Abstract
Background: While studies have evaluated the impact of coronavirus disease 2019 (COVID-19) on the mental health of healthcare workers (HCW), to our knowledge, there are no studies in Pakistan, which have compared psychological distress levels during the first and second waves of the pandemic. This study was done to assess anxiety levels of Internal Medicine residents and identify risk factors for psychological distress.
 Methodology: Cross-sectional study was conducted in the Aga Khan University Hospital, Karachi. A questionnaire comprising of demographic data and risk assessment tools, a seven-item Generalized Anxiety Disorder scale (GAD-7), and a nine-item Patient Health Questionnaire (PHQ) was used for data collection from Internal Medicine residents using nonprobability convenience sampling technique in May–June 2020 and April 2021.
 Results: A total of 88 responses were recorded. Response rate was 75.7 percent (56/74) and 43.2 percent (32/74) during the first and second waves, respectively. Mean age was 27.9 ± 3.2 years and mean clinical career in years was 3.2 ± 2.1. Majority, 51.8 percent (29/56) and 68.8 percent (22/32), were not satisfied with community prevention measures and 75 percent (42/56) and 65.6 percent (21/32) considered interventions necessary in case of psychological distress during pandemic, during the first and second waves, respectively. A higher number of HCW reported their family not supporting their frontline work during the first wave (16.1 percent vs 3.1 percent; p value 0.023). There was a statistically significant difference in psychological distress levels as median GAD-7 scores were 5(IQR 2–8) vs 9.5(IQR 3.25–13) (p value 0.009) and median PHQ-9 scores were 4(IQR 2–11) vs. 7(IQR 4–s17) (p value 0.056) during the first and second waves, respectively.
 Conclusion: There was a significant difference in anxiety levels during the first and second waves of COVID-19, and family support for frontline work was higher during the second wave. Further studies are required to assess these differences.
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