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 Table of Contents  
Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 203-208

Psychological distress and its associated risk factors among health-care professionals of India during Coronavirus Disease 2019 Pandemic: A systematic review and meta-analysis

1 People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of General Medicine, Chirayu Medical College, Bhopal, Madhya Pradesh, India
3 Department of Public Health Dentistry, People's College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
4 Department of Prosthodontics, Data Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
5 Department of Pedodontics and Preventive Dentistry, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
6 Department of General Medicine, People's College of Medical Sciences, Bhopal, Madhya Pradesh, India

Date of Submission05-Jan-2022
Date of Decision22-Jan-2022
Date of Acceptance18-Feb-2022
Date of Web Publication25-Jul-2022

Correspondence Address:
Dr. Dhiraj Bhambhani
Plot Number 221, One Tree Hill Colony, Near Arogya Kendra, Bairagarh, Bhopal - 462 030, Madhya Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_269_22

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Introduction: Millions of lives have been impacted by coronavirus disease 2019 (COVID-19) infection worldwide. The world's health-care system is overburdened and, in some places, in disarray, which has an effect on medical workers' physical and psychological well-being. The psychological impact has more negative effects on people's general well-being. The goal of this review was to ascertain how the COVID-19 pandemic affected these populations' levels of stress, despair, and anxiety. Until March 2022, PubMed, Google Scholar, and journal online databases were searched for articles focusing on stress, anxiety, and depression in Indian health-care professionals. “Psychological distress,” “COVID-19,” and “Health professionals” were utilized as search phrases. The quantitative study was performed using R Software version 4.1.2. Using Cochran's Q test, the studies' heterogeneity (I2) was evaluated. We found 12 studies in the search results. Stress prevalence as a whole was 0.2721 (95% confidence interval [CI] - 0.1336–0.4754). Depression had a combined prevalence of 0.3941 (95% CI - 0.2698–0.5338). Anxiety's pooled prevalence was 0.4158 (95% CI - 0.2790–0.5670). Young age and longer work hours were considered the main risk factors for psychological distress. The COVID-19 had a significant impact on India's medical sector. The critical goal is to recognize psychological issues at an early stage and to use the right technique and intervention to deal with them.

Keywords: Anxiety, coronavirus, depression, health practitioners, stress

How to cite this article:
Bhambhani D, Bhambhani S, Bhambhani G, Bhoyar A, Pachori A, Kulshrestha M. Psychological distress and its associated risk factors among health-care professionals of India during Coronavirus Disease 2019 Pandemic: A systematic review and meta-analysis. J Datta Meghe Inst Med Sci Univ 2022;17:203-8

How to cite this URL:
Bhambhani D, Bhambhani S, Bhambhani G, Bhoyar A, Pachori A, Kulshrestha M. Psychological distress and its associated risk factors among health-care professionals of India during Coronavirus Disease 2019 Pandemic: A systematic review and meta-analysis. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2022 Aug 16];17:203-8. Available from: http://www.journaldmims.com/text.asp?2022/17/1/203/352227

  Introduction Top

Coronavirus disease 2019 (COVID-19) was initially discovered in December 2019 in Wuhan, China,[1] and has since expanded to 220 nations, resulting in 194.1 million confirmed cases and 4.2 million deaths.[2] India had reported 43,029,044 cases and 521,358 deaths as of March 30, 2022.[3] The pandemic has greatly impacted the psychological and physical health of health-care workers across the world. Various challenging tasks emerged in the initial stage of pandemic, such as the novelty of disease nature, fewer intervention choices, fear of infecting self and, in turn, loved ones, shortage and unavailability of PPB, extended duration of work hours, difficulty in decision-making for resource allocation, and ethical triage options, which drained the health-care providers both emotionally and physically.[4] Subsequently, an increasing reluctance to work surfaced, resulting in the loss of jobs and revenue. Those who continued suffered abuse, stigma, and violence in various parts of our country.[5] The situation influenced the psychological and emotional well beings of health-care practitioners (HCPs) of serious concern.

The common manifestations of psychological distress among HCPs reported in pandemic times are anxiety and depression,[6],[7] trauma, posttraumatic stress disorder,[8] and insomnia.[9] During the COVID-19 epidemic, the intensity of the psychological impact was much higher than seasonal influenza or the Middle East Respiratory Syndrome Coronavirus.[10]

Various studies determining psychological impacts on health-care professionals are conducted across the nation in this regard, but obtaining a pooled prevalence through quantitative analysis provides a synthesized data. Primary preventive measures implemented at the provider or institutional level can altogether prevent a potential psychological or mental disturbance from occurring. Hence, the current review was undertaken to answer the research question “What is the prevalence of psychological distress and its associated risk factors among healthcare professionals of India, during COVID-19 pandemic?”

  Methodology Top

The current systematic review and meta-analysis employed reference search from three electronic databases (PubMed, Google Scholar, and Journal on Web) to identify published studies on the psychological impact of COVID-19 in HCPs till the end of March 2022. PRISMA guidelines were strictly adhered to in the analysis.

Descriptive, cross-sectional studies evaluating the literature on psychological variables such as stress, anxiety, fear, and depression in HCPs of India, on any age group were included. A comprehensive search strategy was followed using Medical Subject Headings terms and keywords; “Psychological impact” OR “Psychological stress” OR “Psychological distress” OR “Mental impact” AND “COVID-19” OR “Coronavirus” OR “SARS–COV2” AND “Health professionals” OR “Medical Practitioners” OR “Health-care professionals.” The analysis included studies conducted only on the health-care professionals. Manual searching, in addition, was done to look in for related cross-referencing and bibliography of articles. Data collection was performed by a specifically designed data extraction chart. Articles published in the English language only were considered. Case reports, editorials, and studies on animals were excluded.

The results of the search procedure were imported to Endnote X8 software (Philadelphia, PA) to remove duplicates. Abstracts of the articles were screened according to the eligibility criteria. Included articles in full were retrieved. Data collection was performed by a specifically designed data extraction chart. Two independent reviewers (DB and SB) screened the articles for data extraction and documented the items of the data characteristic table. In case of any disagreement between them, a third reviewer (GB) resolved it by consensus discussion. Extracted data included study ID, study location, sample size, demographic data, data collection method, assessment tool, and outcome and study design. The primary outcome measured was the proportion or prevalence of the psychological impact among the sample studied. For the ease of interpretation, any symptom or its combination (mild/moderate/severe) was considered psychological impact. The secondary outcome evaluated was the risk factors for psychological distress.

Methodological quality appraisal of the studies included for analysis was done using Joanna Briggs criteria for cross-sectional, case–control, and cohort studies. Criteria to assess the risk of bias included nine items such as relevant sampling frame, appropriate sampling technique and size, description of study subjects and settings, correct application of statistics, relevant use of assessment tools, standard measurement, and adequacy of response rate. Studies were appraised by two authors independently. Each item was graded as either “Yes” or “No.” Scoring criteria of “low” was given when >70% of answers given were “yes,” moderate when 50%–69% were ticked “yes,” and high if it was lesser than 49%.

Criteria to assess risk of bias included nine items such as relevant sampling frame, appropriate sampling technique and size, description of study subjects and settings, correct application of statistics, relevant use of assessment tools, standard measurement, and adequacy of response rate.

Data were analyzed using R software version 4.1.2 (Ross Ihaka and Robert Gentleman at the University of Auckland, New Zealand). Heterogeneity (I2) in the studies was assessed using Cochran's Q test. DerSimonian-Laird estimator was used to estimate tau-squared. P ≤ 0.05 indicates statistical significance.

  Results Top

A total of 359 articles were excluded after screening for titles and abstracts. Nineteen articles in full were retrieved for screening, of which further seven were excluded. Twelve studies which fulfilled the eligibility criteria were included in the final study, as shown in [Figure 1]. The characteristics of the studies are elaborated in [Table 1]. Data quality assessment based on JBI scoring criteria, eight studies were categorized into the low risk of bias and with moderate risk of bias.
Figure 1: Flow chart diagram for article inclusion

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Table 1: Data characteristics of included studies

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The overall pooled proportion for stress was 0.2721 (95% confidence interval [CI] - 0.1336–0.4754), which was analyzed based on five studies. I2 was 97.9% (96.7%, 98.7%) and tau-squared (estimate of between-study variance) was observed to be 0.9814 (0.4528–12.6057). The pooled proportion for depression was 0.3941 (95% CI - 0.2698–0.5338) from seven studies evaluated [Figure 2]. I2 was 98.4% (97.7%, 98.8%) and tau-squared (estimate of between-study variance) was observed to be 0.5677 (0.2727–3.7715). The pooled prevalence for anxiety was 0.4158 (95% CI - 0.2790–0.5670), assessed from five studies [Figure 3]. I2 is 96.4% (93.9%, 97.9%) and tau-squared (estimate of between-study variance) was observed to be 0.4648 (0.1402–3.6711).
Figure 2: Forest plot depicting prevalence of stress. CI: Confidence interval

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Figure 3: Forest plot depicting prevalence of depression. CI: Confidence interval

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Figure 4: Forest plot depicting prevalence of anxiety. CI: Confidence interval

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Heterogeneity was found to be higher in each of the analysis, which could be due to variation in assessment tools and data collection methods. Despite the greater heterogeneity, the meta-analysis has a greater weightage considering the alarming concern. Long working hours and being of younger age were considered significant risk factors associated with corona virus disease among health-care professionals [Table 2].
Table 2: Risk factors of psychological distress

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  Discussion Top

The present systematic review and meta-analysis showed a significant number of HCPs suffering from psychological disorders such as stress, anxiety, and depression. This could be attributed to several factors such as limited resources such as personal protective equipment, fear of infecting family back home, and the necessity to be quarantined, if in case of getting infected.

It can be noted COVID-19 psychologically impacted a vast majority of the practitioners as seen in the present meta-analysis. The ability of COVID-19 infection to rapidly proliferate has caused anxiety among people, leading to mental health problems in individuals across the world with subsequent stereotyping and discrimination. Some individuals may also exhibit signs of psychosis, trauma, suicidal thoughts, and panic attacks along anxiety and stress.

A meta-analysis conducted on general population across 10 countries reported a pooled prevalence of stress to be 29.6%, (95% CI - 24.3%–35.4%), anxiety 31.9% (95% CI - 27.5%–36.7%), and depression as 33.7% (95% CI - 27.5%–40.6%) during the COVID-19 outbreak.[22] This shows that psychological distress is more in the health care, with our study showing the prevalence of stress to be 0.2721 (95% CI - 0.1336–0.4754), depression to be 0.3941 (95% CI - 0.2698–0.5338), and anxiety as 0.4158 (95% CI - 0.2790–0.5670).

All 12 studies included were of cross-sectional study design. As decision-makers recognize the value of epidemiological data in shaping policy and practice, systematic reviews of the prevalence data are becoming more relevant. These assessments have the potential to better assist health-care professionals, policymakers, and consumers in making evidence-based decisions that efficiently target and tackle the current and future burden of disease challenges.[23]

Three[13],[17],[19] out of 12 studies used the Depression, Anxiety, and Stress Scale-21 as assessment tool. Literature studies done in various countries employing different cultures and languages have highlighted good internal consistency.[24] JBI critical appraisal system, used in the present analysis, is easier to use and simpler to comprehend. It has established validity and acceptability for the assessment of cross-sectional studies.[25]

The possible limitations could be the inclusion of articles published only in the English language. Furthermore, the employment of various assessment tools involving different scales and grading for depression, stress, and anxiety compromises standardization and synchronization. Hence, to overcome this limitation, the psychological impact of any intensity, be it either mild, moderate, or severe, were all included. This further expanded the comprehensibility of the data.

Psychological disorders such as depression and anxiety can be easily recognized and treated at the primary care level utilizing appropriate evidence-based recommendations. In addition, social media and print media should play a beneficial role in disseminating correct information about the disease's risk and working with health professionals to communicate reliable information. The government should also develop comprehensive programs to address the mental health needs of all health-care personnel. Measures should be taken to identify people who require immediate assistance and to provide them with solid and simple answers [Figure 4]{Figure 4}.

  Conclusion Top

The present analysis confirms the impact of COVID-19 on the psychological well-being of health-care professionals. The demands of this noble profession are both tiring and ever-expanding during the pandemic era, which, if not redressed correctly, can become a great cause of concern.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

  [Table 1], [Table 2]


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