key: cord-0888357-qnm0pc94 authors: Yalçın Bahat, Pınar; Aldıkaçtıoğlu Talmaç, Merve; Bestel, Ayşegül; Topbas Selcuki, Nura F.; Karadeniz, Ozan; Polat, Ibrahim title: Evaluating the effects of the COVID‐19 pandemic on the physical and mental well‐being of obstetricians and gynecologists in Turkey date: 2020-08-11 journal: Int J Gynaecol Obstet DOI: 10.1002/ijgo.13287 sha: a4712c7f206c8371b41e5f01adfaa47697adaf6c doc_id: 888357 cord_uid: qnm0pc94 OBJECTIVE: To apply online surveying to assess the general physical and mental well‐being of obstetricians/gynecologists (OB/GYNs) working in COVID‐19 designated hospitals in Turkey. METHODS: A prospective survey‐based study using an online survey platform. Three hundred participants working at COVID‐19 designated hospitals in Turkey identified from a hospital database were sent a link to the survey by email between April 29 and May 20, 2020. RESULTS: A total of 253 OB/GYNs (31 consultants and 222 residents) completed the survey, for a response rate of 84.3%. Of respondents, 191 (76.4%) were anxious about coming into contact with pregnant women infected with COVID‐19. 74.4% stated that they were afraid of getting sick. 64.8% reported that they had fallen into despair at times because of the pandemic. 66.5% stated that their family lives were affected. 72.4% started living separately from their families because of the pandemic. CONCLUSION: Despite the difficulties in patient care during the pandemic, OB/GYNs continued providing for their patients, which reflected positively on their perceptions of the profession. The importance of trust in the national healthcare system, presence of adequate PPE, finding a suitable coping mechanism, and family support were essential for Turkish OB/GYNs during the COVID‐19 pandemic. ClinicalTrials.gov identifier: NCT04327531. Turkish obstetricians/gynecologists reported anxiety and stress caused by the current situation and future implications of the COVID‐19 pandemic. Global outbreaks of infectious diseases have acute and long-term effects on the mental health of healthcare workers. 1 Since the outbreak of novel coronavirus disease 2019 (COVID- 19) was declared a pandemic by the World Health Organization (WHO) and the announcement of the first positive case in Turkey on March 11, 2020, COVID-19 has become a source of significant stress and worry both nationally and globally. 2 The uncertainty about the virus' effects on individuals, lack of a cure and a vaccine, and an increase in the workload of healthcare workers are the main causes of stress. 1 Sleep disturbances, stress, anxiety, and fear of contagion were among the mental health problems observed among healthcare workers during COVID-19 3 as well as during previous international one perinatologist. The study protocol was approved by the institution's Ethics Committee, the National Research Committee, and was registered on ClinicalTrials.gov (NCT04327531). The principles of the Declaration of Helsinki were followed in carrying out this study. Before starting the survey, participants were informed that the survey was intended for research and that their participation would be anonymous. Those who agreed were directed to the survey by the program. A separate informed consent was not obtained. A total of 300 OB/GYNs, who were or had been resident physicians or consultant physicians in the department of obstetrics and gynecology and whose contact information was in the database, received a link to the survey by email. The survey took 7-8 minutes to complete. Participants did not have to answer all the questions In order to complete the survey. Exclusion criteria were physicians who were retired or did not currently work in a designated COVID-19 hospital, physicians from other specialties, and physicians who were on leave during the pandemic for various reasons. Inclusion criteria were OB/GYNs active during the pandemic period at a designated COVID-19 hospital, regardless of gender, age, experience, and duration of employment. The survey included questions about the respondents' demographic characteristics, changes in their OB/GYN practice during the pandemic period, and basic knowledge of COVID-19. Furthermore, questions evaluating fear and stress associated with the pandemic and those assessing physicians' attitudes toward COVID-19-related precautions were also included. Data from the completed surveys were saved on the SurveyMonkey database and analyzed using Stata version 14 (StataCorp LLC, TX, USA). Continuous data were checked for normality of distribution using the Shapiro-Wilk test. Continuous data that did not fit a normal distribution were described using means with standard deviations (SD). Categorical data were described using frequencies (percentages). The Cronbach alpha coefficient of the questionnaire was 0.78 with an acceptable internal consistency. 9 To cope with pandemic-related stress, respondents stated that they watched TV (66%), slept (17%), did yoga (3%), meditated (7%), and performed breathing exercises (8%) to relax (Table 3 ). An increase in supplement intake was observed (34.8% vs. 55.6%). Respondents began using herbal preparations and, to a lesser extent, complementary medicine supplements (Table 4) . Responses related to OB/GYN practice during this period are shown in Table 5 (Table 6 ). Participants were allowed to skip questions. Therefore, numbers do not always add up to 253 (total number of participants). were better than expected. Of the respondents, 63% stated that their perceptions of their profession had changed positively during this period. This view was also reflected in their perception of the Turkish health system. A high percentage (72.7%) stated that they found the Turkish national health system's response sufficient, which can be interpreted as their approval of the management of the pandemic in Turkey. An important stress factor for respondents during the pandemic was their families and the possibility of infecting them. Therefore, 72% had started living separately during this period. Similarly, in a study conducted with family physicians, their main concern and cause of stress during the pandemic was their families. 14 When responding to questions on their OB/GYN practice, COVID-19-positive pregnant women posed the greatest fear. Although COVID-19 positivity in pregnant women is considered an indication for cesarean delivery in some guidelines, 17,18 this did not change clinical practice in Turkey. Of those responding to the present survey, 52% did not opt for more cesarean delivery during the pandemic and 82% did not start labor earlier. In addition, the potential risk of vertical transmission has become a major concern for OB/GYNs worldwide, although there is still no supporting data. 20 According to the present survey, 56% of respondents thought that there might be vertical transmission, while a high percentage (76%) advocated breastfeeding. Separation is recommended in situations where the mother is in a severe or critical condition, and breastfeeding either directly or through pumping is recommended to maintain milk production. 18 Despite the difficulties in patient care during the pandemic, survey respondents believed that they had been able to provide adequate There are several limitations to this study. The number of participants was limited and they were mostly situated in hospitals in or around Istanbul. A more nationwide, uniform distribution with a larger cohort should be aimed for in future studies. In addition, there was not a balance between the number of residents and consultants, so the survey does not clearly reflect the differences which could arise according to the workload within the specialty. However, since the main focus was to evaluate OB/GYNs' perception of the pandemic, such an imbalance was of minimal concern for this study. One of the main strengths of this study was its timing, which was during the peak of the pandemic in Turkey. Therefore, the results directly reflected the effects of pandemic when the burden was at its highest. are not yet published. Similarly, worldwide information is also not available. In conclusion, as is likely for all healthcare workers, the pandemic period has been a stressful and worrisome period for OB/GYNs surveyed in Turkey. Health and family-related concerns were the main stressors. Despite the difficulties in patient care during the pandemic, OB/GYNs continued to provide care, which reflected positively on their perceptions of the profession. The importance of trust in the national healthcare system, presence of adequate PPE, finding a suitable coping mechanism, and family support were essential for Turkish OB/GYNs during the COVID-19 pandemic. PYB contributed to conception and design, manuscript drafting, and revision. MAT contributed to interpretation of data. AB contributed to manuscript drafting. NFTS critically revised the manuscript. OK contributed to acquisition of data. IP contributed to statistical analysis and supervision. The authors have no conflicts of interest. 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