Anxiety and depressive symptoms among physicians during the COVID-19 pandemic in Bangladesh: a cross-sectional study

  1. M. Tasdik Hasan
  2. Sahadat Hossain
  3. Farhana Safa
  4. Afifa Anjum
  5. Abid Hasan Khan
  6. Kamrun Nahar Koly
  7. Syeda Fatema Alam
  8. Md. Abdur Rafi
  9. Vivek Podder
  10. Tonima Islam Trisa
  11. Rhedeya Nury Nodi
  12. Dewan Tasnia Azad
  13. Fatema Ashraf
  14. S. M. Quamrul Akther
  15. Helal Uddin Ahmed
  16. Simon Rosenbaum
  17. Graham Thornicroft

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Abstract

Objectives

In addition to risking their physical well-being, frontline physicians are enduring significant emotional burden both at work and home during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to investigate the levels of anxiety and depressive symptoms and to identify associated factors among Bangladeshi physicians during the COVID-19 outbreak.

Methods and design

A cross-sectional study using an online survey following a convenience sampling technique was conducted between April 21 and May 10, 2020. Outcomes assessed included demographic questions, COVID-19 related questions, and the Hospital Anxiety and Depression Scale (HADS).

Results

The survey was completed by 412 Bangladeshi physicians. The findings revealed that, in terms of standardized HADS cut-off points, the prevalence of anxiety and depressive symptoms among physicians was 67.72% and 48.5% respectively. Risk factors for higher rates of anxiety or depressive symptoms were: being female, physicians who had experienced COVID-19 like symptoms during the pandemic, those who had not received incentives, those who used self-funded personal protective equipment (PPE), not received adequate training, lacking perceived self-efficacy to manage COVID-19 positive patients, greater perceived stress of being infected, fear of getting assaulted/humiliated, being more connected with social media, having lower income levels to support the family, feeling more agitated, less than 2 h of leisure activity per day and short sleep duration. All these factors were found to be positively associated with anxiety and depression in unadjusted and adjusted statistical models.

Conclusions

This study identifies a real concern about the prevalence of anxiety and depressive symptoms among Bangladeshi physicians and identifies several associated factors during the COVID-19 pandemic. Given the vulnerability of the physicians in this extraordinary period whilst they are putting their own lives at risk to help people infected by COVID-19, health authorities should address the psychological needs of medical staff and formulate effective strategies to support vital frontline health workers.

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  1. Version published to 10.1017/gmh.2022.30
  2. ScreenIT

    SciScore for 10.1101/2020.12.08.20245829: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The questionnaire had 3 parts: (i) demographic questions, (ii) COVID19-related questions, (iii) Hospital Anxiety and Depression Scale (HADS; higher scores on the subscales indicate higher levels of depression and anxiety symptoms)).12 Statistical analysis: All statistical analyses were carried out using SPSS (version 25.0).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study provides novel findings on anxiety and depressive symptoms among Bangladeshi physicians during COVID-19 pandemic, however we cannot overlook the limitations. The cross-sectional nature of the study design could not establish causal relationship between the dependent and independent variables. This study was carried out by conducting a web-based survey, which might generate sampling bias by excluding the physicians who do not have access to internet or inactive in social medias, and thus limit the generalizability of the findings. Besides, self-reported responses on anxiety and depression symptoms only provided subjective data which may greatly differ from objective data, leading to response bias. Finally, although we tried to address major risk factors, several relevant variables, such as residence status (urban or rural), having children, domestic violence, moral dilemma to manage such complex patients and information on physician’s work hours or perceived workloads were not included in the survey. Despite these limitations, our study has several clear public health implications. Our results suggest vulnerability of Bangladeshi physicians for anxiety and depressive symptoms during the pandemic which should be closely monitored. Previous studies emphasized on alarmingly higher rates of ‘physician burnout’, characterized by emotional exhaustion, depersonalization, and low personal accomplishments,33 and alternatively increased risk of suicidal ideation and suicidal ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

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  3. Version published to 10.1101/2020.12.08.20245829v1 on medRxiv