COVID-19 and mental well-being of nurses in a tertiary facility in Kenya

Abstract

Background The 2019 coronavirus disease (COVID-19) epidemic is a global health emergency which has been shown to pose a great challenge to mental health, well-being and resilience of healthcare workers, especially nurses. Little is known on the impact of COVID-19 among nurses in sub-Saharan Africa. Methods A cross sectional study was carried out between August and November 2020 among nurses recruited from the Aga Khan University Hospital, Nairobi. The survey questionnaire consisted of six components- demographic and work title characteristics, information regarding care of COVID-19 patients, symptoms of depression, anxiety, insomnia, distress and burnout, measured using standardized questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health disorders. Results Of 255 nurses, 171 (67.1%) consented to complete the survey. The median age of the participants was 33.47 years, 70.2% were females and 60.8% were married. More than half, 64.9% were frontline workers directly engaged in COVID-19 care. Only 1.8% reported a prior history or diagnosis of any mental health disorder. Depression, anxiety, insomnia, distress, and burnout were reported in 45.9%, 48.2%, 37.0%, 28.8% and 47.9% of all nurses. Frontline nurses reported experiencing more moderate to severe symptoms of depression, distress and burnout. Furthermore, females reported more burnout as compared to males. Multivariate logistic regression analysis showed that after adjustment, working in the frontlines was an independent risk variable for depression and burnout. Conclusion This is one of the few studies looking at mental health outcomes among nurses during the COVID-19 pandemic in Kenya. Similar to other studies from around the world, nurses directly involved with COVID-19 patients reported higher rates of mental health symptoms. Burnout threatens to exacerbate the pre-existing severe nursing workforce shortage in low-resource settings. Cost-effective and feasible mitigating strategies, geared to low-middle income countries, are urgently needed to help cope with mental health symptoms during such a pandemic.

Psychological distress among healthcare workers accessing occupational health services during the COVID-19 pandemic in Zimbabwe

“…Other studies conducted among HCWs in Africa during the COVID-19 pandemic reported prevalence of anxiety including mild, moderate and severe ranging from 25.5% to 90.5%. [ [10] , [11] , [12] , [13] , 17 , [23] , [24] , [25] , [26] ] The prevalence of depressive symptoms ranged between 32.1%–94.0%. [ [10] , [11] , [12] , [13] , 17 , [23] , [24] , [25] , [26] ] Most of these studies used the Generalized Anxiety Disorder 7 (GAD-7) [ 11 , 12 , 15 , 16 , 23 , 24 , [26] , [27] , [28] ] and Patient Health Questionnaire 9 (PHQ-9) [ 12 , 15 , 23 , 24 , 26 , 28 ] to determine anxiety and depression.…”

“…[ [10] , [11] , [12] , [13] , 17 , [23] , [24] , [25] , [26] ] The prevalence of depressive symptoms ranged between 32.1%–94.0%. [ [10] , [11] , [12] , [13] , 17 , [23] , [24] , [25] , [26] ] Most of these studies used the Generalized Anxiety Disorder 7 (GAD-7) [ 11 , 12 , 15 , 16 , 23 , 24 , [26] , [27] , [28] ] and Patient Health Questionnaire 9 (PHQ-9) [ 12 , 15 , 23 , 24 , 26 , 28 ] to determine anxiety and depression. Other data collection tools included the 10-item Cohen Perceived Stress Scale [ 10 , 26 , 27 , 29 ], 14-item Shirom-Melamed Burnout measure [ 10 ], 7-item Insomnia Severity Index [ 12 , 26 , 28 , 30 ], 22-item Impact of Event Scale-Revised [ 12 , 28 ], 16-item Stanford Professional Fulfilment Index [ 12 , 28 ], Hospital Anxiety Depression Score [ 13 ], Coronavirus Anxiety Scale [ 17 ] and Primary Care PTSD Screen.…”

“…[ [10] , [11] , [12] , [13] , 17 , [23] , [24] , [25] , [26] ] Most of these studies used the Generalized Anxiety Disorder 7 (GAD-7) [ 11 , 12 , 15 , 16 , 23 , 24 , [26] , [27] , [28] ] and Patient Health Questionnaire 9 (PHQ-9) [ 12 , 15 , 23 , 24 , 26 , 28 ] to determine anxiety and depression. Other data collection tools included the 10-item Cohen Perceived Stress Scale [ 10 , 26 , 27 , 29 ], 14-item Shirom-Melamed Burnout measure [ 10 ], 7-item Insomnia Severity Index [ 12 , 26 , 28 , 30 ], 22-item Impact of Event Scale-Revised [ 12 , 28 ], 16-item Stanford Professional Fulfilment Index [ 12 , 28 ], Hospital Anxiety Depression Score [ 13 ], Coronavirus Anxiety Scale [ 17 ] and Primary Care PTSD Screen. [ 15 ] The differences in prevalence of anxiety and depression across studies even when using the same tools may be explained by different cutpoints, study populations (primarily doctors versus primarily nurses), settings (COVID-19 specialist services versus general medicine, obstetrics [ 31 ] and psychiatry [ 14 ]), health system capacity, data collection methods (online versus in-person interviewer or self-administered) and timing of the survey in relation to the global and national pandemic situation.…”

“…Cross-sectional surveys among HCWs in sub-Saharan Africa, most of them distributed through online platforms and conducted during the first six months of the pandemic, revealed high prevalence of anxiety, psychological distress, insomnia and symptoms of depression. [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ] To date, there is little evidence on the impact of interventions to benefit the resilience and mental health of HCWs during or after epidemics. [ 19 ] Many countries experience continuing SARS-CoV-2 transmission and substantial associated morbidity and mortality.…”

Factors affecting Nurse Anxiety during COVID-19 pandemic

“…Nurses are becoming health workers who are facing more psychological problems due to the COVID-19 outbreak (SK Ali, Shah, & Talib, 2021). It was also shown that nurses are at higher risk of contracting COVID-19 because they are in closer and longer contact with patients.…”