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Mental Health of Healthcare Professionals During the Early Stage

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Mental Health of Healthcare Professionals During the Early Stage BJPsych Open (2021) 7, e1, 1–6. doi: 10.1192/bjo.2020.130 Mental health of healthcare professionals during the early stage of the COVID-19 pandemic in Ethiopia Yimenu Yitayih, Seblework Mekonen, Ahmed Zeynudin, Embialle Mengistie and Argaw Ambelu Background Results The coronavirus (COVID-19) pandemic causes healthcare The prevalence of psychological distress among healthcare professionals to suffer mental health problems such as professionals was 78.3%. The mean IES-R score was 34.2 psychological distress, anxiety, depression, denial and fear. (s.d. = 19.4). The ISI score indicated that the prevalence of However, studies are lacking related to Ethiopia and to insomnia was 50.2%. Higher psychological distress was Africa in general. associated with younger age, having insomnia, not having a daily update on COVID-19, and feeling stigmatised and rejected in the Aims neighbourhood because of hospital work. To study the mental health of healthcare professionals during the COVID-19 pandemic in Ethiopia. Conclusions This study indicates that, in Ethiopia, the prevalence of Method psychological distress among healthcare professionals is high A hospital-based cross-sectional study was conducted at and associated with specific sociodemographic risks. Jimma University Medical Center among 249 healthcare professionals. The data were collected using self-administered Keywords questionnaires between 22 and 28 March 2020. The COVID-19; distress; health care professionals; insomnia; psychological impact was assessed using the Impact of Event psychological. Scale – Revised (IES-R) and symptoms of insomnia were mea- sured using the Insomnia Severity Index (ISI). Social support was Copyright and usage evaluated using the three-item Oslo Social Support Scale. Data © The Author(s), 2020. Published by Cambridge University Press were analysed using logistic regression to examine mutually on behalf of the Royal College of Psychiatrists. This is an Open adjusted associations, expressed as adjusted odds ratios. The Access article, distributed under the terms of the Creative psychosocial status of the healthcare professionals was pre- Commons Attribution licence (http://creativecommons.org/ dicted using a classification tree model supported by the genetic licenses/by/4.0/), which permits unrestricted re-use, distribu- search method. tion, and reproduction in any medium, provided the original work is properly cited. Globally, control of infectious disease outbreaks continues to be a varying levels during the SARS outbreak in 2003.7,8 This distress major health challenge.1 Cross-species transmission of animal and is aggravated by severely inadequate personal protective equipment human viruses may allow exchange of genetic material and create (PPE) in hospitals and worsened by the implementation of traffic a new virus with the possibility of bringing about a severe control bundling. Although we accept that shortages of PPE have pandemic.2 been much worse in low-income counties, they have also affected COVID-19 is a global pandemic caused by severe acute respira- higher-income countries.9 tory syndrome coronavirus 2 (SARS-CoV-2), which is a beta-cor- Research on previous disease outbreaks has shown that many onavirus that can be spread to humans through intermediate healthcare workers presented high levels of psychological distress, hosts such as bats.3 The leading cause of transmission is reported frequent concerns about their own and their families’ health, to be human to human via virus-laden respiratory droplets.4 worries about their performance of daily activities, and fears of – Some healthcare professionals have low levels of knowledge about stigmatisation by local communities.10 12 During the previous COVID-19, which might put them and their colleagues at risk of SARS outbreak, worry and distress were associated with higher infection with SARS-CoV-2. Many patients with COVID-19 have job stress, social isolation and health fears among healthcare atypical clinical manifestations and there is therefore the chance professionals.10,11 that they might be referred to several medical departments if practi- The outbreak of COVID-19 in Ethiopia officially started on 13 tioners do not recognise the disease.5 Patients may be infectious March 2020, after a Japanese person arrived in Ethiopia from during the period of incubation, and that may place many health- Burkina Faso and tested positive for the novel COVID-19. There care professionals at risk of infection through contacts they make was a subsequent surge of cases, with a peak of 124 new infections with patients. Research findings indicate that, in addition to recorded on 27 April, by which time three deaths had occurred and droplet and contact transmission, SARS-CoV-2 might be transmit- several exposed healthcare workers were under quarantine because ted by the faecal–oral route.4 they had been in contact with patients. Such interactions lead to Apart from the direct infection risks due to close contact with increased stress in the healthcare workforce, which could result in patients and potentially infectious co-workers during the COVID- a serious weakening of the health service delivered. 19 pandemic, healthcare professionals are under increasing stress There is no information available regarding the psychological and mental health risks, as they were during the SARS epidemic.6 impact of the COVID-19 pandemic on healthcare professionals in Different pieces of evidence indicate that healthcare professionals Ethiopia. Given the possibility of a future pandemic, more system- suffered psychological distress such as anxiety and depression at atic research is needed to improve understanding of the 1 Downloaded from https://www.cambridge.org/core. 23 Sep 2021 at 22:09:12, subject to the Cambridge Core terms of use. Yitayih et al psychological impacts of the COVID-19 pandemic and related risk and impact of insomnia. It consists of seven items scored on a 0–4 and protective factors. To address knowledge gaps, this study Likert scale and summed to give a total score that ranges from 0 to describes the mental health status of healthcare professionals 28. The final ISI score was categorised into no insomnia (0–7 score), during the COVID-19 pandemic in Jimma University Medical mild insomnia (8–14 score) and moderate to severe insomnia Center (JUMC), Ethiopia. (15–28 score).19 The three-item Oslo Social Support Scale assesses level of social support.20 The sum of the scores on the three items ranges from 3 to Method 14, and total scores are divided into three broad categories: poor social support (a score of 3–8), moderate support (9–11) and We used a hospital-based cross-sectional study design. This study good support (12–14). A reliability and validity assessment done was conducted between 22 and 28 March 2020 at JUMC, which is in Nigeria yielded a Cronbach’s alpha coefficient of 0.50, and 21 the largest health facility in south-western Ethiopia, having 692 concurrent validity was low but significant. beds. JUMC provides referral medical services to patients coming from different health facilities in south-western Ethiopia. JUMC is Statistical analysis leading most of the prevention, detection and patient care related to COVID-19 in the region. It is also strengthening its capacities The data were extracted, edited and analysed using the Statistical and providing facilities for quarantine and treatment services. Package for Social Sciences (SPSS) version 23 for Windows. At the time of the COVID-19 outbreak, 1256 health profes- Frequency tables were constructed to summarise the sociodemo- sionals were working in JUMC, 249 of whom were invited to partici- graphic characteristics and prevalence of psychological distress. Bivariate logistic regression was performed separately for each inde- pate in the present study. Data were collected from different P departments of JUMC using questionnaires. Each of the data collec- pendent variable. Independent variables with < 0.25 were entered into the final model for multivariable analysis. Variables in the tors had an MSc in a health-related field. Researchers supervised the P data collection process. Investigators gave 1 day of training for the mutually adjusted multivariable model with a two-sided -value data collectors on the objectives of the study and how to approach <0.05 were considered statistically significant. and handle questions. Healthcare professionals were stratified on Classification tree predictions of psychosocial distress were the basis of the type of profession (with four categories: doctor, made using Weka 3.8 for Windows. Weka is an open-source nurse, pharmacist and laboratory technologist). The number of machine learning software developed at the University of Waikato that can be accessed through a graphical user interface and is sample points was determined using a proportional allocation 22 formula for each stratum. To select an individual health professional highly useful for data mining and knowledge generation. Model from each profession, a systematic sampling method was employed building was performed using the J48 algorithm in Java program- using hospital employee rosters. The first health worker was selected ming language; this is thought to be the best machine learning algo- by a lottery method. Participants completed a self-report paper rithm for scrutinising data categorically and continuously in order questionnaire with instructions to complete within 1 week. to generate a reliable classification or decision tree. The use of The study
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