The hidden weight of mental illness amongst frontliners

While healthcare workers (HCWs) are seen as frontliners during the battle against COVID-19, they are not spared from the effects of physical and mental fatigue.  

The situation during the Movement Control Order (MCO) exacted a heavy toll on the mental health of HCWs as it was a unique situation where everyone else was made to stay at home but HCWs were forced to be at work.

According to Dr Ravivarma Rao Panirselvam, a psychiatrist at Hospital Miri, HCWs were affected by COVID-19 and MCO which manifested in the form of distress, depression, anxiety and insomnia. The prevalence was around 20 to 30 percent of the HCWs. Ravivarma was speaking at the Clinical Updates in COVID-19 webinar series organized by the Institute for Clinical Research, National Institutes of Health, on 28 May.

The main cause of psychological distress is attributable to exhaustion, said Ravivarma. The exhaustion stems from additional work on top of the usual shift. To make matters worse, the constant worry of personal protective equipment (PPE) availability and the drastic changes in practice eg, telemedicine, frequent testing, etc, add to the exhaustion factor.

Often overlooked is the media and its influence on the psyche of the population. Frequent reports of COVID-19 cluster lead to unnecessary fear of catching COVID-19 among HCWs and then infecting others. From the other side of the fence, non-HCWs may also stigmatize HCWs due to this perceived source of infection. Ravivarma noted that there have been some reports in Singapore of stigmatization of HCWs as the public shunned them due to the fear of COVID-19 infection. This reaction from the public is an element of moral injury.

Here, Ravivarma said the level of support received by HCWs at the beginning of the pandemic and after the pandemic plays a big role in influencing their psychological state.

How one reacts to psychological stress is influenced by many factors. In Singapore, it was found that HCWs who were older and had lived through the SARS epidemic were more resilient in handling the pandemic. Additionally, the workplace HCWs are attached to can also affect their mental state. Ravivarma said: “A study conducted in China have found that the HCWs who are the support group [not frontliners] were found to be more stressed probably due to the fact that support did not reach them and the amount of workload could be burdening them as well. When staff were deployed to COVID-19 wards, the work in the non COVID-19 departments could increase; shortage of manpower would lead to more work amongst staff working in the non COVID-19 departments.”

In order to address the mental health challenges faced by HCWs, Ravivarma said it was important to recognize the COVID-19 pandemic as a source of fear and anxiety and support each other and help each other to overcome their distress. “HCWs really need to look after ourselves and our colleagues.” 

It is important to realize that being stressed is not a sign of weakness. He said: “The whole idea is that we need to slowly accept that this is a difficult time, and we could simply recharge to make ourselves feel better by looking after ourselves and taking breaks.” Ravivarma said HCWs could also stay connected with friends, as communicating their distress or unhappiness is something that sometimes HCWs fail to do. Most importantly, HCWs must realize it is alright to get help when needed.