Cardiovascular Risk among Healthcare Workers in DCH and DCHC Hospitals during COVID-19 Duty: Correlation of Stress Score with Blood Pressure and Lipid Profile
Correspondence Address :
Dr. Sanjay Wasnik,
Flat No, 201, FBlock GMC Campus, Banjali, Ratlam, Madhya Pradesh, India.
Introduction: Healthcare workers (HCW’s) are at the frontline of the Coronavirus Disease-2019 (COVID-19) pandemic, participating directly in the diagnosis and treatment of Coronavirus patients for the past two years. This puts them at a larger risk of causing long-term stress, mental anguish, and other negative psychological impacts.
Aim: To evaluate stress score, serum lipid profile and blood pressure in a Dedicated COVID Hospital (DCH) and Dedicated COVID Health centre (DCHC) among HCWs, and to correlate the perception of psychological stress with serum lipid profile.
Materials and Methods: This was a hospital-based cross-sectional study conducted from the month of March 2021 to August 2021. Seventy-five HCWs (35 men and 40 women) from DCH and DCHC were included in this study. In these participants, socio-demographic and perceived stress, serum lipid profile was measured. The studied population was divided into two groups: Group A (HCWs in direct contact with COVID-19 patients) and Group B (HCWs not in direct contacts with patients). Stress scores, serum lipid levels, systolic and diastolic Blood Pressure (SBP and DBP) of all the participants were measured and compared with that of controls, using Student’s t-test. Stress scores of HCWs in direct contact with patients were correlated with SBP and DBP and serum lipid profile by using Pearson correlation coefficient (r).
Results: Stress levels were significantly higher in Group A (p>0.05), but serum lipid levels were not significant. Stress levels of Group A were found to correlate strongly with blood Total Cholesterol (TC), (p<0.001) serum Triglyceride (TG), (p<0.01) High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), Very Low Density Lipoprotein (VLDL), LDL/HDL, and SBP and DBP (p<0.001).
Conclusion: Stress scores were elevated in HCWs in direct contact with patients (Group A) and these strongly correlate with serum lipid levels and BP. The health authorities are responsible for implementation of strategies to manage this psychological stress.
Coronavirus disease-2019 pandemic, Dyslipidaemia, Psychological stress
On 13th March 2020, World Health Organisation (WHO) declared COVID-19 a pandemic disease (1). In this pandemic, from the last two years, HCWs are on the frontline directly dealing with COVID-19 patients in the context of care, diagnosis and treatment. This puts them at a larger risk of causing long-term stress, mental anguish, and other negative psychological impacts. Scarcity of specific treatment and inadequate medical facilities along with increasing number of COVID-19 cases overwhelming workload and lack of personal protection equipment increases the mental burden of HCWs (2),(3). Previous research conducted during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak revealed that healthcare personnel experienced negative psychological effects. High levels of stress, as well as anxiety and depression symptoms were found among the HCWs associated with uncertainty, stigmatisation, reluctance to work and resignation (4),(5),(6). The emergency nursery department was found to be more likely to develop distress and behavioural detachment in several studies (7),(8),(9). Currently, HCWs who care for these patients are experiencing comparable affects on their mental health as a result of the COVID-19 pandemic. The public health crisis produces an environment of uncertainty and tension, necessitating health personnel's assessment and containment. COVID-19 research has thus far primarily focused on epidemiological studies, prevention, diagnosis, and treatment. Few studies have examined the mental health difficulties that HCWs experience during a pandemic (10),(11). Dyslipidaemia is prevalent in all over the world (12). Researchers had found the relationship between the occupational psychological stress and lipid disorders (13),(14),(15),(16). Prevalence of cardiovascular risk is more in workers doing night shift due to stress induced dyslipidaemia (17),(18). Most of the studies in frontline workers during COVID-19 pandemic was done on perception of anxiety, psychological stress and depression after exposure to physical and mental burden during pandemic but only few literature is available on association between perception of stress and biochemical stress markers during COIVD-19 pandemic.
In the second wave of COIVD-19, patient load as well as mortality was high in comparison to first wave. So, it is important to study the effect of stress on health in DCH. So, this study was conducted to evaluate stress score, serum lipid profile and blood pressure in a DCH and DCHC among HCWs and to correlate the perception of psychological stress with serum lipid profile.
The present hospital-based cross-sectional study was conducted (from March 2021 to August 2021), after Institutional Ethical Committee (IEC) approval was obtained (GMC Ratlam/2020/IEC/approval/2019 dated 14/12/2020).
Inclusion criteria: HCWs (n=75) between age group 25-40 years and doing morning shift duties in DCH and DCHC since at least one year were included in the study.
Exclusion criteria: Known case of diabetes, hypertension, individuals under treatment with glucocorticoids, psychotropic drugs, with Hypothalamic Pituitary Adrenal (HPA) axis alterations or a previous diagnosis of mental health disorders, dyslipidaemia, central obesity, cardiovascular diseases were excluded from the present study.
After obtaining written informed consent from all participants, they were divided into two groups. Group A (n=40) HCWs in direct contact with COVID-19 patients and Group B (n=35) HCWs not in direct contact with patients.
Stress scores of all subjects were evaluated using Depression, Anxiety and Stress Scale-21 (DASS-21 scale) (19). It comprises of seven questions and subitems which are rated as normal, mild, moderate, severe and extremely severe. Each parameter was scored in a self-rated Likart scale for 0 (Did not apply to me) to 3 (Applied to me to some degree, considerable degree and very much) for the past one week.
All participants were called in the next morning at 8:00 a.m. Subjects were allowed to take relax for 10 min before recording blood pressure and heart rate. Blood pressure was tested in supine with digital sphygmomanometer. The next day morning venous blood was drawn from these individuals after 12 hours of fasting to measure serum TG, TC, LDL-C and HDL-C. TC and HDL-C by using Dimension RxLMax (Siemens). Using Friedwelds formula (20), LDL-C was calculated. HDL-C was measured using the calorimetric enzymatic method.
Using student’s t-test, Statistical analysis was performed in 2 parts-In first part, stress scores, cardiovascular risk factors and morning serum lipid level of Group A and Group B were compared. In second part, stress scores of HCWs in direct contact with patients were correlated with SBP, DBP and serum lipid profile by using Pearson correlation coefficient (r).The value of the Pearson correlation coefficient (r) ranges from +1 to -1. Where 1 is the positive correlation, 0 is no correlation, and -1 is the negative correlation. Statistical software used for statistical analysis was Epi Info.
A total of 75 HCWs were recruited for this study. Group A included 40 healthcare workers in direct contact with COVID-19 patients and Group B included 35 HCWs not in direct contact with patients working in the same DCH and DCHC hospital. Both groups together consist of 35 men and 40 women. (Table/Fig 1) shows demographic profile of HCWs. (Table/Fig 2) shows significant elevation of stress levels in Group A as compared to Group B (p=0.003). Lipid profile was found to be increased non significantly in Group A workers. Both systolic BP and diastolic BP were increased non significantly in Group A.
(Table/Fig 3) shows correlation between stress scores of HCWs in direct contact with COVID-19 patients admitted in DCH and DCHC hospitals with cardiovascular risk factors such as serum lipid profile, systolic and diastolic BP and Pearson correlation coefficient (r) was calculated. Stress scores were found to be strongly correlate with serum TC (p<0.001), serum TG (p<0.01), HDL (p<0.001), LDL (p<0.0001), VLDL (p<0.0001), LDL/HDL (p<0.0001) and systolic (p<0.001), and diastolic BP (p<0.001), with r values 0.713, 0.274, -0.411, 0.644, 0.808, 0.672, 717 and 0.810 respectively.
This study aimed to determine whether HCWs working in DCH and DCHC (group A) can experience increased stress and can demonstrate increased levels of serum lipid levels than their colleagues who worked in same hospital set-up but not in direct contact with COVID-19 patients (Group B). In the present study, stress score and serum lipid level were evaluated in HCWs at DCH and DCHC hospital in the context of COVID-19 pandemic. The results revealed elevated level of stress scores in Group A as compared to Group B HCWs. Recent studies also found that COVID-19 duties affect mental health-anxiety, depression, and post-traumatic stress symptoms (21),(22). In addition, HCWs represent the population that are particularly vulnerable to mental illness due to long working hours, risk of infection, lack of personal protective equipment, physical fatigue, and separation from family members (23). To our knowledge, in India few studies has been done to evaluate stress biomarkers such as serum lipid profiles in this population.
It can be rightly said that physical and psychological stress are indeed a risk factor for increasing TG, and LDL and decreasing HDL. Various studies have reported that chronic stress alters HPA axis activity, which contributes to the development of mental disorders such as depression, anxiety, and burnout (24),(25),(26). According to the results of previous studies, the cardiovascular risk factors will be affected more by physical and mental stress in some of the working environmental conditions such as shift duties exposure to heat (27),(28),(29).
Muldoon MF et al., (30) proposed that psychological stress increases serum lipid levels by increasing hepatic lipoprotein lipase activity due to increase sympathetic response. In addition, the present study showed strong association between perceived stress and serum lipid levels in HCWs doing COVID-19 duties, which was similar to the study done in workers engaged in different types of working environmental condition (31),(32). Sawai A et al., observed that mental stress elevates BP in young men (34). In summary, this study demonstrates the importance of assessing the psychological and physical stress of HCWs, which is a vulnerable population statistic in the context of the COVID-19 pandemic. Additionally, serum lipid level has been a valuable screening instrument for stress.
A possible limitation of this study was related to the small number of HCWs evaluated as only HCWs working in the morning shift i.e. from 8:00am to 2:00 pm were selected for the study. However, depression values are clinically confirmed by inventory. In addition, stress levels and lipid profiles are indicators that support the results of this study.
Stress scores were elevated in HCWs in direct contact with patients and were strongly correlated with serum lipid levels and BP which affects physical and mental health as well as put them on high cardiovascular risk on long-term basis. The implementation of strategies to manage this psychological stress is the responsibility of the health authorities.
Date of Submission: Mar 05, 2022
Date of Peer Review: Apr 14, 2022
Date of Acceptance: May 02, 2022
Date of Publishing: Jul 01, 2022
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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