Mental health of medical professionals during the COVID-19 pandemic in Togo.

Abstract

The coronavirus (COVID-19) pandemic had spread quickly around the world. As of 18 May 2020, there are more than 4 million confirmed cases worldwide. The continuous and rapid spread of the COVID-19 pandemic has had psychological impact on the general population and especially on health-care professionals who have experienced extraordinary stress levels daily and high rates of psychiatric morbidity.1 The prevalence of mental health disorders related to COVID-19 is high in the general population and in health-care staff in many countries,2 but little is known about this frequency in Africa where the number of infections is lower compared to frequencies reported in other continents. Findings of COVID-19 impact on mental health of medical staff are mainly done outside African countries, including Togo. To date (18 May 2020), we have had 330 confirmed cases with 106 recovered cases and 12 deaths due to COVID-19 in Togo. Due to this relatively small number of infections and morbidities in Togo, can we expect a low impact of COVID-19 on the mental health of Togolese medical professionals? The current research aims to examine the impact of mental health status on Togolese medical professionals during the COVID-19 pandemic. We hypothesize that Togolese medical staff may experience anxiety, depression, and psychological distress during the COVID-19 pandemic. Sixty-two medical professionals (mainly doctors and nurses; mean age = 35.5 years, SD: 8.75 years, 56.5% women) from two Lomé medical centers at Togo's first university hospital (Sylvanus Olympio University Hospital) participated in the study. Participants completed three self-questionnaires, the seven-item Generalized Anxiety Disorder (GAD-7) Scale,3 the nine-item Patient Health Questionnaire (PHQ-9),4 and the nine-item Psychological Stress Measure (PSM-9),5 to assess generalized anxiety symptoms, depression symptoms, and psychological distress, respectively. Participants were nurses (n = 20), doctors (n = 19), laboratory technicians (n = 6), and others (n = 17). The protocol for the research project was approved by the Ethics Committee of the Medico-Social Center of Adidogome and conformed to the provisions of the Declaration of Helsinki. All participants agreed to take part in this research and written informed consent was obtained from them. During the COVID-19 pandemic, the proportions of health professionals with mild, moderate, and severe anxiety were 25.8%, 22.6%, and 14.5%, respectively; and their proportions with mild, moderate, moderately severe, and severe depression were 24.2%, 16.1%, 9.7%, and 1.6%, respectively. According to the total GAD-7 and PHQ-9 scores, women had higher scores than men for anxiety, t(60) = 2.83, P < 0.01, and for depression, t(60) = 3.63, P < 0.01. Nurses reported higher scores for depression symptoms than doctors but not other professionals, F(3, 58) = 7.87, P < 0.01. Participants with prior history of chronic somatic pathology, such as diabetes or high blood pressure, had significantly higher GAD-7 and PHQ-9 scores than those without history of somatic disease: t(60) = 2.51, P < 0.05 and t(60) = 2.19, P < 0.01, respectively. Among all participants, PSM-9 score was high and was significantly correlated with anxiety and depression symptoms: r = 0.44, P < 0.01 and r = 0.67, P < 0.01, respectively. Togolese medical professionals have been experiencing extraordinarily high levels of psychological distress, anxiety, and depression during the COVID-19 pandemic. In our study, the anxiety rate was 62.9%, which is higher than the frequency reported by Liu and colloborators6 in China. Previous research has found increased anxiety among medical workers during the Ebola pandemic in Liberia.7 The depression frequency in our research was 51.6%, which is slightly higher than the findings of Liu and collaborators (50.7%).6 Nurses reported a higher depression rate than doctors and this result is in line with previous research.1 Despite the relatively low infection rate of COVID-19 in Togo, medical professionals have reported high symptoms of anxiety, depression, and psychological distress. This could be explained by the poor-quality health-care system in Togo and a lack of adequate equipment to deal with the COVID-19 pandemic. For instance, many health professionals during the current study recommend the use of masks by the entire population as observed in some countries (China and South Korea) to deal with COVID-19. In response to our study's findings, mental health care for Togolese medical professionals is recommended. This suggestion is essential, according to the findings of Kang and collaborators,8 which suggest that mental health protection for medical workers is important for control of the COVID-19 pandemic and their own long-term health. Togolese medical staff would benefit from mental health care to cope effectively with their stress and mental status during and after the COVID-19 pandemic according to suggestions from Chen et al.,9 and lessons learnt during the Ebola outbreak in West Africa.7 Considering lessons from China, using various kinds of mental health interventions for medical professionals, such as relaxation, cognitive therapies, and dance-based exercises,10 is warranted. The authors declare no conflict of interest.