Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : January | Volume : 16 | Issue : 1 | Page : VC05 - VC09 Full Version

Prevalence of Anxiety and its Severity among Different Specialities of Healthcare Professionals during COVID-19 Pandemic


Published: January 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52622.15887
Meghna Gupta, Vitull Kumar Gupta, Parneet Kaur Hari, Kashish Goyal, Harry Goyal

1. Postgraduate Resident, Department of Psychiatry, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India. 2. Professor, Department of Medicine, Kishori Ram Hospital and Diabetes Care Centre, Bathinda, Punjab, India. 3. Intern, Government Medical College, Patiala, Punjab, India. 4. Intern, Department of DMC, DMC Ludhiana, Punjab, India. 5. Undergraduate Student, All India Institute of Medical Sciences, New Delhi, India.

Correspondence Address :
Dr. Vitull Kumar Gupta,
5042, Afim Wali Gali, Bathinda, Punjab, India.
E-mail: vitullgupta2000@yahoo.com

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has adversely affected people’s physical and mental health necessitating a comprehensive public and mental health strategy focusing on venerable populations including Healthcare Professionals (HCPs). Anxiety is a common mental health problem and untreated anxiety may cause immediate and long-term adverse health effects. Currently, the data on the psychological impact of COVID-19 among specialities of HCPs is sparse.

Aim: To study the prevalence of anxiety and its severity among different specialities of HCPs during COVID-19 pandemic.

Materials and Methods: This cross-sectional survey was conducted among HCPs from 1st October, 2020 to 20th February, 2021 at Kishori Ram Hospital and Diabetes Care Centre, Bathinda, Punjab, India, during COVID-19 pandemic in India using e-copies and hard copies of anonymously complete voluntary survey proforma. The proforma included socio-demography variables and a validated pretested structured Generalised Anxiety Disorder Scale (GAD-7) questionnaire distributed physically and by social media platforms to Indian doctors and medical students of >18 years of age from all over India. From all responses received, 2246 were found to be valid responses from HCPs comprising of 1624 from medical specialities, 225 surgical specialities, 101 emergency/critical care specialities and 296 from students/dental speciality. No HCPs other than doctors with valid MBBS/BDS degrees or MBBS/BDS students were included. Valid responses were analysed according to the speciality in relation to prevalence of anxiety, its severity, age and gender. Mann-Whitney U test was used to compare GAD-7 score among different specialty group.

Results: About 972 (43.3%) were in 20 to 40 years age group including 655 (67.4%) medical, 42 (4.3%) surgical, 37 (3.8%) emergency/critical care and 238 (24.5%) from students/dental speciality. Male HCPs were 1513 and female HCPs were 733. Prevalence of anxiety was 79.3% among all HCPs. According to gender groups, prevalence of anxiety was 78.1% in males and 81.6% in females. According to age groups the prevalence of anxiety was 81.3% in 20-40 years age group, 81.6% in 41-60 years and 61.5% in >60 years age group. Among specialities, prevalence of anxiety was 78% in medical speciality group, 86.7% in surgical speciality group, 92.1% in emergency/critical care group and 76.4% in students/dental speciality group. Results showed maximum mean score in emergency/critical care speciality group and minimum mean score in medical speciality group.

Conclusion: High prevalence of anxiety and its severity among HCPs across specialities highlights the adverse mental health impact of the COVID-19 pandemic underscoring the need for appropriate mental health support with multidisciplinary comprehensive mental healthcare measures.

Keywords

Coronavirus disease 2019, Generalised anxiety disorder, Mental health of doctors, Venerable population

World Health Organisation (WHO) announced novel coronavirus infection a Public Health Emergency of International Concern under the International Health Regulation on January 30, 2020 and declared a global pandemic on March 11, 2020 (1). Public health emergencies may adversely affect the individuals and communities causing psychological reactions, unhealthy behaviours and noncompliance of public health directives. Pandemic is not only a medical phenomenon but adversely affects psycho-social and mental health influencing the dynamics of a pandemic (2). So during Coronavirus disease 2019 (COVID-19) pandemic a comprehensive public and mental health strategy for the population with specific focus on venerable populations including Healthcare Professionals (HCPs) is needed.

Anxiety is a common mental health problem and untreated anxiety may cause immediate and long-term adverse health effects on population including HCPs, manifesting various somatic complaints, lost productivity, development of co-morbidities, compromised self-care, interpersonal functioning, negatively affecting professional duties, erroneous clinical decision-making, compromising COVID-19 management and burdening the resource constrained and fragile health system (3),(4),(5),(6). Thus, mental health problems of HCPs have become an issue of an urgent public health intervention, important for effective COVID-19 pandemic management (7).

Generalised Anxiety Disorder Questionnaire-7 (GAD-7) is a seven-item self-reporting version constituent of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool based on Diagnostic and Statistical Manual of Mental Disorders criteria, which has good reliability, criterion, construct, factorial and procedural validity. It is considered to be useful and effective screening tool with strong psychometric validity and reliability for assessment of prevalence of anxiety in community settings as well as for useful comparison in Indian context comparable to research in western settings (8),(9).

Currently, the data on the psychological impact of COVID-19 and its severity among various specialities of HCPs is sparse, so the present survey was conducted to evaluate the prevalence of anxiety and its severity among various specialities of HCPs during COVID-19 pandemic.

Material and Methods

This cross-sectional survey was conducted among HCPs from 1st October, 2020 to 20th February, 2021 at Kishori Ram Hospital and Diabetes Care Centre, Bathinda, Punjab, India, during COVID-19 pandemic in India using e-copies and hard copies of anonymous complete voluntary survey proforma including socio-demography variables and a validated pretested structured GAD-7 questionnaire. The proforma were distributed physically and by social media platforms (email, whatsapp, SMS and other social media platforms) to Indian doctors and medical students of age >18 years from all over India after taking the informed consent. Approval from Institutional Ethics Committee was taken before initiation of the survey wide (letter no. 16/2021 dated 13.9.2021).

Inclusion criteria: Indian HCPs and medical students age >18 years, able to read and understand English, willing to participate. Only Indian doctors with valid MBBS/BDS degrees or MBBS/BDS students were included in the study.

Exclusion criteria: Non Indian HCPs and medical students age <18 years, unable to read and understand English, unwilling to participate.

Generalised Anxiety Disorder Questionnaire-7 (GAD-7)

The validated pretested structured GAD-7 questionnaire comprising of seven questions rated on four-point Likert scale ranging from 0 (not at all) to 3 (nearly every day) in the last two weeks was used. Grading of anxiety was done by GAD-7 score that is:

0-no anxiety,

1-5 mild anxiety,

6-10 moderate anxiety and

score of >11 was accessed as severe anxiety.

Reliability of GAD-7 scale has been excellent in clinical and nonclinical studies, with good internal consistency and inter-rater reliability along with interviewer vs. self-rated correlation ranging from 0.83 and 0.84 and test retest reliability of 0.83. Moreover, GAD-7 also has good content validity covering seven core anxiety symptoms, good construct validity, excellent discriminative validity (0.91 for detecting GAD), good established validity generalisation across multiple populations with excellent clinical and epidemiological utility as it is free to use, easy to score and brief (8),(10),(11).

Procedure

From all the responses received from HCPs, only the valid responses were included in the study and no specific sample size was determined before the survey. From all responses received 2246 were found to be valid responses from HCPs, comprising of 1624 from medical specialities, 225 surgical specialities, 101 emergency/critical care specialities and 296 from students/dental speciality. Valid responses were analysed according to the HCPs speciality (medical, surgical, emergency/critical care and students/dental) in relation to prevalence of anxiety, its severity, age and gender after approval from Institutional Ethics Committee.

Statistical Analysis

Data was represented as frequency, percentage mean, standard deviation and median. Chi-square Test was used to compare the frequency among different sub-groups. Mann-Whitney U test was used to compare GAD-7 score among different speciality groups. The p-value <0.05 was taken as statistically significant whereas p-value <0.001 was taken as highly significant. All the analysis was done using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA).

Results

Among HCPs, 2246 responses were valid for survey analysis including 1624 (72.3%) medical, 225 (10.0%) surgical, 101 (4.5%) emergency/critical care and 296 (13.2%) from students/dental speciality. About 972 (43.3%) were in 20 to 40 years age group including 655 (67.4%) medical, 42 (4.3%) surgical, 37 (3.8%) emergency/critical care and 238 (24.5%) from students/dental speciality. Age group of 41 to 60 years, had 1027 (45.7%) HPCs including 764 (74.4%) medical, 158 (15.4%) surgical, 59 (5.7%) emergency/critical care and 46 (4.5%) from students/dental speciality, whereas 247 (11.0%) HCPs were in age group of >60 years including 205 (83.0%) medical, 25 (10.1%) surgical, 5 (2.0%) emergency/critical care and 12 (4.9%) from students/dental speciality. Study population of HCPs comprised of 1513 (67.4%) males including 1154 (76.3%) medical, 146 (9.6%) surgical, 67 (4.5%) emergency/critical care and 146 (9.6%) from students/dental speciality. Female group had 733 (32.6%) HCPs including 470 (64.1%) medical, 79 (10.8%) surgical, 34 (4.6%) emergency/critical care and 150 (20.5%) students/dental speciality.

(Table/Fig 1) shows prevalence of anxiety and its severity among HCPs, speciality and gender groups. Prevalence of anxiety in study population was 79.3% including 78.1% males and 81.6% females. Overall prevalence of anxiety and severity of anxiety was significantly associated with different specialities (p-value <0.001). Similar significant association between anxiety, severity of anxiety and different specialities were found in males and females. Highest prevalence of anxiety (92.1%) was observed in emergency/critical care group of HCPs including both in male (92.5%) and female (91.2%) groups.

(Table/Fig 2) shows prevalence of anxiety and its severity among speciality groups in relation to age. Prevalence of anxiety of 81.3% was observed in age group of 20-40 years, 81.6% in 41-60 years and 61.5% in >60 years age group. Highest (100%) prevalence of anxiety was observed in age group of 20-40 years among surgical and emergency/critical care speciality group, 91.5% in age group of 41-60 years among emergency/critical care speciality group and 62.9% in >60 years among medical speciality group. Results show highly significant association of overall prevalence of anxiety with speciality groups among age groups of 20-40 years (p-value <0.001), significant association in 41-60 years age group (p-value=0.026) and no significant association in >60 years age group (p-value=0.605). Prevalence of severity of anxiety was highly significantly associated with specialities among age groups of 20-40 years and 41-60 years (p-value <0.001) and not with >60 years age group (p-value=0.061).

(Table/Fig 3) shows the results of response of HCPs study population and different specialities groups to the question about difficulties to do work, takes care of things at home, or get along with other people and need for treatment. Results show statistically significant association between the different speciality groups in relation questions about difficulty for work as well as need for treatment (p-value <0.001).

(Table/Fig 4) shows the comparison of mean values of anxiety score assessed by GAD-7 scale among different speciality groups showing maximum mean score in emergency/critical care speciality group and minimum mean score in medical speciality group. Comparing mean score of GAD-7 among different specialities using Kruskal-Wallis Test: Chi-Square value was 37.372; p-value was <0.001, highly significant. Further multiple comparison of the mean GAD-7 scores among different specialities was done using Mann-Whitney U test shown in (Table/Fig 5).

(Table/Fig 5) shows multiple comparisons of GAD-7 score among different speciality groups of HCPs using Mann-Whitney U test. Results show significant difference of GAD-7 score between medical and surgical speciality group as well as between medical and emergency/critical care speciality group (p-value <0.001). However, the score was not significantly different between medical and students/dental speciality group (p-value=0.272). The GAD-7 score was not significantly different between surgical and emergency/critical care speciality group (p-value=0.072), but the score was significantly different between surgical and student/dental speciality group (p-value=0.014). The GAD score was significantly different in emergency/critical care and students/dental speciality group (p-value <0.001).

Discussion

Undoubtedly, COVID-19 pandemic has adversely affected the routine life of population across nations forcing unanticipated unprecedented public health emergency, severe psychological and mental health crisis among people including HCPs necessitating focus on mental healthcare as a public health issue. Planning and policy making are important for any program and data collection is essential part of policy and planning, so present survey was conducted to generate India specific data regarding prevalence of anxiety and its severity among different speciality groups of HCPs.

Prevalence of anxiety in the present survey among HCPs study population was 79.3% (MS: 4.69±4.009, IQR: 6,95% CI: 4.53-4.86), 78.0% (MS: 4.69±3.938, IQR: 6,95% CI: 4.27-4.65) in medical speciality group, 86.7% (MS: 5.52±3.842, IQR: 5,95% CI: 5.02-6.03) in surgical, 92.1% (MS: 6.05±3.601, IQR: 7,95% CI: 5.34-6.76) in emergency/critical care and 76.4% (MS: 4.89±4.457, IQR: 7,95% CI: 4.38-5.39) was observed in students/dental speciality group. A survey of 3083 HCPs showed 26.6% prevalence of anxiety disorders (12). A meta-analysis showed 34.1% prevalence of anxiety in Indians and 35.3% pooled prevalence in five studies among HCPs (13). Another meta-analysis of studies, among HCPs exposed to SARS/MERS/ COVID-19 from different continents documented 29.0% (95% CI: 14.2-50.3%) anxiety features (14). Similarly, a systematic review of 53 studies using different assessment scales documented 6.3% to 87.5% point prevalence of anxiety, 31.9% (95% CI: 27.9-36.0%) pooled prevalence of anxiety, 29.0% among physicians and nurses and 28.2% among students (15).

Because of paucity of studies related to prevalence of anxiety in different speciality groups, it was difficult to compare data from present survey, but overall prevalence of anxiety in the present survey was higher as compared to above mentioned studies may be because India is having second-highest COVID-19 cases in the world posing a huge stress on unprepared and resource constrained HCPs. Moreover, variations in prevalence rates of anxiety in studies could be because of different assessment tools, scores and cut-off point. In the present study, the prevalence of anxiety according to severity score was 40.2% mild anxiety, 30.7% moderate and 8.3% severe anxiety. A study using GAD-7 scale documented 33.7%, minimal anxiety (0-4 score), 48.6% mild (5-9 score), 13.7% moderate (10-14 score) and 4.0% (>15 score) severe anxiety among HCPs and was found to be more among females (16). Another study involving physicians using GAD-7 scale documented 28.4% prevalence of mild anxiety (5-9 score), 39.3% moderate anxiety (10-14 score) and 22.9% had severe anxiety (15-21 score) (17). Similarly a study among HCPs using GAD-7 scale reported 50% anxiety (score ≥5) and 29% moderate to severe anxiety (score >8) with no statistically significant relation with gender or different demographic characteristics (18). A survey documented 38.2% prevalence of anxiety using GAD-7 scale and 23.2% mild anxiety (5-9 score), 8.6% moderate (10-14 score) and 4.4% severe anxiety (>15 score) among healthcare workers (19). Results of the present study were comparable to the above mentioned studies with comparable GAD-7 scores. Because of paucity of studies, data of the present survey related to severity of anxiety among speciality group was not compared, but present survey data observed higher prevalence of anxiety, significant association of severity of anxiety with different speciality groups, highest among emergency/critical care speciality group may be because of extremely stressful and demanding job profile as compared to other speciality groups.

In present study, the prevalence of anxiety according to severity score among age groups was 39.7% mild anxiety, 32.1% moderate and 9.5% severe anxiety in 20-40 years age group, 41.5% mild anxiety, 33.1% moderate and 7.0% severe anxiety in 41-60 years age group and 37.2% mild anxiety, 15.4% moderate and 8.9% severe anxiety was observed in >60 years age group. A survey conducted during COVID-19 pandemic on healthcare workers in India documented 44.2% minimal anxiety (0-4), 32.5% mild anxiety (5-9), 14.2% moderate anxiety (10-14) and 9.1% severe anxiety (15-21) among <45 years age group, 56.3% minimal anxiety, 27% mild anxiety, 11.9% moderate anxiety and 4.8% severe anxiety among 45-60 years age group, 64.4% minimal anxiety, 22.2% mild anxiety, 6.7% moderate anxiety and 6.7% severe anxiety among >60 years age group (20). Results of present survey showed more prevalence of anxiety in <60 years age group as compared to above mentioned survey.

In present study, the prevalence of severity of anxiety according the gender was 43.9% mild anxiety, 27.8% moderate and 6.5% severe anxiety among males and 32.7% mild anxiety, 36.8% moderate and 12.0% severe anxiety among females. Similarly, a study among healthcare workers using GAD-7 scale showed 59.5% minimal anxiety, 22% mild anxiety, 11.9% moderate anxiety and 6.5% severe anxiety among males, 43.5% minimal anxiety, 35.5% mild anxiety, 13% moderate anxiety and 8% severe anxiety among females (20). Another study among junior doctors and medical students observed 56.6% females and 43.4% males reported anxiety (21). Results showing higher prevalence of anxiety among females in both the studies may be attributed to the factors such as workplace insecurity and added domestic responsibilities.

Increased prevalence of anxiety among HCPs documented by the present survey and other studies necessitate inclusion of mental health into national public health programme with additional multipronged psychological support for HCPs providing adequate care, emotional support and motivation promoting adaptive coping strategies, empathetic communication. Mental health issues in Indian context are much more complex because of large vulnerable population, pre-existing mental illness, insufficient mental health services, inadequate digital mental health solutions and misinformation on social media, so the interventions has to be India specific. The Ministry of Health and Family Welfare- Government of India (MOHFW- GOI), Psychiatry Society of India, National Institute of Mental Health and Neurosciences (NIMHANS), All India Institutes of Medical Sciences (AIIMS), World Health Organisation (WHO) and other organisations has supplemented existing mental health-related initiatives by introducing Behavioural Health initiative, Psycho-Social toll-free helpline-08046110007 for mental health assistance, MOHFW-GOI web portal, several videos, advisories, guidelines and resource materials on coping stress, yoga, meditation advice, online services, telemedicine services for all people. A ‘Psychological intervention medical team’ concept by NIMHANS is very constructive. Initiation of Aarogya Setu mobile application by GOI is appreciable step to connect people with essential health services to fight COVID-19 pandemic (22). Based on the results of our study and existing evidence on mental health issues, we suggest a multi-pronged multi-stakeholder strategy comprising of easy access to mental healthcare, tackling social media misinformation, financial and employment security, prevention of discrimination and stigma of HCPs by regulatory and legal provisions for HCPs and other front line workers.

Limitation(s)

Although the present study contributed to the data of mental health during COVID-19 pandemic in India, but it also has certain limitations related to generalisability, the selection and self-reporting bias of the results may not applicable to all HCPs across India. A major strength of the present study is sufficient sample size and survey was based on validated GAD-7 scale.

Conclusion

High prevalence of anxiety and its severity among HCPs across medical specialities highlights the adverse mental health impact of the COVID-19 pandemic underscoring the need to identify venerable HCPs at an early stage and initiate appropriate mental health and psycho-social support with multidisciplinary comprehensive mental healthcare measures, increasing psychological resilience and alleviating their vulnerability to adverse mental health impact, because adverse effects of anxiety are not only on HCPs’ personal well-being but also adversely impact the healthcare delivery system, impair decision-making ability, judgement and attention to patients. Increased mental health problems during COVID-19 pandemic necessitates a multipronged approach, holistic delivery model taking into consideration the multidimensional physical, mental, social and spiritual health of society and individual patients. The public health systems must be strengthened to incorporate mental healthcare to handle the mental health burden of COVID-19 pandemic.

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DOI and Others

DOI: 10.7860/JCDR/2022/52622.15887

Date of Submission: Sep 28, 2021
Date of Peer Review: Nov 06, 2021
Date of Acceptance: Dec 09, 2021
Date of Publishing: Jan 01, 2022

AUTHOR DECLARATION:
• 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. No


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