key: cord-0683305-3zmmvpq0
authors: Gupta, Anoop Krishna; Mehra, Aseem; Niraula, Abhash; Kafle, Khagendra; Deo, Saroj Prasad; Singh, Babita; Sahoo, Swapnajeet; Grover, Sandeep
title: Prevalence of Anxiety and Depression among the Healthcare Workers in Nepal during the COVID-19 Pandemic
date: 2020-06-24
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102260
sha: 7cd8b68d902ce0885e815d2878ec51c60babcc0b
doc_id: 683305
cord_uid: 3zmmvpq0

nan

Please cite this article as: Gupta AK, Mehra A, Niraula A, Kafle K, Deo SP, Singh B, Sahoo S, Grover S, Prevalence of Anxiety and Depression among the Healthcare Workers in Nepal during the COVID-19 Pandemic, Asian Journal of Psychiatry (2020), doi: https://doi.org/10. 1016/j.ajp.2020.102260 This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Infectious disease outbreaks, such as COVID-19, take a tremendous toll on the general population encompassing various spheres of their life. It is also likely to impact the psychological health of people, including healthcare workers (HCWs) who are in the frontline caring for people with the infection (Tandon R, 2020) . The HCWs are facing pressure of working in resource-deprived settings and ever-growing patient load all over the world (Rana et al., 2020; Spoorthy et al., 2020) . The psychological stress among the HCWs is attributed to prolonged work shift, uncertain pay, lack of Personal protective equipment (PPEs) and added fear of infection to self or family (Grover et al, 2020; Zhang et al., 2020) . Most of the studies came from China. However, little information is available about the psychiatric morbidity among the HCWs from developing countries like Nepal. In this background, the aim of this study was to evaluate the prevalence of anxiety, and depression among the HCWs on duty. For this study, HCWs included, doctors, health assistants, auxiliary nurse-midwifery, nursing students posted in the wards, laboratory assistants, paramedics, staff nurses, sanitization workers, ward attendants, security guards and ambulance drivers who are directly or indirectly involved in the care of patients with COVID-19.

This was an online cross-sectional survey, carried out by using Survey Monkey platform. It was circulated between 11 May, 2020, to 10 June, 2020. The ethical approval for the study was Anxiety Disorder Questionnaire-7 (GAD-7) (Spitzer et al., 2006) : It is a 7-item questionnaire developed to screen patients for anxiety and rate the severity of anxiety. Each item is rated on a 4-point scale (0-3) on the symptoms in the previous two weeks. Perceived Stress Scale (PSS10) (Cohen et al., 1983) : This is a 10-item questionnaire intended to measure distress based on anxiety and depressive symptoms experienced in the most recent 4 week period. 3. Data were analyzed using SPSS 20.0 version, and descriptive statistics were applied.

A total of 150 healthcare workers from four hospitals participated in the study. The mean age of the study participants was 29.5 (SD: 6.1) years. There were more number of females (52.7%) and majority of the participants were not quarantined until the time of participation in the study (94.7%). Participants with postgraduate degrees (18.7%) made up the largest group, followed by those with graduate degrees (33.3%). About one-third were working as nursing staff (31.3%), and this was followed by the faculty members (24.7%). The most common place of work was the speciality OPD (16%). The most common preexisting medical morbidities reported were hypertension (8.7%), followed by chronic obstructive pulmonary disease (5.3%), diabetes mellitus(3.3%), substance use (2.7%), chronic pain (2.7%), stroke(1.3%) and chronic heart disease (0.7%). Around 5% had pre-existing psychiatric illness as well.

The mean GAD-7 score was 3.9 (range 0-20, SD 4.2). The overall prevalence of anxiety disorder was 37.3%, with majority of the participants having mild anxiety. Mean PHQ-9 score was 3.9 (range 0-21, SD 4.2) and 8% of the participants had depression as per the given cut-off. Overall, 38% of the participants, had at least one psychiatric illness ( Studies from different parts of the world have suggested prevalence of anxiety to range from 11.3% to 50% (Zhu et al., 2020; Lai et al, 2020; Chew et al., 2020; Tan et al., 2020) and findings of the present study are within this reported range. This high level of anxiety among the HCWs in Nepal could be attributed to factors like deprivation of protective gears and resultant fear of getting infected. Previous studies have also linked mental morbidity in HCWs to inadequacy of PPEs and increase the risk of exposure to infection (Wu et al., 2020; Du et al., 2020; Liu et al., 2020 ).

In the present study, the prevalence of depression was 8%, which is much lower than that Chew, N., Lee, G., Tan, B., Jing, M., Goh, Y., Ngiam, N., Yeo, L., Ahmad, A., Ahmed Khan, F., Napolean Shanmugam, G., Sharma, A. K., Komalkumar, R. N., Meenakshi, P. V., Shah, K., Patel, B., Chan, B., Sunny, S., Chandra, B., Ong, J., Paliwal, P. R., … Sharma, V. K. (2020) . A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain, behavior, and immunity, S0889-1591(20) J o u r n a l P r e -p r o o f 

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