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A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak.
Brain Behav Immun. 2020 08; 88:559-565.BB

Abstract

OBJECTIVE

Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers.

METHODS

Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated.

RESULTS

Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales.

CONCLUSIONS

Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.

Authors+Show Affiliations

Department of Medicine, National University Health System, Singapore.Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Department of Medicine, National University Health System, Singapore.Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.Department of Neurology, Ng Teng Fong General Hospital, Singapore.Department of Intensive Care Medicine, Ng Teng Fong General Hospital, Singapore.Department of Neurology, Ng Teng Fong General Hospital, Singapore.Department of Neurology, Zydus Hospital and BJ Hospital, Ahmedabad, India.Department of Neurology, Yashoda Hospital, Secunderabad, India.Department of Neurology, SMS Hospital, Erode, India.Department of Neurology, Zydus Hospital and BJ Hospital, Ahmedabad, India.Department of Neurology, Zydus Hospital and BJ Hospital, Ahmedabad, India.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Division of Neurology, Department of Medicine, National University Health System, Singapore.Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece and The University of Tennessee Health Science Center, Memphis, TN, United States.Department of Psychological Medicine, National University of Singapore, Singapore.Department of Psychological Medicine, National University of Singapore, Singapore; Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore.Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore. Electronic address: Vijay_Kumar_SHARMA@nuhs.edu.sg.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32330593

Citation

Chew, Nicholas W S., et al. "A Multinational, Multicentre Study On the Psychological Outcomes and Associated Physical Symptoms Amongst Healthcare Workers During COVID-19 Outbreak." Brain, Behavior, and Immunity, vol. 88, 2020, pp. 559-565.
Chew NWS, Lee GKH, Tan BYQ, et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020;88:559-565.
Chew, N. W. S., Lee, G. K. H., Tan, B. Y. Q., Jing, M., Goh, Y., Ngiam, N. J. H., Yeo, L. L. L., Ahmad, A., Ahmed Khan, F., Napolean Shanmugam, G., Sharma, A. K., Komalkumar, R. N., Meenakshi, P. V., Shah, K., Patel, B., Chan, B. P. L., Sunny, S., Chandra, B., Ong, J. J. Y., ... Sharma, V. K. (2020). A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain, Behavior, and Immunity, 88, 559-565. https://doi.org/10.1016/j.bbi.2020.04.049
Chew NWS, et al. A Multinational, Multicentre Study On the Psychological Outcomes and Associated Physical Symptoms Amongst Healthcare Workers During COVID-19 Outbreak. Brain Behav Immun. 2020;88:559-565. PubMed PMID: 32330593.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. AU - Chew,Nicholas W S, AU - Lee,Grace K H, AU - Tan,Benjamin Y Q, AU - Jing,Mingxue, AU - Goh,Yihui, AU - Ngiam,Nicholas J H, AU - Yeo,Leonard L L, AU - Ahmad,Aftab, AU - Ahmed Khan,Faheem, AU - Napolean Shanmugam,Ganesh, AU - Sharma,Arvind K, AU - Komalkumar,R N, AU - Meenakshi,P V, AU - Shah,Kenam, AU - Patel,Bhargesh, AU - Chan,Bernard P L, AU - Sunny,Sibi, AU - Chandra,Bharatendu, AU - Ong,Jonathan J Y, AU - Paliwal,Prakash R, AU - Wong,Lily Y H, AU - Sagayanathan,Renarebecca, AU - Chen,Jin Tao, AU - Ying Ng,Alison Ying, AU - Teoh,Hock Luen, AU - Tsivgoulis,Georgios, AU - Ho,Cyrus S, AU - Ho,Roger C, AU - Sharma,Vijay K, Y1 - 2020/04/21/ PY - 2020/04/10/received PY - 2020/04/18/revised PY - 2020/04/18/accepted PY - 2020/4/25/pubmed PY - 2020/8/15/medline PY - 2020/4/25/entrez KW - Anxiety KW - COVID-19 KW - Depression KW - Healthcare workers KW - Pandemic KW - Physical symptoms KW - Psychological impact KW - Stress SP - 559 EP - 565 JF - Brain, behavior, and immunity JO - Brain Behav Immun VL - 88 N2 - OBJECTIVE: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers. METHODS: Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated. RESULTS: Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales. CONCLUSIONS: Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded. SN - 1090-2139 UR - https://www.unboundmedicine.com/medline/citation/32330593/A_multinational_multicentre_study_on_the_psychological_outcomes_and_associated_physical_symptoms_amongst_healthcare_workers_during_COVID_19_outbreak_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0889-1591(20)30523-7 DB - PRIME DP - Unbound Medicine ER -