The inevitability of Covid-19 related distress among healthcare workers: Findings from a low caseload country under lockdown

  1. Feras I. Hawari
  2. Nour A. Obeidat
  3. Yasmeen I. Dodin
  4. Asma S. Albtoosh
  5. Rasha M. Manasrah
  6. Ibrahim O. Alaqeel
  7. Asem H. Mansour

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Abstract

To characterize psychological distress and factors associated with distress in healthcare practitioners working during a stringent lockdown in a country (Jordan) that had exhibited one of the lowest incidence rates of Covid-19 globally at the time of the survey.

Methods

A cross-sectional online survey sent to healthcare practitioners working in various hospitals and community pharmacies. Demographic, professional and psychological characteristics (distress using Kessler-6 questionnaire, anxiety, depression, burnout, sleep issues, exhaustion) were measured as were sources of fear. Descriptive and multivariable statistics were performed using level of distress as the outcome.

Results

We surveyed 937 practitioners (56.1% females). Approximately 68%, 14%, and 18% were nurses/technicians, physicians, and pharmacists (respectively). 32% suffered from high distress while 20% suffered from severe distress. Exhaustion, anxiety, depression, and sleep disturbances were reported (in past seven days) by approximately 34%, 34%, 19%, and 29% of subjects (respectively). Being older or male, a positive perception of communications with peers, and being satisfied at work, were significantly associated with lower distress. Conversely, suffering burnout; reporting sleep-related functional problems; exhaustion; being a pharmacist (relative to a physician); working in a cancer center; harboring fear about virus spreading; fear that the virus threatened life; fear of alienation from family/friends; and fear of workload increases, were significantly associated with higher distress.

Conclusion

Despite low caseloads, Jordanian practitioners still experienced high levels of distress. Identified demographic, professional and psychological factors influencing distress should inform interventions to improve medical professionals’ resilience and distress likelihood, regardless of the variable Covid-19 situation.

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  1. Version published to 10.1371/journal.pone.0248741
  2. ScreenIT

    SciScore for 10.1101/2020.06.14.20130724: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: Study variables and measures: The questionnaire was developed and reviewed by a core team of medical staff involved in both research and Covid-19 screening and potential management; and was approved by an AAHRPP (Association for the Accreditation of Human Research Protection Programs, Inc) accredited Institutional Review Board.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Study variables and measures: The questionnaire was developed and reviewed by a core team of medical staff involved in both research and Covid-19 screening and potential management; and was approved by an AAHRPP (Association for the Accreditation of Human Research Protection Programs, Inc) accredited Institutional Review Board.
    Human Research Protection Programs
    suggested: None
    All analyses were conducted in STATA 16.
    STATA
    suggested: (Stata, RRID:SCR_012763)

    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:
    Our study has some limitations. We were not able to qualitatively examine in an in-depth manner the exact sources of distress among our high-distress sample, and how these interacted with one another within individuals (others in high caseload settings have used interviews in limited samples to detail specific sources of distress(39)). We also speculate that a source of distress for healthcare workers that was not probed in our study was the general experience of the stringent lockdown. Our survey was not designed to specifically measure this, but others have shown that generally experiencing a lockdown and quarantines negatively impacts mental health.(40) Furthermore, our survey was cross-sectional in nature, and did not capture the effect of fluctuations in the general Covid-19 situation on distress. However, it is relevant to note that although there is a possibility that the symptoms we report may have existed prior to the Covid-19 situation, we additionally inquired about whether or not – among those who reported any symptoms of anxiety or depression, and those reporting sleep issues or exhaustion – such symptoms existed pre-Covid-19, and found that less than 17% of respondents reported that they suffered from these symptoms in the same intensity pre-Covid-19. Despite its limitations, we have been able to collect valuable data on a large and diverse sample of medical professionals representing various healthcare facilities (governmental and academic hospitals including a...

    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 10.1101/2020.06.14.20130724v1 on medRxiv