Anxiety amongst physicians during COVID-19: cross-sectional study in Pakistan

Exploring medical students' perceptions of empathy after cinemeducation based on Vygotsky's theory

BACKGROUND

Medical students' empathy toward patients with Alzheimer's is rarely found in formal medical curricula. Based on Vygotsky's theory, watching films and reflection can be considered as effective methods to improve empathy. The present study aimed to explore medical students' perceptions of empathy toward patients with Alzheimer after participating in an educational program by using interactive video based on Vygotsky's theory.

METHODS

This qualitative study was conducted at Tehran University of Medical Sciences in 2022. The population included all 40 medical students. Firstly, the Still Alice movie which is about the feelings of a professor who was diagnosed with Alzheimer's disease was shown to the students. Secondly, the students reflected on their experiences of watching the movie. Thirdly, a session was held for group discussion on the subject of the movie, the patient's feelings, the doctor's attitude, the social environment surrounding the patient shown in the movie, and the necessity of empathy toward patients with Alzheimer's disease. The reflection papers were analyzed using the conventional qualitative content analysis method.

RESULTS

After analyzing 216 codes from 38 reflection papers, four categories, including communication with a patient with Alzheimer's, understanding the patient with Alzheimer's as a whole, medical science development, and the student's individual ideology, were extracted.

CONCLUSION

Reflection and group discussion after watching movie by providing opportunities for social interaction about personal interpretations will lead to active role in enhancing empathy. Based on the perceptions of the medical students, they gained a perspective to consider the patient as a whole and pay attention to establishing a proper relationship with the patient.

Assessing the Disruption Impact on Healthcare Delivery

Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.

Initial response to SARS-CoV-2 (COVID-19) outbreak in Sri Lanka; views of public health specialists through an International Health Regulations lens

The COVID-19 pandemic affected Sri Lanka despite having developed an International Health Regulations (IHR) steering committee in 2016 and a national action plan for health security following the Joint External Evaluation in 2018. Many steps were taken to improve the disaster management skills of healthcare workers even before the COVID-19 outbreak. We interviewed seven public health specialists to obtain their views on the country's response to the pandemic. A thematic analysis was conducted, leading to the emergence of three major themes and seven subthemes. The major themes included health security preparedness; COVID-19 management; and effects of COVID-19. The subthemes were; preparedness prior to pandemic and gaps in the preparedness (under health security preparedness); dual burden for the curative sector, strategies to reduce transmission and barriers to managing COVID-19 (under COVID-19 management) and negative and positive effects of COVID-19 (under effects of COVID-19). When COVID-19 reached Sri Lanka, healthcare workers, border control authorities and those involved with infectious disease control were overwhelmed by the magnitude of the pandemic. Healthcare workers' hesitation to work amidst the pandemic due to fear of infection and possible transmission of infection to their families was a major issue; the demand for personal protective equipment by health workers when stocks were low was also a contributory factor. Lockdowns with curfew and quarantine at government regulated centers were implemented as necessary. Perceptions of the public including permitting healthcare workers to perform field public health services, logistical barriers and lack of human resources were a few of the barriers that were expressed. Some persons did not declare their symptoms, fearing that they would have to be quarantined. The pandemic severely affected the economy and Sri Lanka relied on donations and loans to overcome the situation. Pandemic also brought about innovative methods to maintain and upgrade health service provision. Individuals with non-communicable diseases received their regular medications through the post which reduced their risk of being infected by visiting hospitals. Improvement of laboratory services and quarantine services, a reduction of acute respiratory infections and diarrhoeal diseases, improved intersectoral coordination and public philanthropic response were other positive effects.

Anxiety levels among school-going adolescents in peri-urban areas of Karachi, Pakistan

INTRODUCTION

Mental health problems are pervasive nowadays. Adolescents are often expected to balance academic performance with familial obligations and work to support the family financially if they belong to low-socio-economic areas. These pressures can lead to Anxiety, stress, and even depression.

OBJECTIVE

The study's main objective is to assess the association of gender, parenting style, eating habit, and screen timing with the level of Anxiety among school-going adolescents in three peri-urban areas of Karachi, Pakistan.

METHODOLOGY

A school-based cross-sectional study was conducted among adolescents of age group 10-19 years using the Generalized Anxiety Disorder-7 (GAD-7) scale in two months in, three populated peri-urban areas of Karachi, Pakistan. Collected Data was analyzed by statistical software SPSS version with 80% response rate.

FINDING

In our collected data, 544 students participated; 313 (57%) were female, and 231(42%) were male. Among them 173(33%) participants showed moderate to severe level of anxiety out of which 140(26%) were female and 33(7%) were male. As per our study, strict Parenting style plays a significant role in developing moderate to severe 108(20%) levels of Anxiety, shown among adolescents in the studied population. In addition to this, those who do not take tuition 115 (21%), do not use transport to school 91(16%), spend significant time in games on mobile and computer 101 (18%), and have no involvement in physical activities 172 (31%) show more moderate to severe level anxiety than others factors. A significant multivariate association between level of anxiety with gender, school commute, type of lunch Intake, smoker family member at home, physical activity, video game, tuition and strict parent.

CONCLUSION

This study concluded that there are various factors which have great association with anxiety and can affect adolescents' mental health badly. The factors were parental strictness, video game playing, a sedentary lifestyle, and the smoking habits of family members. Children and adolescents must be evaluated as soon as possible while they are still young to prevent mental health issues.

Multidimensional stressors and protective factors shaping physicians' work environments and work-related well-being in two large US cities during COVID-19

INTRODUCTION

Clinician burnout and poor work-related well-being reached a critical inflection point during the COVID-19 pandemic. This article applies a novel conceptual model informed by the Total Worker Health® approach to identify and describe multilevel stressors and protective factors that affected frontline physicians' work environments and work-related well-being.

METHODS

We conducted a qualitative study of hospital-based physicians from multiple hospital types in Los Angeles and Miami who cared for COVID-19 patients. Semistructured interviews lasting 60-90 min were conducted over Zoom. Interview transcripts were thematically coded using Dedoose qualitative software.

RESULTS

The final sample of 66 physicians worked in 20 hospitals. Stressors in the social, political, and economic environment included dealing with the politicization of COVID-19, including vaccine hesitancy; state and federal governmental COVID-19 policies and messaging; and shifting CDC guidance. Employment and labor pattern stressors included the national nursing shortage, different policies for paid time off, furloughs, reduced pay, and layoffs. Organizational-level stressors included institutional policies, staffing constraints and high patient volume (i.e., increased number of cases and longer lengths of stay), and perceived poor leadership. At the individual worker level, stressors included concerns about viral transmission to family, strained personal relationships, and work-life fit, particularly for those with young children. Respondents identified promising protective factors at multiple levels, including responsive state leadership, job security, concrete opportunities to provide input into institutional policy, strong leadership and communication, and feeling cared for by one's institution.

CONCLUSION

Findings support a multi-level strategy that acknowledges internal organizational and external factors shaping clinicians' work-related well-being, consistent with the Total Worker Health® approach.

Secondary traumatic stress and death anxiety in healthcare professionals: Moderating role of social support

Background & Objective

It's hard to deny the buffering impact of social support as it provides much-needed assistance to counter untoward circumstances that individuals face in their daily life. By focusing on the moderating role of social support, the present investigation studied the relationship between secondary traumatic stress and death anxiety that healthcare professionals encounter in their regular work life.

Method

Through a cross-sectional correlational design, 200 participants were included from various hospitals in Lahore (from June-August, 2022) by employing a non-probability purposive sampling technique. They provided basic sociodemographic information along with their responses on self-reported questionnaires for the current investigation.

Results

Results were analyzed through SPSS 21 which indicated that secondary traumatic stress had a positive association with death anxiety, unlike social support which had a negative relationship with death anxiety. Findings also revealed social support as a significant moderator for secondary traumatic stress and death anxiety.

Conclusions

It can be concluded that increased social support could benefit healthcare professionals as it weakened the association between secondary traumatic stress and death anxiety. Other than academia and research, these findings have implications across a variety of professional settings including physical and mental healthcare professionals who can benefit from these indigenous findings.

Mental health and fatigue status of the medical workforce during the COVID-19 outbreak in the Yangzhou city, China

Background

When the coronavirus disease 2019 (COVID-19) erupted in Yangzhou, China, at the end of July 2021, medical workers in Yangzhou immediately joined the frontline for the fight against the pandemic. This study aimed to identify the mental health and fatigue experienced by the medical workers in Yangzhou during the COVID-19 outbreak.

Methods

We included 233 medical workers who participated in the front-line work for more than 1 month through the questionnaire, including doctors, nurses, medical technicians and medical students. The generalized anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), and Fatigue self-assessment scale (FSAS) were administered to the participants and their responses were evaluated.

Results

A total of 233 eligible questionnaires were received. Among them, 130 people (57.08%) were probably anxious and 141 (60.52%) people were clinically depressed. Poor sleep was considered an independent risk factor for anxiety (OR = 7.164, 95% CI: 3.365 15.251, p = 0.000) and depression (OR = 6.899, 95% CI: 3.392 14.030, p = 0.000). A high PHQ-9 score was considered an independent risk factor for general fatigue (OR = 1.697, 95% CI: 1.481 1.944, p = 0.000). Mental fatigue (OR = 1.092, 95% CI: 1.027 1.161, p = 0.005) and fatigue response to sleep/rest (OR = 1.043, 95% CI: 1.011 1.076 p = 0.008) were considered independent risk factors for general fatigue.

Conclusion

Poor quality of sleep led to probable anxiety, depression, and general fatigue. Mental fatigue and fatigue response to sleep/rest were independent risk factors for depression, which merits attention for battling COVID-19.

COVID-19 stress and wellbeing: A phenomenological qualitative study of Pakistani Medical Doctors

The COVID-19 stress and increased job pressure have largely affected healthcare professionals’ various life domains. This study particularly explores the effect of stress caused by treating COVID-19 patients on medical doctors’ wellbeing. To explore this phenomenon, we interviewed 12 doctors treating COVID-19 patients in hospitals of metropolitan cities in Pakistan. The thematic analysis using NVivo V.12 Plus software of interviews resulted in four major themes, COVID-19 Stressors, Effects of Stress, Nature and Personality, Stress Relievers, and Stress Coping Strategies. Physicians were physically and emotionally stressed as a result of the intense work. Although they were carrying a lot of pain and hurt on their insides, participants demonstrated a sense of professional determination to overcome obstacles. Physicians are currently dealing with their emotional issues, and they should have access to complete professional help to ensure their wellbeing. The COVID-19 pandemic’s mental health effects are anticipated to last far longer than the physical health effects. This study is well-positioned to investigate frontline physicians’ opinions and attitudes concerning the COVID-19 and its impact on their daily lives and mental health. This research will help implement context-specific innovative mental health solutions to help the frontline workers.

A Mental Health Survey of Medical Professionals Working During the COVID-19 Pandemic at Shaukat Khanum Cancer Hospital, Lahore

Introduction

The last months of 2019 saw the emergence of a novel coronavirus, SARS-COV-2, capable of causing widespread disease in humans. The rapid spread of this new disease culminated in one of the biggest pandemics in known history. The far-reaching social, economical, and health effects of this pandemic are still unfolding on a global scale.

Given the interconnectedness of social, environmental, and biological factors in manifesting psychiatric illnesses, it is fair to assume that the profound effects of this pandemic would likely increase the strain on mental healthcare systems. 

The objective of this study was to assess the mental health burden amongst healthcare workers at Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH & RC) at the start of the COVID-19 pandemic and to identify any differences in the mental health scores of anxiety, depression, and sleep disturbance for professionals directly involved in the care of COVID-19 patients as compared to those who were not.

Material and methods

This was an observational cross-sectional clinical study that used self-reported questionnaires after approval from the hospital's ethical board. The sample size was calculated based on a study published previously by Huang using a 23.04% incidence of anxiety in medical staff. Depression was quantified using the Patient Health Questionnaire-9 score (PHQ-9), anxiety by the Beck Anxiety Inventory, and sleep quality using the Pittsburgh Sleep Quality Index checklist (PSQI). A total of 221 healthcare workers who completed the questionnaires were included in the study and the results were analyzed using SPSS Statistics v. 23 (IBM Corp., Armonk, NY). Levene’s test was used to assess the equality of variances, and an independent sample t-test and chi-square test were applied for the comparison of means. A one-way ANOVA test was used to compare means across more than two groups.

Results

Of the 221 healthcare workers recruited in the study, 57% were males, and 43% were females. Among the sample, 43% of participants were doctors, 27.1% were nurses, and others were technicians and medical assistants.

It was observed that 50% of males and 36% of female healthcare workers experienced moderate to severe depression at the onset of the pandemic. Furthermore, 35% of males and 25% of females suffered from moderate to severe anxiety, and more than 80% of our study population reported poor quality of sleep.

Conclusion

The present study reported a high prevalence of anxiety levels, depressive symptoms, and poor sleep quality among the healthcare professionals working in SKMCH & RC Lahore during the COVID-19 pandemic irrespective of direct contact with COVID-19 patients in a healthcare setting. 

Factors associated with loss of motivation and hesitation to work amongst frontline health care providers during the COVID-19 pandemic: A cross-sectional survey from a developing country

Background

The COVID-19 took over the world in 2020 and a lockdown has been imposed seeing its fast spread. Frontline health care workers (HCWs) were reported frequently with a lack of motivation, hesitancy and unwillingness to perform their duties during this pandemic. This cross-sectional survey aims to evaluate the factors associated with lack of motivation and increased hesitancy among the frontline HCWs to perform their duties during COVID-19 pandemic.

Materials and methods

A total of 239 HCWs were included in this web-based cross-sectional study, who have worked during the COVID-19 pandemic. The anonymous online questionnaire was sent to all faculty, trainees and staff of Aga Khan University Hospital in Karachi, Pakistan. The survey was conducted from September 2020 to January 2021 during the COVID-19 pandemic. All data was exported into Statistical Package for Social Sciences Version 19 for multivariate analysis.

Results

The risk of getting infected was strongly reported by 180 participants, and it was associated with higher hesitation to work (aOR = 6.09 [2.55–14.59]). Fifty-one participants felt that lack of knowledge about prevention and protection was associated with lower motivation to work (aOR = 0.66 [0.35–1.25]). Participants reported higher hesitation due to the burden of changed quality of work, physical exhaustion, mental exhaustion and altered sleep patterns. Sense of feeling protected by their hospitals was a motivating factor, and participants receiving adequate support reported higher motivation to work (aOR = 2.60 [1.32–5.14]).

Conclusion

Fear of infection, increased working hours, and inadequate support of the workplace played a key role in escalating the hesitancy among HCWs to perform their duties. Lack of disease knowledge and paucity of personal protective equipment further lowered the motivation levels of HCWs to work effectively during the COVID-19 pandemic.

•

The COVID-19 took over the world in 2020 and a lockdown has been imposed seeing its fast spread. Frontline health care workers (HCWs) were reported frequently with a lack of motivation, hesitancy and unwillingness to perform their duties during this pandemic.

•

This cross-sectional survey aims to evaluate the factors associated with lack of motivation and increased hesitancy among the frontline HCWs to perform their duties during COVID-19 pandemic.

•

Fear of infection, increased working hours, and inadequate support of the workplace played a key role in escalating the hesitancy among HCWs to perform their duties.

Optimizing the Practice Environment for Medical Staff in the Post-pandemic Era: A Discrete Choice Experiment

Objective

This study aimed to elicit the stated job preferences of Chinese medical staff in the post-pandemic era and identify the relative importance of different factors in the practice environment.

Methods

We used an online discrete choice experiment (DCE) survey instrument to elicit the job preferences of medical staff (doctors and nurses) in tertiary hospitals in Anhui, China. Attributes and levels were generated using qualitative methods, and four attributes were considered: career development, workload, respect from society, and monthly income. A set of profiles was created using a D-efficient design. The data were analyzed considering potential preference heterogeneity, using the conditional logit model and the latent class logit (LCL) model.

Results

A total of 789 valid questionnaires were included in the analysis, with an effective response rate of 73.33%. Career development, workload, respect from society, and monthly income were significant factors that influenced job preferences. Three classes were identified based on the LCL model, and preference heterogeneity among different medical staff was demonstrated. Class 1 (16.17%) and Class 2 (43.51%) valued respect from society most, whereas Class 3 (40.32%) prioritized monthly income. We found that when respect from society was raised to a satisfactory level (50–75% positive reviews), the probability of medical staff choosing a certain job increased by 69.9%.

Conclusion

Respect from society was the most preferred attribute, while workload, monthly income, and career development were all key factors in the medical staff's job choices. The heterogeneity of the medical professionals' preferences shows that effective policy interventions should be customized to accommodate these drive preferences.

State and trait anxiety among medical staff during the first month of COVID-19 pandemic: A sample from Turkey

OBJECTIVES

During the COVID-19 pandemic, excessive workload, a rapidly changing workplace environment, the danger of carrying the virus and transmitting the disease to their families, relatives and those they live with creates stress for the medical workers. In our study, we aimed to evaluate the state and trait anxiety levels of healthcare professionals who encounter patients with suspected COVID-19 infection and related factors.

METHOD

Data were collected from healthcare professionals working with patients diagnosed or suspected with COVID-19 via online self-report questionnaire between 9-19 April 2020. The state (STAI-S) and trait anxiety (STAI-T) scale was used to measure anxiety.

RESULTS

A total of 291 healthcare professionals, 216 women and 75 men, participated in the study. Women's state and trait anxiety were significantly higher than men's. 11 participants without any lifetime psychiatric illness experienced psychiatric symptoms and consulted to a psychiatrist. The state anxiety of those who have children, nurses and those working in branches directly related to the pandemic (Infectious Diseases, Respiratory Diseases, Emergency Medicine, Internal Medicine, Radiology, Anesthesiology and Reanimation) was higher than others. The state anxiety of those who thought they were not protected with personal protective equipment and those who did not stay in their own home was higher than others.

CONCLUSIONS

At the forefront of the fight against COVID-19, there are medical personnel who pay a serious psychological cost. Especially in terms of anxiety, we should pay attention to women, workers with children, nurses and people working in branches that are directly related to pandemics.

Assessment of fear, anxiety, obsession and functional impairment due to COVID-19 amongst health-care workers and trainees: A cross-sectional study in Nepal

Background:

The emergence of the COVID-19 epidemic threw the world into turmoil. The medical community bore the brunt of the pandemic's toll. Long work hours, and a lack of personal protective equipment (PPE) and social support all had an influence on mental health.

Methods:

This cross-sectional study was conducted among Lumbini Medical College Teaching Hospital students and employees in Palpa, Nepal. Data entailing their demographic details, pre-existing comorbidities, or death in the family due to COVID-19 was collected using a self-administered survey. In addition, the level of fear, anxiety, obsession, and functional impairment due to COVID-19 was recorded using previously validated respective scales.

Results:

In total, 403 health-care workers and trainees participated in our study. The mean age of the study participants was 23±4 years, and more than half of them (n=262, 65%) were females. A significant association was found between fear score with age (p-value=0.04), gender (p-value <0.01) and occupation (p-value<0.001). The participants suffering from chronic diseases (p-value=0.36), were not found to be significantly obsessed with COVID-19. Age (p-value=0.34), was not found to be significantly associated with higher anxiety levels. Nursing students suffered from a significantly greater functional impairment than other health-care professionals (mean rank score=269.15, p-value < 0.001). A moderately positive correlation was observed between fear, anxiety, obsession, and functional impairment scales.

Conclusion:

This study revealed various socio-demographic characteristics as risk factors for psychological stress in the people related to the health-care profession of Nepal during the COVID-19 pandemic. A viable answer to this quandary might be adequate psychosocial intervention by health-care authorities, increased social support, and the introduction of better mental health management measures for the front-line health-care workers.

Leader crisis communication and salesperson resilience in face of the COVID-19: The roles of positive stress mindset, core beliefs challenge, and family strain

The resilience of B2B sales forces is crucial in face of severe wide-ranging challenges during a crisis. This study aims to investigate the role of leader communication of the crisis in promoting salesperson resilience during the COVID-19. The data were gathered from 418 salespersons from 36 manufacturing firms in times of the COVID-19. The data were analyzed using multilevel structural equation modeling. The results demonstrated the positive relationship between leader crisis communication and salesperson resilience, mediated by salespersons' positive stress mindset. Family strain and core beliefs challenge were found to attenuate the positive linkage between leader crisis communication and salespersons' positive stress mindset. Theoretical and practical implications are presented. This study offers insights to help managers in B2B organizations better understand and implement mechanisms that can foster resilience among their B2B sales forces in the COVID-19 outbreak and other crises.

Perceived risk and distress related to COVID-19 in healthcare versus non-healthcare workers of Pakistan: a cross-sectional study

BACKGROUND

Healthcare workers (HCWs) have found themselves and their families more susceptible to contracting COVID-19. This puts them at a higher risk of psychological distress, which may compromise patient care. In this study, we aim to explore the risk perceptions and psychological distress between HCWs and non-healthcare workers (NHCWs) in Pakistan.

METHODS

A cross-sectional study was conducted using an online self-administered questionnaire. Psychological distress was assessed through The Hospital Anxiety and Depression Scale (HADS). Comparisons were made between HCWs (front/backend, students/graduates) and NHCWs related to risk perceptions and stress levels related to COVID-19. Following tests for normality (Shapiro-Wilk test), variables that fulfilled the normality assumption were compared using the independent samples t-test, while for other variables Mann-Whitney U-test was employed. Pearson Chi-square test was used to compare categorical data. Multiple logistic regression techniques examined the association of participant age, gender, household income, and the presence of COVID-19 symptoms with depression and anxiety levels.

RESULTS

Data from 1406 respondents (507 HCWs and 899 NHCWs) were analyzed. No significant difference was observed between HCWs and NHCWs' perception of susceptibility and severity towards COVID-19. While healthcare graduates perceived themselves (80% graduates vs 66% students, p-value 0.011) and their family (82% graduates vs 67% students, p-value 0.008) to be more susceptible to COVID-19, they were less likely to experience depression than students. Frontline HCWs involved in direct patient care perceived themselves (83% frontline vs. 70% backend, p-value 0.003) and their family (84% frontline vs. 72% backend, p-value 0.006) as more susceptible to COVID-19 than backend healthcare professionals. Over half of the respondents were anxious (54% HCWs and 55% NHCWs). Female gender, younger age, lower income, and having COVID-19 related symptoms had a significant effect on the anxiety levels of both HCWs and NHCWs.

CONCLUSION

Frontline HCWs, young people, women, and individuals with lower income were at a higher risk of psychological distress due to the pandemic. Government policies should thus be directed at ensuring the mental well-being of frontline HCWs and improving their satisfaction to strengthen the health care delivery system. The findings suggest the need to provide mental health support for health workers.

The Moderating Role of Personal Resources Between Demands and Ill-Being of Romanian Healthcare Professionals in the COVID-19 Pandemic

Background and Objectives: The illness caused by the new coronavirus (COVID-19) triggered considerable mental consequences for the medical staff. Our aim was to research whether frontline healthcare workers' positive psychological state-PsyCap-impacts the relationship between anxiety/depression and burnout/mental health complaints. Material and Methods: One hundred twenty-six medical professionals working on the frontline at the Intensive Care Unit and Emergency Department in Romania took validated surveys between March and April 2020. All information was collected online after accessing a link that was received in an email message. The inclusion criteria concerned the categories of healthcare professionals who came into direct contact with patients during the COVID-19 global epidemic through the performed medical act, as well as time spent in the medical field of ICU an EM, namely at least 1 year in the department. We excluded from the research other categories of employees and auxiliary staff, as well as healthcare workers with <1-year experience in the medical field. The moderating role of personal resources (PsyCap) between demands (such as anxiety and depression) and ill-being (burnout and mental health complaints) of healthcare professionals were tested via hierarchical multiple regressions. Results: We tested the moderating role of PsyCap on the relation between anxiety and ill-being. The results indicated that high anxiety predicts lower emotional exhaustion and a low level of mental health complaints about Romanian healthcare professionals when PsyCap is high. The moderating role of PsyCap on the relation between depression and ill-being was tested in the second hypothesis. The results indicated that high depression predicts lower inefficacy and a low level of mental health complaints about Romanian healthcare professionals when PsyCap is increased. Conclusions: PsyCap is a crucial variable that may decrease the impact of anxiety and depression on psychological outcomes such as emotional exhaustion, inefficacy, and psychological problems among Romanian medical professionals working on the frontline during the COVID-19 global epidemic. Thus, psychological interventions that help medical staff gain personal resources are appropriate in the context of the COVID-19 pandemic.

Doctors Dealing With COVID-19 in Pakistan: Experiences, Perceptions, Fear, and Responsibility

This study aimed to describe the dealings of 20 biomedical doctors with coronavirus disease-19 (COVID-19) in the Sindh province of Pakistan. Focusing on physicians from three different hospitals, we describe their challenges, emotions, and views concerning the pandemic. Many regarded the virus from a biomedical standpoint. Yet some also perceived it as a “tool of a proxy war” and a “plot,” without giving agency to anyone for that “plot.” Furthermore, these care providers faced a great fear of infection and an even greater fear of transmitting the virus to their families and friends. A few also feared stigmatization as viral carriers. Whether they experienced fear or not, all of our physician interlocutors emphasized their sense of responsibility to “serve humanity,” yet some also expressed a strong belief in the inevitability of the will of Allah. Some were satisfied with the role of the government in containing the virus, while others expressed concerns and felt that the government should be doing much more. All expressed confidence in the use of personal protective equipment (PPE), viewing it as an effective buffer against viral contagion. We conclude with a call for further research especially ethnographic studies on dealings of physicians with COVID-19 across Pakistan as frontline care providers.

Development and criterion validity of the COVID-19 anxiety and fear assessment scale: a cross sectional study

BACKGROUND

The emergence of the new severe acute respiratory syndrome coronavirus 2, which causes COVID-19 disease, has been a major public health challenge and an increase in the feeling of uncertainty of the population, who is also experiencing an increase in levels of anxiety and fear regarding the COVID-19 disease.

OBJECTIVE

The objective of the study was the construct and criterion validation of the Escala de evaluación de la Ansiedad y MIedo a COVID-19 (AMICO, for its acronym in Spanish) to measure both constructs in the general Spanish population.

METHODS

Descriptive study of psychometric validation. A field study was carried out to execute univariate and bivariate analyses, in addition to the exploratory and confirmatory factorial analysis of the scale. For the criteria validity study, the State-Trait Anxiety Inventory (STAI) and sensitivity and specificity values were calculated.

RESULTS

The study sample was composed of 1036 subjects over 18 years of age, who resided in Spain, where 56.3% were women with a mean age of 48.11 years (SD = 15.13). The study of construct validity reported two factors and 16 items, with a Cronbach's alpha value of 0.92. The scale was concurrently valid with the used gold standard and obtained sensitivity values of 90.48% and specificity values of 76%.

CONCLUSIONS

The AMICO scale is valid and reliable for assessing the level of anxiety and fear of COVID-19 in the adult Spanish population and is highly sensitive.

Generalized Anxiety Disorder and Depressive Symptoms among Pakistani Population during the Second Wave of the COVID-19 Pandemic: A Regression Analysis

Over a span of 1 year, with millions infected, COVID-19 has spread to every part of the world and now poses a health threat to each and every one of us. The outbreak has consequently resulted in multiple health problems such as stress, anxiety, depressive symptoms, insomnia, panic, and denial globally. Several factors have contributed to this rising number of psychiatric consults all over the world. The primary objective of this study was to investigate the impact of COVID-19 pandemic on the mental health of Pakistani population during the second wave of the pandemic in this region. We conducted an online web-based cross-sectional survey comprising 500 participants. The questionnaire assessed the demographic information, attitude, and knowledge concerning COVID-19 outbreak in addition to generalized anxiety disorder (GAD) utilizing the GAD-7 scale and depressive symptoms using the Center for Epidemiology Scale for Depression (CES-D) scale. The response rate of the study was 90.9%. The results of the survey indicated a prevalence of 25.4% of GAD, and 18.8% of depressive symptoms. Furthermore, nearly 34.8% of participants feared contracting COVID-19, 62.8% obtained constant critical updates regarding COVID-19, while 17.6% did not understand the knowledge regarding COVID-19. In the multivariate regression models, GAD was significantly associated with gender, age, and checking constantly of critical updates regarding COVID-19. Similarly, participants under 30 years had a higher risk of developing depressive symptoms than those above (> 30 years). Lastly, participants with no formal education were also found to be more prone to developing depression. We identified a potential threat to mental health during the pandemic.

Social Media Use, Self-Efficacy, Perceived Threat, and Preventive Behavior in Times of COVID-19: Results of a Cross-Sectional Study in Pakistan

Although the role of social media in infectious disease outbreaks is receiving increasing attention, little is known about the mechanisms by which social media use affects risk perception and preventive behaviors during such outbreaks. This study aims to determine whether there are any relationships between social media use, preventive behavior, perceived threat of coronavirus, self-efficacy, and socio-demographic characteristics. The data were collected from 310 respondents across Pakistan using an online cross-sectional survey. Reliability analyses were performed for all scales and structural equational modeling was used to identify the relationships between study variables. We found that: (i) social media use predicts self-efficacy (β = 0.25, p < 0.05) and perceived threat of coronavirus (β = 0.54, p < 0.05, R 2 = 0.06), and (ii) preventive behavior is predicted by self-efficacy and perceived threat of coronavirus (R = 0.10, p < 0.05). Therefore, these results indicate the importance of social media's influence on health-related behaviors. These findings are valuable for health administrators, governments, policymakers, and social scientists, specifically for individuals whose situations are similar to those in Pakistan.

A Cross-Sectional Survey of Pakistani Muslims Coping with Health Anxiety through Religiosity during the COVID-19 Pandemic

Investigating the role of religiosity in coping with health anxiety during the outbreak of COVID-19 assumes significance given the continued onslaught of the pandemic and the importance of religion in many societies of the world. The aim of this study is to test the relationship between religious coping and health anxiety in Pakistani Muslims. The online survey method was used to collect data from 408 respondents. Structural equational modeling was performed, with results indicating that people who are suffering with health anxiety opt for religious coping (β = .54, R² = .29, p < .001). We conclude that it is important to consider the role of religion and spirituality during pandemic-induced anxiety. There are implications for counselors, physicians and researchers to integrate religious coping methods when planning mental health interventions during pandemics and otherwise.

Perceptions of COVID–19-related Risks and Deaths Among Health Care Professionals During COVID-19 Pandemic in Pakistan: A Cross-sectional Study

COVID-19 is an established challenge to the health care professionals (HCPs) having physical, emotional, and psychological repercussions. We determine the perceptions of Pakistani HCPs regarding the risks and deaths related to COVID-19. A cross-sectional study was conducted among HCPs throughout Pakistan from 16th February 2021 to 6th March 2021 by disseminating an online Google questionnaire via all possible social media platforms including WhatsApp, Facebook, Twitter, and emails. Out of total of 462 HCPs, 33.55% tested COVID-19 positive and 49.43% had received their first dose of COVID-19 vaccine. The proportion of HCPs worried about contracting COVID-19 was 46.97%. A total of 69.48% mentioned that doctors are at a higher risk of dying from COVID-19 infection compared to the general population. In a dichotomous analysis done for risk perception, 72.06% of doctors reported a high-risk perception of contracting COVID-19 in hospital settings. The main reasons identified to be associated with higher mortality amongst the HCPs, specifically doctors, included comorbidities (47.26%), working in high-risk wards (24.02%) and lack of adequate personal protective equipment (PPE) (28.72%). Using univariate and multivariate regression the HCPs tested positive rated two-fold high risk while performing professional duty during COVID-19 pandemic [unadjusted odds ratio (OR) (95% confidence interval (CI)): 2.23 (1.24–4.02), P = .007; adjusted OR (95% CI) 2.27 (1.22–4.19), P = .009]. In conclusion, Pakistani HCPs have significant COVID–19-related concerns and anxieties. The doctors perceived to be at a higher risk of dying with COVID-19, due to a variety of personal and professional reasons.