Frontline workers buckle under pressure of COVID-19

Amid the pandemic of the novel coronavirus disease (COVID-19), healthcare workers in Asia are suffering from high rates of psychological distress, according to a recent study. The rates vary greatly across countries and seem to be independent of the case burden.

From 29 April to 4 June 2020, 1,146 healthcare workers across five Asia-Pacific countries (India, Indonesia, Malaysia, Vietnam, and Singapore) were enrolled in the study. A self-administered survey showed that lethargy and headaches were common physical symptoms, manifesting in 36.2 percent and 33.5 percent of participants, respectively. [BJPsych Open 2020;6:e116]

During the study period, Singapore logged the highest number of daily cases, confirming 109.6 infections per day per 1 million population. This was followed by Malaysia, Indonesia, and India (1.9, 1.8, and 1.2 cases per day per 1 million population). Vietnam, at 0.03 confirmed infections per day per 1 million population, had the lowest case rate.

Despite this trend in case burden, healthcare workers from Vietnam showed the highest prevalence of COVID-19-related post-traumatic stress disorder (PTSD), as defined by the Impact of Events Scale-Revised (IES-R), at 15.0 percent. Overall, 91 patients (7.9 percent) had PTSD related to the pandemic.

The overall prevalence of depression was 4.5 percent, and anxiety was reported in 5.2 percent of participants. The overall mean scores for the respective subdomains in the Depression Anxiety Stress Scales (DASS-21) were 1.89±3.10 and 1.95±2.75.

In multivariable logistic regression analysis, the presence of physical symptoms, such as lethargy, headaches, and throat pain, emerged as a significant indicator of depression Malaysian (odds ratio [OR], 5.673, 95 percent confidence interval [CI], 1.780–18.075; p=0.003) and Indonesian (OR, 1.241, 95 percent CI, 1.010–1.526; p=0.04) healthcare workers.

In addition, nonmedically trained frontline workers, such as administrative personnel, were significantly more likely to have anxiety in the Indonesian subgroup (OR, 4.908, 95 percent CI, 1.282–18.789; p=0.02).

Among Singaporean healthcare workers, having had medical conditions in the past was tied to anxiety (OR, 5.828, 95 percent CI, 1.397–24.308; p=0.016) and COVID-19-related PTSD (OR, 2.425, 95 percent CI, 1.014–5.802; p=0.046). Other predictors of PTSD in Singaporean frontline workers were being nonmedically trained (OR, 2.729, 95 percent CI, 1.150–6.472; p=0.023) and having physical symptoms (OR, 6.692, 95 percent CI, 1.517–29.521; p=0.012).

“To our knowledge, this is the first multicentre study that has examined the prevalence of psychological outcomes among healthcare workers during the evolution of the COVID-19 pandemic in the Asia-Pacific region,” the researchers said.

“Therefore, as the pandemic reaches its peak, it calls for urgent clinical and policy strategies for identifying healthcare workers at risk, [such as] those who are not medically trained, those with physical symptoms and prior medical conditions,” they added.

“Passive psychoeducation through educational pamphlets, emails, or website can be relatively easy and inexpensive to implement and may serve as a readily available resource for those experiencing psychological distress,” the researchers said.