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Brief Report

Perceived Stress and Stigma Among Doctors Working in COVID-19-Designated Hospitals in India

Perceived Stress and Stigma Among Doctors Working in COVID-19-Designated Hospitals in India

The first case of novel coronavirus disease 2019 (COVID-19) was discovered in India on January 30, 2020 in Kerala state, after which the virus gradually spread across most of the states of India. Published literature during the COVID-19 pandemic has shown that health care workers, including doctors on the frontline, can suffer from significant psychological stress.1 Moreover, it has been reported that health care workers perceive themselves as stigmatized and rejected from others (eg, family or friends) because they work in hospitals and treat patients with COVID-19.2 Some studies3,4 have also shown a link between perceived stress and stigma among nurses as well as patients with infectious disease. There are no studies, to our knowledge, exploring stigma and perceived stress among doctors working in COVID-19-designated hospitals in India to date.

Methods

This was a cross-sectional, observational survey study. A snowball sampling technique was used to recruit participants. An online self-report questionnaire was designed using Google forms. In addition to demographic data, we also added a list of COVID-19 pandemic-related questions. A stigma scale, which measures the perceived stigma of doctors regarding COVID-19, was prepared based on the questionnaire used to study stigma among nursing staff during the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak.5 The stigma scale comprises 13 items, each of which is scored on a 5-point Likert scale. The total score ranges between 0 and 52, with a higher score indicating that the doctors perceived greater stigma. Stress among the doctors was assessed by the Perceived Stress Scale-10 (PSS-10),6 which comprises 10 items, each of which is scored on a 5-point Likert scale. The total score ranges between 0 and 40, with a higher score indicating higher perceived stress.

The link to the questionnaire was sent through WhatsApp and other social media platforms to the contacts of the investigators working in COVID-19-designated hospitals in India, and the participants were encouraged to forward the survey to other doctors working in the hospitals. The data collection was initiated on April 25, 2020 at 7:30 pm IST.

Results

We received 58 responses between April 25, 2020, and April 27, 2020. The majority of the respondents (91.4%) were between the ages of 20 and 40 years, 58.6% were male, and 70.7% were working in COVID-19-designated hospitals in Kerala. The demographic details are summarized in Table 1. Of the participants, 72.4% were part of a medical team directly involved in the management of COVID-19-positive patients. Also, 29.3% of doctors had a history of exposure to COVID-19-positive patients, and 31% had a history of quarantine following exposure.

Table 1

Click figure to enlarge

The mean stigma score was 28.26 (SD = 8.76). Thirty-six doctors (62.1%) had a score ≥ 26 on the stigma scale, indicating higher levels of perceived stigma. The mean PSS-10 score was 20.60 (SD = 6.76). Thirty-seven doctors (63.8%) had a score ≥ 20 on the PSS-10, indicating higher levels of stress. Pearson correlation showed a significant association (0.604, P < .01) between stigma score and PSS-10 score. Spearman correlation showed a significant association between perceived stress score and sex (−0.281, P < .05) and history of exposure to COVID-19-positive patients (0.307, P < .05). There was a significant association between stigma and sex (χ22 = 8.72, P = .013).

Discussion

Recent studies have shown that frontline health care workers, including doctors, can experience significant mental health issues while caring for patients with COVID-19.1 In a similar vein, our results show that a significant proportion of doctors working in COVID-19-designated hospitals in India perceive significant stigma associated with their jobs, and the level of perceived stigma is significantly associated with perceived stress. Previous research5 among health care workers, especially nurses, during the SARS and MERS-CoV outbreaks also showed a similar link between stigma and stress. We found significantly higher stigma and perceived stress among female doctors. A recent study7 from China during the COVID-19 outbreak also showed significantly higher mental health symptoms among female frontline health care workers compared to males.

Together, our findings present concerns about the psychological well-being of doctors working in COVID-19-designated hospitals in India. From these findings, it can be argued that hospital administrators and policymakers should take proactive steps to make sure that doctors do not suffer from COVID-19-related stigma and associated stress, so that they can concentrate on caring for their patients.

Received: June 20, 2020.

Published online: July 30, 2020.

Potential conflicts of interest: None.

Funding/support: None.

REFERENCES

1.Rajkumar RP. COVID-19 and mental health: a review of the existing literature [published online ahead of print April 10, 2020]. Asian J Psychiatr. 2020;52:102066. PubMed CrossRef

2.Koh D, Lim MK, Chia SE, et al. Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn? Med Care. 2005;43(7):676-682. PubMed CrossRef

3.Charles B, Jeyaseelan L, Pandian AK, et al. Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India: a community based cross sectional study. BMC Public Health. 2012;12(1):463. PubMed CrossRef

4.Hernandez SHA, Morgan BJ, Parshall MB. Resilience, stress, stigma, and barriers to mental healthcare in US Air Force nursing personnel. Nurs Res. 2016;65(6):481-486. PubMed CrossRef

5.Park JS, Lee EH, Park NR, et al. Mental health of nurses working at a government-designated hospital during a MERS-CoV outbreak: a cross-sectional study. Arch Psychiatr Nurs. 2018;32(1):2-6. PubMed CrossRef

6.Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, eds. The social psychology of health: Claremont symposium on applied social psychology. Newbury Park, CA: Sage; 1988:31-67.

7.Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976. PubMed CrossRef

aDepartment of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India

bDepartment of Critical Care, Iqraa International Hospital and Research Centre, Calicut, Kerala, India

cDepartment of Dermatology, Iqraa International Hospital and Research Centre, Calicut, Kerala, India

*Corresponding author: N. A. Uvais, MBBS, DPM, Iqraa International Hospital and Research Centre, Calicut, Kerala, India (druvaisna@gmail.com).

Prim Care Companion CNS Disord 2020;22(4):20br02724

To cite: Uvais NA, Shihabudheen P, Bishurul Hafi NA. Perceived stress and stigma among doctors working in COVID-19-designated hospitals in India. Prim Care Companion CNS Disord. 2020;22(4):20br02724.

To share: https://doi.org/10.4088/PCC.20br02724

© Copyright 2020 Physicians Postgraduate Press, Inc.

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