Determinants of Mental Health and Practice Behaviors of General Practitioners During COVID-19 Pandemic in Bali, Indonesia: A Cross-sectional Study

Abstract

Purpose: We aim to study the level of mental health distress and COVID-19 prevention in practice behaviors among general practitioners (GPs) in Bali, Indonesia, as well as their determinants. Methods: We conducted a cross-sectional online survey. Survey recruitment material was disseminated by purposive snowballing through regional professional association as well as research team's personal acquaintances. The survey measured mental health status by DASS-21 questionnaire and practice behavior by a questionnaire based on WHO recommendations for hand hygiene and PPE use during the COVID-19 pandemic. We conducted multivariate analyses to identify independent determinants for mental health and practice behavior. Results: Analyses included 635 (41.75%) of GPs in Bali. Mental health status was relatively good with prevalence of depression, anxiety, and stress of 13.2%, 19.7%, and 11% respectively, lower than previous studies in Indonesia and elsewhere. Practice behavior, however, was not considerably lower with only 65.4% and 32.1% reported consistent hand hygiene and recommended PPE use respectively. Routine optional PPE use was reported by 23.6% of respondents. Long working hours and fear of COVID-19 was identified as detrimental to mental health while consistent hand hygiene improved it. Meanwhile, workplace, work setting, and fear of COVID-19, were identified as determinants for PPE use. GPs working in primary health centers and private hospitals were also found to have less adherence to hand hygiene protocols. Conclusion: Our results showed relatively good mental health status along with inadequate infection prevention in practice behavior of GPs in Bali, Indonesia. Intervention should be made to improve practice behavior. Determinants of practice behavior identified in this study could help to pinpoint intervention targets.

Mental health and health-related quality of life among healthcare workers in Indonesia during the COVID-19 pandemic: a cross-sectional study

“…The prevalence of depression, anxiety and stress observed in this study was 29.4%, 44.9% and 31.8%, respectively, which were higher than that reported in previous studies from Indonesia that also used the DASS-21 as the study instrument, wherein the prevalence was 2.4%–13.2% for depression, 6.8%–20.6% for anxiety and 5.7%–11% for stress 16 17 19. The discrepancy between this study and previous studies might be attributed to the time difference in data collection.…”

“…However, no study from Indonesia was included in this meta-analysis 13 15. To this date, studies on mental health among HCWs in Indonesia remain scarce and are either focusing on a certain HCW profession or conducted only in one part of the country 16–20. Other than that, all studies have adopted a cross-sectional study design, thus only illustrating a particular moment of the pandemic.…”

GP wellbeing during the COVID-19 pandemic: a systematic review

“…Rates of anxiety ranged from 20% in Indonesia 43 to 95% in Turkey and Colombia. 44 , 45 Symptoms of depression were reported to a lesser extent, and ranged from 13% in Indonesia 43 to 37% in Italy.…”

“…Rates of anxiety ranged from 20% in Indonesia 43 to 95% in Turkey and Colombia. 44 , 45 Symptoms of depression were reported to a lesser extent, and ranged from 13% in Indonesia 43 to 37% in Italy. 46 Post-traumatic stress symptoms were reported in 10.6% of GPs in France, 36 moderate-to-severe symptoms were reported in 45.2% of GPs in Croatia, 39 and 32% of GPs in Italy presented with significant post-traumatic stress symptoms.…”

The Magnitude of Psychological Distress Among Interns During COVID-19 Pandemic: A Multicentric Cross-Sectional Study

“…According to Sitanggang et al 21 , higher working hours per week and intense fear of COVID-19 incrementally increased the risk for depression, anxiety, and stress. Consistent hand hygiene behaviour was also found to be an independent protective factor for anxiety and depression.…”