This study assessed the prevalence of anxiety, depression and functional impairment among employees of the Hospital for Children Eye ENT and Rehabilitation Services, Bhaktapur, during the early phase of the COVID-19 pandemic. This study revealed that a significant proportion of the participants experienced mental health symptoms/problems such as anxiety (25.6%) and depression (14.0%). The prevalence rates found in this study are in contrast with the studies done in Nepal and other countries at the time of the pandemic.
A study performed among health workers using the similar tool in Nepal showed that anxiety was found in 18.3% of participants and depression in 13.5% of participants 11. Similarly, a study in China using different tool (9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder) showed that anxiety and depression were prevalent among 44.6% and 50.4% of the participants, respectively 12. Another study in China using WHO five well-being Index and generalized anxiety disorder scale in general population during pandemic revealed that out of all participants, 22.6% had experienced anxiety, and 48.3% had a certain level of depression13.
Similarly, depression was prevalent among 32% of the participants, as depicted by a study in Italy 14. Anxiety and depression were 16% and 28%, respectively, as shown by a recent systematic review of the COVID-19 and mental health literature 15. This shows that there is a wide variation in the prevalence. The reasons behind this variation could be due to the variation in sample size, study population, instruments used and fewer cases with no fatality in the country during the data collection period.
In this study, female participants had a higher prevalence of both anxiety (39.5% vs 11.6%, p<0.01) and depression (18.6% vs 9.3%, p=0.351). Such gender difference has been reported mostly due to biological component and different coping strategies they have. This finding is in line with studies conducted in Nepal, China, India and Italy 12, 14, 16. In this study, both anxiety and depression were found to be associated with marital status. However, in a recent study performed among health workers in Nepal, marital status was not associated with mental health symptoms 11.
Period of
Study ref
|
Country
|
Methodology
|
demography
|
Tool used
|
Sample size
|
Anxiety, depression
|
April 3 to May 2, 2020 (This study)
|
Nepal
|
Online
|
Clinical and non-clinical health care workers
|
HADS,
WHODAS 2.0
|
86
|
A - 25.4%
D- 14.0%
|
April 26 to May 12,
2020 9
|
Nepal
|
Online
|
Clinical and public health practitioners
|
HADS
|
475
|
A - 18.3
D – 13.5
|
January 29 to February 3,
2020. 10
|
China
|
|
Physicians
Nurses
|
PHQ-9,
GAD -7
|
1,257
|
A – 12.3%
D – 14.8%
|
January 31 to February 2,
2020 11
|
China
|
|
General population
|
(WHO-5),
(GAD-7)
|
5,851
|
A –22.6%
D – 48.3%
|
18–22 March 2020 12
|
Italy
|
Online
|
General population
|
DASS-21
|
2,766
|
A – 18.7%
D – 32.8%
|
The low total functional score indicating low functional impairment among the participants was quite surprising during restricted normal outdoor activities during lockdown due to the COVID-19 pandemic. The low average functional impairment score may be due to the loose travel restriction to health care workers having hospital employees’ hospital identity card.
Table 5: Comparison of Anxiety and depression during COVID-19
Limitations
This study has several limitations that need to be acknowledged. First, it was limited in hospitals, thus limiting the generalization of the findings. Second, long-term psychological problems could not be assessed while the situation worsened. This is because this study was performed during the early weeks of lockdown due to the COVID-19 pandemic. We don’t have baseline information for all scales/tools we used. The scores might not be only due to COVID-19 as they might show the caseness prior to our study. There might be respondent bias because a face-to-face interview was not possible during which we may have missed information on sensitive issues. Additionally, the findings are based on self-reports, so there was no means of clinical verification.