Study design and participants
A cross-sectional survey was carried out via Google form as well as a self-administered questionnaire among healthcare professionals face-to-face for those who were not reachable with web-based survey in Yemen from July 2020 to December 2020. A total of 197 participants were selected by convenience sampling from different provinces all over Yemen.
The survey included questions regarding psychological screening, bothering issues faced by the health professionals, assessment of sources of the distress, coping strategies, or behavior. The questionnaire was developed and distributed in English and Arabic language. The questionnaire was validated by two experts in the field and was pilot tested among five participants.
The study was conducted in Yemen which is a country with a low-income economy and the poverty and the decade-long civil war has seriously affected the country. Many healthcare substructures are vulnerable and the basic healthcare facility is unobtainable to many people. Moreover, the shortage of medicines and medical equipment, the fragile healthcare status, and the limited healthcare resources are the challenging factors for the healthcare delivery amid COVID-19 pandemic in Yemen .
All the healthcare professionals comprising physicians, pharmacists, nurses, and others who provided care at the medical center were included in this study. The professionals who refused to participate, from a non-healthcare profession and those who cannot read and write were excluded from the study.
The study questionnaire was categorized into four sections. All the questions were in understandable language and the participant was required to answer the questions on their own.
The first section of the questionnaires was about the demographics of participants that provided personal and organizational information of the health employee.
The second section of the questionnaire comprised of total of seven questions linked to the generalized anxiety scale (GAD-7) for anxiety assessment . It had seven items with a score 0 (not at all) to 3 (nearly every day) that provided a 0 to 21 score. The total score was classified into four severity groups, namely; minimal to none (≤ 4), mild (5-9), moderate (10-14), and severe (≥ 15).
The third section consisted of total of nine questions related to patient health questionnaire (PHQ-9) to assess depression . It had nine items with a score 0 (not at all) to 3 (nearly every day) that provided a 0-27 score. The total score was divided into five severity groups, namely; minimal to none (≤ 4), mild (5- 9), moderate (10-14), moderately severe (15-19), and severe (≥ 20) . In the current study, the participants’ attaining score ≥ 10 on GAD-7 and PHQ-9 were regarded as anxiety and depression, respectively.
The sources of distress from the current pandemic were measured with a 14-item scale designed from an earlier study on anxiety among university students amid SARS outbreak . It was based on a two-point Likert-scale. The items were categorized under 4 scales such as the health of self, family, and loved ones (possible score: 3 to 6); transmission (possible score: 3 to 6); containment (possible score: 3 to 6); measures taken by authority (possible score: 3 to 6); and effects on daily activities (possible score: 3 to 6).
The fourth section was all about 28-questions of the Brief-COPE scale . It aimed to identify the coping strategies implemented amid COVID-19 pandemic. It consisted of four response choices ranging from the importance of doing activities to cope with the outbreak; (a) not doing this at all, (b) a little bit, (c) moderate amount, (d) doing this a lot. That scale was developed to discover the 14 coping methods: self-distraction, active coping, denial, and substance use, use of emotional support, venting, behavioral disengagement, acceptance, positive reframing, planning, humor, use of instrumental support, religion, and self-blame. Likely scores for every subscale were in a range of 2 to 8, where higher scores indicated propensity to appliance the analogous coping style.
The study has been reviewed and approved by The Human Ethical Committee, University of the Punjab, Lahore. The ethical and professional considerations were followed throughout the study to keep the data and investigational information strictly confidential.
The data were coded, entered, and analyzed from SPSS (IBM, version 22). Results were articulated by using descriptive statistics where continuous data were expressed as mean and standard deviation (SD) whereas categorical data were presented as numbers and percentages. A p-value of less than 0.05 was considered statistically significant.
Independent t-test and ANOVA test were executed, wherever applicable, for comparison of the difference of scores related to anxiety, depression, source of distress, and coping strategies among demographic variables. Furthermore, for trior polychotomus variables, a series of post-hoc analysis with Bonferroni adjustment was implemented to evaluate significance among intergroup variables.