Research Article, J Womens Health Issues Care Vol: 10 Issue: 8
Psychological Impact on Healthcare Professionals during a Public Health Crisis: A Cross Sectional Study of Healthcare Workers in MOHAP during the Pandemic (COVID-19) 2020, United Arab Emirates
Shalini Malhotra*, Sweety Kumari, Azka Mujeeb and Muna Khalfan
Department of Obstetrics and Gynecology, Al Qassimi women & Children Hospital, Sharjah
*Corresponding Author: Shalini Malhotra Department of Obstetrics and Gynecology, Al Qassimi women & Children Hospital, Sharjah E-mail: [email protected]
Received: August 05, 2021; Accepted: August 19, 2021; Published: August 26, 2021
Citation: Malhotra S, Kumari S, Mujeeb A, Khalfan M (2021) Psychological Impact on Healthcare Professionals during a Public Health Crisis: A Cross Sectional Study of Healthcare Workers in MOHAP during the Pandemic (COVID-19) 2020, United Arab Emirates. J womens Health, Issues Care, 10:8
Healthcare systems, globally, have been challenged by the COVID-19 pandemic like never before. Its effects have been unbelievably serious in many regions with heavy toll on lives of people and the economies of the countries. Frontline healthcare workers tormented this period without any premonition and that resulted in many different psychological impacts. The spirits of hospital workers in MOHAP UAE was immensely challenged by this pandemic too. The hospitals kept functioning under critical situations with additional burden on each worker and the system as a whole. Despite all challenges, MOHAP hospitals have been responsible for successfully supporting COVID treatment in Northern Emirates, with their large workforce tirelessly working initially. Thus, we considered it important to understand the impact of this situation on the psychology of the MOHAP healthcare workers who worked when others were home safely with their families, away from most risks. Previous hospital based studies have examined this question at the time of H1N1 pandemic in 2009.
Keywords: Gynecologic cancers; Radiotherapy; Side effects; Quality of life; Treatment
Psychological consequences like panic behavior, hopelessness, are not uncommon when fear due to the COVID-19 pandemic encompassed almost every aspect of human life. Apart from clinical, social and financial consequences, a profound mental health impact on healthcare workers has been a less focused area. However, acknowledging and addressing the importance of subject have been the pivot point of this study.
The study aims to investigate the psychological impact and issues within various categories on healthcare professionals in 7 MOHAP (Ministry of Health and Prevention) organizations (secondary/tertiary care hospitals) during the ongoing COVID-19 pandemic. In this study we surveyed the factors considered to be influencing the motivation and hesitation of hospital workers to work in the 7 organizations in UAE during the pandemic till November 2020. The primary outcome is to measure the concerns of the workers and attempt to analyses areas where healthcare professionals need support if they were to be efficiently delivering high risk services.
This survey was approved by MOHAP (Ministry of Health and Prevention) ethical committee. It was directed to all healthcare workers, including Doctors, Nurses, Receptionist Staff and Technicians in Radiology, Laboratory working in tertiary care hospitals in 7 hospitals (secondary/tertiary care organizations) within the Northern Emirates, Ministry of Health and Prevention, UAE.
Participation in this survey was voluntary. A questionnaire developed with a set of questions assessing the reactions and concerns was developed and the link was shared with all participants along with the information sheet of the study, through their CPD coordinators. The questionnaire was developed using effective research on PubMed and NCBI sites.
Using the questionnaire, a cross sectional survey was conducted in August 2020 among MOHAP healthcare workers going through the COVID- 19 pandemic. Close ended questions with choices were included covering simple and practical situations that they might have faced or felt to explore their responses.
The respondents used a 5 point Likert scale (0: “never”, 1: “occasionally”, 2: “sometimes”, 3: “Often”, 4: “always”) to respond to the questions about how they felt about the 18 questions.
A total 92 healthcare workers from the Northern Emirates hospitals of the Ministry of Health and Prevention (MOHAP) completed the questionnaire and submitted the same. Over 95.7% were women with a minority of submissions (4.3%) being male participants, with average age being 31-40 years. Most participants (69.6%) were nurses with 16.3% only being physicians. About 32% respondents were working in the inpatient wards. The rest of the participants were anesthesia technicians, radiographers, pharmacists, receptionists and customer service staff. Majority of respondent worked in tertiary hospitals under MOHAP. Responses were dichotomized as ‘never, occasionally, sometimes’ ‘often’ and “always” (Figures 1 and 2).
Figure 1: Calculations of responses between gender and age.
Figure 2: Calculations of responses between job and workplace.
Approximately 40.2% health workers reported “sometime” having anxiety about being infected during Covid-19 pandemic, while about 18.55% “sometime” felt anxious about spreading the virus to the family. Over 44.6% felt burdened due to increased work “sometimes” with nearly 44.2% feeling burdened “sometime” due to change in quality of work. 31.5% “sometimes” felt anxious about acquiring the infection while travelling to the hospital. As many as 47.5% expressed their confidence on their organizational environment and marked “always” for feeling cared for by the institution they worked for, which is perhaps the most significant finding noted.
30% of healthcare workers responded that wearing personal protecting equipment, mask and shield “never” affected their identity and rapport with the patient. As many as 28.3% health workers “never” thought of wearing gown, gloves and mask, while 27.2% responded “always” for this question. This reflects the dilemma which was prevalent among the healthcare workers about PPE usage. It also points out that many considered wearing more than a mask was helpful.
Approximately 44.6% health worker in MOHAP “never” thought of using N95 as a protective measure throughout the working hours. This perhaps reflects their concern about reducing risk of acquiring infection at work. It is worth noting that even though 40.2% workers “sometimes” felt physically exhausted, another 39.2% workers “sometimes” felt mentally exhausted, a large majority (77.2%) reported “never” feeling any hesitation to work, being in areas with active COVID cases, which reflects a positive attitude and dedication of the healthcare workers in MOHAP. As many as 47.8% MOHAP workers “always” feel motivated to work As many as 30.4% “sometimes” felt social avoidance by the community because of being a healthcare worker. About 25% “never” feel scared to play with their children at home and that reflects the quality of family life.
Over 95% respondents were females in this survey. Consistent with these results is the finding from an online survey of Canadian health care workers in April 2020 (n>500) in which also, 90 percent respondents were females .
Two cross sectional study using self-report instruments close to or during the peak of the pandemic to assess hospital based physicians and nurses (total n>1200) in China and frontline and second line health care workers (n>1300) in Italy were reviewed to study the mental health of healthcare workers in those countries in the pandemic. The prevalence of moderate to severe psychiatric symptoms was as follows [2,3].
• Anxiety 12% to 20%
• Depression 15% to 25%
• Insomnia 8%
• Traumatic distress 35% to 49%
In our study the prevalence of the same in healthcare workers in MOHAP is much less and only felt sometimes by the respondents, clearly establishing that it was mild severity. This reflects the better mental state of workers in MOHAP, UAE, reflecting their improved ability to serve the sick.
Many possible risk factors causing mental health problems in healthcare workers can list. One of the most important is their constant exposure to the affected patients. Definitely background history of psychiatric illness or medical illness in the workers predisposes them Shortage of PPE and lack of organizational support ensuring staff safety could be more reasons for staff to get stressed and protective factors for psychological problems in health care workers . Many healthcare workers perceived social stigma directed towards them due to their occupation from people in society which, causes social isolation rather than more support. This perhaps could also be a contributing factor [5,6].
Some reasons for the healthcare workers in MOHAP in our study group to feel protected could be factors like access to abundant personal protective equipment, supportive colleagues and organizational leaders working towards measured to keep staff safe, access to psychiatric support through talks by experts encouraging positive interventions to feel good and trust in the institution’s infection control measures.
Studies of emerging viral outbreaks suggest that psychiatric symptoms and disorders are more likely to occur in health care workers who are at relatively high risk of exposure, compared with workers who are at low risk of exposure. As an example, a meta-analysis of 25 studies of viral epidemics that examined psychiatric problems in health care workers who had direct contact with affected patients and health care workers who had little or no contact (controls). The analysis included 16 studies of the 2003 SARS epidemic and 5 studies of the COVID-19 pandemic. The primary findings included the following:
• Clinically significant psychological stress was more likely to occur in health care workers exposed to the virus than controls (odds ratio 1.7, 95% CI 1.5-2.0).
• Clinically significant acute and/or posttraumatic distress was more likely to occur in workers exposed to the virus than controls (odds ratio 1.7, 95% CI 1.3-2.3).
It is worth mentioning that despite additional workloads for all healthcare workers in MOHAP in tertiary care hospitals due to referral of sick COVID-19 cases to these facilities, there is such a minimal rate of anxiety and fear among them. Despite reduced access to short leaves or vacations with increased workplace exposure to potentially COVID- 19 affected patients, the staff were reassured that their safety was being taken care of and no financial hardships were forced on them. At a times when most organizations in UAE, inflicted financial deductions in salaries of healthcare workers with loss of jobs for many, the support MOHAP has given its healthcare workers is worth praise. MOHAP has set a high standard for the world in caring for both the sick and those working for them, aiming for the best health for all.
- Calcano R (2020) Insights from the Canadian front lines of the COVID-19 pandemic. Potloc. 16.
- Lai J, Ma S, Wang Y (2020) Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. J American Med Asso Netw Open. 3(3): e203976.
- Rossi R, Socci V, Pacitti F (2020) Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. J American Med Asso Netw Open 2020. 3(5): e2010185.
- Kisely S, Warren N, McMahon L (2020) Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: Rapid review and meta-analysis. BMJ. 369: m1642.
- Kato H, Jena AB, Figueroa JF (2021) Association between physician part-time clinical work and patient outcomes. J American Med Asso Intern Med 4(9): e2010285.
- Stephenson J (2021) As COVID-19 Hospitalizations of Unvaccinated Patients Soar, Private Insurers No Longer Waiving Out-of-Pocket Costs. J American Med Asso Health Forum. 2(8): e213263.