Articles

Mental Health Outcomes Among Tunisian Health Care Workers During the COVID-19 Pandemic

Abstract

The pandemic caused by Coronavirus-19 Disease (COVID-19) is having negative effects on healthcare workers (HCW) mental health due to the tremendous amount of stress to which they are exposed to. We aimed to assess the number of mental health outcomes among HCW treating patients with COVID-19. This cross-sectional study collected demographic data and mental health measurements from HCW in different hospitals using an online questionnaire. Participants were asked to complete the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Insomnia Severity Index (ISI), and the 7-item Generalized Anxiety Disorder scale (GAD-7). One hundred and forty-one participants with a mean age of 30.6±25 years and a sex ratio of 0.3 completed the online questionnaire. Participants from major university-hospital centers of northern Tunisia were divided into two groups: 78% medical and 22% paramedical staff. Twenty-two participants (15.6%) had a chronic disease, and 21 (14.9%) had a history of depression. Nineteen (13.4%) of the participants were infected with COVID-19. Thirteen percent of participants experienced the same anxiety level as the first-time taking care of COVID-19 patients, while 65% were rather an at ease compared to the first time. Forty-seven percent of participants felt the need for psychological support, and 16.7% of them had consulted a psychiatrist. Mild depression was detected in 14.1% of cases, moderate depression in 4.2% of cases, and severe depression in 2.1% of cases. As for anxiety, 36.1% of participants suffered from mild anxiety, 14.9% from moderate anxiety, and 4.9% from severe anxiety. Mild insomnia was detected in 44.6% of cases, moderate insomnia in 14.9% of cases, and severe insomnia in 9.9% of cases. Female gender (depression: P=0.05; anxiety: P=0.05; insomnia: P=0.02), having friends or relatives with COVID (depression: P=0.01; anxiety: P=0.05), psychiatric illness (depression: P=0.05; anxiety: P=0.01; insomnia: P=0.01), and chronic disease (depression: P=0.02; anxiety: P=0.03) were significantly associated with more severe mental health symptoms. Tunisian HCW experienced psychological burdens and a high rate of anxiety, depression, and insomnia. HCW should be protected in order to promote mental well-being.

1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel Coronavirus from patients with Pneumonia in China, 2019. N Engl J Med 2020;382:727‑33.
2. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel Coronavirus–infected pneumonia. N Engl J Med 2020;382:1199‑207.
3. WHO. WHO Coronavirus disease (COVID-19) situation dashboard; 2020.
4. Petrie K, Crawford J, Baker STE, Dean K, Robinson J, Veness BG, et al. Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: a systematic review and meta-analysis. Lancet Psychiatry 2019;6:225‑34.
5. Brooks SK, Dunn R, Amlôt R, Rubin GJ, Greenberg N. A systematic, thematic review of social and occupational factors associated with psychological outcomes in healthcare employees during an infectious disease outbreak. J Occup Environ Med 2018;60:248‑57.
6. Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis 2006;12:1924‑32.
7. De Kock JH, Latham HA, Leslie SJ, Grindle M, Munoz S-A, Ellis L, et al. A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC Public Health 2021;21:104.
8. Gold JA. COVID-19: adverse mental health outcomes for healthcare workers. BMJ 2020;369:m1815.
9. Major A, Hlubocky FJ. Mental health of health care workers during the COVID-19 pandemic and evidence-based frameworks for mitigation: A rapid review. MedRxiv (preprint) 2021.
10. Moitra M, Rahman M, Collins PY, Gohar F, Weaver M, Kinuthia J, et al. Mental health consequences for healthcare workers during the COVID-19 pandemic: A scoping review to draw lessons for LMICs. Front Psychiatry 2021;12:602614.
11. Muller AE, Hafstad EV, Himmels JPW, Smedslund G, Flottorp S, Stensland SØ, et al. The mental health impact of the covid-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Res 2020;293:113441.
12. 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:e203976.
13. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606‑13.
14. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092‑7.
15. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001;2:297‑307.
16. Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, et al. Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. J Affect Disord 2020;275:48‑57.
17. Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: Belastungen des medizinischen Personals. Psychiatr Prax 2020;47:190‑7.
18. Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun 2020;88:901‑7.
19. 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.
20. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr 2020;52:102066.
21. Lee AM, Wong JGWS, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry 2007;52:233‑40.
22. selçuk O, Sukriye O. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. Int J Soc Psychiatry 2020;66:504‑11.
23. Bobevski I, Clarke DM, Meadows G. Health anxiety and its relationship to disability and service use: Findings from a large epidemiological survey. Psychosom Med 2016;78:13‑25.
24. Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY) 2020;12:6049‑57.
25. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054‑62.
26. Shih FJ, Gau ML, Kao CC, Yang CY, Lin YS, Liao YC, et al. Dying and caring on the edge: Taiwan’s surviving nurses’ reflections on taking care of patients with severe acute respiratory syndrome. Appl Nurs Res 2007;20:171‑80.
27. Wong TW, Yau JK, Chan CL, Kwong RS, Ho SM, Lau CC, et al. The psychological impact of severe acute respiratory syndrome outbreak on healthcare workers in emergency departments and how they cope. Eur J Emerg Med 2005;12:13‑8.
28. Matsuo T, Kobayashi D, Taki F, Sakamoto F, Uehara Y, Mori N, et al. Prevalence of Health care worker burnout during the coronavirus disease 2019 (COVID-19) pandemic in Japan. JAMA Netw Open 2020;3:e2017271.
29. Brier ND, Stroobants S, Vandekerckhove P, Buck ED. Factors affecting mental health of health care workers during coronavirus disease outbreaks: a rapid systematic review. PLoS One 2020;15:e0244052.
30. Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ 2020;369:m1642.
31. Melnyk BM, Kelly SA, Stephens J, Dhakal K, McGovern C, Tucker S, et al. Interventions to improve mental health, well-being, physical health, and lifestyle behaviors in physicians and nurses: A systematic review. Am J Health Promot 2020;34:929‑41.
Files
IssueVol 60 No 11 (2022) QRcode
SectionArticles
DOI https://doi.org/10.18502/acta.v60i11.11651
Keywords
Coronavirus disease 2019 (COVID-19) Coronavirus Mental health Healthcare Psychology
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Hamdi O, Sellami M, Miladi S, Fazaa A, Ouenniche K, Souebni L, Kassab S, Chekili S, Ben Abdelghani K, Laatar A. Mental Health Outcomes Among Tunisian Health Care Workers During the COVID-19 Pandemic. Acta Med Iran. 2023;60(11):675-679.