultural difference and different working environments.
Prevalence of insomnia in health care workers in covid labour room was found to be 57% as compared to none in non covid labour room which was significantly high. Pandemic-related stress induces psychological and physical activation in response. This act
hypothalamus–pituitary–adrenal (HPA) system is not compatible with normal sleep which ultimately forms a vicious cycle resulting in sleep disorders. Other studies from China and Italy revealed the prevalence of insomnia as 36.1% and 8.27% during covid pandemic [4, 5]. Study from Italy revealed that being female and younger age were associated with higher insomnia severity.
In present study, depression as assessed by PHQ-9 was prevalent in 92% of participants in covid labour room as compared to 12.5% in non covid labour room. In present study, however, all participant were of similar age and profession but number of healthcare workers living alone was much higher in covid labour room which may be the reason for high prevalence of depression.
Loneliness as a reason for high PHQ-9 has been quoted by another scholar who reported prevalence of depression as 43.6% in nurses of emergency department during covid pandemic [6]. Similar findings were suggested by two other researchers from China which showed prevalence of depression in frontline clinicians as 54.4% and 31.37% [7, 8].
Prevalence of anxiety in present study was 90% in HCW in covid labour room and 6% in HCW in non covid labour room. However, another study recorded a 9.4% prevalence of anxiety in nurses in pandemic [9].
Symptom Check List-9 for psychological morbidity was used in present study and found 21.8% morbidity in participants in covid labour room as compared to 1% in non covid labour room. Symptom Check List -90 had been administered by one study and found a 11.2 % prevalence of psychological morbidity in health care workers in covid pandemic [10].
Anxiety, depression and insomnia were significantly higher in participants of covid labour room and the prevalence was higher than other studies performed in this subject. It may be explained partly by factors like “female sex” and “living alone”. However, most of the other studies on this aspect of pandemic were online surveys which included a wide variety of health care workers who were not directly dealing with covid positive patients like pharmacists and nursing students and majority of HCW were from provinces not affected by COVID-19, while participants in present study were in close contact with covid positive patients for long hours which increased their stress.
We recommend a multicentre study with larger sample size in this aspect of mental health of HCW.
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