Factors associated with mental health outcomes across healthcare settings in Oman during COVID-19: frontline versus non-frontline healthcare workers

Abstract

ObjectiveThis study aims to assess and compare demographic and psychological factors and sleep status of frontline healthcare workers (HCWs) in relation to non-frontline HCWs.Design, settings, participants and outcomesThis cross-sectional study was conducted from 8 April 2020 to 17 April 2020 using an online survey across varied healthcare settings in Oman accruing 1139 HCWs.The primary and secondary outcomes were mental health status and sociodemographic data, respectively. Mental health status was assessed using the Depression, Anxiety, and Stress Scale (DASS-21), and insomnia was evaluated by the Insomnia Severity Index. Samples were categorised into the frontline and non-frontline groups. χ2 and t-tests were used to compare groups by demographic data. The Mantel-Haenszel OR was used to compare groups by mental health outcomes adjusted by all sociodemographic factors.ResultsThis study included 1139 HCWs working in Oman. While working during the pandemic period, a total of 368 (32.3%), 388 (34.1%), 271 (23.8%) and 211 (18.5%) respondents were reported to have depression, anxiety, stress and insomnia, respectively. HCWs in the frontline group were 1.5 times more likely to report anxiety (OR=1.557, p=0.004), stress (OR=1.506, p=0.016) and insomnia (OR=1.586, p=0.013) as compared with those in the non-frontline group. No significant differences in depression status were found between the frontline and non-frontline groups (p=0.201).ConclusionsTo our knowledge, this is the first study to explore the differential impacts of the COVID-19 pandemic on different grades of HCWs. This study suggests that frontline HCWs are disproportionally affected compared to non-frontline HCWs, with managing sleep–wake cycles and anxiety symptoms being highly endorsed among frontline HCWs. As psychosocial interventions are likely to be constrained owing to the pandemic, mental healthcare must first be directed to frontline HCWs.

Psychological Stress Risk Factors, Concerns and Mental Health Support Among Health Care Workers in Vietnam During the Coronavirus Disease 2019 (COVID-19) Outbreak

“…Notably, HCWs working at the frontline had at least 2-fold increased risk for having psychological stress as compared with those not at the frontline. This finding resonated with Lai's study in China and Alshekaili's study in Oman which reported that frontline HCWs were around 1.5 times more likely to develop psychological stress than non-frontline HCWs ( 19 , 32 ). Evidently, having direct and frequent contact with confirmed or suspected COVID-19 patients has been well-recognized to render frontline HCWs vulnerable to suffer from stress disturbances as it places them at an increased risk of infection that might threaten their lives ( 14 ).…”

Anxiety in Frontline and Non-Frontline Healthcare Providers in Kelantan, Malaysia

“…However, a study in China that used the Beck Anxiety Inventory reported higher anxiety levels in frontline medical workers than in non-frontline ones [26]. Similarly, a study in Oman that used the DASS-21 reported higher anxiety levels in frontline than non-frontline healthcare workers [25]. The different outcomes of these studies may be partially accounted for by the countries' policies and differences in the tools used to conduct the assessments [34].…”

“…A study in Paris [24] extended a psychological support system to non-frontline healthcare providers after the researchers realised that non-frontline healthcare providers were also experiencing psychological distress. A few studies reported that frontline healthcare providers experienced more anxiety than non-frontline healthcare providers [25,26] and a study in Singapore [16] reported otherwise. We hypothesized that there would be a difference in the anxiety levels between frontline and non-frontline healthcare providers in Kelantan, Malaysia.…”

An investigation of psychological responses to COVID-19 in Irish healthcare workers: longitudinal quantitative and nested qualitative study

“…In terms of COVID-19 specifically, HCWs who were described as frontline healthcare workers had higher trauma or distress scores than non-frontline healthcare workers (Alshekaili et al, 2020;Cai et al, 2020;Kang et al, 2020;Lai et al, 2020;Lu et al, 2020;Maiorano et al, 2020;Rossi et al, 2020). In some studies there were differences in how distress was being expressed: for example in the Alshekaili et al (2020) study, there were no significant differences in depression scores between patient facing and non-patient facing HCWs, however HCWs in the frontline group were 1.5 times more likely to report experiencing levels of stress, insomnia and anxiety. By contrast there are also studies which found that the differences in distress between frontline and non-frontline HCWs were very small (Babore et al, 2020), or were not significantly different (Jahrami et al, 2020;Man et al, 2020), or that reported that frontline HCWs had significantly lower distress (vicarious traumatisation) than non-frontline HCWs (Li et al, 2020).…”