Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers

  1. Muna Alshekaili
  2. Walid Hassan
  3. Nazik Al Said
  4. Fatima Al Sulaimani
  5. Sathish Kumar Jayapal
  6. Adhra Al-Mawali
  7. Moon Fai Chan
  8. Sangeetha Mahadevan
  9. Samir Al-Adawi

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Abstract

This study aims to assess and compare demographic and psychological factors and sleep status of frontline healthcare workers (HCWs) in relation to non-frontline HCWs.

Design, settings, participants and outcomes

This cross-sectional study was conducted from 8 April 2020 to 17 April 2020 using an online survey across varied healthcare settings in Oman accruing 1139 HCWs.

The primary and secondary outcomes were mental health status and sociodemographic data, respectively. Mental health status was assessed using the Depression, Anxiety, and Stress Scale (DASS-21), and insomnia was evaluated by the Insomnia Severity Index. Samples were categorised into the frontline and non-frontline groups. χ 2 and t-tests were used to compare groups by demographic data. The Mantel-Haenszel OR was used to compare groups by mental health outcomes adjusted by all sociodemographic factors.

Results

This study included 1139 HCWs working in Oman. While working during the pandemic period, a total of 368 (32.3%), 388 (34.1%), 271 (23.8%) and 211 (18.5%) respondents were reported to have depression, anxiety, stress and insomnia, respectively. HCWs in the frontline group were 1.5 times more likely to report anxiety (OR=1.557, p=0.004), stress (OR=1.506, p=0.016) and insomnia (OR=1.586, p=0.013) as compared with those in the non-frontline group. No significant differences in depression status were found between the frontline and non-frontline groups (p=0.201).

Conclusions

To our knowledge, this is the first study to explore the differential impacts of the COVID-19 pandemic on different grades of HCWs. This study suggests that frontline HCWs are disproportionally affected compared to non-frontline HCWs, with managing sleep–wake cycles and anxiety symptoms being highly endorsed among frontline HCWs. As psychosocial interventions are likely to be constrained owing to the pandemic, mental healthcare must first be directed to frontline HCWs.

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  1. Version published to 10.1136/bmjopen-2020-042030
  2. ScreenIT

    SciScore for 10.1101/2020.06.23.20138032: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: All respondents provided informed consent.
    RandomizationOne relevant clinical department was randomly sampled from each chosen healthcare setting, and all HCWs in this department were asked to participate in this study.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    At the end of the study survey, 1160 healthcare workers returned a fully completed study proforma Outcomes and Covariates:
    Covariates
    suggested: None

    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:
    Limitations: Most psychosocial studies of this nature tend to have many limitations owing to the amorphous variables under scrutiny. Firstly, conducting a national wide survey requires proper logistics which was not feasible during the lockdown. An online survey is known to marred by the fact that it tends to accrue a selective population who are technologically savvy and more familiar with the evolving ‘internet culture’ [38]. Notwithstanding such a view, this study appears to have reached its targeted population based on the estimated sample size. Oman has established that > 71% of the total population (4.6 million) has access to internet services [38]. Secondly, DASS-21 and ISI are no match for the ‘gold-standard’ interviews such as those that follow the Diagnostic and Statistical Manual of Mental Disorders and World Health Organization Composite International Diagnostic Interview (CIDI). However, quick symptom checklists such as DAS-21 and ISI are the only viable tools to conduct such a study given the current circumstances [7]. Lastly, time factors are also considered important for quantifying the presence of psychological disorders. Within this view, it not clear whether the observed mental health outcomes constitute adjustment disorders/ acute stress reaction or present a chronic-type and thus irreversible psychological distress. Follow-up studies in this regard are therefore warranted.

    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.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.23.20138032v1 on medRxiv