Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.

Aims: In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.

Method: From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.

Results: A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.

Conclusions: This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.

Keywords: Asia-Pacific; COVID-19; healthcare workers; pandemic; psychological impact.

Fig. 1

Prevalence of physical symptoms experienced by healthcare workers by country during the COVID-19 pandemic.

Fig. 2

The longitudinal trajectory of confirmed cases of COVID-19 in the participating countries. Total number of confirmed COVID-19 cases per 1 million population for each country is also represented. (a) India; (b) Indonesia; (c) Malaysia; (d) Vietnam; (e) Singapore. The denoted section of the trend line (green box) represents the study period in each country.

Fig. 3

The longitudinal trajectory of confirmed deaths because of COVID-19 in the participating countries. Total number of confirmed deaths because of COVID-19 per 1 million population for each country is also represented. (a) India; (b) Indonesia; (c) Singapore; (d) Malaysia. The denoted section of the trend line (green box) signifies the study period of each country.

Fig. 4

The total number of confirmed COVID-19 cases and deaths at the end of the country's study period, with the prevalence of adverse psychological outcomes among healthcare workers in each country (n = 1146). The Depression Anxiety Stress Scales (DASS-21) was used, in which DASS-21 cut-off scores of >9, >7 and >14 indicate a positive screen of depression, anxiety and stress, respectively. Post-traumatic stress disorder was screened using the Impact of Events Scale-Revised (IES-R) score, where a total IES-R cut-off score of 24 is used to classify post-traumatic stress disorder as a clinical concern. India and Singapore did not have any healthcare workers screen positive for stress. PTSD, post-traumatic stress disorder.

Fig. 5

The mean Impact of Events Scale Revised (ES-R) scores for each country, categorised into its subscales of (a) intrusion, (b) avoidance and (c) hyperarousal (n = 1146).