Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India-A cross-sectional study.

Geetha R Menon,Ragini Kulkarni,M Vishnu Vardhana Rao,Ashoo Grover,Asha Ketharam,Jugal Kishore,Jeetendra Yadav,Phibawan Syiemlieh,Beena Thomas,Dhanalakshmi A,Kiran Jakhar,Rakesh Balachandar,Prashant Kumar Singh,Denny John,Swapnil Kharnare,Kangjam Rekha Devi,Srikanta Kanungo,Gajanan Velhal,Bijaya Kumar Mishra,Abuhasan Sarkar,Abey Sushan,Sumit Aggarwal,Geethu Mathew,Tapas Chakma,Jochanan Diengdoh,Alice David,Samiran Panda,Maribon Viray,Basilea Watson,Sairu Philip,Chitra Venkateswaran,Gladston Xavier,K H Jitenkumar Singh,Shalini Singh,Deepika Nandanwar,Ravinder Singh,Jaideep Menon,Simran Kaur,Anniesha Lyngdoh,Raman Swathy Vaman,U Venkatesh ,Shaleen Chandra ,Santosh Kumar Swain ,Pradeep Barde ,Kallol Saha ,Karikalan Nagarajan ,Pradeep K Selvaraj ,Krushna Chandra Sahoo ,Ranjan Kumar Prusty ,Shailesh Kumar

doi:10.1371/journal.pone.0264956

Abstract

COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India. A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers. Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66-3.41), income≥20000(AOR = 1.74, 95% CI, (1.16-2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09-2.46), contact tracing (AOR = 2.05, 95% CI (1.1-3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14-6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28-2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions). The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.

Highlights

The Coronavirus disease 2019 (COVID-19) was first identified in Wuhan in China in December 2019 [1] and has spread to 220 countries leading to 194.1 million confirmed cases and 4.2 million deaths [2]
52.9% of the participants had the risk of psychological distress that needed further evaluation
Risk of psychological distress was significantly associated with longer hours of work ( 8 hours a day) (AOR = 2.38, 95% Confidence Intervals (CI)(1.66–3.41), income 20000(AOR = 1.74, 95% CI, (1.16–2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09–2.46), contact tracing (AOR = 2.05, 95% CI (1.1–3.81), High Emotional exhaustion score (EE 16) (AOR = 4.41 95% CI (3.14–6.28) and High Depersonalisation score (DP 7) (AOR = 1.79, 95% CI (1.28–2.51))

Summary

Introduction

The Coronavirus disease 2019 (COVID-19) was first identified in Wuhan in China in December 2019 [1] and has spread to 220 countries leading to 194.1 million confirmed cases and 4.2 million deaths [2]. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India. Health workers involved in screening and contact tracing were more likely to be at risk of psychological distress (AOR = 1.63 95% CI (1.09–2.46) and (AOR = 2.05, 95% CI (1.1–3.81) respectively) when the model was adjusted for sociodemographic and job-related variables. Over 20–40% of the healthcare workers reported a higher score on each item of depersonalization for eg 40% expressed anger at workplace, lost patience at workplace and felt guilty, 20% responded having an indifferent attitude with fellow colleagues or insensitive to people around (Fig 5)

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Conclusion