KAMPALA – Did you know that healthcare workers on the COVID-19 frontline might be at risk of developing mental health problems? Early evidence has shown that health workers directly involved in the diagnosis, treatment and care of patients with COVID-19 are at risk of developing mental health symptoms. For example, a systematic review of over 50 studies on the mental health impact of COVID pandemic among healthcare workers indicates that between one and two of every five healthcare workers dealing with COVID patients reported anxiety, depression, distress, and/or sleep problems.
The review, published by Elsevier, indicates that high workload and absence of healthy rotation schedules that accommodate adequate rest, sleep, and restoration over time contribute to such mental health problems. Particularly, exposure to patients with COVID-19 and/or a lack of personal protective equipment and subsequent fear of infecting colleagues, family, friends, and oneself were reported as major contributors to distress faced by healthcare workers.
“Even when personal protective equipment was available, not all healthcare workers felt trained enough for proper use, which itself is a well-known stressor for healthcare workers in pandemic times,” the review partly reads.
Worries and fears about contracting the disease, losing loved ones and health systems being overloaded continue to prevail among health care providers. These findings relate with those of another study conducted among 1,250 health care workers in China’s Wuhan city where the disease was first discovered. It examined the psychological status of medical workforce during the COVID-19 pandemic and revealed that health care workers who directly cared for patients with COVID-19 had higher rates of depression, insomnia, and distress than health care workers who were not on the front lines.
“In fact, health care workers were twice as likely as administrative staff to experience anxiety, depression and distress because of their close, frequent contact with patients and working longer hours than usual,” the study emphasizes.
Similar adverse psychological reactions were reported among health care workers in previous studies during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak. One study, ‘Survey of stress reactions among health care workers involved with the SARS outbreak’ published on Google Scholar, showed that health care workers feared being infected and infecting their families and colleagues; felt stigmatized; reported reluctance to work and contemplated suicide, among others.
Relatedly, staff who directly contacted or were exposed to Ebola patients encountered a range of psychological symptoms such as obsession-compulsion, interpersonal sensitivity, depression and paranoid ideation. This is documented in a 2017 study on the prevalence of psychological symptoms among Ebola survivors and healthcare workers during the 2014-2015 Ebola outbreak in Sierra Leone.
Currently, similar concerns about the mental health of health care workers treating and caring for COVID-19 patients are now arising.
Although public data regarding the impact of the COVID-19 pandemic on health professionals is not available in Uganda, some are reporting suffering from mental complications such as anxiety and depression.
Dr. Phionah Atuhebwe’s lived experience demonstrates many a psychological trauma that front-line health workers endure daily. Atuhebwe, who works with the World Health Organization (WHO), endured endless hours on her job, endeavoring to deliver good health to those that had been affected by COVID-19. Like many others, she contracted the virus and ended up being airlifted to Berlin’s Intensive Care Unit, battling for breath and life. Luckily, she healed from the virus but returned home with feelings of emptiness, pain and numbed feelings.
“I knew something was terribly wrong with me. I wasn’t the Phionah I knew and the feelings of emptiness, fear, anxiety, lack of sleep overwhelmed me. No one can understand these feelings and never judge anyone’s actions during depression. I preferred to go back to ICU for 10 years than feel this way even for a minute,” Dr. Atuhebwe said in an interview with PML Daily.
She adds that a week after she returned home, she did not want to speak to anyone including her husband.
“My husband would just sit by my side on the bed and I would say statements like: do you want to go and eat? Just because I wanted him out of the room,” she recalls.
On 31st May 2020, Uganda’s Ministry of Health announced the first cases of Coronavirus among its health workers. The confirmed cases included three nurses, two doctors, and two senior level staff, all of whom were admitted at Entebbe Grade B and Mulago National Specialized Hospitals. Currently, over 240 frontline health workers have tested positive for coronavirus in the country. These are at all at risk of developing psychological challenges.
More Research insights
According to a new study titled “COVID-19 in Africa: care and protection for frontline healthcare workers,” risks of COVID-19 infection may be higher among professionals who work in close physical proximity to patients, such as eye specialists and dentists. The researchers note that while healthcare workers may accept an increased risk of infection as part of their chosen profession, they may have considerable anxiety about spreading the virus to others. Female nurses with close contact to COVID-19 patients appeared to have the highest mental health risks.
“These conditions not only have a major impact on healthcare workers, but also undermine their decision-making ability and quality of interaction with patients. Moreover, many of them have acquired the virus and others have died or lost colleagues to the virus,” reads a statement in the study.
This psychological distress leads to poor-quality care, reduced safety for patients and an increased likelihood of the workers leaving the health care profession.
The research paper also notes that the ever-increasing number of confirmed cases, overwhelming workload, depletion of personal protection equipment (PPEs), widespread media coverage, lack of specific drugs and feelings of being inadequately supported further contribute to the mental burden. Although Uganda has stepped up its preparedness to manage COVID-19, challenges of low staff levels, inadequate PPEs, few intensive care beds and inadequate oxygen in health facilities prevail.
For example, Noeline Naluwugge, a health worker at a COVID-19 treatment facility of Masaka Regional Referral Hospital told UgStandard that the inadequate sense of protection has comprised their performance leading to psychological distress.
“I used my money to buy own PPEs so I can feel protected. It is a miracle that I am still alive!” she remarked.
Supportive interventions needed
Given the likely increased rate of mental health problems amongst health care workers, causal factors must be addressed. The Africa study proposes a range of psychological support interventions for health workers during the pandemic. For example, support among healthcare workers through social media may help to relieve stress among healthcare workers. As such, WhatsApp groups could provide advice on clinical decision making, but also be used to circulate messaging on mental health support.
“For the considerable anxiety about spreading the virus to their children, families and friends, especially those who are elderly or have chronic medical conditions, researchers recommend that healthcare workers have alternative accommodation to avoid the risk of household transmission,” the researchers advise.
Other interventions to support health workers include: providing online psychological services as well as face-to-face psychological crisis intervention; considering shorter working hours and rotating shifts especially for those working in high-risk departments; addressing health care workers physical needs such as access to healthy meals and hydration and providing psychological and mental health education and protection training.
For ongoing efforts to harness good mental well-being of health workers in Uganda, Dr. Kenneth Kalani, the head of Mental Health and psychosocial support in Ministry of Health’s COVID-19 task-force, says government is focusing on reducing stigma and ensuring an adequate support system. He says that the ministry has been running media messages directed at the public to help integrate stigma reduction among health workers and survivors as an important strategy towards COVID-19 response.
As the current pandemic continues to evolve, the Ugandan government must continue to consider the mental health impact that COVID-19 entails for healthcare workers.
This article was made possible with support from the THRiVE Consortium & Africa Centre for Systematic Reviews & Knowledge Translation through CoVPRES project funded by MakRIF.