Psychological impact of COVID-19 on healthcare workers in Sri Lanka

BackgroundHealthcare workers (HCWs) are at risk of mental health problems during a pandemic. Whether they are stationed at the frontline or not may also have implications on their mental health. Differences in perceptions about social and occupational circumstances, as well as coping methods, affect outcomes. The aim of our study was to assess depression, anxiety and stress among HCWs, and to explore differences between frontline and non-frontline workers. MethodsA cross-sectional study was conducted on HCWs, including both frontline and non-frontline personnel, at a COVID-19 screening tertiary hospital located in a densely-populated suburb in Sri Lanka. Mental health impact was assessed using Depression, Anxiety and Stress Scale (DASS)-21. Sociodemographic data and perceptions of social and occupational circumstances were gathered. Categorical variables were analyzed using Chi square, and logistic regression was used to adjust for confounders. Odds ratios were calculated for the effect of different perceptions on psychological morbidity. ResultsA total of 467 HCWs participated, consisting of 244 (52.2%) frontline and 223 (47.8%) non-frontline workers, with a female preponderance (n=341, 77%). The prevalence of depression, anxiety and stress among HCWs in general were 19.5%, 20.6%, 11.8%, respectively. Non-frontline group showed a higher prevalence of depression (27% vs. 11%, p<0.001), anxiety (27% vs. 14%, p=0.001) and stress (15% vs. 8%, p=0.026) compared to the frontline group. Being married, having children, living with family and higher income were associated with better psychological outcomes. Perceived lack of personal protective equipment, inadequate support from hospital authorities, greater discrimination, and the lack of training to cope with the situation predicted poor mental health outcomes. Non-frontline HCWs were more likely to hold such perceptions. ConclusionsDepression, anxiety and stress were more prevalent in non-frontline HCWs when compared to frontline workers in a tertiary COVID-19 screening teaching hospital. Addressing factors that lead to negative psychological outcomes in HCWs should be a key concern during this pandemic.

背景
大流行期间，医疗工作者（Healthcare Workers, HCWs）面临心理健康问题的风险。是否驻守抗疫一线，也可能对其心理健康产生影响。个体对社会与职业环境的认知差异，以及应对方式的不同，均会影响心理健康结局。本研究旨在评估医疗工作者的抑郁、焦虑与压力水平，并探讨一线与非一线医疗工作者之间的差异。

方法
本研究针对斯里兰卡某人口稠密郊区的一所新冠筛查三级医院的医疗工作者开展横断面研究，研究对象涵盖一线与非一线医护人员。采用抑郁、焦虑与压力量表（Depression, Anxiety and Stress Scale, DASS-21）评估心理健康影响。收集社会人口学资料以及受试者对社会与职业环境的认知情况。分类变量采用卡方检验进行分析，采用逻辑回归控制混杂因素，并计算不同认知对心理疾病发病的影响的比值比。

结果
共计467名医疗工作者参与本研究，其中244人（52.2%）为一线医护人员，223人（47.8%）为非一线医护人员，女性占比更高（n=341，77%）。总体而言，医疗工作者的抑郁、焦虑与压力患病率分别为19.5%、20.6%与11.8%。相较于一线医护人员，非一线组的抑郁（27% vs. 11%，p<0.001）、焦虑（27% vs. 14%，p=0.001）与压力（15% vs. 8%，p=0.026）患病率均更高。已婚、育有子女、与家人同住以及较高收入与更佳的心理健康结局相关。感知到个人防护装备不足、医院管理方支持不足、遭遇更多歧视以及缺乏应对疫情的培训，均预示着不良的心理健康结局。非一线医疗工作者更易持有此类负面认知。

结论
在某新冠筛查三级教学医院中，非一线医疗工作者的抑郁、焦虑与压力患病率高于一线医护人员。在本次大流行期间，针对导致医疗工作者出现不良心理结局的相关因素进行干预，应作为重点关注事项。