Mudita Sharma, Digpal Singh Chundawat, Rohit Richhariya, Sunil Kumar Tailor, Shatrughan Pareek

1AIIMS, Bhopal, India

2Indian Railway Health Services, Bikaner, Rajasthan, India

ABSTRACT Objective: To assess perceived stress and coping capacity of frontline health workers from AIIMS during COVID-19 pandemic.Methods: This cross-sectional study conducted from May to July 2021 enrolled 694 participants.An online questionnaire based on Google Forms was developed to collect the data.Participants were assessed using the validated Perceived Stress Scale and the Coping Resources Inventory Scale.Results: The age of participants were 27 (23-52) years old.The majority of respondents (73.5%) felt moderately stressed.Of the 694 participants, 83.0% of the 576 participants had average stress management skills.Sex, marital status, and profession were significantly associated with perceived stress.In addition, marital status and profession were significantly associated with coping capacity.Conclusions: The majority of participants have moderate stress levels and average coping skills.Frontline healthcare workers have to maintain mental and physical health.Achieving this requires early screening and stress management for healthcare workers.

KEYWORDS: COVID-19; Prevalence; Perceived stress; Coping capacity; Frontline health workers; Mental health

1.Introduction

Severe acute respiratory syndrome (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and affects the respiratory system of the human body.COVID-19 disease spreads in human beings through close contact and respiratory droplets[1].Globally 752 517 552 COVID-19 cases were confirmed and 6 804 491 deaths (WHO dashboard census on 26th January 2023)[2].In India, the first case of the coronavirus was detected on 30 January 2020 in Kerela[3].Corona pandemic situation leads to high public reactions and creates a variety of concerns for the public resulting in several mental health issues like stress, anxiety, and emotional instability.Anxiety or crisis in the population is a common response to a stressful situation, especially among frontline healthcare workers like physicians, nurses, and medical staff directly involved in the screening, diagnosis, and care of COVID-19 patients[4].With the increasing numbers of positive and suspected cases, healthcare providers find themselves with overwhelming workloads, deficiencies in personal protective types of equipment, inadequate knowledge of personal safety devices, and shortages of particular medicines[4].The fear of getting an infection in working place may lead to psychophysiological hazards, such as mental distress, fatigue, professional burnout, anxiety, and stress[5].Brooks et al noted that during the 2003 SARS outbreak, healthcare workers feared they would infect their family or friends and felt stigmatized because they were known to be in close contact with sick patients.They experienced significant long-term stress[6].Similar fears are probably contributing to healthcare workers’ distress now since they are at a higher-than-average risk of contracting COVID-19[7].Thus, assessment of perceived stress and coping capacities of the frontline healthcare providers is very important to understand mental health response of healthcare providers during the COVID-19 pandemic, which will help healthcare providers to prepare themselves for their response in such medical emergencies in the future.

2.Patients and methods

2.1.Study design

This cross-sectional study was conducted from May 31, 2021, to July 24, 2021, among frontline healthcare workers from All India Institute of Medical Sciences (AIIMS) hospital, Bhopal, India.There are about 1 200 health workers in AIIMS hospitals and 742 participants were enrolled in the study.

2.2.Inclusion and exclusion criteria

Healthcare workers who were willing to participate, present at the time of data collection, and literate in Hindi or English were enrolled.A total of 742 participants were enrolled using a nonrandomized targeted sampling technique.Healthcare workers who were critically ill, having stress, or psychological problems, had not completed the data collection tools, didn’t respond, and did not present at data collection time were excluded.Out of 742 participants, 694 participants responded to the study.The response rate was 93.53%.

2.3.Data collection

A self-administered online questionnaire based on Google Forms was developed for data collection.Data collection was performed using three tools.The first tool was a demographic questionnaire that included demographic and occupational characteristics, such as age, sex, marital status, education, occupation, experience in the hospital work environment and work area before the COVID-19 pandemic, and present work area i.e.ward/ICU/operation theatre, etc.The second and third tools were the Perceived Stress Scale (PSS), used to assess stress levels, and the Inventory Coping Resource Scale used to assess the coping capacity of healthcare workers.Individual PSS score ranges from 0 to 40, higher scores indicate higher perceived stress.Scores ranging from 0-13 would be considered low stress, 14-26 as moderate stress, and 27-40 as high perceived stress.The scores of coping capacity were further categorized as average, average, above average, and superior coping.The categories were prepared after an intensive review of literature[8].Google forms were prepared for data collection and links were distributed via WhatsApp group of medical professionals and email.The tool was written in English and Hindi, translated, and verified by language experts.

2.4.Ethical statement

Formal written ethical approval was obtained from the Research Ethics Committee of AIIMS Bhopal before data collection.This study was approved by the Institutional Human Ethics Committee, AIIMS Bhopal, with approval number IHEC-LOP/2021/IM0286 dated 26 February 2021.The participant was asked to provide an informed consent form and record it online before completing the survey.The survey was conducted anonymously and the information was kept confidential.

2.5.Statistical analysis

The sample size was estimated by using the formula (Z(1?α/2)2(p) (q)/d2[5]with a 5% margin of error, 95% confidence interval, and prevalence was taken from the previous study[4,6], which was nearly 75%.The estimated minimum sample size was 289.

SPSS 21.0 version was used.Data were presented as frequency and percentage.Chi-square test was used to analyze.The difference was considered significant as P<0.05.

3.Results

3.1.Demographic and clinical characteristics

A total of 694 Health care workers participated in the study (Figure 1).Most of the participants were aged 20-30 years old (75.5%), followed by the 31-40 age group (22.5%).Participants consisted primarily of 602 registered nurses (86.7%), followed by 66 physicians (9.5%).Out of 694 participants, 434 (62.5%) respondents have 1-3 years of experience, followed by 150 (21.6%) with 4-6 years of experience.A total of 310 (44.7%) also said they worked in the COVID ward, and 568 (81.8%) received pre-deployment training on how to put on, take off and use personal protective equipment.Regarding marital status, most of the respondents were married (59.9%), and 510 of them (73.5%) had college degrees (Table 1).

Figure 1.Flow diagram.

3.2.Perceived Stress Scale score

The majority (73.5%) of respondents have a moderate level of stress followed by 19.9% having high stress, and only 6.6% of participants had low stress.

3.3.Coping Resource Scale

A total of 96 (13.81%) healthcare workers had stress coping capacities below average, 576 (83%) participants had average stress coping capacities, 20 (2.9%) respondents had above average Stress coping capacities and only 2 (0.3%) are superior stress coping.

3.4.Association between demographic variables and stress levels

Table 2 shows the association between selected demographic variables and levels of stress.Sex (P<0.001), marital status (P=0.012), and profession (P<0.001) were significantly associated with levels of stress.

3.5.Association of demographic variables with coping capability

Table 3 shows the association between demographic variables and levels of coping capabilities.Marital status (P<0.001) and profession (P<0.001) were highly significantly associated with levels of coping capabilities.

Table 1.Demographic and clinical characteristics (n=694).

Table 2.Association between demographic variables and levels of stress (n=694).

Table 3.Association between demographic variables and levels of coping capabilities (n=694).

4.Discussion

Healthcare workers are playing an important role in the management of COVID-19 pandemic.The psychological status of healthcare workers becomes worse during the COVID-19 pandemic.Literature has indicated considerable individual and group psychological effects following epidemics and outbreaks.The globe is experiencing a shutdown or slowdown in daily operations as a result of the COVID-19 epidemic, yet healthcare professionals must maintain their job routines[9,10].

This study aimed to assess perceived stress and coping capability among healthcare workers during the COVID-19 pandemic in the west-central part of India.In this study, 73.5% of respondents had moderate perceived stress.This finding was similar to the result of a multination study, where a majority of the population suffered from moderate stress[11].Yubonpunt et al conducted research among 517 healthcare workers to assess perceived stress.The prevalence of perceived stress was 41.97%[12].In contrast, another study inIran highlighted that the prevalence of perceived stress was lower compared to the present study[13].Lee et al stated that there was a considerable increase in perceived stress levels among healthcare workers[14].To cope with stress due to COVID-19, a wide range of coping strategies have been reported.Although the patterns are different depending on the context, culture, and the situation of an outbreak, the choice of positive and problem-oriented coping strategies was the most common in previous studies[15].In our study, 576 (83.0%) participants had average stress-coping capacities.Some studies also revealed that medical and healthcare students have good or positive coping strategies to overcome stress or mental health problems[16,17].

Variables like sex, marital status, and profession have a highly significant association with perceived stress.Kowal et al also stated that married status has a significant association with stress levels[18].Ali et al.reported that sex and profession were significantly associated with the level of stress[19].Certain demographic variables like age, year of experience, and previous working area have no significant association with stress and coping capability in our study.In contrast, a study conducted in Saudi Arabia revealed that age, education level, and years of experience are associated with stress and coping capability.

The main limitation of this study is that it was conducted in a single higher specialized center in Bhopal.This study was conducted in an online mode, which was another limitation of the study.

Medical staff is under great strain and emotional stress due to the highly contagious nature of COVID-19 and the lack of understanding of the effect on physical and mental health.The current study concluded that most participants (73.5%) had moderate levels of stress and the majority (83.0%) had average coping skills.Hospital administrators should pay particular attention to the mental health of healthcare workers.Psychological counseling and crisis psychological interventions must be provided to improve the mental health of nursing staff.With certain restrictions, stress is evitable.

Conflict of interest statement

The authors report no conflict of interest.

Funding

This study received no extramural funding.

Authors’contributions

MS, DSC, RR, SKT, and SP have designed and conducted the study, data analysis, preparing and designing the manuscript.SP would act as the corresponding author of the manuscript.