Socio-demographic characteristic of study participants
Among the study participants, 52.6% were female, 68.4% were in the age group of 20-29 years and 65.9% belonged to Brahmin/Chhetri ethnic group. The mean (±SD) age of the participants was 28.20 (±5.80) years. More than two-thirds of health workers were either nurses (35.2%) or doctors (33.9%). Majority of the participants were single (62.9%) and had a nuclear family structure (64.8%). More than half of the participants (54.5%) had a family member with a chronic disease condition, 25.1% were living with younger children and 34.3% had elderly in the family. The proportion of health workers who had a history of medication for any kind of mental health conditions was 4.6% (Table 2).
Table 2: Socio-demographic characteristics of study participants (n=475)
Variables
|
Categories
|
Number
|
Percentage
|
Age (years)
|
Mean(±SD): 28.20 (±5.80)
|
|
|
|
20-29
|
325
|
68.4
|
|
30-39
|
124
|
26.1
|
|
40-49
|
19
|
4.0
|
|
50 and above
|
7
|
1.5
|
Sex
|
|
|
|
|
Male
|
225
|
47.4
|
|
Female
|
250
|
52.6
|
Ethnicity
|
|
|
|
|
Brahmin/Chhetri
|
313
|
65.9
|
|
Janjati
|
110
|
23.2
|
|
Madhesi
|
29
|
6.1
|
|
Dalit
|
7
|
1.5
|
|
Others
|
16
|
3.4
|
Education
|
|
|
|
|
Technical school level
|
8
|
1.7
|
|
Intermediate
|
86
|
18.1
|
|
Bachelors
|
277
|
58.3
|
|
Masters and above
|
104
|
21.9
|
Position
|
|
|
|
|
Nurse
|
167
|
35.2
|
|
Doctor
|
161
|
33.9
|
|
Paramedics
|
81
|
17.1
|
|
Laboratory staff
|
19
|
4.0
|
|
Pharmacist
|
15
|
3.2
|
|
Public health professional
|
32
|
6.7
|
Marital status
|
|
|
|
|
Single
|
299
|
62.9
|
|
Ever married
|
176
|
37.1
|
Family type
|
|
|
|
|
Nuclear
|
308
|
64.8
|
|
Joint
|
167
|
35.2
|
Living with children
|
|
|
|
|
Yes
|
119
|
25.1
|
|
No
|
356
|
74.9
|
Living with older adults (>60 years)
|
|
|
|
|
Yes
|
163
|
34.3
|
|
No
|
312
|
65.7
|
Family member with a chronic medical condition
|
|
|
|
|
Yes
|
259
|
54.5
|
|
No
|
216
|
45.5
|
History of medication for mental health
|
|
|
|
|
Yes
|
22
|
4.6
|
|
No
|
453
|
95.4
|
Work-related characteristics
Regarding the type of health facility, 39% worked in a central or provincial hospital, and 28.2% worked in a private hospital. Nearly half of the participants (45.3%) mentioned working as frontline workers for COVID management while 70.7% had started their job within the last five years. Majority of the participants reported changes in their regular job duties (70.3%) and insufficient precautionary measure in their workplace (78.9%). Around half of the participants (49.1%) were working overtime. The proportion of health workers aware of government incentive scheme for health workers during COVID-19 was 56.8% among which 69.6% were dissatisfied with this scheme. More than half of the participants (53.7%) faced stigma from the community members. Among those who faced stigma, they were stigmatized because of profession (49.8%), accused of being a carrier of the disease (40.0%), threatened (5.9%) or asked to leave their rented place (4.3%) (Table 3).
Table 3: Job-related characteristics of the study participants (n=475)
Variables
|
Category
|
Number
|
Percentage
|
Level of health institution
|
|
|
|
|
Central hospital and province hospital
|
185
|
39.0
|
|
Private hospital
|
134
|
28.2
|
|
Health post
|
45
|
9.5
|
|
Community hospital
|
27
|
5.7
|
|
Primary hospital (under local government)
|
20
|
4.2
|
|
Primary Health centre
|
19
|
4.0
|
|
Managerial task of COVID19
|
45
|
9.5
|
Type of health facility
|
|
|
|
|
Primary
|
84
|
17.7
|
|
Secondary and tertiary
|
391
|
82.3
|
Work role
|
|
|
|
|
Front line
|
215
|
45.3
|
|
Second line
|
260
|
54.7
|
Working experience (years)
|
|
|
|
|
Up to 5
|
336
|
70.7
|
|
>5
|
139
|
29.3
|
Precautionary measures in the workplace
|
|
|
|
|
Sufficient
|
100
|
21.1
|
|
Not sufficient
|
375
|
78.9
|
Experience of stigma due to occupation
|
|
|
|
|
Yes
|
255
|
53.7
|
|
No
|
199
|
41.9
|
|
Don’t want to answer
|
21
|
4.4
|
Type of major stigma experience (n=255)
|
|
|
|
|
Stigmatized because of profession
|
127
|
49.8
|
|
Accused of being a carrier of disease
|
102
|
40.0
|
|
Threatened
|
15
|
5.9
|
|
Asked to leave rented place
|
11
|
4.3
|
Aware of government incentives for health workers
|
|
|
|
|
Yes
|
270
|
56.8
|
|
No
|
205
|
43.2
|
Satisfied with government incentive (n=270)
|
|
|
|
|
Yes
|
82
|
30.4
|
|
No
|
188
|
69.6
|
Change in regular job duties during covid19
|
|
|
|
|
Yes
|
334
|
70.3
|
|
No
|
141
|
29.7
|
Working overtime during COVID-19
|
|
|
|
|
Yes
|
233
|
49.1
|
|
No
|
242
|
50.9
|
Prevalence of anxiety, depression and insomnia
More than one-third of the participants had some symptoms of anxiety (borderline: 23.6% and abnormal: 18.3%). Similarly, 37.5% of the participants experienced symptoms of depression (borderline: 24% and abnormal: 13.5%). Likewise, symptoms of insomnia was prevalent in 33.9% of the participants (sub-threshold insomnia: 26.7%, moderate insomnia: 5.7% and severe clinical insomnia: 1.5%).There was a significant difference in anxiety (p<0.001) and depression (p=0.001) across different types of profession. However, type of profession was not statistically significant with insomnia (p=0.142). Nurses had a higher proportion of symptoms related to abnormal anxiety, abnormal depression and severe clinical insomnia than other professions (Table 4).
Table 4: Prevalence of anxiety, depression and insomnia by study groups (n=475)
Mental health outcomes
|
Categories
|
Total
N (%)
|
Doctor (n=161)
|
Nurse
(n=167)
|
Other health workers
(n=147)
|
P-value ⃰
|
Anxiety
|
|
|
|
|
|
|
|
Normal
|
276 (58.1)
|
106 (65.4)
|
73 (43.7)
|
97 (66.4)
|
<0.001
|
|
Borderline
|
112 (23.6)
|
34 (21.0)
|
54 (32.3)
|
24 (16.4)
|
|
Abnormal
|
87 (18.3)
|
22 (13.6)
|
40 (24.0)
|
25 (17.1)
|
Depression
|
|
|
|
|
|
|
|
Normal
|
297 (62.5)
|
122 (75.3)
|
89 (53.3)
|
86 (58.9)
|
0.001
|
|
Borderline
|
114 (24.0)
|
27 (16.7)
|
46 (27.5)
|
41 (28.1)
|
|
Abnormal
|
64 (13.5)
|
13 (8.0)
|
32 (19.2)
|
19 (13.0)
|
Insomnia
|
|
|
|
|
|
|
|
No clinically significant
|
314 (66.1)
|
115 (71.0)
|
98 (58.7)
|
101 (69.2)
|
0.142
|
|
Sub threshold
|
127 (26.7)
|
38 (23.5)
|
53 (31.7)
|
36 (24.7)
|
|
|
Moderate
|
27 (5.7)
|
9 (5.6)
|
12 (7.2)
|
6 (4.1)
|
|
Severe
|
7 (1.5)
|
0 (0)
|
4 (2.4)
|
3 (2.1)
|
⃰ Significant at p <0.05, Chi-square test
Factors associated with anxiety among health workers
In the multivariable logistic regression models, the effect of gender, ethnicity, profession, education, living with elderly, family member with chronic disease, precautionary measures in the workplace, faced stigma, worked overtime, awareness about government incentive and history of medication for mental health problem was adjusted. The analysis showed ethnicity, profession, precautionary measures in the workplace, stigma experience and history of medication of mental health problem significantly associated with anxiety. As compared to Brahmin/Chhetri ethnic group, Janajati (AOR=2.34; 95% CI: 1.44-3.81) and nurses (AOR= 2.33; 1.21-4.47) as compared to other health workers had significantly higher odds of having anxiety. Similarly, health workers who had previous history of medication for mental health problems (AOR=3.40; 95% CI: 1.31-8.81), having inadequate precautionary measures in their workplace (AOR=1.89; 95% CI: 1.12-3.19) and those who faced stigma (AOR=2.47; 95% CI: 1.62-3.76) had significantly higher odds of having anxiety as compared to those with no previous history of medication, having adequate precautionary measures in the workplace and those not facing stigma respectively. Gender, education, living with elderly, family member with chronic disease, working overtime and awareness about government incentive was however not statistically significant with anxiety (Table 5).
Table 5: Factors associated with anxiety among health workers (n=475)
Variables
|
Category
|
Anxiety
N (%)
|
Unadjusted OR (95% CI)
|
Adjusted OR (95% CI)
|
Gender
|
|
|
|
|
|
Male
|
76 (38.2)
|
Ref
|
Ref
|
|
Female
|
123 (61.2)
|
1.90 (1.31-2.75)⃰
|
1.05 (0.59-1.88)
|
Ethnicity
|
|
|
|
|
|
Brahmin/Chhetri
|
110
|
Ref
|
Ref
|
|
Janajati
|
69
|
2.71 (1.75-4.20)⃰
|
2.34 (1.44-3.81)⃰
|
|
Madheshi
|
10
|
0.97 (0.44-2.16)
|
1.11 (0.47-2.59)
|
|
Others
|
10
|
2.64 (0.98-7.12)
|
2.19 (0.73-6.54)
|
Profession
|
|
|
|
|
|
Doctor
|
56
|
1.05 (0.65-1.68)
|
1.17 (0.68-2.04)
|
|
Nurses
|
94
|
2.55 (1.61-4.04)⃰
|
2.33 (1.21-4.47)⃰
|
|
Others
|
49
|
Ref
|
Ref
|
Education
|
|
|
|
|
|
Intermediate and below
|
47
|
Ref
|
Ref
|
|
Bachelor
|
116
|
0.72 (0.45-1.15)
|
0.97 (0.57-1.67)
|
|
Masters and above
|
36
|
0.53 (0.30-0.94)⃰
|
0.99 (0.49-1.97)
|
Living with elderly
|
|
|
|
|
|
Yes
|
78 (39.2)
|
1.45 (0.99-2.12)
|
1.43 (0.92-2.22)
|
|
No
|
121 (60.1)
|
Ref
|
Ref
|
Family member with chronic disease
|
|
|
|
|
|
Yes
|
121 (60.8)
|
1.55 (1.07-2.25)⃰
|
1.25 (0.81-1.93)
|
|
No
|
78 (39.2)
|
Ref
|
Ref
|
Precautionary measures in the workplace
|
|
|
|
|
|
Sufficient
|
29 (14.6)
|
Ref
|
Ref
|
|
Insufficient
|
170 (85.4)
|
2.03 (1.26-3.27)⃰
|
1.89 (1.12-3.19)⃰
|
Faced stigma
|
|
|
|
|
|
Yes
|
131 (65.8)
|
2.36 (1.62-3.44)⃰
|
2.47 (1.62-3.76)⃰
|
|
No
|
68 (34.2)
|
Ref
|
Ref
|
Worked overtime
|
|
|
|
|
|
Yes
|
107 (53.8)
|
1.39 (0.96-2.00)
|
1.31 (0. 87-1.97)
|
|
No
|
92 (46.2)
|
Ref
|
Ref
|
Aware about government incentive
|
|
|
|
|
|
Yes
|
100 (50.3)
|
0.63 (0.44-0.91)⃰
|
0.78 (0.51-1.18)
|
|
No
|
99 (49.7)
|
Ref
|
Ref
|
History of medication
|
|
|
|
|
|
Yes
|
14 (7.0)
|
2.54 (1.04-6.17)⃰
|
3.40 (1.31-8.81)⃰
|
|
No
|
185 (93.0)
|
Ref
|
Ref
|
Factors associated with depression among health workers
In the multivariable logistic regression model, the effect of age, ethnicity, profession, education, living with children, precautionary measures in the workplace, faced stigma, awareness about government incentive and history of medication for mental health problem was adjusted, The analysis showed that age, profession, precautionary measures in the workplace, stigma experience, awareness about government incentive, and history of medication of mental health problem was significantly associated with the symptoms of depression. As compared to older health workers (>40 years), younger health workers (AOR=0.33; 95% CI: 0.12-0.91), doctors as compared to other health workers (AOR=0.57; 95% CI: 0.33-0.99) and those who were aware of government incentive for health workers during COVID-19 (AOR=0.51; 95% CI: 0.34-0.78) as compared to those not aware had lower odds of experiencing depression symptoms. Similarly, health workers who had previous history of medication for mental health problems (AOR=3.83; 95% CI: 1.45-10.14), those having inadequate precautionary measures in their workplace (AOR=1.97; 95% CI: 1.16-3.37) and those who faced stigma (AOR=2.05; 95% CO: 1.34-3.11) had significantly higher odds of having depression symptoms as compared to those with no previous history of medication, having adequate precautionary measures in the workplace and those not facing stigma respectively. Ethnicity, education and living with children was however not statistically significant with depression (Table 6)
Table 6: Factors associated with depression among health workers (n=475)
Variables
|
Category
|
Depression
N (%)
|
Unadjusted OR (95% CI)
|
Adjusted OR (95% CI)
|
Age (years)
|
|
|
|
|
|
20-40
|
165 (92.7)
|
0.40 (0.17-0.95)⃰
|
0.33 (0.12-0.91)⃰
|
|
>40
|
13 (7.3)
|
Ref
|
Ref
|
Ethnicity
|
|
|
|
|
|
Brahmin/Chhetri
|
107 (60.1)
|
Ref
|
Ref
|
|
Janajati
|
51 (28.7)
|
1.51 (0.98-2.33)
|
1.19 (0.74-1.93)
|
|
Madheshi
|
9 (5.1)
|
0.87 (0.38-1.97)
|
1.03 (0.43-2.49)
|
|
Others
|
11 (6.2)
|
3.53 (1.27-9.81)⃰
|
2.18 (0.73-6.57)
|
Profession
|
|
|
|
|
|
Doctor
|
40 (22.5)
|
0.47 (0.29-0.76)⃰
|
0.57 (0.33-0.99)⃰
|
|
Nurses
|
78 (43.8)
|
1.26 (0.80-1.97)
|
1.25 (0.76-2.06)
|
|
Others
|
60 (33.7)
|
Ref
|
Ref
|
Education
|
|
|
|
|
|
Intermediate and below
|
51 (28.7)
|
Ref
|
Ref
|
|
Bachelor
|
95 (53.4)
|
0.44 (0.27-0.71)⃰
|
0.69 (0.41-1.16)
|
|
Masters and above
|
32 (18.0)
|
0.38 (0.21-0.67)⃰
|
0.70 (0.35-1.40)
|
Living with child
|
|
|
|
|
|
Yes
|
53 (29.8)
|
1.48 (0.97-2.26)
|
1.19 (0.74-1.92)
|
|
No
|
125 (70.2)
|
Ref
|
Ref
|
Precautionary measures in the workplace
|
|
|
|
|
|
Sufficient
|
28 (15.7)
|
1
|
Ref
|
|
Not sufficient
|
150 (84.3)
|
1.71 (1.06-2.78)⃰
|
1.97 (1.16-3.37)⃰
|
Faced stigma
|
|
|
|
|
|
Yes
|
116 (65.2)
|
2.13 (1.45-3.12)⃰
|
2.05 (1.34-3.11)⃰
|
|
No
|
57 (34.8)
|
1
|
Ref
|
Aware about government incentive
|
|
|
|
|
|
Yes
|
82 (46.1)
|
0.50 (0.34-0.72)⃰
|
0.51 (0.34-0.78)⃰
|
|
No
|
96 (53.9)
|
1
|
Ref
|
History of medication
|
|
|
|
|
|
Yes
|
14 (7.9)
|
3.08 (1.27-7.51)⃰
|
3.83 (1.45-10.14)⃰
|
|
No
|
164 (92.1)
|
1
|
Ref
|
Factors associated with insomnia among health workers
In the multivariable logistic regression models, the effect of age, ethnicity, profession, education, work experience, living in affected district, faced stigma, working overtime, awareness about government incentive and history of medication for mental health problem was adjusted. The analysis showed that ethnicity, work experience, stigma experience, and history of medication of mental health problem were significantly associated with insomnia. As compared to the Brahmin/Chhetri ethnic group, Janajati (AOR=1.74; 95% CI: 1.04-2.91) had significantly higher odds of having insomnia. Regarding work experience, those who had work experience within the last five years (AOR=0.50; 95% CI: 0.29-0.85) were significantly at lower risk of having insomnia as compared to those with experienced health workers. Similarly, health workers who had previous history of medication for mental health problems (AOR=3.82; 95% CI: 1.52-9.62), and those who faced stigma (AOR=2.37; 95% CI:1.46-3.84) had significantly higher odds of having insomnia as compared to those with no previous history of medication, and those not facing stigma respectively. Age, profession, education, working in affected district, working overtime and awareness about government incentive was however not statistically significant with insomnia (Table 7).
Table 7: Factors associated with insomnia among health workers (n=475)
Variables
|
Category
|
Insomnia
N (%)
|
Unadjusted OR (95% CI)
|
Adjusted OR (95% CI)
|
Age (years)
|
|
|
|
|
|
20-40
|
108 (92.3)
|
0.45 (0.19-1.08)
|
0.45 (0.16-1.29)
|
|
>40
|
9 (7.7)
|
Ref
|
Ref
|
Ethnicity
|
|
|
|
|
|
Brahmin/Chhetri
|
70 (59.8)
|
Ref
|
Ref
|
|
Janajati
|
41 (35.0)
|
1.90 (1.19-3.02)⃰
|
1.74 (1.04-2.91)⃰
|
|
Others
|
6 (5.1)
|
0.52 (0.21-1.28)
|
0.40 (0.15-1.06)
|
Profession
|
|
|
|
|
|
Doctor
|
31 (26.5)
|
0.72 (0.42-1.25)
|
1.24 (0.65-2.35)
|
|
Nurses
|
50 (42.7)
|
1.31 (0.79-2.16)
|
1.46 (0.82-2.60)
|
|
Others
|
36 (30.8)
|
Ref
|
Ref
|
Education
|
|
|
|
|
|
Intermediate and below
|
32 (27.4)
|
Ref
|
Ref
|
|
Bachelor
|
65 (55.6)
|
0.59 (0.36-0.99)⃰
|
0.69 (0.39-1.24)
|
|
Masters and above
|
20 (17.1)
|
0.46 (0.24-0.88)⃰
|
0.53 (0.24-1.18)
|
Work experience (year)
|
|
|
|
|
|
Up to 5
|
71 (60.7)
|
0.54 (0.35-0.84)⃰
|
0.50 (0.29-0.85)⃰
|
|
>5
|
46 (39.3)
|
Ref
|
Ref
|
Affected district
|
|
|
|
|
|
Yes
|
94 (80.3)
|
1.63 (0.98-2.71)
|
1.55 (0.89-2.68)
|
|
No
|
23 (19.7)
|
Ref
|
Ref
|
Faced stigma
|
|
|
|
|
|
Yes
|
80 (68.4)
|
2.26 (1.45-3.52)⃰
|
2.37 (1.46-3.84)⃰
|
|
No
|
37 (31.6)
|
Ref
|
Ref
|
Aware about government incentive
|
|
|
|
|
|
Yes
|
58 (49.6)
|
0.68 (0.45-1.03)
|
0.66 (0.41-1.05)
|
|
No
|
59 (50.4)
|
1
|
Ref
|
Working overtime
|
|
|
|
|
|
Yes
|
69 (59.0)
|
1.70 (1.11-2.60)⃰
|
1.53 (0.96-2.42)
|
|
No
|
48 (41.0)
|
1
|
Ref
|
History of medication
|
|
|
|
|
|
Yes
|
12 (10.3)
|
3.98 (1.67-9.47)⃰
|
3.82 (1.52-9.62)⃰
|
|
No
|
105 (89.7)
|
1
|
Ref
|